We want to start by asking YOU, our MARSP members, to help us disseminate this information to the 100,000+ MPSERS retirees who are not members and may not have listened or read carefully enough to know that these changes are happening. Remind them that if they were members of the organization, they first would have had information in September. Please refer to your copy of the September-October VANGUARD centerfold for the latest MARSP brochure to assist you in convincing your friends and former colleagues that MARSP is the organization for you and them. Then go to page 4 of that issue for the first notification of changes effective January 1, 2010.

After costing out the MPSERS Master Health Care Plan for retirees with original Medicare versus the reimbursement slashed Medicare Advantage (MA) plan for 2010, the board was informed that it would cost $62 million more to remain with Medicare Advantage for 2010; Original Medicare would in fact save money for retirees and schools. The health insurance committee considered several options, such as reduction in covered services, elimination of certain classes of drugs, larger increases in out-of-pocket costs, and other Medicare Advantage (MA) Preferred Provider Organization (PPO) options. Even with the return to original Medicare, there were still some cost gaps; so at the October meeting the MPSERS Board added other changes to the September announcement.

Following is a comprehensive review of all of the changes in your MPSERS Master Health Care Plan which take effect on January 1, 2010, as we know them at this writing. There are still some DETAILS that need to be worked out before implementation, so some of these items may change ever so slightly. HOWEVER, the plan benefits/coverages are almost exactly the same as they were in 2009. Members should have received a summary of benefits in the mail in December.

Medicare retirees return to Original Medicare with BCBSM Supplemental (which is your FREE Medi-gap plan from MPSERS); just as it was before Medicare Advantage

· You MUST use your Medicare Advantage card through December 31, 2009

· Medicare will automatically send new Medicare cards to all current MPSERS MA subscribers before January 1, 2010; you have to DO NOTHING

· DO NOT use your Medicare card before January 1, 2010

· You will automatically receive a new MPSERS/Blue Cross Blue Shield of Michigan card; you have to DO NOTHING

· DO NOT use the new BCBSM card before January 1, 2010

Prescription drug premium added

· $10 premium per month per contract (i.e., retiree with dependent(s) is one contract) from MPSERS pension check ($120 per year)

· Applicable to BCBSM contracts only, HMO contracts not included

· No more than $12.00 per month for 2011 ($144 per year)

· Medicare Part D is automatically retained as the MPSERS pharmacy plan with Medicare – you DO NOTHING

Ø Medicare retirees cannot have more than one prescription plan

Non-formulary drugs NOT covered when generic is available

· Retiree pays 100% of cost of non-formulary drug when generic is available

· MPSERS/BCBSM personally notified each retiree currently affected

· Current drug medical necessities/prior authorizations should be honored

Annual deductible and coinsurance maximums raised

· Deductible $400 ($250 in 2009)

· Medical coinsurance maximum $700 ($500 in 2009)

· Pharmacy coinsurance maximum $1,000 ($800 in 2009)

Emergency room copayment added

· $50 per visit ($0 in 2009 after deductible and coinsurance maximums met)

· Once the coinsurance maximum and deductible maximums have been met, emergency room services will be subject to a flat $50 copayment with no maximum; UNLESS you are admitted directly from this visit, in which case it is waived

Enhanced mental health benefit

90% coverage for outpatient and physician visits (50% in 2009)

Enhanced Hospice benefit

Expanded to 12 months of coverage (6 months in 2009)

New VENDOR for prescription drug benefit

· Catalyst Rx will replace BCBSM for retail/local and MEDCO for mail order pharmacies

· All existing drug records will be transferred to Catalyst

· Retirees will not need to get new prescriptions from the doctor

· Catalyst uses the drug interaction program

· Catalyst has MI contracts; already works with MI pharmacies for 30-day supplies

Ø Retail/local pharmacies that agree to match the Catalyst mail order pricing for 90-day supplies will still be allowed for Medicare members only

· Non-Medicare members cannot purchase 90-day supplies from retail/local pharmacies

· Catalyst has a discount program similar to BCBSM

· Catalyst formulary should look very similar to the current program

· Catalyst step therapy, for those who use it, will work similar to the current program

· Catalyst should honor current prior authorization

· Retirees will have new card before January 1, 2010

Expansion of “LivingWell” program – originally called “Healthy Living” program

The LivingWell program works with members to help you to understand your current health status and gives you tools so that you can work toward a healthier lifestyle. LivingWell also provides members with the opportunity to make your copayment and deductible maximums lower as you work toward your health goals.

Because Medicare members completed the Health Assessment when they enrolled in the Medicare plan, they will be considered “LivingWell” for 2010 and enjoy the reduced deductible and copays; but will need to complete a new form received from BCBSM in September 2010 to continue those discounts.

Non-Medicare retirees in the BCBSM PPO completed a Health Risk Assessment form and returned it to Blue Cross Blue Shield of Michigan by December 1, 2009, (NO EXCEPTIONS!) which qualified them for $100 each off on the maximum deductible, medical coinsurance and pharmacy coinsurance. If you returned your assessment form on time, your 2010 annual maximums will be:

· Deductible $300 ($250 in 2009)

· Medical coinsurance maximum $600 ($500 in 2009)

· Pharmacy coinsurance maximum $900 ($800 in 2009)

The form was mailed about October 16^th and was NOT available online this year. If it was not returned by December 1, 2009, you will not be eligible until 2011. The annual form will be mailed from BCBSM each year in September; it may be online late in 2010.

Non-Medicare retirees who are in the HMOs did NOT receive the form because they did NOT need to return it to the HMO; the HMO already has lower out-of-pocket costs.

How to avoid additional cost

· HMO options, in Michigan’s Lower Peninsula ONLY

Ø HMOs have lower premiums – no $10 drug premium

Ø HMOs have more wellness benefits

Ø HMOs generally have lower copayments on services

Ø Click here for the HMO Program Option

ü all necessary information and phone numbers are in that publication

ü you can transfer from the PPO into the HMO anytime you wish; 45-day turn-around period

ü you must remain in the HMO for 6 months before transferring back to the PPO plan, 45-day turn-around period

ü the 2010 HMO comparisons will be on the MPSERS website soon; www.michigan.gov/orsschools

ü the 2010 HMO program will not be a pilot, it is now a permanent option in the plan

· Medicare assistance with premiums for low income (we are investigating this avenue and will report in the next issue)

· Discuss generics with your doctor(s)

Dental and vision contracts

There are NO CHANGES in the dental and vision contracts for 2010

Hearing aid benefit

There are NO CHANGES in the hearing aid benefit for 2010

2010 premium deductions from MPSERS check

MPSERS will release 2010 premium information in December (this is written in November)

Total out-of-pocket in 2010 with formulary drugs and “LivingWell” in the BCBSM PPO and Supplemental (Medi-gap) plans

For HMO information, check the comparison document or call the HMO

$300 deductible

$600 medical coinsurance

$900 prescription coinsurance

$1800 total

Other information

· Medicare Part B premium in 2010; see www.medicare.gov

Ø $96.40 (no increase) for those who currently have their premiums deducted from their Social Security check (73% of ALL beneficiaries) with incomes of $85,000 or less ($170,000 joint filers)

ü $0.00 deducted from MPSERS check for retiree since the Supplemental (Medi-gap) is FREE to MPSERS retirees on Medicare; dependent premiums to be set by early December still apply

Ø all others will be $110.50 (including those with income less than or equal to $85,000 who are married but file separately)

Ø New Part B beneficiaries on or after January 1, 2010, will pay $110.50

Ø Current and New Medicare Part B beneficiaries with incomes above $85,000 ($170,000) will have higher premiums based on the income related monthly adjustment amount

· There will be no Social Security cost of living adjustment in 2010; and probably not in 2011

For further information contact staff-marsp@marsp.org.