City
of
2008 Retiree Medical Plan Options
|
Plan
Name |
1
Medica Elect/ Essential |
2
Medica Elect/Essential |
3
Passport from Medica (Medica
Choice with United Health Care Options PPO) |
4
Passport from Medica (Medica
Choice with United Health Care Options PPO) |
||||
|
Plan
Type |
Care
system model Clinic # required |
Care
system model Clinic # required |
Open
Access |
Open
Access |
||||
|
|
In-Network |
Out-of-Network |
In-Network |
Out-of-Network |
In-Network |
Out-of-Network |
In-Network |
Out-of-Network |
|
Calendar
Year Deductible |
$250/person $500/family |
$1000/person $2000/family |
$750/person $1500/family |
$1000/person $2000/family |
$500/person $1000/family |
$1000/person $2000/family |
$1000/person $2000/family |
$1500/person $3000/family |
|
Annual
Out-of-Pocket Max |
$1000/person $2000/family |
$2000/person $4000/family |
$1000/person $2000/family |
$2000/person $4000/family |
$1500/person $3000/family |
$2000/person $4000/family |
$1500/person $3000/family |
$2000/person $4000/family |
|
Lifetime
Maximum |
Unlimited |
$2
million |
Unlimited |
$2
million |
Unlimited |
$2
million |
Unlimited |
$2
million |
|
Preventative
Care |
100%
coverage |
100%
coverage |
100%
coverage |
100%
coverage |
||||
|
|
Member/Patient
Responsibility |
Member/Patient
Responsibility |
Member/Patient
Responsibility |
Member/Patient
Responsibility |
||||
|
Office
Visits
Illness or Injury Chiropractic
Care Mental
Health & Substance Abuse |
Deductible 10% Deductible
10% Deductible
10% |
Deductible
40% Deductible
40% Deductible
40% |
20% 20% 20% |
Deductible
40% Deductible
40% Deductible
40% |
Deductible
20% Deductible
20% Deductible
20% |
Deductible
40% Deductible
40% Deductible
40% |
Deductible
20% Deductible
20% Deductible
20% |
Deductible
40% Deductible
40% Deductible
40% |
|
Prescription
Drugs Retail
(up to a 34-day supply) |
Formulary
Only $12 copay |
Deductible
40% or $12 whichever is greater |
Formulary/
Non-Formulary: 20% $10 min - $30 max |
Deductible
40% or $30 whichever is greater |
Formulary/
Non-Formulary: 20% $10
min - $40 max |
Deductible
40% or $40 whichever is greater |
Formulary/Non-Formulary:
20% $10 min - $40 max |
Deductible
40% or $40 whichever is greater |
|
Prescription
Drugs Mail
order (up to a 93-day supply) |
Formulary
Only $24 copay |
No
coverage |
Formulary/
Non-Formulary: $40
copay |
No
coverage |
Formulary/
Non-Formulary: $50
copay |
No
coverage |
Formulary/Non-Formulary: $50
copay |
No
coverage |
|
|
All
Specialty Drugs must be filled at Walgreen’s Specialty Pharmacy |
|||||||
|
|
Deductible
10% |
Deductible
40% |
Deductible
20% |
Deductible
40% |
Deductible
20% |
Deductible
40% |
Deductible
20% |
Deductible
40% |
|
|
Deductible
10% |
Deductible
40% |
Deductible
20% |
Deductible
40% |
Deductible
20% |
Deductible
40% |
Deductible
20% |
Deductible
40% |
|
Lab
and Pathology |
Deductible
10% |
Deductible
40% |
20% |
Deductible
40% |
Deductible
20% |
Deductible
40% |
Deductible
20% |
Deductible
40% |
|
X-Ray
and Other Imaging |
Deductible
10% |
Deductible
40% |
20% |
Deductible
40% |
Deductible
20% |
Deductible
40% |
Deductible
40% |
Deductible
40% |
|
Emergency
Care
Urgent Care
Hospital ER |
Deductible
10% Deductible
10% |
In-network
deductible 20% |
20% Deductible
20% |
In-network
deductible 20% |
Deductible
20% Deductible
20% |
Covered
as in-network benefit |
Deductible
20% Deductible
20% |
Covered
as in-network benefit |
|
Monthly
Premium
Single
Family |
$394.18 $1,393.72 |
$376.81 $1,337.05 |
$421.19 $1,484.99 |
$329.86 $1,161.44 |
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|
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 Go to www.medica.com
|
|
Finding
a Network Provider Plans
3 and 4 |
Call Medica customer
service at 952-945-8000 and identify yourself as a City of Go to www.medica.com
|
Contact us by email at: mppension@mpra.net
2008 Senior Health Care Products – Medicare Eligible
Benefit Comparisons
At this time you have the opportunity to change or enroll in one of the three MPRA 2008 Senior plans. Below is a benefit comparison of the three plans offered by the MPRA. You must have Medicare Parts A & B to join one of the three 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 Friday, November 30, 2007. 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.
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