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Helping You Prepare For Your Upcoming Medicare Enrollment Retiree Benefits 2019 Sandia
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Provide assistance to help you review all of your health care options.
Individualized telephone support provided at no cost to you.
Via Benefits customer service:
1(888) 598-7809
Available 6 am – 7pm MT Monday – Friday.
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Via Benefits (formerly OneExchange) We are here to help!
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What Should I Have Received in The Mail?
Via Benefits mailed to each Medicare household: 2019 Benefit Choices and Enrollment Guide
Note:
If you retired prior to 2012, you
will received one version of the booklet .
If you retired after 2012, you
will receive a different version. Each booklet contains
information for Medicare and PreMedicare participants.
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YSA Reimbursement Request forms can be requested through the Via Benefits Interactive Voice Response (IVR) phone system.
Expanded online enrollment for Medicare retirees.
Prescription Coverage Checkup Tool allows retirees to evaluate their plan options for the new year.
Please see our representatives at the table if you have specific questions.
What’s ”New” for 2019
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Coverage: Take Action: Medical To enroll or disenroll in a medical plan
To change your current medical plan To waive coverage
Dental (retirees only) To enroll or disenroll in the dental plan To waive coverage
Dependent Coverage If you wish to add a dependent, you must do so during open enrollment.
Mid-year additions require a qualifying event. You may drop a dependent at any time.
If you are satisfied with your coverage, you do not need to take any action.
Do I Need to Take Action During Open Enrollment?
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Retired on or before 12/31/2011
Retired on or after 1/1/2012
Your Spending Arrangement Individual Medicare Plan
Sandia Medicare Options
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Sandia Kaiser Group Sponsored Medicare Plan
Your Spending Arrangement Individual Medicare Plan
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Your Spending Arrangement
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Alternative to the Sandia-Sponsored Group Medicare Advantage Plans.
An amount provided to you to use to purchase an individual Medicare plan and use towards eligible healthcare expenses (outlined in your 2019 Benefit Choices and Enrollment Guide).
You, not Sandia, will be responsible for choosing your medical coverage.
You must be enrolled in both Medicare Part A and B and continue to pay these premiums.
Any unused balance in your account rolls over and is available to use next year.
Your Spending Arrangement (YSA)
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Tax-advantaged account used to reimburse you for eligible healthcare expenses.
Premiums Out-of-pocket expenses (deductibles, medical copays, etc.)
You receive money from Sandia to pay for your expenses through the spending account.
Account is shared with your spouse. Reimbursements are tax free. Your funds will be automatically available January 1, 2019, if you enroll
in an individual plan with Via Benefits. You must stay enrolled with Via Benefits to continue access to the YSA
allocations.
How YSA Works
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Choice of Medicare Type Plans
Guarantee Issue – same rates and benefits regardless of your healthcare condition.
No Exclusions for pre-existing conditions.
Network plans that include Medicare Part A and B benefits and often include Rx coverage.
Medicare Advantage Plan
Guarantee Issue – same rates and benefits regardless of your healthcare condition (when newly enrolling). If you change plans after first year, you may be subject to insurance underwriting.
No exclusions for pre-existing conditions, when first enrolling.
These plans pay after Medicare pays (e.g. the 20% coinsurance that Medicare does not pay)
There are no network restrictions allowing a retiree to go to ANY doctor or hospital in the country that accepts Medicare.
Medicare Supplement / MediGap Plans
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All Medicare Plan Types
Sample of Individual Insurance Company Partners
Plan and Carrier Options
Medicare Advantage Medigap/Supplemental
Prescription Drug (Part D) Sandia Dental Care
Individual Dental Vision
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Plan Type Number of Plans Offered
2019 Monthly Premium
Company
Medicare Advantage 5 $69 - $157
Health Net, Stanford, Kaiser Permanente, UHC
Medigap/ Medicare Supplement (71 yr. old male)
31
$48 - $184
Blue Cross Blue Shield CA, Health Net, Anthem Blue Cross, Aetna, Humana, Cigna
Part D
21
$20 - $170
Aetna, UHC, Humana, Silver Script, WellCare, Coventry, Express Scripts
2019 Plan Availability in Alameda County
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You Pay Full Retail Until Deductible is Met 2019 - $0 to $415
You pay copays for your plan coverage for the first $3820 in actual costs of Medications
You pay 25% of Brand Name and 37% of Generics until your out of pocket costs reach $5100; Pharmaceutical contributions will count towards the $5100 True Out-of-Pocket (TrOOP)
You Pay $3.40 for Generics and $8.50 for Brand Name or 5% - whichever is greater
Only 25% reach Donut Hole
Only 4% reach Catastrophic
Medicare Prescription Drug Coverage 2019
Catastrophic Coverage
Coverage Gap
Initial Coverage Deductible
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Your Spending Arrangement
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Automatic Monthly Premium Reimbursement
Up to the amount available in your YSA
YOU Your Bank
Reimburse
Insurance Provider
Set Up Automatic Withdrawal
Receipt of Payment
Premium
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Reimbursement Option A
Automatic Reimbursement
Reimbursements are up to the amount
available in the YSA
Manual Reimbursement
Reimbursement Option B
Participant
Via Benefits Insurance Carrier
Participant
Via Benefits Insurance Carrier
Your Spending Arrangement
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Educate
Evaluate/Enroll
Manage/Advocacy
Via Benefits Enrollment Process
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Benefit Choices Prepare you for enrollment discussion
Review your plan options and important Medicare basics
Appointment confirmation reminder
Website: My.ViaBenefits.com/Sandia
Educate
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Enrollment Process
Benefit Advisors can discuss coverage options with anyone – are required to speak to the participant to complete the enrollment.
Once you have made a coverage selection, enrollment is conducted via telephone.
100% of calls are recorded.
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The plans you select continue on year to year. No need to re-enroll in the fall unless you want to make a plan change.
A Lifetime Advocate Navigation Enrollment Prescription changes Affordability concerns
Reimbursement issues Late enrollment YSA Annual plan review
Personal Advocacy For a Lifetime
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There is a premium increase to the Dental Plan for 2019.
If you need an additional ID card, these can be ordered at www.toolkitsonline.com
Retired 12/31/2009 or earlier
Retired 1/1/2009 through 12/31/2011 Monthly Premiums
Retired on or after 1/1/2012 Monthly Premiums
Retiree Only
$0
$9.00 $46.00
Retiree plus one $18.00 $90.00
Retire plus two or more $26.00 $118.00
Sandia Delta Dental Plan
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Medical Coverage
To continue coverage, the surviving spouse and/or dependents must elect continuation of coverage through Via Benefits.
Continued coverage cost is 50% of the full medical premium for the survivor of a retiree or employee with 15 or more years of service.
Continued coverage is available until the surviving spouse remarries, dependent children become ineligible and/or coverage is terminated with Sandia.
Surviving Spouse Continuation of Coverage
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Dental Coverage
Dental coverage for surviving spouse and/or eligible dependents is discontinued at the end of the month of retiree’s death.
Group coverage may be temporarily continued (COBRA), for up to 36 months by paying the full monthly premium COBRA surviving spouse rate $46 plus the 2% administrative fee.
Other long-term dental plan coverage information for surviving spouse is available through Via Benefits Benefit Advisor.
Surviving Spouse Continuation of Coverage (cont.)
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Check to ensure that your child meets the eligibility requirements to be enrolled.
Children are covered until age 26.
If your child is no longer eligible, please be sure to contact Via Benefits to disenroll.
You must disenroll dependents within 31 days of qualifying event.
Dependent Eligibility
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Confirmation/Billing Statements
NO ACTION You will continue with same plan
options.
You will NOT receive a new confirmation statement.
You will NOT need to make any changes to your automatic debit for premium payment.
New premium amounts will be applied beginning with January premium payment for Sandia group sponsored plans. Check with insurance company on individual plans.
TAKE ACTION You will receive a new
confirmation statement of new plan coverage.
You will NOT need to make any changes to your automatic debit for premium payment for Sandia Group sponsored plans. *Individual plans may require a change.
New premium amounts will be applied beginning with the January premium payment.
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PreMedicare/Medicare information @ SandiaRetireeBenefits.com
Via Benefits Medicare plan options @ My.ViaBenefits.com/Sandia
Contact information is located in the front of your open enrollment guide
Resource Website information
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Kaiser Senior Advantage Plan
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Questions
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