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”

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.