Health Insurance


Answers to Questions from Medicare Eligible Retirees:


I’ve heard that the ICSD is moving Retirees to a new health insurance to avoid the Affordable Care Act obligations?  Is that true?

It has come to our attention that a rumor has been circulating that the ICSD is transitioning retirees to the Medicare Supplemental F Plan underwritten by the Hartford in order to evade its obligations pursuant to the Affordable Care Act.  This is completely false.  As reflected in the minutes of our Board of Education Committee meetings and minutes of the TST BOCES Health Insurance Consortium, the SOLE motivation behind offering the Medicare Supplemental F Plan option to retirees is fiscal.  This plan provides the same or enhanced coverage to retirees for LESS expense to each retiree and LESS expense to our taxpayers.  Although retiree health care plans are exempt from the Affordable Care Act, this fact was never a part of any discussions regarding our health care transition for Medicare eligible retirees.

How will my experience with GeoBlue international coverage compare to the international coverage I received under the District's self-insurance plan?

Prior to the move to Supplemental F Plan underwritten by the Hartford, an employee or retiree on a BC/BS plan who was traveling overseas would have had access to a BC/BS program called “BCBS Global Core”.  In the event that an employee or retiree had covered medical needs overseas, this network would be called upon to handle coverage and payment.  This BCBS Global Core program is operated and overseen by GEO-BLUE.  

Now, if you transition to the Supplemental F Plan underwritten by the Hartford, your international coverage will be provided directly by the GEO-BLUE program.  Your travel policy will be paid for by ICSD.  Because GEO-BLUE actually operates the "BCBS Global Core" program that was previously in place, the provider networks will be exactly the same, so coverage should be seamless.  If the international provider from whom you receive treatment is included in the GEO-BLUE network, the provider will bill GEO-BLUE directly and no upfront payment will be due from you.  If, by chance, you receive treatment from a non-participating provider (a provider who does not accept payment from GEO-BLUE), now, like in the past, you will pay the claim upfront.  Like in the past, you will submit a receipt of payment and a billing statement from the provider to GEO-BLUE, which indicates services rendered.  When you return home, you will submit a claim form to GEO-BLUE, and GEO-BLUE will provide reimbursement to the same extent that reimbursement was provided under the previous BCBS Global Core coverage.  

There is a 1-800# available 24/7 for travelers who may have questions at any time during their travel.

The District is satisfied that the international coverage that will be available to retirees via the GEO-BLUE policy will be the same as or superior to the international coverage that was in effect through the BCBS Global Core policy.  The District is committed to correcting any gap between the coverage that is provided to active employees and the coverage that is provided to retirees that occurs as a result of inadvertent oversights during and after the transition.

What assurances does the Ithaca City School District make so that I know that I will have equal or better than coverage?  

Each retiree's right to health insurance coverage in retirement derives from the collective bargaining agreement to which the District and their respective union were parties.  Each bargaining agreement is a legal and binding document.  The District does not have the legal authority to negotiate directly or establish Memorandums of Understanding with retirees, because they are neither employed by the District, nor members of any bargaining unit. 

The District is satisfied that the transition to the fully funded Supplemental F Plan underwritten by the Hartford and the Supplemental D Plan offered by Express Scripts is fully consistent with rights for which your union bargained with the District while you were an active employee.  Further, the District's intent is to not diminish retiree medical, hospital or prescription benefits.  We have selected the Medicare Supplemental Part F underwritten by the Hartford coupled with the Express Scripts Prescription Part D based in large part on analysis and assurances that we have received from the Hartford, Express Scripts and our independent consultant ENV Insurance that a retiree who transitions to the Medicare Supplemental Plans will receive the same or enhanced benefits, compared to the benefits that they would have received if they had remained in the District's self insured plan.  The District is committed to correcting any gaps in coverage that occur as a result of inadvertent oversights during and after the transition.

Could you help me understand the difference between a premium, a deductible, a coinsurance and copay?  How will all of these things change when we move to the Hartford Plan?

All of the terms represent some type of “out-of-pocket” expense.  Essentially, they represent the cost of the insurance or the portion of the medical bill that you or the Ithaca City School District are responsible for in case you get sick, injured, or obtain prescriptions.

Premium:  This is the cost of your insurance plan.  If you have been retired for many years, most of you pay $0 in premium and the ICSD picks up 100% of the costs.  More recent retirees pay either 10% (former EA or ESPI members) or 11% (former ITA or IPDA members) of the premium and ICSD picks up the remaining costs.

When ICSD was a member of the TST BOCES Consortium, we would pay premiums for every individual and family plan to the Consortium.  The Consortium would then use those premiums payments to pay for all of the medical, hospitalization and prescription drug costs.

Since we are now self-funded, we will use the premiums to pay our providers directly for the medical, hospital and prescription costs (claims) for everyone covered by ICSD.  If the costs of medical, hospitalization and prescriptions are MORE than what our premiums are, then ICSD needs to pay the difference to the providers.  That also was the same when we were a member of the Consortium.

When we move to the Hartford, we will be fully-insured which means that we will only pay a premium for each Medicare eligible individual and family plan to the Hartford.  ICSD will not have to pay any more, even if the actual cost of medical, hospital and prescriptions is more than what we paid in premiums.  

Deductible:  A deductible is a fixed dollar amount that you have to pay out of your own pocket before the insurance will cover the remaining eligible expenses. Currently, all of our Medicare Eligible Retirees have a deductible of either $50 or $100 if you have an individual plan, or $150 or $300 if you have a family plan based on your bargained agreement when you retired.  The Hartford plan has no deductible.  With both the current plan and the Hartford plan, it is the District’s understanding that the Medicare Part B premium will continue to be deducted from a retiree's social security payments.

Coinsurance:  Coinsurance is a percentage of the cost that you currently share with the insurance company to pay your medical expenses. Our current plan has a coinsurance of either 100% or 80% / 20% split for all medical and hospitalization care.  This means that if you go to a doctor the insurance will either cover 100% of the medical/hospitalization costs or 80% of the costs after Medicare, depending on the type of services that you are undergoing.  You would be responsible for paying the other 20% yourself.  Under our current plan, your deductible is commonly used together with coinsurance. In this case, you would pay the deductible amount first and after you would have the leftover coinsurance amount.

With the Hartford Plan there is no coinsurance after Medicare.  You will not have to share the cost of your services with the Hartford as they pay 100%.

*Please note that we are currently using Express Scripts as our prescription administrator for our Retiree Drug Subsidy Prescription Plan that is paired with Excellus Blue Cross Blue Shield to provide medical/hospitalization coverage.  Upon moving to the Hartford plan for medical and hospitalization coverage, we will continue to use Express Scripts as our prescription administrator, however, it will become a Medicare Part D prescription plan.

Copay (copayment):  Copays are similar to deductibles, in that it is a fixed amount of money you have to pay each time you need to use your insurance plan. Unlike deductibles, copays are smaller dollar amounts that are applied to prescriptions on a per fill basis.  Some retirees pay either $1 or $6 for copayments while others pay either $5 or $10 for copayments when filling their prescriptions.   Upon moving to the Hartford*, your current copayments will remain intact.  You will continue to pay the same amount when you pick up your prescriptions or utilize mail order as you do today.

Why is the timeline so short to make a decision?  

We have received feedback on both sides of the coin regarding decision making timing.  Some feel that one month is sufficient while others would like more time.  Others have asked why we are waiting so long to roll out a transition that will result in significantly decreased premium payments and more money in their pockets.  Quite frankly, we assumed that offering coverage that matched the current plan elements with enhancements that was at a lesser cost to all would not need an extended timeline for decision making to occur.

What will my new premium be?  

If you paid nothing before, you will pay nothing once you move to the Hartford.  If you paid 10% or 11% of the premium once you turned 65, then you will continue to pay those percentages of the premium.

NO PREMIUM - Retirees $50/$150 and $1/$6 - NO PREMIUM
Current Monthly Rates
Hartford Monthly Rates
100% COSTS PAID BY ICSD
$806.25
$534.24
Individual
$1,878.58
$1,068.48
Family
(Hartford rate assumes 2 people)
Retirees $100/$300 and $5/$10
Current Monthly Rates
Hartford Monthly Rates
 
$741.93
$506.37
Individual
$1,728.74
$1,012.74
Family
(Hartford rate assumes 2 people)
10% Premium Payment - EA and ESPI
$74.19
$50.64
Individual
$172.87
$101.27
Family
(Hartford rate assumes 2 people)
11% Premium Payment - ITA, IPDA and Admin
$81.61
$55.70
Individual
$190.16
$111.40
Family
(Hartford rate assumes 2 people)

What will my spouse pay if I pre-decease him/her?  

All bargaining agreements provide spouses to continue on District Health Insurance.  However, surviving spouses must pay the full premium amount.  

Retirees $50/$150 and $1/$6
Current Monthly Rates
Hartford Monthly Rates
 
$806.25
$534.24
Surviving Spouse Rate
Retirees $100/$300 and $5/$10
Current Monthly Rates
Hartford Monthly Rates
 
$741.93
$506.37
Surviving Spouse Rate
 

Videos:

**Click here for an introduction to the video below by Amanda Verba, ICSD Chief Operations Officer**

Medicare Supplemental F Presentation by Terry Engels, ENV Insurance

IMPORTANT INFORMATION FOR MEDICARE ELIGIBLE RETIREES:

WHEN YOU CALL YOUR DOCTOR TO SEE IF THEY "ACCEPT THE HARTFORD”. . .

Instead, please ask them if they take Medicare - - - not the Hartford.  

Here is why:

  • When you go to the doctor, hospital or receive medical care after age 65, all claims are submitted to the Medicare system by the provider of the service.

  • All claims that are eligible for Medicare are paid (usually at 80% for most services and most doctors).

  • The claims that are not paid for by Medicare are then taken care of by either a secondary insurance (like Excellus BCBS) OR a supplemental Medicare insurance (like Part F from Hartford).

  • Currently, the remaining unpaid claims are sent from Medicare to our existing medical/hospital insurance plan (Excellus BCBS) and then they are paid according to the plan coverage rules for each medical or hospital benefit.  Some services are paid in full, some are subject to a deductible, some are subject to a co-insurance fee.

  • On the Medicare Supplemental F Plan (Hartford), Hartford will go into the Medicare system and pay in full all of the remaining claims. 100% payment means no deductibles and no co-insurance fees.  Even the excess charges for services provided by doctors that do not participate with Medicare are covered at 100%.  

In short, your doctors will not be submitting any claims directly to the Hartford.  Your doctors do not need to "accept the Hartford" in order for you to receive coverage.

Announcements

Recent Mailings from Express Scripts
You may have received a 5 page document from Benistar/Express Scripts, Inc. (ESI).  This document included talking points on Medicare Part D and opting out.  ICSD wants to ensure that you understand that this document is a regulatory document required by the Centers for Medicaid and Medicare Services (CMS) to be sent to you as a retiree.  It is most important to note that your current and future prescription programs offered through Express Scripts DO NOT HAVE A DOUGHNUT HOLE.  Both prescription programs have FULL COVERAGE as explained in the meetings and the materials presented.

Downloads

Ithaca City School District 2017 5-20 plan benefit summary
Ithaca City School District 2017 5-10 plan benefit summary
Ithaca City School District 2017 1-6 plan benefit summary
FAQs for Ithaca CSD
WKQRG_BXMA_Benistar_08032015_v1
P00SES6W_Pharmacy_Directory_Notice_for_EGWP_Buckets_3_and_on_v2
Notice of Privacy Practices
EOC_E00SOS6A_2016-EGWP-OpenInc-EOC_ArtRel_v3_080715
NEW UPLOAD: What will my premium be?
Medicare and You
International Travel Health Insurance GEO Blue
2017_GRH Benefit Summary_Ithaca City School DIstrict
Retiree The Hartford Plan Town Hall Flyer