| Marianne Long Human Resources Director Toni White Human Resources Administrator (781) 979-4145 humanresources@cityofmelrose.org |
On
25 September 2008 the City's unions voted by 71.7% to accept Mayor
Dolan's proposal to join the State's Group Insurance
Commission (GIC), effective 1 July 2009.
Terms and conditions include:
The City will pay
86% of the premium for HMO/PPO plans
The City will pay 60% of the premium for Indemnity plans
The City will pay 70% of the premium for Medicare Supplemental plans
The City will pay 70% of the premium for Medicare Part B
The City will pay for the debit card and administrative costs for the FSA
More
information about the GIC Health Insurance plans is available on www.mass.gov/gic
and will be available in the HR office.
This page will
be updated regularly regarding open enrollment information for retirees
and active employees of the City.
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Questions
& Answers |
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| GIC
Health Plans Benefits-At-A-Glance: (Requires Adobe Acrobat Reader) |
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Municipal
Employees and Non-Medicare Retirees and Survivors |
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| Side-by-Side
Comparisons: (Requires Adobe Acrobat Reader) |
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HMO Options (Green handout) |
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Indemnity, PPO & POS Options (Pink handout) |
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Plans for Medicare Eligible Retirees & Survivors (Yellow handout) |
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The Group Insurance Commission (GIC) was established by the Legislature in 1955 to provide and administer health insurance and other benefits to the Commonwealth's employees and retirees, and their dependents and survivors. The GIC also covers housing and redevelopment authorities' personnel, and some municipalities, retired municipal employees and teachers in certain governmental units. The
mission of the GIC is to deliver high quality care at a reasonable cost. The GIC's FY2008 appropriation is $1.175 billion. Over 286,000 people are enrolled in GIC plans. Health Coverage Options include an Indemnity plan, Preferred Provider-type Organizations (PPO) and multiple HMO plans. As part of its Indemnity and Navigator Plans, it manages mental health/substance abuse benefits and also manages pharmacy benefits for the Indemnity Plans. If you want specific information about the plans go to www.mass.gov/gic and click on the specific link. Health
Plans For Employees and Retirees/Survivors without Medicare |
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The
following questions were raised at the GIC Information Sessions. |
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| Q:
The premiums for the GIC plans are lower but the co-pays are higher. How
will I know if I'm really going to save money? A: First, not all of the GIC plans have higher co-pays. Second, all of the GIC premiums are lower. The best thing to do is to write down the number of office visits, the number of hospitalizations, and the number of prescriptions you had filled this past year and tally your out-of-pocket expenses. Using the same number of visits, hospitalizations, and prescriptions, tally the out-of-pocket expenses for different GIC plans using the side-by-side comparisons.
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| Q:
I am a retiree and when I
turned 65 I declined Part A & Part B coverage with Medicare because I
had HMO Blue coverage with the City of Melrose. If the GIC plans are accepted, the GIC requires Medicare Part A
& Part B enrollment and my question is will I have to pay the penalty
for late enrollment for Part B?
A: The City of Melrose will pay 70% of the current fee for Medicare Part B and will pay the late enrollment penalty fees.
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| Q:
I am a retiree of the City
of Melrose and both my spouse and I have Medicare Part A & B. Will the City of Melrose reimburse both of us for the Part B
monthly cost or to me only because I am the retiree?
A: The City of Melrose will reimburse 70% of the Part B fee for both you and your spouse.
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| Q:
What is the length of term to enroll in the GIC?
A: The minimum term is 3 years; the maximum term is 6 years.
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| Q:
What are the terms for leaving the GIC?
A: The terms are specified in the contract between the City and the Public Employee Committee.
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| Q:
If the City joins the GIC, am I able to stay with my health providers?
A: Before making the switch, look at the different plans and identify which ones you would be interested in. Either call your provider's office manager or look at the plan's website. Virtually every doctor in Massachusetts is in more than one of the GIC insurance companies.
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| Q:
It looks like the mail order prescription benefit is more expensive.
A: Each plan is different. With the plan you have now, one co-pay of $10 gets 3 months supply; with Fallon HMO $20 gets 3 months supply. Bear in mind that the state plan does not exclude any drugs; Blue Cross Blue Shield does.
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| Q:
Earlier in 2008 the Beacon Hill Leadership thought the GIC was so good
they wanted to give cities and towns the right to join without collective
bargaining. Public employees worked hard to make it not happen this
year. If we choose to go with the GIC, can we choose any plan?
A: If the PEC agrees to join the GIC, every active employee and retiree can pick any plan. You can even pick the wrong plan meaning if you find that the plan you pick the first year doesn't suit your needs you can switch plans the following year.
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| Q:
What about a plan where one spouse that is Medicare eligible and one
isn't?
A: There are paired plans for a couple where one spouse that is Medicare eligible and one is not.
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| Q:
Who is Harvard Pilgrim Healthcare? Do I have to use their facility?
A: Harvard Community Health Care was an early health plan where you had to use their doctors and their facility. Harvard Pilgrim Healthcare is completely different. It's the second largest provider in Massachusetts and has virtually every doctor in every hospital.
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| Q:
Will Medicare be the main insurance carrier for eligible employees and
retirees and the plan I choose be the secondary insurance?
A: Yes. If you are eligible, the federal program becomes the primary payer, the GIC plan becomes the secondary, and the enrollee is the third.
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| Q:
What if I'm Medicare eligible and I move out of state?
A: Two plans are designed for out-of-state retirees: Harvard pilgrim Medicare Enhanced Indemnity Plan and UniCare State Indemnity Plan/Medicare Extension.
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| Q:
What is a POS?
A: It's a Point of Service plan. It's between a PPO and and HMO. Like a PPO there is an in-network and out-of-network benefits. Like an HMO you need a PCP. However, POS is not available in Massachusetts.
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| Q:
If we join the GIC we have to sign up for Medicare Part B. The City
is offering to pay 70% of something we're not paying at all. Is the
City offering to split the overall savings or are they only giving us 1%?
A: The offer is closer to splitting the savings 50/50 than 1%. It looks like it's 35-40%.
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| Q:
Medicare eligible retirees will probably do better with the GIC than
active employees. The City had to get a special act of legislature
to allow retirees to pay only 15% of the premium. Will that remain the
same? A: Retirees do very well in this proposal and will pay only 14% if they choose an HMO plan.
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| Q:
What are the three tiers for physicians?
A: Physicians are tiered on the basis of grades they receive which is based on the outcome of care they deliver. 20% of physicians are graded Excellent and theirs is the lowest co-pay. 65% are graded Good. 15% are graded Standard. But some plans don't have tiering.
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| Q:
What is the $96.40 for Medicare Part B?
A: That's the monthly cost. The City is offering to pay 70% of that. It will likely reimburse you either annually or semi-annually.
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| Q:
Will I need proof that I paid it in order to be reimbursed?
A: The City will likely receive a data tape.
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| Q:
What about employees that live out of state, like in New Hampshire?
A: Pick your plan carefully. Harvard Pilgrim covers all of New Hampshire. Some plans go into New Hampshire and some don't. The GIC has to have plans that cover broader areas than just the City of Melrose because there are state employees that live all over the United States.
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| Q:
Is JP O'Neill going to contact every retiree?
A: The other union presidents are going to speak to him about that.
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| Q:
My question is, will I have a vote in this?
A: Melrose has gone to coalition bargaining. Retirees have 10% of the total vote. There has to be a mechanism to allow each retiree to cast a vote. Ultimately the majority wins.
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| Q:
How does a change to GIC
impact the legislation that was passed through the State a couple of years
ago regarding the retirees and their contribution to their health
insurance reverting back to 15% upon retirement?
A: Coalition Bargaining, as defined in Chapter 32B, S19 requires that all employees and retirees pay the same percentage for the same plan. The reason the City of Melrose has Special Legislation is because Mayor Dolan agreed to keep Retirees contributing 15% towards HMO plans while the active employees contribute 18%. During recent bargaining with the Public Employee Committee about joining the GIC, Mayor Dolan offered to pay 86% of the cost towards the HMO plans meaning that retirees and employees enrolled in HMOs will pay 14% instead of 18%. Retirees will pay less for their HMO plan than they do now. Also, the GIC agreement can be for either three years or six years. If, at the end of the agreement, it is decided not to continue with the GIC, everything would revert back to current contributions (unless otherwise agreed upon). In other words the Special Legislation which allows Retirees to pay 15% while active employees pay 18% would continue.
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Q: With Blue Cross Blue Shield HMO, my doctor will not be able to write a prescription for my allergy beginning in January 2009. Is it the same for the GIC providers? A: Carriers tend to follow one another and it's possible by January 2009 the GIC providers could have something similar to BCBS. The best way to find out if the drugs you take are covered by the GIC plans is to call the 800 telephone numbers
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Q: On the yellow handout, are the co-pay prices for a 90-day supply? A: Yes, the Mail-Order co-pay is for a 90-day supply.
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Q: My spouse is Medicare eligible and I am not. What if Tufts is better for him and I want Harvard Pilgrim? Is it possible to enroll that way? A: No; due to the policy decision of the GIC that combination of plans is not possible, but you may each get single plans by the same provider: Tufts for Medicare eligible and Tufts for Non-Medicare eligible or Harvard Pilgrim for Medicare eligible and Harvard Pilgrim for Non-Medicare eligible or UniCare for Medicare eligible and UniCare for Non-Medicare eligible.
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Q: My spouse is on Medicare but I've never paid into Social Security. Do I have to join a plan for Medicare eligible retirees? A: Yes, you become Medicare entitled at age 65 if your spouse has worked 40 quarters in a job that deducts for Medicare. You will enroll in a Medicare plan with the GIC.
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Q: On the pink handout, please clarify out-of-network costs after the annual deductible is reached. A: Harvard Pilgrim and Tufts are PPO plans which have an In-Network level of benefits and an Out-of-Network level of benefits. You will pay 20% of the Out-of-Network bill until you reach the out-of-pocket maximum of $3,000
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Q: If I'm on Medicare. If I go to California to visit and if I have to be hospitalized and have surgery, would it be covered under the GIC because it's an emergency situation? A: There is retiree coverage and Medicare coverage, which are two different situations. If you're visiting and it's an emergency, all GIC plans would cover you.
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Q: If I move to California, would I still be covered? A: This is a gray area. Moving means you bought a condo, registered your automobile, and registered to vote in another state. HMO Blue doesn't provide coverage for a $150,000 surgery that's non-emergency care. Medex does that as does the Harvard Pilgrim Medicare Plan and the UniCare Indemnity OME plan, which is the largest. The GIC has several plans that won't cover you. You'll need to weigh the plans if you are primarily living out of state or planning to move
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Q: If you're traveling and there's an emergency, do you pay up front or show the insurance card? A: Nine out of ten times having the card will be valid, but it's not 100% guaranteed. Not every hospital in the United States is in BCBS, but most institutions are linked to carriers via computers.
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| Q:
Unions will have meetings with their representatives and get to vote.
450 retirees will have no say whatsoever about their 10% of the
total vote. Our representative
is not even going to ask us what we want.
A: The statute says that when a municipality is investigating the GIC and it creates the PEC, a retired individual is appointed by the Retired State, County and Municipal Employees Association, who casts a vote worth 10% on behalf of the retirees.
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| Q:
I don't care what the statute says; I think it's unfair that a vote will
be cast without asking us what we want.
A: Retirement representative J.P. O'Neil responds that if a retiree has an opinion to call Retirement Office and voice whether for or against. He says the staff won't have time to send out another mailing.
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Q: You couldn't get another mailing out? Isn't the vote to be taken in late September? A: Human Resources Director Marianne Long says her department is more than happy to help Barbara Jo and Jean to send out a ballot vote.
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Q: If the unions and the retirees agree to join the GIC will they lose the privilege of future collective bargaining and program design? A: Under Section 19, a municipality can propose changes to the PEC, who gets to negotiate the co-pays, deductions, and premium splits. The total cost is not negotiable. In municipalities that join the GIC, the only item left that is subject to collective bargaining is premium splits.
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Q: Under Medicare, if a person doesn't join at age 65 and begin to pay the Part B premium, s/he can be subject to penalties and paying higher premiums when s/he does join later on. A: With the GIC, the penalty for late entrance will be paid by the City of Melrose, not the individual member enrollee.
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Q: Is the $3,000 out-of-pocket maximum per item of annually? A: It is the individual maximum, the total out-of-pocket spending, annually.
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Q: Which plan is closest to Medex? A: There are two – UniCare OME and Harvard Pilgrim Medicare Enhance. They give you the freedom to live somewhere else. You'll have to study the yellow handout to see what is best for you. Tufts has two very good Medicare supplemental plans if you are only going to live in Massachusetts.
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Q: Could you explain the difference between people who are Medicare eligible and those who will never be? A: Massachusetts opted out of immediate participation in the Medicare program for municipal employees. Those people who have retired and will never be Medicare eligible will pick from plans for active employees and non-Medicare eligible plans (pink handout). With the GIC, if you or your spouse is Medicare eligible, you must pick from the Medicare supplemental plans (yellow handout). These cost less money because considerable costs are picked up by federal taxpayers.
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Q: I'm Medicare eligible and so is my wife. All of the plans on the yellow handout are individual plans. Do I multiply those premiums by tow? A: The Medicare plans are based on individual eligibility. A husband and wife pays two individual premiums times 70%. The City will pay 30% of the cost of the Medicare supplement plan.
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Q: I have Medicare Part B and an HMO. I'll be reimbursed for the Medicare payment? A: With the GIC, you will pay the Medicare Part B payment and the City will reimburse you 70%. Whether it's quarterly or semi-annually has not been determined.
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Q: We have Express Scripts now. Do these other plans compare with that? A: The GIC plans have extensive use of mail order programs but there are differences between them.
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Q: Are you allowed to have three insurances? A: You're allowed to have 100 insurances but it might be a bad decision. You don't want to be over-insured. You only need enough insurance to cover yourself. If you're Medicare eligible you need Medicare Parts A and B and a Medicare supplemental plan.
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Q: Are we paying 70% or 86% for the plans on the yellow handout (plans for Medicare Eligible Retirees and Survivors)? A: Based on the materials in the packet, you'll pay 70% for the Medicare plan and 70% for Medicare Part B premium.
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Q: How long is the GIC contract? A: A municipality can join for three years or six years; Melrose will opt for three years.
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Q: Do you need a referral from a Primary Care Physician with the plans listed on the yellow handout? A: Some do – the lowest cost plans and the managed care plan require a referral.
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Q: What about the most expensive one, Harvard Pilgrim Enhanced? A: No referral is needed; it's an open network.
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Q: Is there a gap on prescription services? A: No. These are comprehensive plans that fill the gap.
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Q: This is complicated information. Is there a number we can call to clarify questions we have? A: You may call the Human Resources Department at 781-979-4145 or email twhite@cityofmelrose.org. You may also call the Retirement Office at 781-979-4150 and leave a message for J.P O'Neil. You may also call Marianne Long at 781-979-4146 or email her at mlong@cityofmelrose.org. Additionally, the GIC website is an extremely rich source of information: www.mass.gov/gic. It lists doctors, drugs, benefits and wellness programs.
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Q: Assuming I go with an indemnity plan and my wife is 9 months younger and is not Medicare eligible; which plan would I go on? A: One of the UniCare plans. The GIC has three employees that answer all Medicare eligible and almost Medicare eligible questions.
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Q: If I won't turn 65 for six months, could I go with an HMO for the first 6 months and then switch to a Medicare supplemental plan? A: Yes.
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Q: How many city and towns are in the GIC? A: In addition to all state employees and retirees, there are 10 municipalities today and two more have submitted paperwork for the year starting July 2009.
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Q: How many have considered it and decided not to go forward? A: Mr. Brouder says he has been involved with 35 reviews. Last year about 20 communities looked seriously at joining. Ten joined. Almost every municipality is looking at the GIC because it's a no-brainer – it saves money. It's a whole other step when the PEC is created. A smaller number of communities have gone further and none has gone to this level of public meetings.
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Q: I'm currently a PPO member. I'll save 1% on the premium and my co-pays will increase. My union will lose negotiating ability. Is there any one reason to join the GIC? A: You'll need to calculate your expected costs by putting in the number of events. Page 4 of today's handout compares HMO Blue with two of the GIC PPOs. In this example using the same number of medical services, this person ends up $1000 better off than with HMO Blue. Folks that have joined the GIC are saving money. You have to do the arithmetic.
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Q: Medicare Part B reimbursement. I'll be turning 65. Will I be reimbursed? A: If you are Medicare eligible and will be enrolled in a Medicare plan, you are eligible for reimbursement and you will receive it.
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Q: Are preexisting conditions covered? A: 100% yes. State law mandates that providers can't exclude people for preexisting conditions who have had continuous insurance coverage.
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Q: On the yellow handout there are 5 plans listed. To the left is Blue Cross Medex. Is that one included in the GIC? A: Medex is not included. Blue Cross of Massachusetts does not participate in the GIC.
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Q: In a household, the husband is Medicare eligible but the wife has two years to go before she's Medicare eligible. Which plan does she go on? A: The husband will enroll in a Medicare eligible plan; his spouse enrolls in a linked plan. Each person gets an individual plan.
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Q: One spouse is Medicare eligible and one isn't. The choices are UniCare and Fallon? A: No. There is a Harvard Pilgrim option and a Tufts option available on the pink handout.
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Q: Those are not HMOs – they’re PPOs. A: Correct. Most people are joining either Harvard Pilgrim or Tufts.
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Q: As a non-Medicare eligible person, what factors are used to determine to enroll in an HMO or PPO? A: Start by narrowing down options with a sense of how you use medical services. See which plans look attractive to you. Call your physicians and ask if they participate in the various plans. Some HMO plans cover some hospitals and not others. Do a little homework. All of this information may be gotten from physicians, the GIC website or the GIC operators. In Melrose, the majority of active employees are enrolled in HMO plans. In the GIC, very few are enrolled in HMO plans.
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Q: The BCBS Comprehensive Major Medical plan has a lifetime maximum out-of-pocket. Do the GIC plans have an annual maximum feature? A: None of the GIC plans have annual maximums or lifetime maximums.
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Q: Am I to understand that if I'm dissatisfied with the plan I've chosen that I can choose another plan the next year? A: Yes. The GIC has open enrollment every year.
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Q: I'm looking at two different plans because my husband has Medicare and I'll have it in October. Why is the Medicare plan less expensive? A: The Federal government picks up the lion's share of the cost. The Medicare plan supplements the costs.
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Q: Why is there $400 difference between the two plans? A: You are looking at the full cost of the premium, not the cost after the City's contribution.
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Q: I'm on a plan with a maximum out-of-pocket but it looks like these plans don't have that. A: If you have the option to enroll in a plan without a maximum, you should join it.
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Q: Is there any possibility that BCBS will come up with a similar plan? A: They are doing that. BC has developed a product called Municipal Blue which looks like the GIC plans. There is a hearing aid benefit and a tired network of providers. They brought the rate they charge municipalities down, like Harvard Pilgrim and Tufts.
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Q: Within the GIC, not everyone is in the same plan. Can the City restrict the number of choices of plans? A: No, but you can only choose from the plans that are in your area.
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Q: Do we lose Section 19 bargaining if we join the GIC? A: No. Section 19 is the only way the City can join the GIC.
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Q: Are generic drugs Tier 1? A: Ten years ago there was only one co-pay for drugs; there are up to five tiers now. Generic drugs are manufactured by more than one company, causing the prices to drop dramatically. 70% of drugs are generic, 20-25% are brand name, and 10% are nonformulary brand names, which are the highest co-pay. Therapeutic alternatives exist in Tier 2.
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Q: It appears that there is a 24 month period between eye exams. A: One reason is that all active State employees have access to supplemental vision programs; municipal employees are not part of that program.
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Q: I'm the primary insurance carrier. If I die will my husband be covered? A: Coverage for surviving spouses is a local decision, not the GIC's. Melrose covers surviving spouses.
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Q: Can the State, in the future, make us join the GIC? A: There have been several proposals. The one to remove health insurance coverage from collective bargaining was defeated. Others require cities and towns to bargain but negotiations are restricted to either the co-pay or the premium splits. This proposal to allow municipalities to join the GIC was a democratic decision with debate and discussion. It was a joint decision between labor and management. It's unknown what it will look like in 2 years.
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Q: If I was non-Medicare eligible before retiring but since retiring I am working and having Social Security deducted, is it advantageous to join Medicare? A: It is advantageous to get on Medicare. To be Medicare eligible either you or your spouse paid into Social Security for 40 quarters (10 years) and both spouses reach age 65.
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Updated 8 September 2008