NonMedicare Retirees

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October 20 - November 10, 2008
Non-Medicare Retirees
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What Should I Have Received in the Mail?

• Packet including
• Annual Open Enrollment Booklet (2009)
• Open Enrollment Change Form
• Medical Plans Comparison Chart
• Self-addressed envelope

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Presentation Topics

• Whats New for 2009
• 2009 Medical Plans Overview
• 2009 Prescription Drugs Overview
• Choosing a Medical Plan
• 2009 Dental Care Plan Overview
• How to Get the Most from Your Benefits
• Open Enrollment Information
• Questions

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Whats New for 2009?

• Plans eliminated UHC High Deductible Health
  Plan, and CIGNA Premier PPO
• Plan design changes (e.g., copays and coinsurance
  as described under each plan)
• Prescription drug coverage for CIGNA members
  change to Catalyst Rx
• Waiver of prescription drug coverage no longer an
  option
• New Dental Care Plan replaces Dental Expense Plan
• Class I eligibility rules modified (OE Booklet,
  pg. 36-38)
• New Class IIs no longer eligible

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2009 Medical Plans Overview
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Medical Plan Options for 2009
CIGNA In-Network Plan
UnitedHealthcare Premier PPO Plan
Lovelace Health System ABQ Health
Partners UNMH Independent Providers
Presbyterian Hospital/Doctors UNMH Independent
Providers
For details, review your 2009 OE Booklet and
Medical Plan Comparison Chart
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Summarized Comparison
Does not include prescription drug coverage.
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UHC Premier PPO Plan Changes
Subject to deductible
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CIGNA In-Network Plan Changes
Combined maximum of 60 visits per calendar year
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What is Applied to Deductibles and Out-of-Pocket
Maximums

• CIGNA In-Network Plan
• Copays (e.g., 20/PCP visit, 30/specialist
  visit) DO apply to the out-of-pocket maximum
  (except for Rx drug copays)
• UHC Premier PPO Plan
• Copays for PCP or specialist office visits
  (including Rx copays/coinsurance) are NOT applied
  to out-of-pocket maximum or to the deductible
• Deductibles and coinsurance amounts ( e.g., 15,
  20, 30) DO apply to out-of-pocket maximums
  (with some exceptions)
• Deductibles and out-of-pocket maximums are NOT
  cross applied between in-network and
  out-of-network benefits

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Emergencies, Urgent Care, Follow-up Care

• Call 911 if you require immediate medical or
  surgical care or go to the nearest hospital!
• If admitted, call member services within 48 hours
  or as soon as reasonably possible.
• Emergencies are covered at the in-network benefit
  level worldwide under all plans as determined by
  the claims administrator.
• UHC Premier PPO Plan
• Urgent care and follow-up care benefit level
  (within USA) is according to the provider of
  service (in-network versus out-of-network
  provider)
• Urgent care and follow-up care (outside USA) will
  be covered at the out-of-network benefit level
• CIGNA In-Network Plan
• Urgent care is covered worldwide
• Follow-up care (within USA) is covered only if
  received from an in-network providers
• Follow up care (outside USA) is NOT covered

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Eligibility Changes

• Refer to IRS Code Section 152 or Publication 502,
  or consult your tax advisor for qualifying child
  or qualifying relative for health care coverage.
• Financially dependent on you has been
  eliminated and changed to unmarried child under
  age 24
• Although dependent may be eligible for our plans,
  you are required to report to Sandia any
  dependents who do not meet the tax requirements
  as we will need to impute income on the premiums
• Imputed income means that the full premium rate
  for your dependent shall be reported as taxable
• Stepchildren of the primary covered member who
  lives with the primary covered member at least
  50 of the calendar year, or if ages 19 through
  23, is a full-time student.

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Ineligible Dependents

• You must disenroll ineligible dependents within
  31 calendar day of the event causing
  ineligibility
• Consequence of failing to disenroll ineligible
  dependents
• Ineligible dependents coverage retroactively
  terminated
• You will be held liable to refund to Sandia the
  health care plan claims or monthly premiums
• Your dependent could lose any rights to temporary
  continued health care coverage (COBRA)
• Sandia shall not be required to refund any
  premiums to the subscriber

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2009 Prescription Drug Overview
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Summarized Rx Changes
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Specialty Drug Program New!

• Specialty drug coverage through Walgreens/MedMark
• Limited to 30 day supply at the preferred brand
  drug rate (30 with a 25 minimum and 40
  maximum)
• Drugs delivered via mail order through
  Walgreens/MedMark
• Specialty Care Team
• Making contact by December 15
• Available Monday to Friday (6 a.m. to 5 p.m MST)
  at 866-823-2712
• Specialty Drugs
• Treatment for cancer, multiple sclerosis, HIV,
  hemophilia, etc.
• Tend to be very expensive and require special
  monitoring

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Catalyst Rx Coverage New Members

• Catalyst has different preferred drug list so the
  status of your drug may change (e.g., from
  preferred to non-preferred)
• Mail Service is provided by Walgreens Mail
  Service
• Most prescriptions with open refills will be
  transferred to Catalyst/Walgreens
• Certain prescriptions such as controlled
  substances cannot be transferred and will require
  a new prescription from your provider
• Register with Walgreens Mail Service first before
  ordering refills through mail order

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Catalyst Rx Coverage New Members

• Welcome Kit mailed in mid-December
• Letter with general info
• ID cards (1/single 2/family)
• Preferred brand name listing (condensed version)
• Pharmacies (major) listing (include Lovelace
  pharmacies)
• Registration and prescription form
• Present your new Catalyst ID card when getting a
  new prescription beginning January 1, 2009
• Pharmacy Help Desk 1-866-854-8851 (available
  24/7)
• Website www.catalystrx.com Username SNL
  Password SNL
• Sandia external website at www.sandia.gov,
  Resources for, Employees and Retirees, Retiree
  Open Enrollment
• Catalyst reps will be available in the lobby

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Choosing a Medical Plan
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Open Enrollment Coverage Options
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What to Consider When Choosing a Medical Plan

• Provider Networks (e.g., doctors, hospitals)
• Benefits coverage
• In-network and out-of-network coverage
• Copays vs. coinsurance payment for services
• Coverage while on travel
• Dependent coverage
• Premiums, if applicable

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How do I know which medical plan is best for me?

• Want to choose the plan that gives you the most
  bang for your buck? Use the Medical Plan
  Estimator Tool!
• Estimates your costs for both premiums and
  out-of-pocket expenses (deductibles, copays)
• Located on Sandia external website
  www.sandia.gov under Resources for
• Employees and Retirees
• Retiree Open Enrollment

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Medical Plan Estimator Tool
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Medical Plan Estimator Calculation
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Dental Care Plan Overview
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2009 Dental Care Plan Overview

• Delta Dental remains the Administrator
• Dental Care Plan (one plan)
• Coinsurance coverage based on a percentage of the
  maximum approved fee
• 100 preventive care
• 80 basic and restorative
• 50 major and orthodontic
• Deductible Maximum 50 individual/150 family
• Annual Maximum 1500 per person
• Lifetime Maximum 1800 orthodontia
• Premium-sharing if retirement after 12/31/2008
• 8.00 for retiree only
• 15.00 for retiree 1
• 20.00 for retiree 2

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2009 Dental Overview

• The Dental Care Plan includes coverage
  enhancements
• Sealants covered for all dependent children under
  age 14
• Benefits for specified (Endosteal) implant
  services
• You can see any dentist in the Delta Dental PPO
  or the Delta Dental Premier or an out-of network
  dentist.
• Your out-of-pocket costs will be lower if you see
  a Delta Dental PPO network dentist because those
  dentists have agreed to a lower maximum approved
  fee thus making your percentage portion lower.
• If you see an out-of-network dentist, those
  dentists can balance bill you for any amount
  above the maximum approved fee for the Delta
  Dental Premier network.
• Maximum approved fee is contracted fee between
  Delta Dental and the network providers.

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How to Get the Most from your Benefits
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Maximizing Your Benefits

• Preventive Care covered 100 by your plan
• Annual Physical including CBC, urinalysis,
  metabolic profile, diabetes screening, thyroid
  screening
• Pap Test, PSA Test, Mammography, Colonoscopy,
  Bone Density Testing at certain intervals
• Immunizations, including flu shots
• Prescription Drugs
• Use Generics much lower copays and costs for
  therapeutically equivalent medicines
• Mail Order for maintenance medications can save
  up to the cost of one 30 day prescription at
  retail and convenient delivery
• Stay in the network!
• Get any necessary pre-authorizations from the
  claims administrator) ahead of time

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UnitedHealthcare Pre-certification Requirements

• UHC Plans must call prior to certain services
• Congenital heart disease services
• Dental services stemming from an
  accident/injury/sickness
• Durable medical equipment (DME) with a
  purchase/cumulative rental value of 1,000 or
  more (includes oxygen)
• Home health care
• Hospice care
• Hospital inpatient stays
• Reconstructive procedures
• Air ambulance services
• Skilled nursing facility/inpatient rehab
• Transplant services
• Certain behavioral health benefits
• Failure to pre-notify will result in reduction of
  benefits by 300.

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CIGNA Pre-certification Requirements

• CIGNA In-Network Plan
• Ask your provider to handle this for in-network
  care
• Services that need pre-certification include
• Hospital stay
• Surgical procedures (inpatient or outpatient)
• Acupuncture
• Biofeedback
• Dental service stemming from an accident or
  illness
• Durable medical equipment (DME) including oxygen
• External prosthetic appliances
• Home health care
• Hospice care
• MRI, CT and PET scans
• Varicose veins treatment, etc.
• Failure to pre-certify will result in reduction
  of benefits by 300.

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Continuation of Coverage for Surviving Spouse

• Medical Coverage
• Coverage for surviving spouse and enrolled
  dependents is provided for six months, after
  retirees death, at the same premium-share rate
  that retiree paid
• To continue coverage after six months, surviving
  spouse/dependents must elect continuation of
  coverage prior to the end of this six-months
  period
• Continued coverage (7th month and beyond) cost is
  50 of the full medical premium for the
  applicable medical plan (see pg 34 of OE
  booklet).
• Continued coverage is available until surviving
  spouse remarries, dependent children become
  ineligible and/or coverage is terminated with
  Sandia
• Premiums for 2009 can be located in the Open
  Enrollment Booklet

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Continuation of Coverage for Surviving Spouse

• Dental Coverage
• Dental coverage for surviving spouse and eligible
  dependents is discontinued at the end of the
  month of retirees death
• Coverage may be temporarily continued (COBRA
  process), for up to thirty-six months, by paying
  the monthly COBRA surviving spouse/dependent
  group rate (2009 single rate 38.00/month 2
  administrative fee)

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What Do I Do When I Turn 65?

• Within a few months before reaching age 65
• Enroll in Medicare Parts A and B
• Approximately 2-3 months before you turn 65, you
  should receive information from Sandia Benefits
  and Medicare
• Once you reach age 65, the Retiree Medical Plan
  Option is available for transition as follows
• UHC Senior Premier PPO for aging-in UHC Premier
  PPO members
• Lovelace Senior Plan for aging in CIGNA
  In-Network members, (must complete Lovelace
  enrollment paperwork to assign Medicare)
• Lovelace Senior Plan for retirees whose spouse is
  already in this Plan (must complete Lovelace
  enrollment paperwork to assign Medicare)
• Presbyterian MediCare PPO Plan for retirees whose
  spouse is already in this Plan (must complete
  Presbyterian enrollment paperwork to assign
  Medicare)
• Coverage takes effect the first day of the month
  in which you reach age 65
• Contact Medicare or your local Social Security
  office for Medicare Parts A and B information

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Open Enrollment Information
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Open Enrollment Process Tips

• Review Medical Plans Comparison Chart
• Review Annual Open Enrollment booklet for more
  information
• Use the Medical Plan Estimator Tool
• Complete Open Enrollment Change Form 2009
  (especially important for current members in the
  UnitedHealthcare High Deductible Health Plan or
  the CIGNA Premier PPO Plan)
• Submit to Benefits by deadline of Nov. 10th
• Confirmations will be sent to only those who make
  changes

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OE website
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To make a change
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Do I Need to Take Action?
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Sandia Benefits Contacts

• Sandia Open Enrollment website at www.sandia.gov
  Resources for
• Employees and Retirees
• Retiree Open Enrollment
• Benefits Customer Service Center
• (505) 844-HBES (4237) or
• [phone], ext. 844-HBES (4237)
• Fax [phone]
• If you have questions you can
• Send an email to HBE_at_sandia.gov OR
• Go to http//www.sandia.gov
• click on Employees Retirees
• click on HBE Weekly Update
• click on ? Get answers

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Open Enrollment Period October 20 November 10,
2008 No changes to any of your open enrollment
elections will be allowed after November 10th
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Questions ?