Rebecca Olson, Sonatina Fernandes, and Anne Thurston from University Benefits answer questions from UI retirees, a follow up to the November 18 Zoom meeting on retiree benefits. Also see the list of common types of insulin provided after the meeting.
How long do we have to keep those equivalent letters you send to us each year? Forever or just the recent year?
If you are referring to the annual “Letter of Creditable Coverage” for drug coverage, you will need to keep all the letters you’ve received, not just the most recent.
Roughly, what are the numbers/percents of retirees who participate in each of the four health plan options (UI Choice, UI Select, Health Alliance HMO, Health Alliance PPO)?
As of August 1, 2022:
- UI Choice Medicare Carveout = 1,925
- UI Select Medicare Carveout = 45
- Health Alliance Medicare Advantage (PPO and HMO plans combined) = 820
What are "PPO," "HMO," and "carveout?"
- PPO = Preferred Provider Organization. Health Alliance Medicare Advantage Plans offer a PPO option. Refer to Health Alliance for more details.
- HMO = Health Maintenance Organization. Health Alliance Medicare Advantage Plans offer an HMO option. Refer to Health Alliance for more details.
- Carveout = Retirees on Medicare and who are on one of the University of Iowa retiree health plans are placed in a carveout plan. This provision of Wellmark group coverage allows coordination of health care coverage among Medicare (which pays primary) and the university retiree health plan (which pays secondary).
Do you know the total number of UI retirees (e.g. denominator for your stats)? That is, the total number of retirees (like are there currently around 10,000 UI retirees)?
We only track the number of UI retirees who decide to keep the UI retiree health plans.
How much would the increase be in dental, and over how much?
The 2022 monthly dental premium is $45 (single). The 2023 monthly dental premium will be $46.50 (single).
What does carveout mean? Why is it necessary? Why does carveout make a higher cost when Medicare pays part?
Retirees who are on Medicare and one of the University of Iowa retiree health plans are placed in a carveout plan. This provision of Wellmark group coverage allows coordination of health care coverage among Medicare (which pays primary) and the university retiree health plan (which pays secondary).
Medicare pays primary for Medicare-approved covered services. Medicare coverage does not include prescription drugs or other services unique to the University of Iowa retiree health plans. The UI carveout plans pay for those claims.
What is the biggest change in UI Choice?
Changes for 2023 include plan provision changes (copays, deductibles, and out-of-pocket maximums) and premium increases for health and dental.
Why is UI Choice often referred to as the Cadillac of health insurance coverage for retiree coverage?
The UI Choice health plan is a very robust plan.
Why didn't we stay in the group we were in?
When individuals retire from the University of Iowa and become Medicare eligible, they are moved to the carveout plan, as Wellmark must administer the plan differently for retirees on Medicare.
So, are you saying that because our group (retirees) uses more services under the UI policies (are more costly) that we are separated from the active employees and our premiums are higher because of our experience rating for a smaller group? I think the previous question was aimed at getting a rationale for removing us from the policy group defined by employment status.
When individuals retire from the University of Iowa and become Medicare eligible, they are moved to a Carveout plan, as Wellmark must administer the plan differently for retirees on Medicare.
Since the retiree plans are self-funded, the premiums collected from retirees must cover the cost of their retiree plan’s medical and drug claims, as well as administration of the plan.
The benefits are truly very good. Another way to impact cost is to increase the number of persons insured on the plan. That's hard to do with the current premium level. We appreciate the $288 participation, but increasing that would also allow for pulling back on pass-through premium cost increases. Not trying to be argumentative.
Your feedback will be shared with executive leadership.
Can you speak to the "why" Wellmark requires that retiree plans need to be administered differently?
The retirees on the UI carveout plans are set up in the Wellmark system as a retiree plan because they must be administered differently than an employee plan, such as: (1) Retiree claims need to be sent to Medicare first before the UI plan pays, (2) UI plans pay secondary to Medicare, (3) Wellmark Customer Service needs to be able to identify retirees separately from employees, so they can explain to retirees how their coverage works, (4) the employee plan system set-up at Wellmark includes requirements concerning not having other coverage, (5) the employee plan pays primary.
How much influence, if any, does the UI have in negotiations with Wellmark on benefits and costs of the retiree plans?
The University of Iowa meets annually with Wellmark to review and discuss plan coverages, costs, and administrative fees.
What is the international travel coverage under UI Choice?
UI Choice is a plan that provides global coverage. When you’re out of the state of Iowa, you will be out of network, so insurance will bill you at Level 3. If it a life-threatening emergency handled in an ER, it is billed at Level 1—as if you were here at UIHC. You will have to pay for costs up front as most providers abroad will not file claims for you. Then once you are home, you can file the claim yourself.
See the international claim form so you know ahead of time what information is required.
Also see the summary of benefits for UI Choice and the coverage manual on our website:
https://hr.uiowa.edu/sites/hr.uiowa.edu/files/2019-05/BCBSGlobalCoreClaimForm.pdf.
If you move to a neighboring state, can you stay with Health Alliance PPO?
The Health Alliance PPO plan offers out of network benefits, so you could move and stay on the plan. As long as you receive care from providers that accept Medicare, out-of-network benefits would apply. However, if a member is moving outside of Iowa or Illinois, we would encourage them to look at other coverage options that would offer in-network benefits in that state.
My wife is on the PPO plan and has an expensive tier 3 drug with a 50% coinsurance. Is this drug covered by the $1,100 out-of-pocket maximum?
Yes, all drugs on the formulary are subject to the $1,100 out of pocket maximum.
On the UI Choice and UI Select Plans, I thought UI was self-insured. Does that hold true for the retiree plans as well?
Yes, both retiree health plans (UI Choice and UI Select carveout plans) are self-insured.
Who determines what is an “emergency?" Is it the patient (or person accompanying the patient) or is this determined by Assist America?
Assist America would provide service any time you are seeking medical care when you are more than 100 miles away from home. If you are traveling and in need of medical care that cannot wait until you arrive home, that would always be considered urgent or emergent care.
Under what circumstances should you call Assist America prior to receiving care versus seeking care and then notify Assist America?
You are never required to make contact with Assist America. It is there if you feel you need it. You can reach out to Assist America at any point.
Is there a health care confidentiality agreement between Health Alliance and Assist America that protects the patient’s rights about any proposed or received health care during this episode? For example, would medical records for a patient who required to be transferred to another health care facility be directly sent to the second facility or would the paperwork be physically handled by Assist America as the intermediary?
The easiest answer to this question is that Assist America does not handle any medical records. Those would be transferred from facility to facility.
Is the toll-free number in operation 24 hours a day, 7 days per week?
Yes, and there is also an Assist America app you can download to your phone to access care 24/7 when traveling. We have included an Assist America flier with instructions.
At what point, if any, does Health Alliance become involved in this process?
If a member is inside the U.S., the facility would sends claims to Health Alliance. If a member is traveling outside the U.S., it’s the member’s responsibility to get their billing and receipts to Health Alliance to process.
We have included a hypothetical scenario from Assist America that we think would be helpful: A member is traveling from Iowa to Thailand for vacation. Unfortunately, the member is ill and has no idea where to go to see a doctor. Thankfully, the member downloaded the Assist America mobile app and taps the “Tap for Help” function. This gets the member connected to the 24-hour Operations Center in the United States.
The member speaks to our staff and we ask for signs and symptoms and other issues. Assist America then credentials facilities in the area that can see the member. We find two or three local hospitals that have English-speaking doctors and give the member the price to visit. For example, we will tell the member they can visit Bangkok Hospital and the emergency room fee is $25 USD. This is our medical referral service. We do not pay any fees for the member to visit the hospital. The member will pay and claim with their insurance company.
We are a service that ensures members get the care they need when traveling. If we provide a medical referral, we do not handle the paperwork. We also do not handle any claim financials and we do not bill members for anything. When it comes to medical evacuation and medical repatriation or a variety of services that we offer, we arrange and pay for those services. The member will never receive a bill.
How do you get the wellness reward. Are there forms to fill out?
Health Alliance tracks this when claims come in, and we mail out the reward in the form of a gift card.
What advantage is there to stay on either UI Choice or UI Select under the circumstances of escalating cost structure?
Each individual has a different set of health care needs and financial resources available to pay for their health care coverage. Each individual must decide if there’s an advantage to staying on either UI Choice or UI Select.
What effect has non-vaccinated persons getting COVID have on UI Choice and UI Select?
University Benefits does not track vaccination status for any University of Iowa health plan. Our observations are: There have been vaccinated members who have been hospitalized with COVID and other members who are not vaccinated who have not been infected with the COVID virus.
How do we decide if it is more cost effective to stay with UI Choice for drug coverage or explore another plan?
To decide between UI Choice and Health Alliance, I would encourage members to look up their drugs on the Health Alliance formulary.
They can determine what tier those prescriptions would be on, and their pharmacist can advise what the retail cost would be so they can determine cost share. Also, keep in mind the $1,100 out-of-pocket maximum on the PPO plan and the “donut hole” of the HMO plan.
You may email benefits@uiowa.edu if you wish to cancel your insurance for 2023.
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