AEP Benefits Enrollment Guide for Age 65 and Over Retirees & Survivors
Total Page:16
File Type:pdf, Size:1020Kb
2013 AEP Benefits Enrollment Guide for Age 65 and Over Retirees & Survivors 204303_guide.indd 1 10/3/12 10:42 AM What’s here: About This Guide. ............................. 1 Tax Considerations When Covering 2013 Annual Enrollment ........................ 1 Your Dependents .......................... 8 What’s New/Changing for 2013? ................. 1 If Both You and Your Eligible Dependents Life Insurance Plan ......................... 1 have AEP Benefits. ......................... 9 Summary of Benefits and Coverage ........... 1 Your Medical Plan Options – Highlights ........... 9 AEP Comprehensive Medical Plan .............1 Aetna Medicare Coordination Preventive Services for Women Expanded. ... 1 of Benefits (COB) Plan .................. 9 A Dependent Audit is Coming. ................ 1 Coordinating Benefits. .9 New Express Scripts Medicare Plan Aetna Medicare Maintenance For Retirees and Dependents of Benefits (MOB) Plan ..................10 Age 65 and Older ....................... 2 Coordinating Benefits. 10 You Will Be Automatically Medical Comparison Chart . 10 Enrolled in this Program ................. 2 Aetna Discount Programs and Services. 10 ID Cards ...............................2 Prescription Drug Program. .11 Member Out-of-Pocket Maximum ..........2 Behavioral Health .............................11 Retail Refill Allowance (RRA) Rule .........2 Dental Plan Benefits ...........................11 Long-Term Care (LTC) Pharmacy ...........2 Your Dental Coverage Options. .11 Out-of-Network Coverage. ............... 3 DPPO Plan Option .........................11 Medicare Medical Coverage. ................. 3 DMO Plan Option .........................12 Medicare Part D Income-Related Medicare ...... Covered DPPO Dental Expenses Chart ......12 Adjustment Amount (D-IRMAA) .......... 4 DMO/DPPO Plan Comparison Chart ...... 12 Changes to the AEP Prescription Drug Plan Availability of Providers. ................ 12 For Under Age 65 Dependents of EyeMed Comprehensive Vision Plan Benefits ...... 13 Retirees Age 65 and Older. ............... 4 Vision Plan Program Chart .............. 13 Medco Moving to Express Scripts Name. .... 4 EyeMed Secondary Purchase Plan ............ 14 Contraceptives ..........................4 Additional Voluntary Benefits ................... 14 Important – Participating Pharmacy Change. 4 Long-Term Care Insurance .................. 14 What Materials Am I Supposed to Have? ........... 4 MetLife Auto & Home Group Insurance ....... 14 Enrolling In Benefits for 2013 ................... 5 Veterinary Pet Insurance. 14 Default Benefit Coverage for 2013 ................ 5 Notice of Privacy Practices ..................... 15 When Does Coverage Begin? .................... 5 Reconstructive Surgery Benefit ................. 15 When Coverage Ends .......................... 5 How to Enroll ............................... 15 Paying for Coverage ........................... 5 Four Simple Steps to Enroll ................. 15 Making Changes .............................. 6 Notice of Premium Assistance Opportunities . 16 Eligibility for AEP Benefits ..................... 6 Medicaid and the Children’s Health Surviving Spouse and Dependent Eligibility .....7 Insurance Program (CHIP) Offer Free or Low-Cost Coverage Levels .............................. 7 Health Coverage to Children and Families . 16 Eligible Dependents ........................ 7 Benefit Resources .....................Back Cover Please note: The information presented in this guide pertains to both retirees and surviving dependents. This enrollment guide is intended to highlight your AEP benefit options and particularly the changes being made. Every effort has been made to ensure this information is accurate. However, the plans are governed by legal documents and insurance contracts. If there is any difference between the information in this enrollment guide and the official plan documents, the plan documents (as revised by the items described as changes in this guide) will rule. If changes in the plans are necessary to comply with the law or applicable IRS regulations, you will be notified. AEP reserves the right to change or terminate any of the plans at any time. Enrollment in these benefits is not a guarantee of future benefits. 204303_guide.indd 2 10/3/12 10:42 AM 2013 AEP Benefits Enrollment Guide for Age 65 and Over Retirees and Survivors | 1 About This Guide • Your options under each plan In addition to important information that is intended • Instructions for making your enrollment elections to help you to understand your benefit options for 2013 (including how they have changed), this Guide includes 2013 Annual Enrollment an important notice that is required to ensure that The 2013 annual enrollment period is Friday, October 19 you are informed about the interaction between the through Wednesday, November 14, 2012. The elections medical benefits AEP provides and Premium Assistance you make during this annual enrollment period become Opportunities (page 16) that may be available in effective on January 1, 2013, and continue through certain states to individuals who may not otherwise be December 31, 2013, unless you have a qualifying change able to afford the medical plan options we offer . in family or employment status. This Benefits Enrollment Guide provides details about the AEP benefit programs, their features, what you need Have you visited www.AEPretirees.com? to do to make sure you have the coverage that’s right for you, and how to make your 2013 benefit elections. It also It’s a public website for AEP retirees and contains plan highlights, along with information you will alumni with information regarding ben- need to enroll in coverage. Here, you can quickly find: efits, service anniversaries and obituaries • Information on the cost of coverage as well as other relevant news. • Coverage levels ★ What’s New/Changing for 2013? ★ There are some important changes to the AEP benefit are being provided a copy of a Summary of Benefits and programs for 2013. Details on the changes listed below are Coverage (SBC) document. The purpose of the SBC is explained in this Guide. Please read before making your to provide consumers of health care with a concise, stan- benefit enrollment decisions and store this guide in your dardized document detailing basic, consistent information Summary Plan Description binder for future reference. about medical plan benefits and coverage that will enable • Life Insurance – Minnesota Life Insurance Company consumers to compare coverage from one plan to another. will be the new vendor • Required Documents – Summary of Benefits and AEP Comprehensive Medical Plan Coverage included in this mailing Expansion of No-Cost Preventive Services • Dependent Audit – review who you cover under the for Women AEP plans carefully In compliance with the Patient Protection and Affordable • Medical Plan includes more no-cost preventive services Care Act (PPACA) - health care reform - the AEP for women Comprehensive Medical Plan will be expanding no-cost • New AEP Medicare Prescription Drug Plan for over preventive services for women. For a complete list of all age 65 retirees and over age 65 dependents preventive services under your plan option, call the Aetna • AEP’s Prescription Drug Plan for under age 65 member services number on your Aetna ID card. dependents - Medco is moving to the Express Scripts name - Generic contraceptives at zero co-pay A Dependent Audit is Coming - Walgreens, Happy Harry’s and Duane Reade no During this year’s annual enrollment period, voluntarily re- longer participating pharmacies move any dependents not eligible for coverage. Make sure each dependent that you cover is still an eligible dependent Life Insurance Plan under the AEP Comprehensive Medical, Dental and/or The life insurance vendor will change from MetLife to Vision plans. Minnesota Life Insurance Company beginning January 1, 2013. The amount of coverage you have will not change. The definitions of eligible dependents are listed in this Summary of Benefits and Coverage Enrollment Guide. As part of annual enrollment and in compliance with the Patient Protection and Affordable Care Act (PPACA), you 204303_guide.indd 1 10/3/12 10:42 AM 2 | 2013 AEP Benefits Enrollment Guide for Age 65 and Over Retirees and Survivors Beginning in early 2013, AEP will conduct a dependent Representatives are certified to answer questions on verification audit to ensure that only those who are eligible Medicare Part D plans and are available 24 hours a day, are covered under AEP’s benefit plans. seven days a week. Ineligible dependents will be removed from AEP’s Note: An exception will be made for an AEP retiree whose permanent residence is outside the U.S. In coverage and retroactively terminated from the plan(s). that case, the retiree will be covered under the AEP If your ineligible dependent has incurred claims during Prescription Drug Plan, not the Express Scripts Medicare the time for which he or she was ineligible for AEP’s Part D plan. coverage, then you or your dependent will become financially responsible for those claims. You Will Be Automatically Enrolled in this Program Covering ineligible dependents under your AEP medical, There is no action required from you to enroll in an AEP dental or vision plans is considered a violation of AEP’s prescription drug plan. AEP is enrolling you and/or your Rules of Conduct and could subject you to disciplinary covered dependents automatically if you are enrolled action, up to and including termination of benefits. in