Annuitants Age 65 and Over Only

Benefits Provider

United HealthCare – United HealthCare Medicare Advantage National PPO

Type Of Plan

The United HealthCare Medicare Advantage National PPO Plan is a Medicare C Plan which combines Medicare, gap coverage and Part D prescription benefits. It requires participants to have Medicare Parts A and B for eligibility in the plan. The Plan pays Medicare’s 80% portion of a claim and the 20% left after Medicare’s responsibilty. No network participation for providers is required. The Plan pays the same benefit both in and out of network.

The Medicare D prescription component is through Optum RX’s mail order pharmacy.

Eligibility

  • Retired clergy/laity age 65 and older with 20 or more years with annuity credit. Premium paid by conference. Those with less than 20 approved years of annuity credit pay pro rated premium based on years served. See 2014 Guidelines.
  • Must be in Conference Plan 5 years prior to retirement or have 5 years of Creditable Coverage in another Employer Group Plan.
  • Must be under appointment (no leave of absence) last 7 years immediately prior to retirement.
  • All dependents under age 65 will be in active plan.

Enrollment

Within 30 days of retirement only; if coverage at retirement is waived*, enrollment available within 30 days of loss of other coverage. *Signed waiver at time of retirement is required.

Premiums

Call for 2015 premiums. Barbara Gruezke, Conference Insurance Coordinator 732.359.1037

Pharmacy

Initial Coverage
Stage
Network Pharmacy
(30 day retail supply)
Mail Service
Pharmacy (90 day supply)
Tier 1: Generic $10 copay $20 copay
Tier 2: Preferred Brand 20% of the cost up to a $45 maximum 20% of the cost up to a $120 maximum
Tier 3: Non-Preferred Brand 20% of the cost up to a $90 maximum 25% of the cost up to a $225 maximum
Tier 4: Specialty Tier 20% of the cost up to a $90 maximum 25% of the cost up to a $225 maximum
Coverage Gap Stage After your total drug costs reach $2,960, the plan continues to pay it’s share of the cost of your drugs and you pay your share of the cost
Catastrophic Coverage Stage After your total out of pocket costs reach $4,700, you will pay $2.65 copay for generic; $6.6

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