Open Enrollment

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October 20 - November 10, 2008
Medicare Retirees
Open Enrollment
Benefits Choices 2009
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What Should I Have Received in the Mail?

• Packet including
• Annual Open Enrollment Booklet (2009)
• Open Enrollment Change Form
• Medical Plans Comparison Chart
• Self-addressed envelope

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Presentation Topics

• Whats New for 2009
• 2009 Medical Plans Overview
• 2009 Prescription Drugs Overview
• Choosing a Medical Plan
• How Medicare Works with Sandias Plans
• 2009 Dental Care Plan Overview
• Open Enrollment Information
• Questions

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Whats New for 2009?

• Plan eliminated CIGNA Senior Premier PPO
• Plan design changes (e.g., copays and coinsurance
  as described under each plan)
• Waiver of prescription drug coverage no longer an
  option
• New Dental Care Plan replaces Dental Expense Plan
• Class I eligibility rules modified
• New Class IIs no longer eligible

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2009 Medical Plans Overview
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Medical Plan Options
Presbyterian MediCare PPO
UnitedHealthcare Senior Premier PPO
NM Only
Presbyterian
Presbyterian UNMH Independent Providers
Lovelace Senior Plan
NM only
Lovelace Health System UNMH ABQ Health Partners
For details, review your 2009 Open Enrollment
Booklet
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UHC Senior Premier Plan Changes
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Out-of-Pocket Maximums (UHC Senior Premier PPO)

• Prescription drug payments do NOT apply to the
  out-of-pocket maximums
• Coinsurance (e.g., 20) does apply to the
  out-of-pocket maximum (with some exceptions)
• One annual out-of-pocket maximum for both in- and
  out-of-network services

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Out-of-Pocket Maximum (UHC Senior Premier PPO)

• Example of how the out-of-pocket maximum works
  for hospital care (2009 costs)

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UHC Senior Premier PPO Rx Plan Changes
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Catalyst Rx forUHC Senior Premier PPO

• Mandatory Specialty Drug Program through mail
  order from Walgreens/MedMark (limited to 30 day
  supply)
• Drugs delivered via mail order through
  Walgreen/MedMark
• Specialty Team
• Making contact by December 15
• Available Monday to Friday (6 a.m. to 5 p.m. MST)
  at 1-866-823-2712
• Specialty Drugs
• Treatment for cancer, multiple sclerosis, HIV,
  hemophilia, etc.
• Tend to be very expensive and require special
  monitoring

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Catalyst Rx Info

• Welcome Kit mailed in mid-December (for new UHC
  Senior Premier PPO members)
• Letter with general info
• ID cards (1/single 2/family)
• Preferred drug listing (condensed version)
• Pharmacies (major) listing
• Registration and prescription form
• Present your new Catalyst ID card when getting a
  new prescription beginning January 1, 2009
• Pharmacy Help Desk 1-866-854-8851 (available
  24/7)
• Website www.catalystrx.com Username SNL
  Password SNL
• Sandia external website at www.sandia.gov,
  Resources for, Employees and Retirees, Summary
  Plan Descriptions, Catalyst Rx Info
• Catalyst reps available in lobby

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Catalyst Mail Order Form
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Medicare Advantage Plans Overview
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Medicare Advantage Plan Changes
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Medicare Advantage Plans Summarized Comparison
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Medicare Advantage PlansRx Comparison
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Medicare Advantage Plans (Lovelace Senior Plan
and Presbyterian MediCare)

• Must be continuously enrolled in Medicare Part A
  and B
• Required to assign your Medicare benefits to the
  plan
• Cannot be enrolled in one of these plans and
  another Medicare Advantage plan or another
  Medicare Part D plan at same time
• Release of Medicare assignment if switching out
  of these plans (e.g., moving out of state)
  requires notification to Sandia Benefits at least
  six weeks prior or as soon as reasonably possible
  to avoid delays in release of your Medicare
  Assignment
• Must select PCP although referrals to specialists
  are not required
• Must inform health plan before moving or leaving
  the state for more than six months
• Important if you enroll in one of these plans
  you must complete the application form sent by
  Lovelace or Presbyterian and return it to them
  prior to December 31, 2008
• Your plan benefits are described by the
  Evidence of Coverage document which is mailed
  to members in January ( Lovelace or Presbyterian)

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Presbyterian MediCare Mail Order Form
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Choosing a Medical Plan
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Open Enrollment Coverage Options
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What to Consider When Choosing a Medical Plan

• Provider networks (e.g. doctors, hospitals)
• Benefits coverage
• In-network and out-of-network coverage
• Copay vs. coinsurance payment for services
• Filing claims or not
• Prescription drug formulary under the plan
• Coverage while on travel
• Dependent coverage
• Premiums, if applicable
• Deductible
• Out-of-pocket maximum

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Emergencies, Urgent Care, Follow-up Care

• Medicare does not cover services outside of the
  USA
• Call 911 if your require immediate medical or
  surgical care
• Call member services within 48 hours or as soon
  as reasonable possible if admitted

• If you are traveling and covered by UHC Senior
  Premier PPO
• Emergencies, urgent care, and follow-up care are
  covered worldwide
• If you are traveling and covered by the
  Presbyterian MediCare or Lovelace Senior Plan
• Emergencies and urgent care are covered worldwide
• Follow-up care under Lovelace Senior Plan is not
  covered (need to return to NM)
• Follow-up care under Presbyterian MediCare PPO
  Plan
• Follow up care (outside USA) is covered
  out-of-network
• Follow-up care (within USA) is covered
  out-of-network

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What Do I Do When I Turn 65?Retirees in New
Mexico

• Within a few months before reaching age 65
• Enroll in Medicare Parts A and B
• Approximately 2-3 months before age 65, you
  should receive information from Sandia Benefits
  and Medicare
• Retiree Medical Plan Options
• UHC Senior Premier PPO (complete Medicare
  crossover form)
• Lovelace Senior Plan (Sandia employer group)
• Presbyterian MediCare PPO (enollment only during
  Open Enrollment and/or if other family members
  are already in the Plan)
• Coverage takes effect the first day of the month
  in which you reach age 65
• Contact Medicare or your local Social Security
  office for Medicare Parts A and B information

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What Do I Do When I Turn 65? Retirees in CA and
Other

• Within a few months before reaching age 65
• Must enroll in Medicare Parts A and B (even if
  you are not taking your Social Security)
• Approximately 2-3 months before you turn 65, you
  should receive information from Sandia Benefits
  and Medicare
• Kaiser HMO members will receive a solicitation
  for Kaiser Senior Advantage Plan
• Once you reach age 65, the Retiree Medical Plan
  Option is available for transition as follows
• UHC Senior Premier PPO for aging-in UHC Premier
  PPO members
• CIGNA In-Network members must move to the UHC
  Senior Premier PPO Plan (non-Medicare members
  must also move to UHC Premier PPO Plan)
• Kaiser Senior Advantage Plan (must complete
  Kaiser enrollment paperwork to assign Medicare)
• Coverage takes effect the first day of the month
  in which you reach age 65
• Contact Medicare or your local Social Security
  office for Medicare Parts A and B information

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Continuation of Coverage for Surviving Spouse

• Medical Coverage
• Coverage for surviving spouse and/or eligible
  dependents is provided for six months, after
  retirees death, at the same premium-share rate
  that retiree paid
• To continue coverage after six months, surviving
  spouse and/or dependents must elect continuation
  prior to the end of this six-months period
• Continued coverage (7th month and beyond) cost is
  50 of the full medical premium (see pg 34 of OE
  booklet).
• Continued coverage is available until surviving
  spouse remarries, dependent children become
  ineligible and/or coverage is terminated with
  Sandia

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Continuation of Coverage for Surviving Spouse

• Dental Coverage
• Dental coverage for surviving spouse and/or
  eligible dependents is discontinued at the end of
  the month of retirees death
• Coverage may be temporarily continued (COBRA
  process), for up to thirty-six months, by paying
  the monthly, COBRA surviving spouse group rate
  (2009 single rate - 38.00/month 2
  administrative fee)

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Medicare and Sandia Employer Group Plans
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Medicare Part D

• Part D is Medicares Prescription Drug Plan
• Sandias Retiree Medical Plan Option includes
  prescription drug coverage NO NEED to enroll in
  an individual Part D plan
• Individual Part D Plan
• Use your Part D plan first for prescription drug
  coverage
• Submit your claim to Catalyst Rx (for UHC Senior
  Premier PPO members) for consideration of
  secondary coverage
• Ex If you pay 10 for a drug through your Part
  D plan, you would submit a paper claim to either
  Catalyst Rx (UHC Senior Premier PPO members) and
  if an eligible drug, you would be reimbursed 50
  of the copay so you would receive 5 payment
• Individual Part D members must disenroll from
  their individual plan to be eligible for the
  Employer Group Medicare Advantage plans (Lovelace
  Senior Plan or Presbyterian MediCare) by December
  31, 2008.

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Medicare Part D

• UHC members your Notice of Creditable Coverage
  for Part D starts on page 54 of the OE Booklet
• This Notice ensures that you can enroll, without
  penalty, in an individual Part D plan if you lose
  coverage with Sandia (the Medicare Advantage
  plans may require this notice)
• Medicare does not allow double coverage by
  Medicare plans therefore, your coverage through
  Presbyterian MediCare or the Lovelace Senior Plan
  will be dropped altogether if you enroll in an
  individual plan

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Medicare Coordination of Benefits with UHC Senior
Premier PPO

• Medicare is always the primary payer of benefits
• The UHC Senior Premier PPO Plan is secondary
  coverage
• After Medicare pays, then UHC Senior Premier PPO
  Plan calculates what it would have paid if not
  for Medicare, and then subtracts what Medicare
  has paid and pays the difference
• Once a retiree has met the out-of-pocket maximum
  for the calendar year, your UHC plan will pay the
  remaining balance of Medicare-eligible expenses
  that are not paid by Medicare and are eligible
  for benefits under this Plan (up to 150,000
  lifetime maximum)

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COB In-Network Example Specialist Office Visit
with UHC coverage
Medicare
UHC Senior Premier Benefit
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COB In-Network Example Emergency Room Visit with
UHC coverage
Medicare
UHC Senior Premier Benefit
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COB In-Network ExampleHospital Care with UHC
coverage
Medicare
UHC Senior Premier Benefit
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Medicare Advantage Plans

• Lovelace Senior Plan and the Presbyterian
  MediCare PPO Plan
• Fully insured employer group plans
• Assign your Medicare to them
• Provide all your medical and prescription drug
  coverage
• No coordination of benefits with Medicare

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Dental Care Plan Overview
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2009 Dental Overview

• Delta Dental remains the claims administrator
• New Dental Care Plan replaces Dental Expense Plan
• Coinsurance coverage based on a percentage of the
  maximum approved fee
• 100 for preventive
• 80 for basic and restorative services
• 50 for major and orthodontic
• Annual deductible 50 per person/150 family
• Annual maximum benefit 1500 (non-orthodontic)
• Lifetime maximum benefit 1800 for orthodontic
• Monthly Premium-sharing for retirement after
  12/31/2008
• 8.00 for retiree
• 15.00 for retiree 1
• 20.00 for retiree 2

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2009 Dental Overview

• The Dental Care Plan includes coverage
  enhancements
• Sealants covered for all dependent children under
  age 14
• Benefits for specified (Endosteal) implant
  services
• You can see any dentist in the Delta Dental PPO
  or the Delta Dental Premier or an out-of network
  dentist.
• Your out-of-pocket costs will be lower if you see
  a Delta Dental PPO network dentist because those
  dentists have agreed to a lower maximum approved
  fee thus making your percentage portion lower.
• If you see an out-of-network dentist, those
  dentists can balance bill you for any amount
  above the maximum approved fee for the Delta
  Dental Premier network.
• Maximum approved fee is contracted fee between
  Delta Dental and the network providers.

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Eligibility Changes

• Refer to IRS Code Section 152 or Publication 502,
  or consult your tax advisor for qualifying child
  or qualifying relative for health care coverage.
• Financially dependent on you has been
  eliminated and changed to unmarried child under
  age 24
• Although dependent may be eligible for our plans,
  your are required to report to Sandia any
  dependents who do not meet the tax requirements
  as we will need to impute income on the premiums
• Imputed income means that the full premium rate
  for your dependent shall be reported as taxable
• Stepchildren of the primary covered member who
  lives with the primary covered member at least
  50 of the calendar year, or if ages 19 through
  23, is a full-time student.

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Ineligible Dependents

• You must disenroll ineligible dependents within
  31 calendar day of the event causing
  ineligibility
• Consequence of failing to disenroll ineligible
  dependents
• Ineligible dependents coverage retroactively
  terminated
• You will be held liable to refund to Sandia the
  health care plan claims or monthly premiums
• Your dependent could lose any rights to temporary
  continued health care coverage (COBRA)
• Sandia shall not be required to refund any
  premiums to the subscriber

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Open Enrollment Information
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Open Enrollment Process Tips

• Review Medical Plans Comparison Chart
• Review Open Enrollment Booklet for more
  information
• Complete Open Enrollment Change Form 2009
  (especially important for CIGNA Senior Premier
  PPO members)
• Must be postmarked by Nov. 10th
• Complete Presbyterian MediCare or Lovelace Senior
  Plan form (if applicable)
• Confirmations will be sent to only those who make
  changes

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Do I Need to Take Action?
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To make a change (postmarked by November 10th)
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Member Resources
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OE website
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Sandia Benefit Contacts

• Sandia Open Enrollment website www.sandia.gov
• Resources for
• Employees and Retirees
• Retiree Open Enrollment
• Benefits Customer Service Center
• (505) 844-HBES (4237) or
• [phone], ext. 844-HBES (4237)
• Fax [phone]
• If you have questions you can
• Send an email to HBE_at_sandia.gov OR
• Go to www.sandia.gov
• click on Employees Retirees
• click on HBE Weekly Update
• click on ? Get answers

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Open Enrollment Period October 20 November
10th, 2008 No changes to any of your open
enrollment elections will be allowed after
November 10th
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Questions ?