HomeMy WebLinkAbout2010-175 7� 3/1d
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Eligibility Requirements Olt)
To be eligible to enroll in the BlueMedicaresm Group PPO plan , eligible retirees
and their eligible dependents must be enrolled in Medicare Part A and Medicare Part
B . If a retiree did not enroll in Medicare Part B , the retiree must contact the Social
Security Administration at 1 -800 - 772 - 1213 for assistance in enrolling in Medicare
Part B . TTY users should call 1 -800 - 325 -0778 . A late enrollment penalty may apply .
r For the BlueMedicaresm Group PPO plan , retirees must reside in the nationwide
service area and not be actively working .
> Medicare eligible dependents of an active group employee may enroll in the
BlueMedicares"^ Group PPO plan . The active employee would need to select the
group ' s commercial plan , and their Medicare eligible dependent can enroll in the
BlueMedicare Group PPO plan . This is considered a " split- contract" .
r The Medicare eligible group retiree and their Medicare eligible dependent must
both enroll in the same BlueMedicaresm Group plan , or both remain on the
commercial plan .
Eligible retirees and dependents may enroll during the group ' s Annual Open
Enrollment Period . Retirees and their dependents may also enroll if they met the
requirements for a Medicare Special Election Period .
Retirees and their dependents may disenroll during the group ' s next Annual
Open Enrollment Period , at the group ' s discretion if returning to the group ' s
commercial plan , or per Medicare guidelines . The employer group will also need to
contact Blue Cross and Blue Shield of Florida .
If a BlueMedicaresm Group member permanently moves out of the plan service
area , the member will need to contact the group and also contact the Centers for
Medicare & Medicaid Services at 1 - 800 -633 -4227 . TTY users should call 1 - 877 -486-
2048 .
The employer group will also need to contact Blue Cross and Blue Shield of Florida .
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Plan Design & Benefits
The benefit matrix attached is for informational purposes only . See plan documents
for a complete description of benefits , limitations , and conditions of coverage .
Governmental entities may be subject to Florida Statute 112 . 0801 , which requires
that retired employees and their eligible dependents be offered the same health
coverage options that are offered to active employees . While retirees who are
eligible for Medicare may be offered a separate plan and the plan may be
experience rated separately from the active employee group plan , this coverage
must be basically the same as the coverage offered to active employees . Also , if
active employees are permitted to change plan options annually , Medicare eligible
retirees must also be offered that option .
The employer group has the option as to whether or not to contribute to the
BlueMedicare Group PPO plan .
BlueMedicares" Group PPO Plan Implementation
We will provide the following services at no additional cost :
Assist employers in preparing communications to retirees
> Provide enrollment materials to the group for their retirees
> Assist in BlueMedicares" Group retiree enrollment meetings
Maintain toll -free phone lines to answer retiree questions and assist them in the
enrollment process
➢ Provide a dedicated BlueMedicares"" Member Services Department & dedicated
Group Administrator phone line and email access
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Financial Conditions for BlueMedicaresm Group Products
➢ Effective Date — The benefit plan design provided in this proposal will be
effective from October 1 , 2010 through September 30 , 2011 .
r Rates and Benefit Approval — All benefits , value -added services , and
premiums are subject to CMS and the State of Florida OIR approvals , where
applicable . All Group Medicare Advantage , PDP benefits , and service areas are
subject to change at the next enrollment period .
➢ Rates — All rates are calculated and based on a per- member , per- month
( PMPM ) basis and are effective from October 1 , 2010 through September 30 , 2011 .
Rates may be lower than quoted for those Medicare eligible retirees who meet the
Low- Income Subsidy ( LIS ) guidelines . A retiree can confirm if they qualify for LIS by
contacting Social Security at 1 - 800- 772- 1213 , visit www. socialsecurity . gov on the
web , or apply at the State Medical Assistance ( Medicaid ) office . TTY users should
call 1 -800 - 325- 0778 . The group ' s montly invoice will reflect retirees ' reduced
premiums and the group must pass this savings on to the eligible retirees .
r Part D Creditable Coverage - If prior creditable coverage cannot be proven , the
enrollee may incur a Late Enrollment Penalty ( LEP ) as defined and set by CMS . This
may cause an increase in their premium .
Medicare Part B — The premium /s provided in this proposal exclude the
Medicare Part B premium required of Medicare eligible enrollees to enroll in
Medicare Advantage or Medicare Supplement plans . Retirees who did not enroll in
Part B when they became eligible may do so during the Medicare Part B Annual
Election Period of January 1 st — March 31 st . Their Part B coverage would not become
effective until July 1st . Depending on the retiree ' s circumstances , CMS may impose a
Part B late enrollment penalty . Possible changes by CMS in year 2011 .
BlueMedicaresM Group Medicare Advantage plans replace Original
Medicare , Individual Medicare plans , and commercial health and Rx plans
offered under the employer ' s group plan .
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Enrollment Process
The employer group agrees to send an enrollment meeting invitation letter to
their Medicare eligible retirees
BCBSF will assist the employer group with the BlueMedicaresm Group enrollment
meeting
> BlueMedicaresm Group PPO enrollment forms will be returned to the employer
group by the enrollees at the close of the group ' s annual enrollment period . The
employer group will review the forms for completion , bundle them , and send them to
the BCBSF Front End Services Department for processing . In addition , the group
agrees to provide a roster of their enrollees to the BCBSF Account Management
Specialist .
Note : If a member is renewing the same BlueMedicare Group PPO plan, they do not
need to complete a new enrollment application for plan year 2010.
Each accepted new BlueMedicaresm Group PPO member will be mailed a
Welcome Package . The Welcome Package includes a member I . D . card , Evidence
of Coverage , if applicable , a Provider Directory , and other important information
concerning their enrollment into the plan .
Note: If a member is renewing their same BlueMedicare Group PPO plan, they will
not receive a new 2010 I. D. card. Please note their current BlueMedicare Group I. D .
card is applicable for plan year 2010.
❖ Note : CMS makes the final determination of eligibility for all Medicare plans . If
after receiving their Welcome Package , CMS determines that the member is not
eligible for a BlueMedicaresm Group plan , the member can then enroll as usual into
the employer group ' s commercial plan .
> I . D . cards are normally sent out at least 5 days prior to the member' s effective
date . The effective date is always the first of the month .
> Family members who are eligible according to the group ' s eligibility guidelines
but are not eligible for Medicare , should select the group ' s commercial plan under
normal processing guidelines .
> The employer group will receive premium invoice for BlueMedicarell Group PPO
members separate from their commercial plan invoice . Invoices are sent to the
group , or by special request , can be billed to a Third Party Administrator (TPA ) .
I have reviewed and accept the attached renewal proposal :
Signature : Date :
Title : County Administrator Group Name : Indian River County BOCC
APPROVED AS TO FORM
AND LEGAL. SUFFICIENCY
BY�: _
ALAN S . POLACKWICH
COUNTY ATTORNEY