MINNEAPOLIS POLICE RELIEF ASSOCIATION  

 

2010 Medica Health Plan Design Options and Rates 

 

Medica provides medical coverage for City employees and retired members under 65.  Below is a benefit comparison of the THREE Medica plans available to you.  The single and family premium rates for 2010 are noted at the bottom of the plan comparison.  If you would like to make a change for 2010, you will need to complete a Medica application and return it to the MPRA office by Tuesday, December 1, 2009.  Forms are available by calling 612-378-1449 or 1-800-484-9729, #9356.

Please contact Medica at (952) 945-8000 or 1-800-952-3455 with questions regarding coverage and plan designs. 

City of Minneapolis

2010 Retiree Medical Plan Options

Under 65, Live Out of the Area and without Medicare Parts A & B

City of Minneapolis Medical Plan Options

 

 

 

 

Plan 1 – Medica Elect/Essential

 

Plan 2 – Medica Elect/Essential

 

Plan 4 – Medica Choice

Plan Provision

In-Network

Out-of-Network

In-Network

Out-of-Network

In-Network

Out-of-Network

Calendar Year Deductible

$250 / person

$500 / family

$1,000 / person

$2,000/  family

$750 / person

$1,500 / family

$1,000 / person

$2,000 / family

$1,000 / person

$2,000 / family

$1,500 / person

$3,000 / family

Out-of-Pocket Maximum

$1,500 / person

$3,000 / family

$3,000 / person

$6,000 / family

$1,500 / person

$3,000 / family

$3,000 / person

$6,000 / family

$2,000 / person

$4,000 / family

$3,000 / person

$6,000 / family

Lifetime Max

Unlimited

$2 million

Unlimited

$2 million

Unlimited

$2 million

Preventive Care

100% coverage; deductible does not apply

100% coverage; deductible does not apply

100% coverage; deductible does not apply

 

 

Member/Patient Responsibility

 

Member/Patient Responsibility

 

Member/Patient Responsibility

Office Visits

10% after annual deductible

40% after annual deductible

20%, deductible does not apply

40% after annual deductible

20% after annual deductible

40% after annual deductible

Hospital Services

10% after annual deductible

40% after annual deductible

20% after annual deductible

40% after annual deductible

20% after annual deductible

40% after annual deductible

Lab, Pathology, X-Ray, Other Imaging

10% after annual deductible

40% after annual deductible

20%, deductible does not apply

40% after annual deductible

20% after annual deductible

40% after annual deductible

Emergency

      Urgent Care

      Hospital ER

 

10% after annual deductible

 

20% after in-network deductible

 

20%, no deductible

20% after deductible

 

20% after in-network deductible

 

20% after annual deductible

 

Covered as in-network benefit

Prescription Drugs (retail)

$12 generic

$25 brand

(formulary only)

Deductible, then greater of 40% or $25

$10 generic

$25 brand

$50 non-formulary

Deductible, then greater of 40% or $50

$10 generic

$25 brand

$50 non-formulary

Deductible, then greater of 40% or $50

Prescription Drugs

(mail order)

$24 generic

$50 brand

(formulary only)

No coverage

$20 generic

$50 brand

$100 non-formulary

No coverage

$20 generic

$50 brand

$100 non-formulary

No coverage

Monthly Premium

     Single

     Family

 

$520.99

$1,836.98

 

$484.34

$1,716.56

 

$429.51

$1,510.11

 

 This health care plan may not cover all of your health care expenses; read your Certificate of Coverage carefully to determine which expenses are covered.  This is a benefit summary and does not outline all of your benefits.  If there is a discrepancy between information in this summary and your Certificate of Coverage, the Certificate of Coverage will take precedence in determining your benefits.

 Definitions  

Plan Type

Network and access model for each plan.  Plans 1 and 2 require you and each family member to select a primary care clinic at the point of enrollment.  Plans 3 and 4 are open access network plans in which a primary care clinic selection is not required.

 

Calendar Year Deductible

The fixed dollar amount you must pay on a calendar year basis before claims for health services or supplies are reimbursable.  When members in an enrolled family unit (an employee and his/her dependent(s) have together paid the family deductible for benefits received during the calendar year, then all members of the family unit are considered to have satisfied their deductible for that calendar year.

 

Annual Out-of-Pocket Maximum

Accumulation of copayments, coinsurance and deductibles.  When members in an enrolled  family unit (an employee and his/her dependent(s) have together satisfied the family out-of-pocket maximum for benefits received during the calendar year, then all members of the family unit are considered to have satisfied the family out-of-pocket maximum for that calendar year.

 

Lifetime Maximum

The dollar amount your plan will pay for eligible health care expenses in a member’s lifetime. Each member has a separate lifetime maximum.

 

Preventive Care

Preventive health care when there is no existing condition or complaint about your health, regardless of the reason the office visit was scheduled.  Services include: health education and supervision services provided during office visit, immunizations, early disease detection services (including physicals), routine screening procedures for cancer.

 

Prescription Drugs

Formulary:  Medica’s preferred list of drugs (includes generic and brand name), some OTC drugs and supplies that are used for dispensing some drugs.  Non-Formulary:  Any drug or supplies not on the Formulary List. 

 

Prescription unit equals up to 34-consecutive day supply (unless limited by drug manufacturer’s packaging or Medica’s appropriate use guidelines), up to 34-day supply per type of insulin or 3 cycles or oral contraceptives.

 

Mail Order Drugs:  Prescription unit equals up to a 93-day consecutive supply (unless limited by drug manufacturer’s packaging or Medica’s appropriate use guidelines).  Mail order drugs may be obtained through BioScrip or Walgreens Mail services.

 

Specialty Drugs:  All Specialty Drugs (to see list go to www.Medica.com and click on Pharmacy) must be obtained through Walgreens Specialty Pharmacy (a separate mail order program)

 

X-ray and Other Imaging

In addition to standard x-rays, other imaging includes (but not limited to) enhanced imaging such as CT, MRI and PET scans.

 

Finding a Network Provider

Plans 1 and 2

Call Medica customer service at 952-945-8000 and identify yourself as a City of Minneapolis retiree OR

Go to www.medica.com

  • Click on “Find a Doctor” (on the left hand side of the page)

  • In the section labeled “Network Selection Option”, click on the drop down arrow and select “Medica Elect” or “Medical Essential” and click on “Submit”

  • If you are looking for a national provider, click on “Travel Benefit – UnitedHealthCare Options PPO” and click on “Submit”

Finding a Network Provider

Plans 3 and 4

Call Medica customer service at 952-945-8000 and identify yourself as a City of Minneapolis retiree OR

Go to www.medica.com

  • Click on “Find a Doctor” (on the left hand side of the page)

  • In the section labeled “Network Selection Option”, click on the drop down arrow and select “Medica Choice with United Health Care Options PPO-Insurance” and click on “Submit”

 

   Contact us by email at:  mppension@mpra.net

2010 Senior Health Care Products – Medicare Eligible Benefit Comparisons  

At this time you have the opportunity to change or enroll in one of the MPRA 2010 Senior plans.  Below is a benefit comparison of the plans offered by the MPRA.  You must have Medicare Parts A & B to join one of these plans.  If you elect to change from your current coverage, please contact the MPRA office and we will send you out an enrollment form.  Enrollment forms need to be completed and submitted to the Pension Office by Tuesday, December 1, 2009.   You do not need to complete a medical change form to keep your current coverage.   If you have any questions about any other different benefit levels, or need assistance with any of the below plans, please call their Customer Service Department.  

By having coverage with the MPRA through the three plans below, the Medicare Prescription Drug Coverage (Part D) is part of your already comprehensive set of benefits. 

                                                                                         

HealthPartners Freedom Plan                952-883-5601 Local # or

                                                                 1-800-247-7015

                                                                                                                     

Medica Group Prime Solution                952-992-2330 or

                                                                 1-800-575-2330        

 

UCare for Seniors                                    612-676-6900 or

                                                                  1-877-598-6574 

     

2010 City of Minneapolis Senior Medical Plans – Benefit Comparison

HealthPartners and UCare

 

Type of Service

 

HealthPartners Freedom Plan

 

UCare for Seniors

Preventive (physicals, cancer screenings, eye exams, immunizations, etc.)

100% Coverage

100% Coverage

Office Visits (non-preventive care including mental health, substance abuse)

$10 Co-Pay

$15 Co-Pay

Inpatient Hospital

100% Coverage

100% Coverage ($25 Co-Pay for non-surgical outpatient)

Urgent Care

$10 Co-Pay

$20 Co-Pay

Emergency (In or Out-of-Network)

$50 Co-Pay

$50 Co-Pay

Emergency Ambulance

100% Coverage

100% Coverage

Prescription Drugs (Medicare Part D)

  Retail pharmacy

  Mail order

Generic / Brand Name Co-Pays

   $12 / $24 (30-day supply)

   $24 / $48 (90-day supply)

Generic / Brand Name Co-Pays

   $10 / $30 (34-day supply)

   $20 / $60 (three month supply)

Diabetic Equipment & Supplies

(under Medicare Part B)

90% Coverage

Diabetic supplies – 100% coverage

Part B drugs – 80% coverage

Mental Health Outpatient

Mental Health Inpatient

$10 Co-Pay individual session/$5 for group

100% Coverage (190 days lifetime max)

$15 Co-Pay

100% Coverage

Substance Abuse Outpatient

Substance Abuse Inpatient

$10 Co-Pay

100% Coverage

$15 Co-Pay

100% Coverage

Durable Medical Equipment

90% Coverage

80% Coverage

Chiropractic

$10 Co-Pay

100% Coverage

Preventive Dental Services

$10 Co-Pay

100% Coverage

Out of Area Travel Benefit

Non-Emergency Services

The Extended Absence Benefit provides plan level of coverage for up to 9 months while you are away from the service area.  Call Member Services to activate.

80% Coverage; no limit.

Out-of-Network Services

Medicare Benefits Only

Point of Service Benefit 80%; no limit

Out-of-Pocket Maximum

$3,000 Medical only

$3,400 Medical only

 

Prescription Drug Threshold

2010 Medicare Prescription Drug Part D threshold is $4,550; once this threshold is met you pay a $2.50 to $6.30 co-pay per prescription or 5% co-insurance, whichever is greater

2010 Medicare Prescription Drug Part D threshold is $4,550; once this threshold is met you pay a $2.50 to $6.30 co-pay per prescription or 5% co-insurance, whichever is greater

2010 Monthly Rates: Single/Couple

$262.35 / $524.70

$233.25 / $466.50

Telephone Numbers

952-883-5601 or 1-800-247-7015

612-676-6900 (1-877-598-6574 toll-free)

 

 

 

 RESIDENCY REQUIREMENTS:

·         HealthPartners Freedom Plan:  Must live in HealthPartners Freedom Plan service area which includes the state of Minnesota and western Wisconsin.

·         UCare:  Coverage in all 87 Minnesota counties and 26 counties in western Wisconsin. 

This comparison provides a brief summary of benefits of the senior health care plan offered by the City of Minneapolis.  Not all covered services, exclusions and limitations are shown.  If there are any inconsistencies between the summaries shown above and the Certificates of Coverage, the Certificates of Coverage shall prevail.

  

2010 City of Minneapolis Medica Senior Health Care Plans – Benefit Comparison Medica Group options

 

Medica Option 1

Medica Option 2

Medica Option 3

 

 

Type of Service

Medica Group Prime Solution & Medica Group Advantage Solution with Part D

Medica Group Prime Solution & Medica Group Advantage Solution without Part D   (may result in future penalty)

Medica Group Prime Solution & Medica Group Advantage Solution modified standard Part D Rx (subject to Medicare limits)

Preventive (physicals, cancer screenings, eye exams, immunizations, etc.)

100% Coverage

100% Coverage

100% Coverage

Office Visits (non-preventive care including mental health, substance abuse)

$15 Co-Pay

100% Coverage

100% Coverage

Inpatient Hospital

100% Coverage

100% Coverage

100% Coverage

Urgent Care

$15 Co-Pay in network

$50 Co-Pay out-of-network

100% Coverage

100% Coverage

Emergency (In or Out-of-Network)

$50 Co-Pay (waived if admitted within 24 hrs)

100% Coverage

100% Coverage

Emergency Ambulance

100% Coverage

100% Coverage

100% Coverage

Prescription Drugs (Medicare Part D)

  Retail pharmacy

  Mail order

Generic / Brand Name Co-Pays

   $15 / $30 (31-day supply)

   $30 / $60 (93-day supply)

 

No Coverage

Generic / Preferred Brand / Non-Preferred Brand

   $10 / $34 / $74 (31-day supply)

   $20 / $68 / $148 (90-day supply)

Specialty drug: 25% Coinsurance

Diabetic Equipment & Supplies

(under Medicare Part B)

100% Coverage

100% Coverage

100% Coverage

Durable Medical & Prosthetics

90% Coverage

100% Coverage

100% Coverage

Chiropractic

$15 Co-Pay

100% Coverage

100% Coverage

Preventive Dental Services

No Coverage

No Coverage

No Coverage

Out of Area Travel Benefit

Non-Emergency Services

Prime Solution: Medicare benefits only unless Extended Absence Option (EAO) is activated; with EAO, members can take their coverage with them anywhere in the United States.              Advantage Solution: Can obtain services anywhere in the United States

Prime Solution: Medicare benefits only unless Extended Absence Option (EAO) is activated; with EAO, members can take their coverage with them anywhere in the United States.              Advantage Solution: Can obtain services anywhere in the United States

Prime Solution: Medicare benefits only unless Extended Absence Option (EAO) is activated; with EAO, members can take their coverage with them anywhere in the United States.              Advantage Solution: Can obtain services anywhere in the United States

Out-of-Network Services

Prime Solution: Medicare benefits only unless Extended Absence Option is activated.  Advantage Solution: Members can see any Medicare provider who is willing to accept Medica’s terms and conditions for payment at their Medicare rate.

Prime Solution: Medicare benefits only unless Extended Absence Option is activated. Advantage Solution: Members can see any Medicare provider who is willing to accept Medica’s terms and conditions for payment at their Medicare rate.

Prime Solution: Medicare benefits only unless Extended Absence Option is activated.            Advantage Solution: Members can see any Medicare provider who is willing to accept Medica’s terms and conditions for payment at their Medicare rate.

Out-of-Pocket Maximum

$3,000 includes medical copays & prescriptions

$3,000 includes all medical copays

$3,000 includes all medical copays

Prescription Drug Threshold

N/A. Rx copayments accumulate toward the $3000 Out-of-Pocket Maximum.

N/A

Level 1: See above for annual prescription drug costs up to $2,850.

Level 2: After you and Medica have purchased a combined $2,700 in prescription drugs, you pay 100% of drug costs.

Level 3: After your out-of-pocket drug payments equal $4,350, you pay the greater of $2.40 copay for generics and $6.00 for other drugs or 5% coinsurance.

2010 Monthly Rates: Single/Couple

$240.25 / $480.50

$108.25 /  $216.50

$137.25 / $274.50

Telephone Numbers

                                                                        Customer Service Number 952-992-2330  or 1-800-575-2330

RESIDENCY REQUIREMENTS:

·          Medica Group Prime Solutions:  Must live in Medica’s Prime Solution service areas in Minnesota, Wisconsin, North Dakota and South Dakota.

·          Medica Group Advantage Solution:  Must live within the United States.

This comparison provides a brief summary of benefits of the senior health care plan offered by the City of Minneapolis.  Not all covered services, exclusions and limitations are shown.  If there are any inconsistencies between the summaries shown above and the Certificates of Coverage, the Certificates of Coverage shall prevail.

 

Contact us by email at:  mppension@aol.com