Info from David Amerson, AFSCME Retiree Coordinator concerning Medicare Advantage and Audit Verification for health insurance. Retiree Leaders, I have much information to share with you and your members: Medicare Advantage There have been some large developments this week with regards to Medicare Advantage. While the precise details are still being analyzed, we can report to you the winners of the bids for the new plans. Four plans will be offered: • PPO Plan – administered by United Healthcare • Three HMO Plans –one administered by Aetna, two administered by Humana, depending on geographic region Details are still emerging on these plans. We are currently preparing mailings and educational materials for members. Once we have enough information on the plans we will immediately begin outreach efforts to ensure our membership is making an informed decision. CMS will also be conducting community outreach efforts across the state and we will make sure you get the details for that as soon as dates and venues are confirmed. The biggest concern among members over the coming weeks is whether or not their doctor will accept the new insurance plans. When you get these calls, it’s important to keep a few things in mind: • Details are still emerging about the plan. At the time of this writing (October 4, 2013) the state is going through an appeals process for the bid, where the losing bidders (Blue Cross/Blue Shield, Health Alliance, etc.) can appeal to the state that their bid be accepted. Once that process concludes I expect that plan details will be coming out quickly. • No matter what members may read in the newspaper there is one absolute truth that we know right now: we have union contract language, signed by the state, which ensures that these new healthcare plans include comparable networks, comparable benefits, and no increase in insurance costs for members. When we say comparable, we mean it: if networks are being shrunk, if you can’t go to a doctor in your local area anymore, or if the local hospital doesn’t take your insurance, the state has violated its union contract. • Let them know that it would be irresponsible for AFSCME or yourself to speculate about what is included in the plan until we get the hard data from CMS. • That hard data from CMS will include lists of providers that are covered under the new plans. We will compare these to the old lists to determine if the networks are comparable. AFSCME will fight with the full measure of our strength any violation of the union contract. Dependent Verification Audit Many members are receiving correspondence from the state requesting information to verify eligibility of dependents in state health care coverage. The reason for this is that the state is conducting an audit to verify that dependents are still eligible for state coverage. In the past, there have been occasions when a member’s spouse passes away and the member fails to let CMS know, and the state continues to cover the spouse. These are being sent to retirees this fall and current workers will have to go through the same process in the Spring. I encourage you and your members to send in the required information. Let them know that it is not a scam and that their action is required in order for the spouse to remain covered on state insurance. Please have them call me or CMS if they have any questions or concerns. While the state is on firm legal footing to conduct this audit, we have concerns over the process they are using. Roberta and Henry are sending letters to sub-chapter presidents outlining what we are doing to address these issues. CMS has already agreed to extend the deadline for submission of audit materials until December 5th. In the meantime though, encourage your members to comply. We don’t want them to lose their benefits and that is priority one.
Posted on: Fri, 04 Oct 2013 20:25:08 +0000