HomeMy WebLinkAbout2018-27PULASKI
WHERE YOUR NEW PATH BEGINS
RESOLUTION 2018-27
Electing to Provide
Health Insurance Coverage
for Retirees and Dependents of Retirees
WHEREAS, the Town of Pulaski, Virginia is a participant in The Local Choice Health
Benefits Program; and,
WHEREAS, the Town of Pulaski, Virginia offers health insurance to its eligible employees
and their dependents; and,
WHEREAS, the Town of Pulaski, Virginia has in place a policy to provide coverage to
retirees and their dependents not eligible for Medicare; and,
WHEREAS, the Town of Pulaski, Virginia does not have in place a policy to provide coverage
to retirees and their dependents eligible for Medicare;
NOW, THEREFORE be it RESOLVED that the Town of Pulaski, Virginia does hereby elect to
provide coverage to Medicare Eligible Retirees and their dependents effective on October 1,
2018. Our choice of Medicare Supplemental coverage is Advantage 65 with Dental/Vision as
shown in Attachment A -Resolution 2018-27, attached hereto and expressly made part of this
resolution as if set forth herein.
This resolution is hereby adopted by the Town Council of the Town of Pulaski, Virginia this 24th
day of July 2018, by the duly recorded vote of the Town Council of the Town of Pulaski, Virginia
as follows:
Lane R. Penn
Brooks R. Dawson
Gregory C. East
ATTEST:
David N. Quesenberry
Clerk of Council
-Aye Joseph K. Goodman -Aye
-Aye G. Tyler Clontz -Aye
-Aye James A. Radcliffe -Aye
4:1d
=Clark ULASKI, V IA
L.
Mayor
Office of the Town Manager — 42 1" Street NW / P.O. Box 660 — Pulaski, VA 24301
Attachment A -Resolution 2018-27
ADVANTAGE 65 WITH DENTAL/VISION
Effective January 1, 2018 - December 31, 2018
Medical, Dental and Vision administered by
Anthem Blue Cross and Blue Shield
The Local Choice is a unique health benefits program managed by the Commonwealth
of Virginia Department of Human Resource Management (DHRM). The Advantage 65
with Dental/Vision plan may be offered to you if you are eligible
for Medicare and to your Medicare -eligible family members by
your group. Benefits are administered on a calendar year basis
to coincide with your Medicare coverage. Changes in your
monthly premium are effective July 1 (or October 1 for certain
school groups) to coincide with your former employer's The Local Choice (TLC) health
plan renewal.
The Advantage 65 with Dental/Vision plan provides medical benefits that work with
Medicare Part A and Part B. It does not provide prescription drug coverage.
This guide is only an overview. For a complete description of the benefits,
exclusions, limitations, and reductions, please see the Medicare Coordinating
Plans Member Handbook.
SERVICE AREA
Wherever retirees live.
MEDICAL BENEFITS
To receive full benefits you must be enrolled under both Part A and Part B of
Medicare. Always show both your Medicare card and your Anthem identification
card when you receive care.
Advantage 65 covers the Medicare Part A hospital deductible (after you pay $100) and
copayment amounts, and the Part B copayment for Medicare -approved charges. It also
y covers out -of -country Major Medical services.
ADVANTAGE 65 WITH DENTAL/VISION
CHOOSE HEALTH CARE
PROVIDERS CAREFULLY
Physicians
Ask your doctor if he or she is a Medicare participating physician. A doctor who
participates in Medicare agrees to:
■ File claims on your behalf
■ Accept Medicare's payment for covered services
This means your copayment is limited to a percentage of the Medicare -approved charge.
Go to Medicare.gov for additional information about Medicare -participating physicians.
This brochure describes benefits based on Medicare -approved charges. Doctors who do
not accept assignments may not charge you any more than 15% above what Medicare
considers a reasonable fee. This applies to all doctors and all services.
Hospitals
Hospitals that participate in the Medicare program are covered. Admissions not approved
by Medicare are not covered.
ADVANTAGE 65
What The Plan Covers
'Allowable Charge (AC) —The term has two meanings, depending on whether the service is provided by a doctor (or other healthcare
professional) or a hospital. For care by a doctor or other healthcare professional, the allowable charge is the lesser amount of your plan's
allowance for that service, or the provider's charge for that service. For hospital services, the allowable charge is the amount of the negotiated
compensation to the facility for the covered service or the facility's charge for that service, whichever is less. For complete information about
the allowable charge, please see the Medicare Coordinating Plans Member Handbook.
ADVANTAGE 65 WITH DENTAL/VISION
Plan Pays
PART A SERVICES
Hospitallnpatient
■ Medicare Part A hospital deductible less $100 per benefit period, days 1-60
In full
■ Medicare Part A daily hospital copayment amount, days 61-90
In full
■ 100% of the allowable charge', for eligible expenses for an additional 365 days.
In full
■ Copayment amount for Medicare Lifetime Reserve Days (60 days available)
In full
Skilled Nursing Facility
■ Medicare Part A skilled nursing facility copayment, days 21-100 (Medicare
In full
covers days 1-20 in full.)
■ A daily amount equal to Medicare skilled nursing home copayment, days
In full
101-180 (Medicare provides no coverage beyond 100 days.)
Plan Pays
PART B SERVICES
Physician And Other Services
■ Part B copayment of Medicare -approved charges for services such as:
In full
(after you pay the Medicare
• Doctor's care
Part B calendar year
• Surgical services
deductible)
• Outpatient x-ray and lab services
• Professional ambulance service
AT HOME RECOVERY
■ At-home recovery care for an illness or injury approved under a Medicare
Up to $40 per
SERVICES
home health treatment plan. Benefits include:
visit (limited
• Home visits up to the number approved by Medicare, not to exceed
to $1,600 per
7 visits per week (This benefit applies to home health services, certified
calendar year)
by a physician, for personal care during the recovery period)
Plan Pays
OUT -OF -COUNTRY
MAJOR MEDICAL
SERVICES
■ Lifetime maximum
$250,000
(after you pay $250
calendar year deductible)
0 Annual restoration of lifetime maximum (limited to the amount of benefits
$2,000
used in any one year)
Covered Services
■ Medically necessary services received in a foreign country
80% AC'
Out -Of -Pocket Expense Limit
■ In a calendar year when your out-of-pocket expenses for covered services
reach $1,200, the plan pays 100% of the allowable charge for the rest of the
calendar year.
'Allowable Charge (AC) —The term has two meanings, depending on whether the service is provided by a doctor (or other healthcare
professional) or a hospital. For care by a doctor or other healthcare professional, the allowable charge is the lesser amount of your plan's
allowance for that service, or the provider's charge for that service. For hospital services, the allowable charge is the amount of the negotiated
compensation to the facility for the covered service or the facility's charge for that service, whichever is less. For complete information about
the allowable charge, please see the Medicare Coordinating Plans Member Handbook.
ADVANTAGE 65 WITH DENTAL/VISION
DENTAL/VISION BENEFITS
Dental Benefits
The plan pays up to $1,500 per member per calendar year. It also pays 100% of the allowable charge for diagnostic and preventive services,
such as oral examinations and dental x-rays. It pays 80% of the allowable charge for basic services, such as fillings, re -cementing of crowns, inlays
and bridges, or repair of removable dentures. The remaining 20% is your responsibility. The plan also pays 5% for major services such as crowns,
dentures, and implants.
When you need services, simply present your plan identification card to your dentist. If you go to an Anthem Dental Complete
network dentist, you will be responsible only for your coinsurance. If services are provided by a non -network dentist, you pay
your coinsurance, plus the difference, if any, between the plan's allowable charge for a covered service and the dentist's charge.
Network dentists are listed on the Web at www.anthem.com/tic, or call Anthem Dental Complete at 1-855-648-1411 to
determine if a dentist is in the network.
Plan Pays $1.500 Maximum Per Person Per Calendar Year In -Network You Pay
Diagnostic And Twice -a -year visits to the dentist for oral examinations, so
Preventive Services x-rays, and cleanings
Basic Dental Care Fillings, oral surgery, periodontal services, scaling, 20% AC"
repair of dentures, root canals and other endodontic services,
and recementing of existing crowns and bridges
Major Dental Care Crowns (single crowns, inlays and onlays), prosthodontics 95% AC**
(partial or complete dentures and fixed bridges) and dental implants.
Out -Of Network Care For services by a non -network dentist, you pay the applicable coinsurance plus any amounts above
the allowable charge.
"Allowable Charge (AC) — The allowable charge is the lesser amount o f the Anthem Dental Complete plan allowance for that covered
service, or the provider's submitted charge for that covered service. Participating Anthem Dental Complete dentists have agreed to accept
Anthem's payment plus any required coinsurance (i f applicable) as payment in full for covered benefits..
Routine Vision Benefits
Your routine vision benefits are through the Anthem Blue View Vision network. Available once per calendar year, your
vision benefits include a routine eye exam, eyewear and special eye accessory discounts. You may receive services from any
ophthalmologist, optometrist, optician and/or retail location in the Anthem Blue View Vision network.
To locate an Anthem Blue View Vision provider, select Find A Doctor at www.anthem.com/tlg, or contact Member Services at
800-552-2682 for assistance. To receive vision services, simply present your Anthem identification card to your Blue View Vision
provider when you receive your eye exam or purchase covered eyewear. Your Blue View Vision provider will verify eligibility and
file your claims.
While some vision benefits are also covered out -of -network, you will receive the most value when you choose a Blue View Vision
provider. If you use an out -of -network provider, your benefits will be covered at a lower payment level. You will need to pay for covered
services and purchases at the time of your visit and send an out -of -network claim form to Blue View Vision. The claim form is available at
anthem.com/tic under Forms.
Certain non -routine vision care such as eye surgery may be covered under your primary medical coverage under your Medicare plan.
Refer to your Medicare and You Handbook or contact Medicare for more information.
4 ADVANTAGE 65 WITH DENTAL/VISION
Vision Benefits Highlights
Routine vision care services
In -Network You Pay
Routine eye exam (once per calendar year)
$20 copayment
Eyeglass frames
Once per calendar year you may select any eyeglass framer and receive the following
$100 allowance then 20% off
allowance toward the purchase price:
remaining balance
Standard Eyeglass Lenses
Polycarbonate lenses included for children under 19 years old.
Once per calendar year you may receive any one of the following lenses.
■ Standard plastic single vision lenses (1 pair)
$20 copay; then covered in full
■ Standard plastic bifocal lenses (1 pair)
$20 copay; then covered in full
■ Standard plastic trifocal lenses (1 pair)
$20 copay; then covered in full
■ Standard progressive lenses (1 pair)
$85 copay; then covered in full
Upgrade Eyeglass Lenses (available for additional cost)
Lens options
Member cost for upgrades
When receiving services from a Blue View Vision
■ UV coating
$15
provider, you may choose to upgrade your new
■Tint (solid and gradient)
$15
eyeglass lenses at a discounted cost. Eyeglass lenses
■ Standard scratch resistance
$15
copayment applies, plus the cost for the upgrade.
■ Standard polycarbonate
$40
■ Standard anti -reflective coating
$45
■ Other add-ons and services
20% off retail price
Contact lenses
Lens options
Prefer contact lenses over glasses? You may choose to
■ Elective conventional Ienses2
$100 allowance then 15% off the
receive contact lenses instead of eyeglasses (frames and
remaining balance
lenses) and receive an allowance toward the cost of a sup-
■ Elective disposable Ienses2
$100 allowance (no additional
ply of contact lenses once per calendar year.
discount)
■ Non -elective contact Ienses2
$250 allowance (no additional
discount)
I Discount is not available on certain frame brands in which the manufacturer imposes a no -discount policy.
2 Elective contact lenses are in lieu of eyeglass lenses. Non -elective lenses are covered when glasses are not an option for vision correction.
OPTIONS FOR PRESCRIPTION DRUG COVERAGE -
MEDICARE PART D
If you want prescription drug coverage, you must enroll in a separate Medicare Part D Prescription drug plan.
Several Medicare Part D plan options are being offered. To determine what drug coverage option best meets your needs, consult the
Medicare and You Handbook, call 1 -800 -MEDICARE (1-800-633-4227) or visit the Medicare Web site at www.medicare.gov.
ADVANTAGE 65 WITH DENTAL/VISION
Get help in your language
Curious to know what all this says? We would be too. Here's the English version:
This notice has important information about your application or benefits. Look for important dates. You might need to take
action by certain dates to keep your benefits or manage costs. You have the right to get this information and help in your
language for free. Call the Member Services number on your ID card for help. (TTY/TDD: 711)
Spanish
Este aviso contiene informacion importante acerca de su solicitud o sus beneficios. Busque fechas importantes. Podria
ser necesario que actue para ciertas fechas, a fin de mantener sus beneficios o administrar sus costos. Tiene el derecho
de obtener esta informacion y ayuda en su idioma en forma gratuita. Llame al n6mero de Servicios para Miembros que
figura en su tarjeta de identificacion para obtener ayuda. (TTY/TDD: 711)
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French
Cette notice contient des informations importantes sur votre demande ou votre couverture. Vous y trouverez egalement
des dates A ne pas manquer. II se peut que vous deviez respecter certains delais pour conserver votre couverture sante
ou vos remboursements. Vous avez le droit d'acceder gratuitement a ces informations et a une aide dans votre langue.
Pour cela, veuillez appeler le numero des Services destines aux membres qui figure sur votre carte d'identification.
(TTY/TDD: 711)
German
Diese Mitteilung enthalt wichtige Informationen zu Ihrem Antrag oder Ihren Beihilfeleistungen. Profen Sie die Mitteilung
auf wichtige Termine. Moglicherweise mussen Sie bis zu einem bestimmten Datum Maf�nahmen ergreifen, um Ihre
Beihilfeleistungen oder KostenzuschOsse aufrechtzuerhalten. Sie haben das Recht, these Informationen and
Unterstutzung kostenlos in Ihrer Sprache zu erhalten. Rufen Sie die auf Ihrer ID-Karte angegebene Servicenummer fur
Mitglieder an, um Hilfe anzufordern. (TTY/TDD: 711)
6 ADVANTAGE 65 WITH DENTAL/VISION 05179VAMENMUB 06/16 Notice
Hindi
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(TTY/TDD: 711)
Tagalog
May mahalagang impormasyon ang abisong ito tungkol sa inyong aplikasyon o mga benepisyo. Tukuyin ang
mahahalagang petsa. Maaaring may kailangan kayong gawin sa ilang partikular na petsa upang mapanatili ang inyong
mga benepisyo o mapamahalaan ang mga gastos. May karapatan kayong makuha ang impormasyon at tulong na ito sa
ginagamit ninyong wika nang walang bayad. Tumawag sa numero ng Member Services na nasa inyong ID card para sa
tulong. (TTY/TDD: 711)
Urdu < t
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Vietnamese
Th6ng bao nay co th6ng tin quan trong ve dan dang ky hoac quyen lai bao hiem c6a quq vi. Hay tim cac ngay quan trong.
Quy vi co the can phai co hanh dgng truft nhirng ngay nhAt dinh de duy tri quyen lai bao hiem hoac quan Ij chi phi cOa
minh. Quy vi co quyen nhan mien phi th6ng tin nay va slx tra gi6p bang ng6n ngCr c6a quq vi. Hay goi cho Dich Vu Thanh
Vi6n tr6n th6 ID c6a quq vi de du°ac giup da. (TTY/TDD: 711)
Yoruba
Akiy6si yii ni iwifun pataki nips ibe6re tabi awon anfani re. Wa d66ti pataki. O le ni lati gbh igb6se ni d66ti kan pato Iati
tgju awon anfani tabi sak6so iye ow6 re. O ni 6t6 Iati gba iwifun yii ki o si s6ranw6 ni 6d6 re lofee. Pe Nomba awon ip6s6
omo-egbe I6ri kaadi idanimo re fun iranwo. (TTY/TDD: 711)
It's important we treat you fairly
That's why we follow federal civil rights laws in our health programs and activities. We don't discriminate, exclude people,
or treat them differently on the basis of race, color, national origin, sex, age or disability. For people with disabilities, we
offer free aids and services. For people whose primary language isn't English, we offer free language assistance services
through interpreters and other written languages. Interested in these services? Call the Member Services number on your
ID card for help (TTY/TDD: 711). If you think we failed to offer these services or discriminated based on race, color,
national origin, age, disability, or sex, you can file a complaint, also known as a grievance. You can file a complaint with
our Compliance Coordinator in writing to Compliance Coordinator, P.O. Box 27401, Mail Drop VA2002-N160, Richmond,
VA 23279. Or you can file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights at
200 Independence Avenue, SW; Room 509F, HHH Building; Washington, D.C. 20201 or by calling 1-800-368-1019
(TDD: 1- 800-537-7697) or online at https://ocrportal.hhs.gov/ocr/portal/lobby.isf. Complaint forms are available at
hftD://www.hhs.aov/ocr/office/file/index.html.
05179VAMENMUB 06/16 Notice ADVANTAGE 65 WITH DENTAL/VISION 7
Local ✓
CHOICE
ism
r-mqq
IF YOU NEED ASSISTANCE
ANTHEM BLUE CROSS
AND BLUE SHIELD
THE LOCAL CHOICE
MEDICARE
A10293(1/2018)
Medical and Routine Vision Care
1-800-552-2682
Monday through Friday 8:00 a.m. - 6:00 p.m
Saturday 9:00 a.m. - 1:00 p.m.
On the Web at www.anthem.com/tic
Dental Care
1-855-648-1411
Monday - Friday 8:00 a.m. - 9:00 p.m.
On the Web at www.anthem.com/tic
The Local Choice Health Benefits Program
Commonwealth of Virginia
Department of Human Resource Management
101 North 14th Street -13th Floor
Richmond, VA 23219
On the Web at www.thelocalchoice.virginia.gov
1 -800 -MEDICARE (1-800-633-4227)
On the Web at www.medicare.gov