Humana Medicare Employer Plan Plans that go the extra mile

Joel Thacker

GHHHWTDEN_18_PEIA

2

Making Healthcare Decisions: What You Need to Know Today we will focus on how Humana can partner with you to help you achieve your healthcare goals. We will also answer questions you may have about your new Humana plan. What We Will Discuss Today:

Benefits and Programs

Your Plan

MILE 1

A health and physical activity program at no extra cost.

A wellness program just for Humana members at no extra cost; earn “Bucks” for healthy activities. Go365 Bucks must be spent by the end of the plan year.

Resources Extra Benefits and

silversneakers.com

Go365.com

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Benefits of having a Primary Care Physician (PCP) • Your PCP can get to know your overall

health history

• You can build a trusting, long-term relationship

• Your plan doesn’t require referrals to see other providers

• Your PCP will help take care of you when you’re sick and help you stay healthy with preventive care

Building Healthy MILE 1

Relationships

MILE 1

• Humana has teamed up with MDLIVE to provide this telemedicine benefit

• No appointment needed • Copay is the same as the copay for an in office visit to your PCP

• Talk with a board-certified doctor from the comfort of your home

• Private, secure and confidential

• Doctors can treat conditions including: allergies, cold and flu, constipation, diarrhea and fever

See a doctor virtually anytime or anywhere you need one, for non-emergency medical conditions. 24 hours a day, 7 days a week.

Resources Extra Benefits and

Download the MDLIVE mobile app from the App Store® or Google PlayTM - Internet access required and data fees may apply.

Nurse Advice Line

MILE 1

Medical advice at no extra cost from a registered nurse 24 hours a day, seven days a week.

This service isn't intended for emergencies. In case of emergency, dial 911.

Resources Extra Benefits and

Humana Well Dine

MILE 1

After your overnight inpatient stay in a hospital or skilled nursing facility, you’re eligible for 10 nutritious, precooked frozen meals delivered to your door at no additional cost to you.

Resources Extra Benefits and

MILE 1

• Understand your doctor’s advice

• Learn about and find ways to help you afford your medicine

• Make arrangements to get to medical appointments

• Make your home a safer place to live

• Provide ways to help you get meals and groceries

If you are eligible, your Humana at Home care manager can help you:

Resources Extra Benefits and

• Check PEIA website for educational pieces updated quarterly

Health Resources

MILE 1

• Case Management

• Disease Management

• Transplant Management

• Health Planning and Support Nurses

Resources Extra Benefits and

Humana’s Preferred Provider Organization (PPO)

What is a PPO?

MILE 2

No Copayment for certain Preventive Care

Out-Of-Pocket Maximum

Worldwide Emergency Coverage

* All PEIA members will receive a new Humana ID card for the 2018 plan year.

What is Part D coverage?

MILE 2

Generic to Specialty drug coverage

Your plan also includes prescription drug coverage

With your PPO plan, you will pay the same amount both in and out-of-network for care.

Your 2018 PPO Benefits

Your PPO plan Plan 1 Plan 1 Benefit Assistance Plan 2 Annual Deductible $150 $50 $375 Annual Maximum Out of Pocket $1,200 $600 $1,950

Hospital Care

Outpatient Hospital Visits $100 $50 $115 Inpatient Hospital $100 per admit $100 per admit $150 per admit Physician and Facility Services

Primary Care Physician $20 $2 $20 Specialist $40 $5 $50 Outpatient Ambulatory Surgical Center $100 $50 $115

Durable Medical Equipment $0 $0 $0 Emergency Services

Emergency Room Care $50 $50 $65

MILE 2

Coinsurance A percentage of your drug costs that you may pay out of your pocket after you pay any plan deductible. Copayment The set dollar amount you pay when you have a prescription filled.

Your 2018 Part D Benefits MILE 2

Tiers

Plan 1

Standard Retail Cost-Sharing

(30 day supply)

Plan 1 Benefit Assistance

Standard Retail Cost-Sharing

(30 day supply)

Plan 2

Standard Retail Cost-Sharing

(30 day supply)

Tier 1 (Generic/Preferred Generic) $5 $5

$5

Tier 2 (Preferred Brand) $15 $15 $20

Tier 3 (Non-Preferred Drug) 50% 50% 50%

Tier 4 (Specialty) $100 $100

$100

Stage 2 - Initial Coverage:

Your Rx Drug Phases MILE 2

Stage 1: Deductible

Stage 2: Initial

Coverage

Stage 2: $75 - $3,750

Stage 3:: $$3,750 - $5,000

Stage 4: Catastrophic

Coverage

• PEIA members pay $75 deductible. • PEIA members have a $1,750 maximum out-of-pocket

• After you’ve met your $75 deductible you will pay your copayment/coinsurance up to the total drug cost amount of $3,750.

• This amount is the total drug costs paid by both you and your Part D plan.

• For Tier 3 drugs your coinsurance will decrease from 50% to 35%. • There is no effect on your Tier 1, 2 & 4 copayments.

• Once the total cost paid by both you and your plan reach $5,000 PEIA members pay:

• $3.35 copay-generic, $8.35 copay-all other, or 5% coinsurance

MILE 2

• Injectable/IV drugs given in provider's office • Vaccines: Influenza, Pneumococcal, Hepatitis B, rabies,

tetanus • Diabetic testing supplies, Insulin pumps, Insulin for insulin

pumps

Part B

• All commercially available vaccines — except for those covered by Part B

• Diabetes medications, Regular insulin, Syringes • All prescription drugs covered under the PEIA formulary

Part D

Part B versus Part D prescription drug coverage

Diabetic Supplies and Coverage Many brands of diabetic supplies —

blood glucose testing meters and test strips — are available through your plan benefit.

Obtain a new prescription from your

provider for one of the preferred meters. There will be no out of pocket cost for this change.

Obtain a Prior Authorization from your provider if you choose to continue using your current meter and it is a non-preferred .

Preferred* Diabetic Supplies

Roche Accu-Chek Nano®

Roche Accu-Chek Aviva Connect®

Roche Accu-Chek Aviva Plus®

Humana Pharmacy® TRUE METRIX® AIR

*Specific meter models subject to change dependent upon manufacturer availability

Diabetic Eye Exam There is a change to the Diabetic Eye Exam benefit in 2018. $0 copay for the Diabetic Eye Exam

2 MILE

An overview of your health benefits and health spending on medical and prescriptions, throughout the year.

SmartSummary and SmartSummaryRx

MILE

• Stay informed

• Clear and detailed financials

• Information you can share with your provider

• Prescription information

MILE

• View your plan and coverage details

• Check the status of your claims

• View electronic versions of letters sent to you

• Track your healthcare spending

• Find providers in your network

• Get tips for staying healthy

Whether you prefer using a desktop, laptop or smartphone, you can access your healthcare information in one convenient place.

Resources Extra Benefits and

Stay Connected With Humana

Use MyHumana as an online tool to access your benefits information anytime. Or use the

MyHumana app.

1-800-783-4599 (TTY:711)

Monday – Friday 8:00 a.m. – 9:00 p.m.

MILE 4

You will have a dedicated customer care team to help you with anything related to your Humana plan.

What do I do with my Medicare card? Provide your Humana card to your provider from now on, but keep your Medicare card in a safe and secure place. You will not need to present it when receiving care.

What do I need to do after I become effective with Humana? Read through the materials Humana sends you and expect to receive a call from Humana within 90 days to discuss your health goals *

Use Your Plan: What’s Next

Keep, but don’t use Use this card now * * *

Thanks for your time and attention

Questions? For more information:

• Refer to your enrollment kit • Visit Humana.com • Call Group Medicare

customer care

Thank You Humana is a Medicare Advantage PPO organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. You must continue to pay your Medicare Part B premium. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and member cost-share may change each year.

The pharmacy network and provider network may change at any time. You will receive notice when necessary.

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

MDLive: Limitations on healthcare and prescription services delivered via telemedicine and communications options vary by state. Telemedicine is not a substitute for emergency care and not intended to replace your primary care provider or other providers in your network. This material is provided for informational use only and should not be construed as medical advice or used in place of consulting a licensed medical professional.

Discrimination is Against the Law Humana Inc. and its subsidiaries (“Humana”) comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. Humana does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Humana provides: • Free auxiliary aids and services, such as qualified sign

language interpreters, video remote interpretation, and written information in other formats to people with disabilities when such auxiliary aids and services are necessary to ensure an equal opportunity to participate.

• Free language services to people whose primary language is not English when those services are necessary to provide meaningful access, such as translated documents or oral interpretation.

If you need these services, call 1-877-320-1235 or if you use a TTY, call 711.

If you believe that Humana has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Discrimination Grievances P.O. Box 14618 Lexington, KY 40512 - 4618 If you need help filing a grievance, call 1-877-320-1235 or if you use a TTY, call 711. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800–368–1019, 800-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html