Retiree Medical Brochure - Yale University
Retiree MedicalBrochureP L E A S E K E E P T H I S B RO C H U R E F O R R E F E R E N C E
Dear Yale RetireeCongratulations on your retirement. As a Yale retiree, the university providesyou with an option to enroll in one of two Aetna Medicare plans. Both plansoffer benefits, services, and programs above and beyond basic Medicarecoverage and include a comprehensive retiree service center and website. If you are a retiree turning age 65, your current medical coverage willend the day you become eligible for Medicare. If you enroll in an AetnaMedicare plan through Yale, your covered dependents can continue theircurrent coverage. If you do not enroll in an Aetna Medicare plan offered bythe university when you become eligible for Medicare, your dependents’coverage will end. If you are a spouse turning age 65, your current medical coverage will endon the day you become eligible for Medicare. You can elect to enroll in anAetna Medicare plan through Yale or you can enroll in a plan outside of Yale. If you are age 65 or older, you can choose from two Aetna Medicare plans,but you must enroll in Medicare Parts A and B at least 30 days before youelect your post-65 retiree coverage.Yale and Aetna have prepared the following materials to guide you throughyour decisions and to ensure you meet deadlines:1. This brochure, which includes an enrollment checklist, the steps necessary toenroll, and an overview of the medical and prescription drug plans.2. Your Personalized Enrollment Worksheet, which details the date by whichyou need to enroll, as well as costs for your medical plan options; and3. Plan benefits summary, shows the complete plan coverage details.It is recommended that you keep all of the communications you receive, as theywill serve as useful references for your medical benefits.2YALE RETIREE MEDICAL BROCHUREContents04Your Yale RetireeMedical Benefits06Well-BeingBenefits07Your EnrollmentChecklist08After You Enroll10Questions andAnswers11Resources
Your Yale RetireeMedical BenefitsYou can choose to enroll in one of these two plans:The Aetna Medicare Extended ServiceArea (ESA) Open Access PreferredProvider Organization (PPO) planprovides access to any providerwho participates in the Medicareprogram, including Yale Health (ifyou were enrolled in Yale Healthbefore retiring).The Aetna Medicare PreferredProvider Organization (PPO) planprovides access to in-network andout-of-network providers, exceptfor Yale Health, which is excludedfrom this plan’s network and cannotbe accessed as an out-of-networkprovider. If you use providers who arenot part of the plan’s network, yourcost sharing amount will be higher.Both plans offer: Health and well-being programs at no additionalcost to you. Access to the National Medical Excellence Program,which is a select network of doctors and facilities.They treat members with complex illnesses orinjuries and ensure you get the right care. Coverage for emergency or urgently neededmedical treatments, even when traveling outsidethe United States. Online tools at aetnaretireehealth.com/yale anda Retiree Service Center at 1-800-338-4533(TTY: 711) with designated Customer ServiceRepresentatives. A 24-hour toll-free nurse hotline at1-800-556-1555. Aetna Medicare prescription drug plan (PDP)benefits—the plan benefits summary providesplan details. Note that the Centers for Medicare &Medicaid Services (CMS) has certain enrollmentrequirements. You can have only one stand-aloneMedicare PDP. So, if you enroll in the AetnaMedicare ESA Open Access PPO plan or theAetna Medicare PPO plan, CMS will cancel anyindividual PDP coverage you may have.Your Yale Retiree Medical BenefitsThe main differencebetween the two plans arewhat you will pay when youseek services, as shown inthe chart to the right.Please note that thischart is a summary ofthe main provisions.Complete details on themedical plans, thenetwork of providers,and the prescriptiondrug plan are in theplan benefit summaryand available on theretiree benefits website ataetnaretireehealth.com/yale.Plan FeatureAdditionalWell-Being BenefitsMedicare Advantage plans are offered by private insurance companies that contract with the Medicare programto provide beneficiaries with Medicare Part A (hospital) and Part B (doctor and outpatient) benefits, as well asa variety of additional benefits and services intended to improve member health and well-being. The MedicareAdvantage program is known as Medicare Part C.4YALE RETIREE MEDICAL BROCHUREYou pay:Medicare PPOIn-NetworkYou pay:Out-of-NetworkYou pay:See the “Well-Being” Benefits section on the next page 0 020%(coinsurance)of the cost forthe annualwellness or routinephysical examAnnual Wellness/RoutinePhysical Visit) 0 10 copay20%coinsurance formost servicesAnnual Deductible 0 0 500 0 1,500 4,000(combinedin- ntive Care(Annual Wellness/RoutinePhysical Exam)PCP Visit (other than anAnnual Out-of-PocketMaximum (includingdeductible and copays)Lifetime Maximum(paid by plan)InpatientHospitalization 0 per stay 0 per stay20%coinsuranceper staySpecialist Visit 0 25 copay20% coinsuranceEmergency Room 0Urgent Care 0 25 copay 25 copayMedicarePart B Drugs 0 0 0(worldwide coverage)What is a Medicare Advantage Plan?Medicare ESAOpen Access PPO(worldwide coverage) 50 copay 50 copayWaived if admitted Waived if admittedYALE RETIREE MEDICAL BROCHURE5
Well-BeingBenefitsRetiree ServiceCenter HoursThe Retiree Service Centerhas designated ServiceCenter Representativeswho are available Mondaythrough Friday duringthese hours:8 a.m. to 6 p.m. ET,between February 1 andSeptember 308 a.m. to 8 p.m. ET,between October 1 andJanuary 311-800-338-4533(TTY: 711)Your Enrollment ChecklistBoth plans offer these additional programsand services to help you manage your shortand long-term health and well-being needs.SilverSneakersAccess fitness equipment, group exercise classes, and more at over13,000 participating SilverSneakers locations nationwide at no additionalcost to you.Vision and Hearing Aid AllowanceYou receive a 500 allowance for vision eyewear and hearing aids onceevery 36 months. You will receive more information after you enroll in oneof the plans.Telemedicine (Teladoc )Talk with a doctor over the phone (except in Idaho) or through an onlinevideo consultation, where permitted. Teladoc provides you with access toa national network of physicians. These doctors can diagnose, treat, andprescribe medication for many common medical issues.Resources for LivingConnect to resources in your community to help you find a wide rangeof life services in your area—from personal care, housekeeping, andmaintenance to caregiver relief and support.Case ManagementNeed extra assistance and support for managing chronic conditions andcomplex medical issues? Aetna will assign you a case manager who will workwith you and your physicians to support your care plan. It’s like having anurse in the family.Preferred Diabetic Supply ProgramGet OneTouch by LifeScan blood glucose meters and test strips at no cost.Healthy Home VisitIf you choose to participate, a licensed health care professional will come toyour home to review your health needs and do a home safety assessment.They’ll also review your medicines and ask about your medical history.6YALE RETIREE MEDICAL BROCHUREThis checklistStep 1: Enroll in Medicare Parts A and Boutlines steps to take To be eligible for enrollment in either Yale Medicare plan, you must beenrolled in Medicare Parts A and B. You’ll need to continue to pay yourto be covered by one Part B premium. If you are not enrolled in Medicare Part A and Part B, go to medicare.govof the two medicalor call 1-800-633-4227. TTY users should call 1-877-486-2048. Youplans offered by Yale:can also visit your local Social Security office in person. Information is Aetna MedicareESA Open Access PPOplan; or Aetna MedicarePPO plan.Is Your DoctorIn-Network?Use the providersearch tool onaetnaretireehealth.com/yale to find ifyour doctors are innetwork for a plan,and to find in-networkspecialists, hospitals,pharmacies, and otherhealth care facilities.available 24 hours a day, including weekends. If you are not sure if you are enrolled in Medicare Parts A and B,call the Social Security Administration Office at 1-800-633-4227or go to medicare.gov. Information is available 24 hours a day,including weekends.Step 2: Understand Your OptionsRead this guide and additional enclosed materials to fully understandthe plans, your costs, whether your providers are in the networks,your enrollment deadline, and what to expect after you enroll. If youhave any questions, call the Retiree Service Center at 1-800-338-4533(TTY: 711).Once you decide if you’re enrolling in the Aetna ESA Open Access PPO planor the Aetna Medicare PPO plan, it is time to enroll.Step 3: EnrollYou have two ways to enroll.Online:Log in to the retiree benefits websiteat aetnaretireehealth.com/yale. You’ll need to register ifyou haven’t yet.By Phone:Call the Retiree ServiceCenter at 1-800-338-4533(TTY: 711). Once you’re logged in,click on “Enroll Now.” Follow the prompts to enroll.Make sure you enroll by the deadline shown on your PersonalizedEnrollment Worksheet. You must make your election on the Aetna retireewebsite or by phone by the last day prior to your coverage effective date.YALE RETIREE MEDICAL BROCHURE7
After You EnrollAfter You EnrollAfter you enroll in the Aetna Medicare ESA Open Access PPO plan or the Aetna Medicare PPO plan, you will receive(or have access to) more information about your medical and prescription drug coverage. Below is an overview ofwhat you can expect to receive, and by when.What to Expect NextEnrollmentconfirmationstatementConfirmation that Aetnahas processed yourenrollment.Plan confirmationletterLetter confirming thatAetna has received, andCMS has approved, yourapplication for the plan.Monthly billingstatementIf dependents’ coverage differs,they will receive a separatebilling statement.Member ID cardsEvidence ofCoverage (EOC)Formulary** Applicable for Aetna MedicareRx Plan (PDP)8DescriptionLets you know howmuch you owe foryour health plan premiumeach month.Member ID cards (AetnaMedicare Plan card andAetna Prescription card) toshare with providers.Booklet provides a fullexplanation of how yourplan works.List of prescriptiondrugs that are coveredunder your plan.An Aetna representativecalls you to ask generalquestions regarding yourHealth surveyhealth (or you can completethe survey on paper andmail it back to Aetna).YALE RETIREE MEDICAL BROCHUREIf you do not have your premiumdeducted from your pension check,you have two options for payment:1. You can enroll in Autodebit.Enroll by filling out the form that will beincluded with your first monthly billingstatement. Autodebit means that yourpremium payments will be automaticallydeducted from your checking account.Enrolling in AutodebitOnce Aetna receives your completedAutodebit form with a copy of a canceledcheck (as described on the form), it willtake at least one billing cycle to process yourform. You will continue to receive a paper billuntil Aetna has configured your account forAutodebit. Once Autodebit is set up, you willno longer receive a paper bill in the mail—instead, your premium will be automaticallydeducted from your checking account.2. You can mail your payment directly to Aetna.When you receive your statement, youwill need to mail your premium paymentto Aetna at the billing address provided inthe billing statement. Be sure to check theaddress on your first Aetna Medicare billingstatement you receive before you mail yourpayment. Generally, Faculty and Managerialand Professional retirees will be billed forpremiums by Aetna. Hourly staff will havepremiums deducted from pension, unlessthe pension does not cover the full amountof premium.Please contact the Retiree Service Center at1-800-338-4533 for guidance on whetheryour premium will be pension deducted ordirect billed.What to Expect NextEnrollmentconfirmationstatementPlan confirmationletterWhen You Can Expect ItAvailable online ataetnaretireehealth.com/yale as soon asAetna processes your enrollment.About 10 calendar days after Aetna receivesapproval from CMS.Monthly billingstatementAround the 20th of the month beforeyour premium is due.Member ID cardsAbout 10 calendar days after Aetna receivesapproval from CMS.Evidence ofCoverage (EOC)Within 10 calendar days from the CMSconfirmation date, or the last day of the monthbefore the effective date, whichever is later.Formulary** Applicable for Aetna MedicareRx Plan (PDP)Health surveyNotice regardingMedicare-eligiblemedical, pharmacy,and dental payments(if applicable)Your payment is due onthe date indicated onyour billing statement.If the full payment is notreceived within 90 daysof this due date, yourbenefits will terminatethe first of the monthfollowing this 90-daygrace period.Within 10 calendar days from the CMSconfirmation date, or the last day of the monthbefore the effective date, whichever is later.Three to four weeks after your enrollmentis received.YALE RETIREE MEDICAL BROCHURE9
Questionsand Answers1. When I enroll in a medical plan andMedicare Parts A and B, what cardswill I receive and need to show whenI receive care?Once you enroll in one of the two Aetna Medicareplans offered by Yale, you will receive: An Aetna Medicare plan card, which you willshow when you receive medical services; and A prescription drug card, which you will showwhen filling prescriptions at the pharmacy.Your Medicare-eligible spouse will receive theirown medical and prescription drug plan cardwith their own unique numbers.Once you enroll in Medicare, you will receive ared, white, and blue Medicare card, but you willnot need to show it for medical and prescriptiondrug services. However, you should keep thatcard in a safe place.2. Can I travel outside of the U.S.and still have coverage under theAetna Medicare plan?Yes, emergency and urgently needed services arecovered under the Aetna Medicare plans when youtravel outside the U.S. You may be required topay the bill at the time of service and file theclaim with Aetna for reimbursement. Aetna willreimburse you based on Medicare’s allowableamounts at the time of service.The plan will not provide a benefit fornon-emergency, non-urgently needed servicesoutside the U.S.10YALE RETIREE MEDICAL BROCHUREMoreover, if you are permanently relocatedoutside the U.S. and U.S. territories, you are noteligible for the Aetna Medicare plans. Youshould contact the Yale Employee Service Centerat 203-432-5552 to discuss your options.3. I currently use Yale Health. Can Icontinue to use it?Yes, if you are enrolled in the Medicare ESA OpenAccess PPO, are currently enrolled in Medicare,and currently using Yale Health, you can continueto access services as you do today, at thedepartments listed below. *Acute CareDiagnostic ImagingGynecologyInternal d separately by Quest Diagnostics.** The Yale Health Pharmacy participates in the Aetna program. Provide yourAetna ID number and bring your Aetna card to the Yale Health Pharmacy (or anyother pharmacy) when ordering prescriptions or picking them up.*** Flu, pneumococcal, and some other immunizations. Allergy services or shots arenot available.ResourcesIf you have questions about your plan, billing,eligibility, and/or enrollment information, youcan find answers by:Logging in to the retireebenefits websiteat aetnaretireehealth.com/yaleORCalling the Retiree Service Centerat 1-800-338-4533 (TTY: 711).Designated Service CenterRepresentatives are availableMonday through Fridayduring these hours:8 a.m. to 6 p.m. ET, betweenFebruary 1 and September 308 a.m. to 8 p.m. ET, betweenOctober 1 and January 31YALE RETIREE MEDICAL BROCHURE11
P H O T O C R E D I T S : A L L P H O T O S A R E P RO V I D E D B Y YA L E U N I V E RS I T Y.Cover: Trumbull College, Campus in the Spring and Maya LinWomen’s Table reflections by Michael MarslandPage 10: Sterling Memorial Library by Jack DevlinPage 4: Starr Reading Room in SML by Jack DevlinPage 11: Inside the Beinecke Library and Beautiful Yale Campusby Michael MarslandPage 6: Evans Hall by Chuck ChoiBack: Tulips on Campus by Michael MarslandPage 8: Yale Law School Courtyard by Michael MarslandThe benefit descriptions stated in this document are brief summaries of the benefits offered. If anything differs from what is stated in the legalplan documents, the legal plan documents will prevail.YA L E U N I V E RS I T Y 2 0 1 9
8 YALE RETIREE MEDICAL BROCHURE YALE RETIREE MEDICAL BROCHURE 9. After you enroll in the Aetna Medicare ESA Open Access PPO plan or the Aetna Medicare PPO plan, you will receive (or have access to) more information about your medical and prescription drug coverage. Below is an
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When Jenny turns 65, she retires with IU Retiree Status. Both elect IU Retiree coverage: ‒ Jenny—IU Anthem Blue Retiree Plan (for 65 ) ‒ Dan—IU Anthem U65 PPO HDHP (for under 65) When Dan turns 65, he can switch to the IU Blue Retiree plan—the same plan as Jenny. Scenario #1 . Jenny & Dan. Dan - Age 63 (Spouse) Jenny .
If you are selecting 'Retiree & Children,' 'Retiree & Spouse' or 'Retiree & Family' coverage, you must complete the dependent information in Section 4. Group Legal Plan: You must complete the dependent information in Section 4. Please send the white copy of the form to: FBMC Benefits Management, Inc. Retiree Direct Bill PO Box 10789
the Yale Access App The Yale Access App is needed to control your Yale products from your mobile device. The Yale Access App is available for iPhone and Android. Download the Yale Access App from the App Store or Google Play depending on your device. Once you have downloaded the Yale Access App, log in to
Retiree Medical Plan (also referred to as the "Retiree Medical Plan" or "Plan"), which is a Component Plan of the Huntington Ingalls Industries, Inc. Retiree Welfare Benefits Plan (the "Welfare Benefits Plan"). If you have questions that are not answered in this SPD, contact
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1 Yale University Press, “Books from Yale at Christmas” (print advertisement), Yale Daily News, 10 December 1958, 9. 2 Gideon Gordon, “From the Couch: Study of Yale Mind Published,” Yale Daily News, 22 October 1958, 1. 3 Bryant M. Wedge, preface to Psychosocial Problems of College M
Anatomi Tulang dan Fisiologi Panggul 2.1.1 Tulang Tulang pelvis merupakan komposisi dari tiga buah tulang yakni dua tulang kokse . tulang pria lebih kekar dan kuat, sedangkan kerangka perempuan lebih ditujukan kepada pemenuhan fungsi reproduksi. Pada wanita bentuk thorak bagian bawah lebih besar, panggul berbentuk ginekoid dengan ala iliaka lebih lebar dan cekung, promontorium kurang .
