Medical Benefits & Plan Types

- Plan Types -

It’s important to understand that the plan options available to you depend on where you live and can vary based on your Medicare enrollment. Also, keep in mind that plan options are reviewed annually to determine if they will be renewed. Often times there are yearly changes that are communicated to you in the Benefit Highlights newsletter mailed every fall.

TCN 

MA PPO

HMO 

Traditional Care Network

Medicare Advantage

 Health Maintenance Organization

 

About the Plan

This is the base plan option available to all Trust members. Based on a nationwide network of providers, the TCN plan allows services to be performed both in-network and out-of-network.

 

About the Plan

An MA PPO plan type is approved by Medicare and administered by a private company (such as Blue Cross Blue Shield or Aetna). These plans provide your Original Medicare, Part A (hospital) and Part B (medical) benefits, and include additional benefits. MA plans are based on a nationwide network of providers and allow services to be performed both in-network and out-of-network.

 

About the Plan

While HMO plans have been a popular choice among members, they are only offered in limited areas where they are able to be competitive with the Traditional Care Network (TCN) plan. HMO plan options are based on a regional network of providers and do not offer out-of-network benefits (although emergency services may be covered out-of-network).

Eligibility

All members, both Medicare and Non-Medicare.
 
For Medicare members in this plan, Medicare is primary and TCN coverage is secondary

Eligibility

Medicare Members
 
Must be enrolled in Medicare Parts A and B and living in one of the states where an MA PPO plan is offered*

Eligibility

All members, both Medicare and Non-Medicare.
 
Must be living in areas where an HMO plan is offered

Cost

See cost share for 2018

May have copays, deductibles, coinsurance and out-of-pocket maximums.

In order to receive the highest level of benefits with the lowest out-of-pocket cost, you need to receive services from an in-network provider.

Cost

See cost share for 2018

May have copays, deductibles, coinsurance and out-of-pocket maximums.

In order to receive the highest level of benefits with the lowest out-of-pocket cost, you should receive services from an in-network provider.

Cost

See cost share for 2018

May have copays and deductibles but do not have coinsurance or out-of-pocket maximums.

For More Info

Refer to the Summary Plan Description (SPD).Contact your health plan carrier for information about your specific medical benefits.

For More Info

Refer to your evidence of coverage or contact your MA PPO plan carrier.

 

For More Info

Refer to your certificate of coverage or contact your HMO plan carrier.

 

*To stay eligible for this plan, you must continue to pay your monthly Medicare Part B premium.

Cost Share

Before reviewing more details on your available plan options, it’s important to understand all Trust provided plans have copay and cost share elements. As a member of the Trust, you are responsible for paying certain health care coverage costs including a monthly contribution, annual deductible, coinsurance, copayment and annual out-of-pocket maximum. Understanding how these work will help you know when they apply and how much you will have to pay for care, click to view coverage costs.

Copay elements are fixed dollar amounts for services such as Primary Care Physician (PCP) office visits, specialist visits, urgent care visits and emergency room visits. Cost share elements can include deductibles, coinsurance and out-of-pocket maximums. Want more detail on what these terms mean? Visit the Health Care Glossary

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- Benefit Materials for Download -

Below are the four main documents you will need to understand and utilize your benefits - click on the links below the images to download copies.

2018

Benefit Highlights

2018

Health Care
Benefits Summary
(Schedule of Benefits)

2015-Present

Summary Plan Description
(SPD)

2017

Plan Document

close up of summary plan description front page close up of 2017 plan document front page
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Learn about your 2018 cost share and benefit coverage updates. An addendum to the SPD that includes year-to-year changes in cost share and benefit coverage. This is mailed to members every fall.

An addendum to SPD including current cost share and detailed coverage information on health plans, physical therapy, vision, hearing aid, dental, health programs and additional plan provisions (Benefit Highlights information is included). This is mailed to participants by request and is available online.

A summary of the Plan Document. This is written to be more easily understood and is typically updated and mailed to Trust members every five years (the current version was published in 2015). Because of this, changes made in the years between are detailed in the annual Benefit Highlights and Health Care Benefits Summary (Schedule of Benefits).

The legally required comprehensive document describing the operation and administration of the Plan. This is written using legal language and is mailed to participants by request and is available online.