If you are currently Medicare-eligible

• General Info
  
• Eligibility
  
• Cost
  
• Covered Benefits
  
• Medicare Part D
  
• Enrolling in the Plan
  
• Frequently Asked Questions
  
• When Coverage Ends
  
• Trinity Health – Group Retiree Health Insurance Plan Brochure / Summary Plan Description
  
• Contact Us

General Info

What is the Trinity Health – Group Retiree Health Insurance Plan?
If you’re a Medicare-eligible Trinity Health retiree, you may be eligible to enroll in the Trinity Health – Group Retiree Health Insurance Plan. This plan offers you (and your spouse, if you are married) a high-quality, competitively priced insurance plan that supplements your Medicare coverage. The Trinity Health – Group Retiree Health Insurance Plan is designed to bridge the gap between your actual health care costs and the amount Medicare pays. The Plan — which is underwritten by Bankers Life and Casualty Company, an organization that has specialized in the senior health insurance market for more than 125 years — offers very competitive group rates on a plan designed especially for Trinity Health retirees.

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Eligibility

Who is eligible to enroll in the Trinity Health – Group Retiree Health Insurance Plan?
Individuals who are eligible for coverage include those who are:

• Eligible for Medicare by reason of age or disability;
• Covered under Medicare Parts A and B;
• Not eligible for Medicaid;
• Not covered under a Medicare supplement policy or certificate;
• Not covered by an employer’s health plan that is primary to Medicare due to employment of such person or his or her spouse; and
• A retiree of Trinity Health, or the spouse to whom the retiree is married at the time he or she leaves the organization.

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Cost

How much does the Trinity Health – Group Retiree Health Insurance Plan cost?
For current monthly premium rates, call the Bankers Life / Trinity Health toll-free help line at 866.222.3102, ext. 105.

An important feature of the Trinity Health Plan is that your out-of-pocket medical costs are lowest when you choose a Trinity Health facility for your care. For example, if you are hospitalized at a Trinity Health facility, the Plan covers your Medicare Part A inpatient deductible, which currently is $1,068 per admission.

Once the hospital receives payment from Medicare they will bill Bankers Life for the balance not covered by Medicare. This will include the Part A deductible of $1,068 for 2009. Bankers Life will process the benefit payment and sends a check to our hospital with a "remittance advice". The remittance advice sent by Bankers Life will specify that the Part A deductible is a non-covered service. The patient accounting department will adjust their records so the retiree does not receive a bill from our hospital for the Part A deductible.

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Covered Benefits

What services are covered under the Trinity Health – Group Retiree Health Insurance Plan?
The key benefits provided under the Plan are summarized below.

¹A benefit period begins the first day you receive Medicare-covered services in a hospital or skilled nursing facility, and it ends when you have been out of a hospital or skilled nursing facility for 60 consecutive days. If you enter a hospital again after the 60 days, a new benefit period begins. The date it ends is determined by Medicare.
²Coverage is provided to the extent not covered by Medicare for Medicare-eligible expenses for medically necessary emergency hospital, physician and medical care received in a foreign country, which care would have been covered by Medicare if provided in the United States, and which care began during the first 60 consecutive days of each trip outside the United States. For purposes of this benefit, “emergency care” means care needed immediately because of an injury or sickness of sudden and unexpected onset.

Other Benefits:

Coverage for any federal Food and Drug Administration-approved drug for use in antineoplastic therapy, subject to conditions outlined in the Plan documents.

Coverage for participation in a program to prevent the onset of clinical diabetes, including certain equipment, supplies and educational training for the treatment of diabetes, if determined to be medically necessary and prescribed by an allopathic or osteopathic physician. Certain exclusions and limitations as described in the Plan documents apply.

Coverage for up to $1,500 in benefits for intermediate and outpatient care for substance abuse per individual per year.

Exclusions:
The Plan does not cover or consider for payment any service or supply, or any portion hereof, that is not a Medicare-eligible expense, nor will the Plan duplicate any benefit paid by Medicare or any other group or insurance program. The Plan does not cover payments for Medicare Part A deductible for days 1-60 in a hospital for each benefit period. However, if you are hospitalized at a Trinity Health facility, Trinity Health will pay your $1,068 Part A deductible.

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Medicare Part D

Does the Trinity Health – Group Retiree Health Insurance Plan offer Part D coverage?
As of January 1, 2006, Medicare beneficiaries are eligible to enroll in the voluntary Medicare Part D-approved prescription drug benefit. As part of the Trinity Health – Group Retiree Health Insurance Plan, you may elect prescription drug coverage through AdvantraRx, a Medicare Part D plan offered through Bankers Life.

Here’s how AdvantraRx Medicare prescription drug coverage works:

• You pay a monthly premium for coverage. The amount of your premium depends on the level of coverage you select: AdvantraRx Value, AdvantraRx Premier, or AdvantraRx Premier Plus. (For current premium rates, call the Bankers Life / Trinity Health toll-free help line at 866.222.3102, ext. 105.)
• You pay no prescription drug annual deductible, regardless of whether you choose AdvantraRx Value, AdvantraRx Premier, or AdvantraRx Premier Plus coverage. You’ll pay only a set co-payment amount at the pharmacy, depending on the level of coverage you choose.
• All levels of AdvantraRx coverage pay for both brand-name and generic drugs. However, the formulary list (which is the list of approved drugs) for each level differs. You will want to carefully review the information in the AdvantraRx Value, AdvantraRx Premier, and AdvantraRx Premier Plus formulary lists before deciding which level of coverage is right for you.

It’s important to understand that, generally, if you enroll in a Medicare Part D plan after May 15, 2006 you’ll pay a late enrollment penalty of 1 percent per month if you go 63 days or more without creditable coverage. However, if you have creditable coverage through an employer’s health plan you may stay in that plan instead of enrolling in Medicare Part D, and still avoid late enrollment penalties if you later decide to switch to Part D. If you don’t have access to creditable coverage, you’ll need to enroll in Medicare Part D before the deadline to avoid the late enrollment penalties.
For more information or to apply for AdvantraRx prescription drug coverage, call the Bankers Life / Trinity Health toll-free help line at 866.222.3102, ext. 105.

Please note: If you have limited income and resources, you may qualify for extra help paying for Medicare prescription drug premiums, deductible and cost shares. For more information on who can get extra help with prescription drug costs and how to apply, call the Social Security Administration at 800.772.1213 or visit the Social Security website. (TTY users should call 800.325.0778.)

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Enrolling in the Trinity Health – Group Retiree Health Insurance Plan

How can I enroll in the Plan?
To enroll, call the Bankers Life / Trinity Health toll-free help line at 866.222.3102, ext. 105. After the enrollment process is complete, you’ll receive a Bankers Life ID card in the mail. Be sure to notify your doctor and other providers about your coverage under the Trinity Health – Group Retiree Health Insurance Plan.

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When Your Trinity Health – Group Retiree Health Insurance Plan Coverage Ends

When will my coverage end?
Coverage will end for you and / or your spouse in the event that Trinity Health terminates the Plan, or if you fail to pay the required premiums.

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Frequently Asked Questions

What is the advantage of choosing the Trinity Health – Group Retiree Health Insurance Plan?
In addition to the fact that the Trinity Health – Group Retiree Health Insurance Plan is offered to you at a discount rate, it’s important to consider that the Plan was designed specifically with your needs in mind. For example, if you need to be admitted to the hospital and you choose a Trinity Health facility, you won't be responsible for paying the $1,068 Medicare Part A deductible that would normally apply.

If I currently have a Medigap policy, what should I do before deciding to enroll in the Trinity Health – Group Retiree Health Insurance Plan?
Before switching, you’ll want to compare both the benefits and premiums of your current policy to those of the Trinity Health Plan. If you decide to switch, don’t cancel your current Medigap policy until after your Trinity Health policy goes into effect.

How can I compare the benefits of my current Medigap policy with the Trinity Health – Group Retiree Health Insurance Plan?
Currently, there are ten standardized Medigap plans titled “A” through “J.” Each of these plans has a different set of standard benefits so you can compare them easily. These policies, which are sold to individuals by various private insurance companies, must follow federal and state laws. The first page of a Medigap policy must clearly identify it as “Medicare Supplement Insurance.”
Insurance companies can only sell standardized Medigap policies to individuals. The Trinity Health Plan is a group plan. The benefits provided under this group Plan most closely follow the benefits provided under a standard Plan F Medigap policy (see attached benefit summary). The major difference between the Trinity Health Plan and Plan F is that Bankers Life does not cover the Medicare Part A deductible, which is $1,068 for 2009. Instead, the Part A deductible is paid directly by Trinity Health provided you are hospitalized at a Trinity Health facility. If you are not hospitalized at a Trinity Health facility, you will be responsible for paying the Part A deductible. Therefore, in most cases, the Trinity Health – Group Retiree Health Insurance Plan is best suited for retirees who live near a Trinity Health facility.

How can I compare the premiums for the Trinity Health – Group Retiree Health Insurance Plan to my current Medigap policy?
While the benefits provided for Medigap policies are standardized, there can be big differences in the premiums that insurance companies charge for exactly the same coverage. Since each insurance company sets the price of their policy premiums, the way they set the price affects how much you pay. Generally, insurance companies use one of the following methods to develop their premium rates:

• Monthly premiums are the same for everyone with the same Medigap policy, regardless of the individual’s age. Premiums for these policies may increase each year based on inflation.
• Monthly premiums are based on your age at the time you buy your Medigap policy. Insurance companies call these “issue-age-rated” polices. Premiums may increase each year based on inflation, but not based on your age.
• Monthly premiums are based on your current age, so your cost goes up each year. Insurance companies call these “attained-age-rated” polices. Premiums may also go up because of inflation. The Trinity Health – Group Retiree Health Insurance Plan uses this method for setting its premium rates. This is important to know when comparing premium rates, especially if your current carrier uses one of the other two rate-setting methods.

If I enroll in the Trinity Health – Group Retiree Health Insurance Plan, can I decide at a later date to drop my coverage and enroll in another plan?
Yes, you can drop the Trinity Health – Group Retiree Health Insurance Plan at any time. However, you will want to make sure to avoid any gaps in your coverage by making sure your coverage with the new carrier is in effect before discontinuing the Trinity Health Plan. Also, keep in mind that the other carrier may require you to provide evidence of insurability before accepting you into their plan.

What if I have a Medicare SELECT policy?
Medicare SELECT is a type of Medigap policy that is sold in some states. When you buy a Medicare SELECT policy, you are buying one of the ten standardized Medigap Plans A through J. However, with a Medicare SELECT policy, you must also use specific hospitals and, in some cases, specific doctors to get full benefits (except in an emergency). For this reason, Medicare SELECT policies generally cost less than other Medigap policies. Therefore, if you are currently enrolled in a Medicare SELECT policy you will want to carefully compare premiums for the Trinity Health – Group Retiree Health Insurance Plan with those of your Medicare SELECT policy before switching.

Can I keep seeing the same doctor if I enroll in the Trinity Health Plan?
Yes, you can see any doctor you wish. If you are enrolled in Medicare and choose the Trinity Health – Group Retiree Health Insurance Plan, you are free to go to any doctor, hospital or health care provider.

I’ve paid monthly premiums to my current carrier through the end of the year. Can I receive a refund from my carrier if I enroll in the Trinity Health – Group Retiree Health Insurance Plan before year-end?
You will need to discuss this with your current carrier.

If I have already satisfied (or partially satisfied) my Medicare Part A or Part B deductible for the year, will I have to re-satisfy them if I switch to the Trinity Health Plan?
No. The Trinity Health – Group Retiree Health Insurance Plan will take into account any amounts you’ve already paid toward your 2009 Medicare deductibles in determining how your benefits are paid.

Can Trinity Health or Bankers Life cancel my coverage if I become ill or for other reasons?
Your coverage can be cancelled only if the Plan as a whole is no longer sponsored by Trinity Health, and / or you fail to make your premium payments on a timely basis.

I spend my winters in Florida. If I have coverage under the Trinity Health – Group Retiree Health Insurance Plan, will I be responsible for additional costs if I’m hospitalized in a non-Trinity Health facility while I’m away?
If you are hospitalized at a non-Trinity Health hospital, you are responsible for paying the $1,068 Medicare Part A deductible and other expenses not covered by the Plan.

What are some of the benefits not covered by the Trinity Health – Group Retiree Health Insurance Plan?
You must read your insurance certificate carefully for all exclusions and limitations. The Trinity Health Plan does not cover:

• Long-term care,
• Vision or dental care,
• Hearing aids,
• Private-duty nursing, or
• Outpatient prescription drugs

Trinity Health – Group Retiree Health Insurance Plan Brochure / Summary Plan Description

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Contact Us

• For information on Plan participation or current monthly premium rates, contact the Bankers Life / Trinity Health toll free help line at 866.222.3102, ext. 105.
• For more information on benefits that are covered by the Plan, call Bankers Life at 800.859.5304.

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