Aon/Healthcare Exchange

October 28, 2015

                                                                             Heads up to Grandfathered Retirees!!

New Dental Plans from AT&T

Here is a heads up for those Grandfathered AT&T retirees.  AT&T is offering three dental options to retirees this year…Bronze, Silver and Gold.  See the chart below.  Each plan is slightly different and the cost is the same…”0”.  The reason for the heads up is that the Gold plan appears to be the best option and the cost is the same.  You should carefully consider using that option for 2016.  We’ve asked AT&T for an explanation but have yet to get an answer.  See the chart below:

 

New options for the AT&T Dental Plan
Bronze   Silver   Gold
Network/ONA Non-Network Network/ONA Non-Network Network/ONA Non-Network
Deductible:(per person) $50 $100 Deductible:(per person) $25 $50 Deductible:(per person) $0 $25
CoinsurancePreventive CoinsurancePreventive CoinsurancePreventive
(no deductible) 0% 0% (no deductible) 0% 0% (no deductible) 0% 0%
Minor: 20% 40% Minor: 10% 30% Minor: 0% 20%
Major: 40% 60% Major: 20% 40% Major: 10% 30%
Maximums Maximums Maximums
Current year: $1,500 $750 Current year: $1,750 $875 Current year: $2,000 $1,000
Lifetime ortho: $2,000 $1,500 Lifetime ortho: $2,000 $1,500 Lifetime ortho: $2,000 $1,500
Monthly contribution: $0 Monthly contribution: $0 Monthly contribution: $0
Your benefit is based on the provider you chose at the point of service.  You may also have a Dental Health Maintenance Organization (DHMO) option (depending on your ZIP code) available to you.  Refer to your SPD for details on eligibility.

October, 19, 2015

                                                                          REGARDING ENROLLMENT FOR 2016

                                                                               AON HEALTHCARE EXCHANGE!!

We have received a lot of calls from retirees who believe that they need to confirm or re-enroll into their current Medicare plan(s) for 2016.  Can you help us spread the word?  If they are happy with their current plan – they do not need to re-enroll each year!  They will automatically be renewed (with no medical questions, even for Medigap renewals!) and remain covered as long as they continue to pay their premiums in 2016. NO ACTION IS NEEDED.

The only exception to this is if their carrier’s plan is ending and won’t be available in 2016.  For reference, this is a very small number and the retiree would have been notified by the insurance company if that were happening.  If they have not received materials from their carrier yet or have specific questions, they can contact their carrier directly using the phone number provided on their insurance card.

September 29, 2015

                                                                   Open Enrollment Information for 2016

On Sept. 18, 2015 we had a conference call pertaining to the open enrollment process for 2016.  Below is a summary of the call.  Many of you may already have received this information in the mail…if not, here it is:

In 2015, AT&T Medicare-eligible retirees and their Medicare-eligible dependents enrolled in health care coverage in a new way, through the AON Retiree Health Exchange.  The Exchange provides access to an expanded selection of medical, prescription drug, dental and vision insured policies which allow participants to elect the coverage that works best for them.

As part of our continued support of our retirees, AT&T established a Health Reimbursement Account (HRA) in 2015 for eligible participants.  The HRA can be used to help pay for individual insurance coverage and eligible out-of-pocket expenses for those who enrolled in medical and/or prescription drug coverage through the Exchange.

For 2016 AT&T will continue to support our retirees by providing HRA credits for HRA eligible participants who participate in qualifying coverage through the Exchange.  We’ve even expanded the availability of HRA credits to those who only need dental and/or vision coverage.

Your 2016 Exchange enrollment options under the AT&T Medicare-Eligible HRA Program

Medical and/or Prescription Drug Coverage purchased through the Exchange*

  • Eligible Retiree – $2700
  • Eligible Dependent of Retiree – $1500

Dental and/or Vision Coverage purchased through the Exchange*

  • Eligible Retiree – $300
  • Eligible Dependent of Retiree – $200

*For 2016, the maximum HRA crediting amount for an eligible retiree is $2700 and the maximum HRA crediting amount for their eligible dependent is $1500.

Important Information

  • HRA credits are provided if the HRA eligible retiree and/or eligible dependent enroll through the Exchange. These amounts are prorated if enrollment occurs later in the year.
  • If eligible retirees have dependents under age 65, they must enroll in at least one policy through the Exchange for them to remain eligible under the AT&T group health plans.

You will soon receive additional information from the Exchange providing details about the 2016 Medicare open enrollment period, which takes place from October 15th through December 7th, including information about how to receive or change your current coverage if your needs have changed.  You also will receive an updated Summary Plan Description, which will include the complete HRA eligibility provisions.

February 28, 2015

CarePlus Hearing Aid Insurance Benefits

The examples below are just that “Examples”! Before you proceed to purchase any hearing device with the intent of using the CarePlus benefits, contact CarePlus first and explain your situation and obtain their advice.

Below are two examples to outline the process and provisions for the CarePlus hearing aid benefit. CarePlus requires that the participant exhaust any available benefit under their medical plan before a claim can be submitted for reimbursement. This means that the participant would need to meet any existing deductible and pay the appropriate copay or coinsurance before the medical plan benefit would be paid out by the plan.

If the participant uses a non-network provider for hearing aids, the costs would go toward meeting the non-network deductible, which for most plans is higher than the in-network deductible. In this instance the non-network deductible would need to be met in full before the base medical plan would pay out a hearing aid benefit.

Once the plan has paid out the maximum amount available then the participant will file with CarePlus for any remaining balance owed, up to $1,000 per 36 months.

Please note for retirees submitting claims, that original Medicare and many Medigap plans don’t offer coverage for routine hearing exams, hearing aids, or exams for fitting hearing aids. Some Medicare Advantage plans offer coverage, which would be described by the examples below. If there is no coverage available under a supplemental medical program, then the retiree can move directly forward to filing a claim for CarePlus benefits.

Note:
• If there are no hearing aid benefits under the medical plan(s) to exhaust, then the hearing aid must be determined by an Audiologist to be medically necessary.
• The audiologist/provider must submit a claim to the medical carrier for the hearing aid, even no coverage is provided under the medical plan. This will generate an EOB to submit with the CarePlus claim, as required.

Plan participants should contact their medical carrier to confirm coverage for hearing aids under their medical plans. If plan participants have questions about hearing aid coverage and the plan provisions under CarePlus, they can refer to their summary plan document or contact the CarePlus team at 877-261-3340

Reimbursement Process – CarePlus Reimburses Participant

1. The participant is prescribed hearing aids by a licensed audiologist.

2. The participant and/or audiologist files a medical claim for coverage.
a. The participant must pay the annual deductible (or remaining amount from prior claims) before the medical program pays anything.
b. The participant must pay the applicable coinsurance amount before the medical program pays anything.
c. After the participant meets the deductible and pays the coinsurance amount to the audiologist, the medical program will pay up to the maximum allowed amount for hearing aids ($1,000).

If a balance due remains after deductible, coinsurance and medical program payment then:

3. The participant pays any remaining balance to the audiologist in order to take possession of the hearing aids.

4. The participant files a manual paper CarePlus claim for reimbursement of the amount paid in Step 3. They must provide both the claim from the provider/audiologist and the Explanation of Benefits (EOB) from the medical carrier which describes how the medical program paid out the claim.

The CarePlus program will reimburse the participant for any remaining costs (Step 3) up to the maximum allowed amount ($1,000 per 36 months) for hearing aids under the program

Here is an example of what this would look like if CarePlus reimburses the participant for out of pocket expenses:

Example: CarePlus reimburses participant Medical Program Pays Participant Pays CarePlus Program Pays/Reimburses
Full cost of hearing aids $5,000
The participant pays the annual deductible of $1,000. $1,000
Balance $4,000
The participant pays 20% coinsurance of the remaining balance after the deductible is met. $800
Balance $3,200
The medical program pays up to the maximum allowed amount for hearing aids. $1,000
Balance $2,200
The participant pays the remaining balance to provider/audiologist. $2,200
Balance $0
The participant files a CarePlus claim for reimbursement.CarePlus reimburses the participant up to the maximum allowed amount for hearing aids. $1,000
Participant Total Out of Pocket Costs: $3,000

Alternately, the participant may choose to request reimbursement be paid directly to the Audiologist and pay the remaining balance, if any, before picking up their hearing aids.

Reimbursement Process – CarePlus Reimburses Provider/Audiologist

1. The participant is prescribed hearing aids by a licensed audiologist.

2. The participant and/or audiologist files medical claim for coverage.
a. The participant must pay the annual deductible (or remaining amount from prior claims) before the medical program pays anything.
b. The participant must pay the applicable coinsurance amount before the medical program pays anything.
c. After the participant meets the deductible and pays the coinsurance amount to the audiologist, the medical program will pay up to the maximum allowed amount for hearing aids ($1,000).

If a balance due remains after deductible, coinsurance and medical program payment then:

3. The participant files a manual paper CarePlus claim for payment of the remaining balance due. They must provide both the claim from the provider/audiologist and Explanation of Benefits (EOB) from the medical carrier which describes how the medical plan paid out the claim.

4. The CarePlus program will reimburse the provider/audiologists for remaining costs up to the maximum allowed amount ($1,000 per 36 months) for hearing aids under the program.

5. If balance still remains, participant pays the remaining balance and then can take possession of their hearing aids.

Below is an example where CarePlus would reimburse the provider directly, rather than the participant.

Example: CarePlus pays provider Medical Program Pays Participant Pays CarePlus Program Pays/Reimburses
Full cost of hearing aids $5,000
The participant pays the annual deductible of $1,000. $1,000
Balance $4,000
The participant pays 20% coinsurance of the remaining balance after the deductible is met. $800
Balance $3,200
The medical program pays up to the maximum allowed amount for hearing aids. $1,000
Balance $2,200
The participant files a CarePlus claim for reimbursement.CarePlus reimburses the participant up to the maximum allowed amount for hearing aids. $1,000
Balance $1,200
The participant pays the remaining balance to the provider/audiologist. $1,200
Participant Total Out of Pocket Costs: $3,000

Examples provided by Mary Catherine Hogue of AT&T Benefits