PURA Health Insurance News
Other PURA Health Benefits
Silver Sneakers fitness program
In the event that an individual on the PURcare plan (Senior Supplement + Part D) is admitted to the hospital as an inpatient, Medicare Part A will pay for all drugs that are received, including self-administered drugs. “Self-administered drugs” are drugs prescribed by a doctor prior to entering the hospital that you would normally take on your own. The only responsibility of the plan participant will be that of their typical cost share for the inpatient hospital stay.
A retiree enrolled in the Group Medicare Advantage plan who is admitted as an inpatient will pay only their Hospital per-day copayment; self-administered drugs will be covered.
When a member of the PURcare plan is kept in the hospital on an observation basis, payments for the medical services would be covered under Medicare Part B, which does not cover self-administered drugs under any circumstance.
Under observation, the plan member in PURcare or the Medicare Advantage plan will be billed for self-administered drugs and will be expected to pay the hospital. The member must file a claim for reimbursement under their Part D prescription drug plan. The Part D plan will reimburse the member on an out-of-network basis which will put all the prescription drugs in a Tier 3 level cost share or copay. The plan will only reimburse the cost of the drug up to an amount that is comparable to a contracted rate; any difference between the charged amount and the reimbursed amount will be the responsibility of the plan member.
Contact the UnitedHealthcare Customer Service number on the back of your Part D or Medicare Advantage ID card to ask for the “Direct Member Reimbursement Form” for prescription reimbursement. If you have questions or problems, please contact Kate LaMar, Human Resources, at firstname.lastname@example.org or (765) 494-1694.
Yes! The inpatient or observation status of the patient affects Medicare and supplement insurance payments to the hospital, to skilled nursing or rehabilitation facilities, and for prescription drugs. Administrative personnel at Lafayette area hospitals, St. Elizabeth East Hospital and IU-Arnett Hospital, responsible for compliance with Medicare rules provided the following information. A hospital’s failure to comply with Medicare rules can result in the hospital not being reimbursed for services and possible fines.
Inpatient admitted status is covered by Medicare Part A. Observation status is covered by Medicare Part B. Currently the hospital is reimbursed $4400 a day for Part A inpatient admission and $400 a day for observation. Insurance coverage with PURcare and other Medicare supplement plans and different Medicare Advantage plans varies depending on the plan.
Important information for you or an advocate to remember when you or a loved one is hospitalized:
- You should select an advocate before you enter the hospital to speak for you and ask questions in case you cannot.
- The admitting physician determines whether the patient is admitted as an “inpatient” or admitted “for observation”.
- Observation—the admitting physician believes the problem can be resolved in less than a 2 midnights stay. If not resolved in 2 midnights, the status may be changed to inpatient. However, this does not happen automatically.
- Inpatient Admission—the admitting physician believes 3 or more midnights and specialized treatment or care is needed.
- A patient is not necessarily told whether he/she is admitted as an inpatient or under observation. The patient or the advocate must ask.
- The physician’s decision on inpatient admission or observation status is reviewed by a case management team to insure that Medicare rules are met. If more information is needed, a hospitalist or a specialist’s opinion may be sought. Medicare rules state that observation status cannot be appealed. However, one hospital administrator suggested talking to the case management nurse if there are questions about the patient’s observation status.
- After outpatient surgery certain conditions may warrant further outpatient observation. Depending of care needed, the patient or advocate must ask whether the status is observation or inpatient admission.
- There is no Medicare coverage for prescription costs when in observation status. The prescription bill must be paid by the patient. The patient can then file a claim with his/her Part D prescription plan for reimbursement. The claim may or may not be paid depending on the insurance policy.
- A patient must have inpatient admission status over 3 midnights to be eligible for Medicare to cover a skilled nursing or rehabilitation facility stay. Medicare covers up to 100 days in a skilled nursing facility when meeting Medicare requirements.
- PURcare Senior Supplement coverages continue for day 101 and beyond, if the patient continues to meet Medicare requirements.
- Medicare Advantage plans do not have a 3 midnight inpatient requirement to be eligible for a skilled nursing or rehabilitation facility. Coverage is provided up to 100 days if the patient continues to meet Medicare requirements.
The Benefits Committee of the Purdue University Retirees Association (PURA) has renewed the PURcare and Medicare Advantage PPO group health insurance plans with United Healthcare (UHC) for 2016 with a reduction in premium for PURcare members and no premium increase for Medicare Advantage members.
The goals of the committee were to maintain the very best medical and drug insurance plans with the lowest premiums possible, while maintaining your ability to manage your health care with your Medicare doctor. The committee worked to position the plans for the future when escalating costs in the healthcare industry, rapid cost increases in prescription drugs and the reductions in federal subsidies are anticipated to continue.
After three months of work by the committee, consultants from Aon Hewitt and the staff of Purdue Human Resources, a renewal has been accomplished. PURcare, the Purdue sponsored Senior Supplement plan and Part D Prescription Drug Plan, will continue for 2016 with the same medical/vision benefits. The total premium will be $263.96 per member per month, a 4.4% reduction in the premium from 2015. How did we do that?
For the PURcare Prescription Drug Plan United Healthcare originally proposed a 23% increase for the same plan as 2015. The reasons given for such a dramatic increase were:
- Escalating costs of all drugs, especially generics and specialty drugs,
- Changes to member’s cost sharing during the Gap stage (Donut Hole) with Maximum Co-Pays implemented in 2013,
- The introduction of several new and very expensive specialty drugs often used to treat cancer, Alzheimer’s disease, diabetes, depression and other life threatening illnesses.
The committee could not accept a 23% increase, therefore we reviewed several options over the past 2 months to find a way to control the escalating cost of premiums. United Healthcare presented an option called CMS minimum gap coverage, in which members would pay 58% of the costs for generic drugs and 45% for brand name drugs in the Gap, until they reached the 2016 Catastrophic stage at $4,850 True Out-of-Pocket (TrOOP) costs. PURcare members pay nothing for prescriptions in the Catastrophic phase above the $4,850 TrOOP.
This is similar to the plan design prior to 2013, when members paid 50% of the cost of all covered prescriptions at retail drug stores. Such a plan works very well into the future, when in 2020 members will only pay 25% of drug costs in the Gap. Returning to a percentage in the Gap with no maximum copays helps us take full benefit of the reductions in cost sharing in the Gap legislated for the next four years.
The PURcare total premium for medical/vision and prescription coverage for 2016 will be $263.96/member/month. This is excellent coverage that remains very competitive in the market. Members will save $12.26 per month (or $147.12 per year) compared to 2015. Members with Rx coverage from the Veterans Administration - for 2016 the PURcare Supplement only premium will be $189.70/member/month.
Medicare Advantage PPO Plan
For The Medicare Advantage PPO Plan, United Healthcare proposed a 5% increase in premiums. The committee negotiated to have no increase in premium with changes to the co-payments for Office Visits and Emergency Room services, and the Maximum Out-of-Pocket amount:
- Primary Care office visit $20
- Specialist office visit $35
- Emergency Room $75
- Maximum Out-of-Pocket $3400/calendar year
Without some plan changes the premium would have increased by 5% making it very difficult for some of our members to continue on the plan. The survey of our members indicated they didn’t want the premium to rise, and if a change had to be made to maintain a level premium, they would recommend changes in the co-pays. Even with these changes the plan is well below the industry trend for costs and remains a good and competitive buy for our members. The reduction of subsidy from Medicare started last year and will continue until the plans are not subsidized by Medicare in the year 2020.
For 2016, the premium for the Medicare Advantage Plan will be the same as for 2015 at $208.49/member/month.
Members Enrolled Who Do Not Want to Make a Change
Members enrolled in either of the retiree group plans who do not want to make a change: your coverage will automatically continue for 2016 – no re-enrollment.
If You Terminate Your Purdue Retiree Group Coverage for a Non-Purdue Plan
If you decide to terminate your Purdue Retiree group coverage for a non-Purdue plan, you will not be able to join again at a later time.
The Purdue University Retirees Association (PURA) Benefits Committee and Purdue University Human Resources desired to have in place a member eligibility for enrollment and continuation in any Health Insurance Plan offered by PURA and a termination policy to govern members with 90 days of past due health insurance premiums. Due to various reasons some of our members have not been able to keep current on their premium payments to UnitedHealthcare. The Benefits Committee of PURA working with UnitedHealthcare has developed such a policy effective September 1, 2015. Under the Affordable Care Act UHC can’t terminate a member’s insurance without a policy supported by the sponsoring group.
Eligibility and Enrollment- All official retirees of Purdue University (55 years of age with 10 or more years of service) and their spouse who are Medicare eligible may enroll in Health Insurance Options offers by the Purdue Retirees Association (PURA) in partnership with Purdue University.
All individuals desiring health insurance through one of the PURA plans must individually enroll in the selected plan through the designated staff of Purdue Human Resources.
All members of any PURA sponsored health insurance plan must pay their premiums on the schedule set forth by United Healthcare (UHC).
Involuntary Termination Policy:
All members of any plan must pay their premiums to UHC on a schedule determined by UHC. Failure to pay premiums will result in the member receiving a past due invoice.
Members who disagree with UHC on any past due premiums by reason of payments made and not recorded or others reasons for disagreement of payment due will have an appeal process to resolve such disagreements.
Failure to pay premiums will result in the forfeiture of eligibility and termination from the plan. No action will be taken to terminate coverage during the first 60 days of delinquency (grace period).
At the end of 90 days of past due premiums, (equivalent of three months of total premiums due) if the member has not responded to the past due invoice by making a full payment of past due amounts, a letter will be sent by UHC indicating that the members coverage will be terminated due to no longer meeting the eligibility requirements for the Purdue/PURA sponsored health insurance.
This letter will be sent at least 21 days prior to the effective termination date to provide the member opportunity to purchase another plan so that they will not have a gap in coverage.
Claims with a date of service provided after the specified termination date will not be considered for payment by UHC. Claims with a valid date of service provided prior to the termination date will be adjudicated and paid according to the plan benefits.
Voluntary Termination: Voluntary termination will result from death of the member, member ineligibility due to moving out-side the United States or by cancellation of the policy at the end of a calendar year. Voluntary termination does not remove the member’s obligation to pay premiums until the time of termination.
Special Note: Members who have past due premiums of 60 or more days prior to the implementation of this policy will be contacted by the Purdue Human Resources Department to work out a plan for each member, if they desire to continue health insurance through PURA.
The Benefits Committee monitors the medical plans for retirees, evaluates changes, and investigates alternatives where advantages may be gained.
A key part of the execution of this committee's responsibilities is through the support provided by the Purdue University Human Resource Services department that handles the communication, gathers additional vital data, and provides a focal point for problem resolution.
The committee also strives to keep retirees aware of additional University benefits and privileges and promotes program improvements where possible.
Questions concerning the PURA health care plan should be sent to Don Gentry, Chair, at email@example.com
Purdue retirees and spouses are eligible for membership to this or any other PURA committee. Appointments are for a three-year term with membership limited to six consecutive years (two three-year terms). Anyone interested in joining this or any other committee should contact the committee chair.
Guidelines Utilized by the PURA Benefits Committee In Selecting a Health Insurance Plans and Provider
Medicare Senior Supplement Plan (PURcare):
- Any Senior Supplement plan and provider of the insurance must be able to serve our PURA members wherever they live.
- The plan must give complete freedom for the member to select any doctor or provider of health services that accept Medicare patients.
- The plan must cover medical and prescription drugs.
- Any prescription drug plan must cover any legal drug prescribed by a doctor.
- The insurance company must have a good reputation for service in the industry.
- The plan must cover emergency healthcare services while the member is traveling outside the United States.
- The plan must have a market competitive premium with the lowest possible annual deductible rate and with no or very low co-pays or other out-of-pocket costs to the member.
- The plan must be comprehensive with marketing advantages over off the shelf plans provided by the insurance company.
Medicare Advantage or Preferred Provider Organization Plan
- The Plan and provider of the insurance should be able to serve our PURA members wherever they live in the State of Indiana.
- The plan must cover medical and prescription drugs.
- The insurance company must have a good reputation for service in the industry.
- The plan must have a market competitive premium with competitive co-pays and other out-of-pocket costs to the member.
Learn more about the "Road to Retirement" hereGo to top
Retirees Benefits Committee Update
Members of PURA Health Insurance plans may pay their premiums for the entire year, pay by the month or use automatic monthly bank debits for the premium payments, known as Electronic Funds Transfer (EFT). EFT is highly recommended as a reliable and convenient way to make your premium payments. A member can change their method of payment anytime throughout the year. A large number of our members use this method and have experienced no problems. If you are interested in making a change in your payment method, contact Kate LaMar at 765-494-1694.
PURA members continue to receive outstanding support from Purdue Human Resources. Our support person for health insurance is Kate LaMar. Please email or phone Kate with questions at firstname.lastname@example.org or 765-494-1694. Any questions related to PURA activities, updating your contact information (mailing address, email address) please phone or email Michele Salla at email@example.com or 765-494-1779.
A UnitedHealthcare Benefit for PURcare and Medicare Advantage PPO Retirees
SilverSneakers is a fun, energizing program that helps older adults take greater control of their health by encouraging physical activity and offering social events. SilverSneakers provides a fitness center membership to any participating location across the country. You can join a center close to where you live or at any participating location while you’re traveling.
- Access to conditioning classes, exercise equipment, pools, sauna and other available amenities in participating centers
- Customized classes
- Health education seminars
- Specially trained Program Advisors at fitness centers
Cordova Recreational Sports Center Open For Silversneakers
The wait is over! All PURA Health Insurance participants are now eligible to use the Cordova Recreational Sports Center at no charge.
To use the Cordova Recreational Sports Center either take your current Silversneakers card plus your Purdue ID, or, if you do not have a Silversneaker card, take you PURA United Healthcare medical card and your Purdue ID to the registration desk to get instructions on using the facility. If you do not have a Purdue ID, take a photo ID with you and the registration desk will put you in the system.
PURA and its over 2500 Health Insurance members participants are most appreciative to Purdue University and particularly thank Howard Taylor, Director of the CRSC for making this benefit available to our members.
Would you like to know more about SilverSneakers?
To check out the benefits and locations, visit the web site, www.silversneakers.com .
Participating Fitness Centers in the Lafayette/West Lafayette Area:
- Cordova Recreational Sports Center, Purdue University
- Lyles-Porter Hall, northwest corner of Harrison & University Streets, West Lafayette
- Club Newtone, 725 Sagamore Pkwy N., Lafayette
- Lafayette Family YMCA, 1950 S. 18th St., Lafayette
- Snap Fitness – Lafayette, 3830 State Rd. 26 E., Lafayette
- Snap Fitness – West Lafayette, 2060 US 52, West Lafayette
- Curves (women only), 441 Sagamore Pkwy., West Lafayette
- Curves (women only), 2200 Elmwood Ave., Lafayette
- Curves (women only), 3613 18th St., Lafayette
To participate or to just take a tour, take your UnitedHealthcare Medical Insurance card to a location of your choice.
If you are a member or want to see if you are eligible, please call:
Toll-free: 888-423-4632, Monday - Friday, 8 a.m. - 8 p.m. EST.
Retirees on Purdue Health Plan, Purdue Health Plan Plus HSA 1 or Purdue Health Plan Plus HSA 2 Can Use Center for Healthy Living
Purdue’s new Center for Healthy Living opened Feb. 27 in the Purdue West Shopping Center at 1400 W. State St. The center serves benefits-eligible employees, retirees and their dependents covered on the Purdue Choice Fund, Purdue Incentive or Purdue Copay medical plans. Retirees must be covered by one of these three medical plans to be eligible to use the center. Retirees 65 and over with United Healthcare (PURcare and Medicare Advantage PPO) are not eligible to use the services of the Center for Healthy Living at this time.
For more information about the center, including services, costs and hours, visit www.purdue.edu/healthyliving. For questions, call the center at 765-494-0111 or contact Purdue Human Resources at 765-494-2222.
ATTENTION FUTURE PURDUE RETIREES!
Are you concerned about Medical and Prescription Drug Insurance after you retire?
As you plan for your retirement the decision you make on Supplemental Medical and Prescription Drug health insurance will be one of your most important decisions. There are lots of choices and if you are healthy now you may be tempted to buy the cheapest available plan. However, we suggest that you consider that as you grow older your medical and drug needs will most likely increase—maybe exponentially. The old adage of “pay me now or pay me later” applies here. Find out more about the Purdue retiree's group insurance plan, PURcare, here.