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Chapter 1 – Welcoming remarks and overview

Welcome to this web video that will help you learn more about your Aetna Medicare Advantage plan offered by the UAW Retiree Medical Benefits Trust (which from now on we’ll call “the Trust”).

At some points during this video we’ll reference the Aetna “Cruising ahead” informational brochure you received in the mail, so you may want to have your brochure handy before we continue. You can also download this brochure from our website (uawtrust.aetnamedicare.com).

OK, now let’s get started! There are important changes happening to your medical coverage for 2018. We’re here to help you understand those changes.

So, what exactly is happening? To start, you’ll be automatically enrolled in the Aetna Medicare Advantage plan effective January 1, 2018 unless you choose another available plan option in your area. If you are a member of the protected group, you’ll need to elect to enroll in the plan by calling Retiree Health Care Connect (RHCC). It’s important to note that this change will not affect your prescription drug, your dental coverage, your vision coverage or your hearing aid coverage. Those coverages will remain with the current vendor.

You may be wondering why the Trust chose our plan. After a detailed review, the Trust determined that Aetna demonstrated a good balance of quality, network scope and savings for both you and the Trust in your area.

The Aetna Medicare Advantage plan includes comprehensive coverage, including 100 percent coverage for most preventive services (examples include: your routine physical exams, mammograms and colonoscopies).

This plan also has predictable copays for most medical care, including a $20 primary care copay and a $25 specialist copay. We’ll talk about how these copays work a little later in our presentation.

The plan has benefits that complement your doctors’ care, like a healthy home visit. There’s also lower costs’ including a $0 monthly contribution, a lower deductible and a lower out-of-pocket maximum. The plan also includes more benefits than your current plan.

We recognize that you are on a unique health journey. We want to join you and support that journey. We are going to do that by making health care simpler, helping you save money and supporting you with programs that are tailored for your needs. We’ll come back to these ideas during this video.

We’ve developed this video to help you understand important changes that are happening to your medical coverage.

We’ve divided this video into six chapters.

Chapter 1: Welcoming remarks and overview

Chapter 2: About Aetna

Chapter 3: Let’s talk about your doctors

Chapter 4: Simplicity and a cost share review

Chapter 5: Support programs

Chapter 6: Reasons to love the plan and what you can expect next

Chapter 2 – About Aetna

So who are we here at Aetna? First, I’m pleased to tell you that Aetna has been providing coverage to a subset of Trust retirees since 2012. We’re one of the country’s largest health insurers, and we have over 164 years of experience. As a matter of fact, Aetna paid the very first Medicare care claim in 1966.

We’re devoted to helping our over 1.4 million Medicare Advantage members manage and improve their health. We’re also a highly rated plan based on quality that CMS measures. CMS is the Centers for Medicare and Medicaid Service, or the government agency that oversees Medicare. Every year CMS gives Medicare Advantage plans a Star rating, and our national plan received 4 out of 5 stars. This means our plan is highly rated on important measures like: member satisfaction and service, helping you stay healthy and helping you manage your long-term conditions.

Our mission is to build a healthier world for retirees. To us, this means simplifying the health care experience. At Aetna, we want to help you reach your full potential in life, however you define it. We want you to be happy and healthy and to have the support you deserve during your retirement.

After you try the plan, we think you’ll love it. As I mentioned earlier, many of your fellow Trust retirees have enjoyed this plan since 2012.

Trust members are very happy with the plan. In fact, 97 percent are satisfied with the plans coverage and benefits.* How do we know this? Every year, we conduct a survey specific to retirees covered by the UAW Trust to ensure they are satisfied with their coverage. And again, 97 percent of UAW Trust retirees expressed satisfaction with this plan’s coverage and benefits.

We also talked about savings, and with the Aetna plan you have no monthly contribution. So you will save at least $204 per person, per year compared to the other Trust health plans. You can save even more because the Aetna plan also has lower deductibles and out of pocket maximums.

 *2016 Aetna Medicare Advantage Trust group plan member satisfaction survey

Chapter 3 – About your doctors

Now let’s talk about your doctors. We know the most important thing for our retirees when reviewing health plan options is, “will my doctor take this plan?” So we want to make sure we spend plenty of time covering this topic.

I’m going to talk about two different plans. First, the Aetna Medicare Advantage PPO plan, or Preferred Provider Organization plan. Second, we’ll talk about the Aetna Medicare Advantage ESA plan, or Extended Service Area plan.

You can refer to your “Cruising ahead” packet if you aren’t sure which plan applies to you in your area. And if you don’t have your packet, you can call us at 1-855-406-4062 (TTY: 711), Monday through Friday, 8 a.m. to 6 p.m. all time zones. Our customer service representatives will be able to tell you the plan that is available in your area.

First, let’s spend some time talking about the PPO Plan.

We want you to know you’re covered, wherever you are in the country. We have a large, national network of doctors and hospitals, and you can see doctors nationwide. This means if you’re a retiree who likes to travel out of state, you’ll still have access to our network of providers.

Let’s say you’re traveling out of state and you want to see a doctor for a routine physical – in that situation, you’ll have access to our network doctors.

Our customer service representatives are available by phone to help you find an in-network provider or doctor no matter where you are in the country.                                   

With this plan, you also don’t need a referral to see specialists. This means if you want to see a specialist, you don’t need to go get a referral from your primary care doctor prior to seeing a specialist.

The plan also covers you when you’re traveling outside the country in case you need emergency or urgent medical care. Most foreign hospitals won’t bill Aetna directly, so you might be required to pay out of pocket. In this situation, keep your invoice. You can submit this and a claim form and Aetna will reimburse you based on the plan’s benefits.

Now let’s talk about out-of-network doctors. The Aetna Medicare Advantage PPO plan gives you flexibility to see doctors who are not in our network. But, if you see an out-of-network doctor, you’re going to pay a little bit more out of your pocket. We’ll go over these details when we review the plan benefits a little later in this video.

How do you know if your doctors are in the network? If you’re concerned about your current doctors accepting this plan, you can call us to check for you. You can call the phone number listed on the back cover of your “Cruising ahead” brochure. Our representatives are available Monday – Friday, 8 a.m. to 6 p.m. in all time zones.

You can also visit our website at uawtrust.aetnamedicare.com. But don’t worry if you don’t see your providers there. Our network is continually growing. You can give us a call and we can help you determine whether your doctors accept our plan.

Finally, you can check directly with the office manager at your doctor’s office. They should be able to tell you if they’ll accept the Aetna Medicare Advantage plan.

Now let’s spend some time talking about the Extended Service Area plan, or “ESA” for short.

Earlier, we reviewed the Aetna Medicare Advantage plan PPO network. Now let’s talk about two key differences with the ESA plan.

1. Your doctor does not have to be in our network.

2. You get the same benefits in or out of network. This means if you see an out- of- network doctor, you’ll pay the in-network copay, coinsurance and deductible.

Like the PPO plan, this plan provides coverage nationwide. It also covers you when you are traveling outside the country in case you have an emergency or urgent need for medical care. When traveling away from home, Aetna will help you find a doctor that accepts the Aetna Medicare Advantage plan.

So how do you know if your doctors will accept this plan? As we discussed with the PPO plan, your ESA or extended service area plan is designed to give you the flexibility to see any provider, whether or not they are in or out of the network. With this plan, if you see an out-of-network provider, you’ll pay the in-network cost share.

You should know that most doctors do in fact accept Medicare and accept Aetna Medicare Advantage, but there may be some that don’t. If you’re not sure if your doctor accepts the plan, give us a call. Our customer service reps will be happy to verify that information.

Will my doctors accept this plan? How do you know? Again, as a reminder, these are the ways in which you can find out if your doctor will accept the Aetna Medicare Advantage Extended Service Area Plan:

• Call us if you have questions about certain doctors and/or if you need help finding a new provider. As a reminder, our representatives are available Monday – Friday, 8 a.m. to 6 p.m. all time zones. 
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• And you can also visit our website at uawtrust.aetnamedicare.com where we have an online provider directory. But again, don’t worry if you don’t see your providers there. Our network is continually growing. You can give us a call and we can help you determine whether your providers will accept our plan.

Chapter 4 – Simplicity and cost share review

Now that we’ve covered the provider network, let’s talk about how your new plan works. You should know that the plan you have through the Trust is a highly customized group plan – it’s just for Trust members!

In order to better understand your new Medicare Advantage plan, let’s first give you a quick refresher on how your current plan works today.

Your current plan involves a payment process with many steps, including paperwork from your doctor, Medicare and your current plan.

Today, when you seek medical services, you have to show two ID cards. One is the red, white and blue Medicare card, and the other is the card from your current medical plan.

So what happens after that? Your provider submits the claim to Medicare. Part A makes a coverage determination. Part B makes a coverage determination. Then your provider submits the claim to your current plan. Then, your current plan will make a coverage determination.

After the claim processes, you receive statements from Medicare, your current plan and your doctor. You then need to determine if you owe any money out of your pocket.

There is a lot of paperwork with this process and it can be very time consuming.

Now, let’s look at how these pieces are different for Medicare Advantage. When you go to the doctor, you’ll only need to show your Aetna Medicare Advantage card, and your provider will submit the claim directly to Aetna.

You can put your red, white and blue Medicare ID card away in a safe place, because you won’t need that while you’re enrolled in this plan. For you, that means one ID card, one explanation of benefits and less paperwork. For your doctor it also means less paperwork, and claims are paid more quickly.

Medicare Advantage is simple because it’s an all-in-one plan. That means it’s easy to use. When you go to your doctor for an office visit, you’ll need two things; your Aetna ID card and your office visit copay. That’s $20 for your primary care physician or $25 for a specialist.

Medicare Advantage must cover all Medicare-approved services, so it includes comprehensive coverage similar to your current plan.

Plus it offers extra benefits such as the care advocacy and wellness programs that we’ll talk about in a few minutes.

Now let’s spend some time reviewing benefits. What you see here is a high level overview of the most commonly used benefits. First, will talk about the PPO benefits and then we’ll spend time reviewing the ESA or extended service area plan benefits.

You’ll see two columns here – one for in-network and another for out-of-network benefits. If you recall earlier when we were talking about network, I mentioned this plan gives you the ability to see out-of-network providers, but you’ll pay more out of pocket – that’s illustrated here. For the purposes of our conversation today, I’m going to focus mostly on the in-network benefits because I want you to save the most money.

First, you’ll see the office visit copay of $20. Next, you’ll see the specialist office visit copay of $25. The third row is the emergency room copay of $50. You’ll see that if you look over in the out of network column that $50 also appears. This is because if you’re in an emergency situation, we want you to go to the closest emergency room and you’ll continue to pay your $50 copay regardless of if the hospital is in or out of network. The same also applies for urgent care. There is a $25 in-network copay and a $25 out-of-network copay.  Chiropractic care is covered at a $20 copay. The last three rows are your deductible, your coinsurance and out-of-pocket maximum.Copays will continue to apply after the primary out-of-pocket maximum has been met.

These words may be intimidating to some, so let’s talk through an example of when the deductible/coinsurance and primary out of pocket (OOP) max might apply.

Let’s say you’re in the hospital for a five day hospital stay. You would expect to pay your $245 deductible. Then, you would be responsible for 10 percent and Aetna would pay the other 90 percent. You would pay 10 percent until you reach a $630 out-of-pocket maximum.  So the most you’d pay for that hospital stay is $630.

Now you’re probably wondering what other services apply to my deductible, coinsurance and out-of-pocket max. Things like an inpatient hospital stay, an outpatient surgery, MRIs/CT scans, PET scans – those things would apply to the deductible, coinsurance and primary out-of-pocket maximum.

If you would like to know if your specific service apples to the deductible, coinsurance and primary out-of-pocket maximum, you can refer to the full plan design on page six of your “Cruising ahead” brochure. Or, give us a call, we would be happy to help.

Another important thing about this plan is that after you met the $630 out-of- pocket max, you will continue to pay copays for your primary care office visits, your specialist office visits, or if you have an emergency room or urgent care visit.

Now let’s take a look at one benefit in the out-of-network column, and that’s the primary out of pocket. That’s the last column on this grid. And you’ll see there is a $1,395 primary OOP maximum. This means if you happen to see OON providers, you still have financial protection. The most you’d pay for that plan year, if you’re seeing out-of-network providers is $1,395. Now let’s look at the same benefits for those covered by the extended service area plan.

You’ll see there is only one column for both in- and out-of-network benefits. If you recall from our earlier discussion, I said with the ESA plan you would have the same cost share for doctors – regardless if they are in or out of network.

Now, let’s talk about the benefits. The first row, office visit is $20 copay. Specialist office visits $25 copay. There is $50 emergency room copay, $25 urgent care copay, $20 copay for chiropractic care and then you’ll see the last three rows are your deductible, coinsurance and primary out-of-pocket maximum.

Again, the deductible, coinsurance and primary out-of-pocket maximum will apply if you are inpatient, in a hospital stay, if you have an outpatient surgery, MRI, CT scan, or PET scan. 

If you have a question about if your service applies to the deductible/coinsurance or out of pocket, you can give us a call or refer to your “Cruising ahead” brochure. The full plan design starts on page six.

Now let’s look closer at the costs with this plan and how it compares to your current coverage.

Please know that the information on your screen is also on page five of your “Cruising ahead” brochure. Here, we highlight some services that are important to many of you, such as office visits, emergency room and urgent care.

You can see on the right side of the chart how much you could save with the Aetna plan.

Let’s start with office visits on line two. When you go to see your primary care doctor, with the Aetna plan you will pay a $20 copay. For specialists, it’s $25. But how does it work with your current plan? With your current plan, you are paying 20 percent after the Part B deductible. The Part B deductible for 2017 is $183. This means, you’re paying a $183 deductible at the beginning of every year for office visit coverage. After you meet the $183 deductible, you pay 20 percent and Original Medicare pays the other 80percent.

Many retirees like the Aetna plan because there are predictable copays. This is especially true for specialist office visits. With this plan, you know exactly what you’re going to owe for office visits - $20 or $25.

Line four shows your deductible of $245. This compares to a $400 deductible with your current plan.

The next line shows the annual primary out-of-pocket max of $630. That’s compared to $800 with your current plan.

The emergency room copay on the Aetna plan is $75 cheaper and the urgent care copay is $25 cheaper.

For chiropractic care, the Aetna plan has a $20 copay. Under your current plan, you have to meet the $183 Part B deductible we talked about earlier – then you pay 20 percent and Original Medicare pays the other 80 percent.

Chapter 5 – Support programs

We talked about the network of doctors, and how simple the Aetna Medicare Advantage plan is. We’ve also talked about savings. But now, we’d like to share some of the support programs that are included with your new plan.

We want to let you hear about the plan from one of your fellow Trust retirees. John is from Buffalo, NY. He’ll talk about some of the extra benefits you’ll get with the Aetna Medicare Advantage plan and how these benefits helped him.

John: “The company that I originally started with was Harrison Radiator, which was a division of General Motors. We took pride in what we did. We were making all the heating and air conditioning units for the General Motors cars, and in fact, I spotted several cars where my sticker was put on one of the heaters that was in the car, so I knew that was a job I did and I was very proud of that.”

“The plant at Harrison Radiator was a smaller plant and it was a lot like family. There were tricks that people played on one another.  I would just say with grease and things like that and gloves and maybe in a sandwich.”

“When I was a kid, I built model cars and I loved to draw automobiles. I did want to be an auto designer and originally when I was thinking about going to college, I did want to go to General Motors Institute and study car design.”

“When you join up with Aetna, first they have a doctor, which they hire to assign and come over and give you an initial physical to see what kind of help you might need with your medications or your overall health. He took my blood pressure. The blood pressure was abnormally high, so when he saw my medication that I was on he said I really think I should get ahold of your doctor, and if it wasn’t for the Aetna physician, I may not have the results that I have.  I have to watch my diet specifically now because I am diabetic. Walking was the exercise that I always liked to do and that’s an important part of being healthy. “

“Aetna has been a big blessing in providing us with really excellent health care. They’ve encouraged us to take advantage of a lot of the programs that they have and we’ve done that. It’s been just a wonderful service to have. I would have to say a word that describes my relationship with Aetna would be excellence.”

John mentioned two specific programs in the video.

1. The healthy home visit
2. The Diabetes Support Program

We’ll talk about both of these programs in more detail in just a minute, but first I want to show you how Aetna can support you no matter where you are on your health journey.

We value your total health – physical, emotional and social. We want to help you reach your full potential in life, however you define it. We can help support you wherever you are on your health journey.

For those who want to focus on wellness, we have programs such as the healthy home visit that John mentioned, and we’ll talk about in just a minute. We also offer Healthy Lifestyle Coaching, which can help you quit smoking or lose weight. The Aetna plan also includes the popular SilverSneakers^® fitness benefit.

A few things most retirees don’t know about SilverSneakers:

1) First, SilverSneakers is fitness program for seniors. The program allows you to access certain gyms and fitness centers and it doesn’t cost you anything.

2) Second, SilverSneakers allows you to join more than one gym. Maybe you have a participating gym within 5 miles of your house and it has treadmills and weights, but the gym 15 miles from your house has an indoor pool – you can join both gyms!

3) Last, this is also applicable if you travel out of state. This is especially convenient for snowbirds – this means if you travel out of state, you can join a gym in that location without losing access to other facilities at home.  

For those who want to prevent health challenges from getting worse, we have programs to help with complex conditions such as diabetes and heart disease. You can also use Teladoc^®, which is our 24 hour telemedicine support tool. Teladoc allows you to connect with a doctor through a smart phone or a computer and you have the ability to video chat with the doctor. There is a $20 copay to access Teladoc.

Teladoc does not take the place of the 24/7 nurse line. The 24/7 nurse line is another service that is available and there isn’t a charge to access a nurse through this program.

For those who have complex medical conditions, we offer nurses who can help guide you through the health care system.

An example is maybe you’ve been in the hospital for 5 days after a surgery and your doctor tells you that you need home health care. The Aetna nurse can help you find an in-network home health care provider and help you coordinate that process, so you can focus on your recovery.

Now that you’ve heard about some of the extra benefits Medicare Advantage offers you, let’s review the specific benefits John described. John mentioned a healthy home visit. This visit is totally voluntary and is available at no cost to you. If you choose to take part, a nurse will come to your home to review your health needs. They make sure everything is safe, do a medication review and ask you about your medical and family history. The visit doesn’t replace care from your doctor, but if you’d like we’ll share the results of your visit with them. The nurse that comes to your house also recommends any of our support programs that may be helpful for you.

Now let’s talk about the other program John mentioned, and that’s the diabetes support program. Again, this program is voluntary. It helps many retirees keep their diabetes under control. In this program, nurses call you each week. They help you make sure you’re taking your medications as prescribed, they’re helping you keep track of your blood sugar levels, and they’ll coach you to make healthy lifestyle choices and answer any questions you may have about your condition. We also have dieticians who can give you advice about your special nutrition needs.

If you have questions about this program or any other program we talked about, you can call us at the number listed on the back of your brochure.

Chapter 6 – Reasons to love the plan and what to expect next

Let’s review some of the reasons why you’ll love your new Aetna Medicare Advantage plan: No monthly contributions,  coverage nationally if you travel, predictable copays for most medical services,. You’ll also get a SilverSneakers membership included with your plan and 24/7 access to Teledoc.

There’s one program listed here that we haven’t talked about and that’s Resources for Living^®. This is a great program that’s unique to our plan. With this program, you’ll have access to an 800 phone number. The team of people behind this phone number is there to help CONNECT you with local community resources.

Now, let’s talk about the next steps.

You’ve received a letter from the Trust that says you’ll be automatically enrolled into the Aetna Medicare Advantage plan for 2018 – so you don’t need to do anything! This change is only for your medical coverage. It will not impact your prescription drug, your dental, your vision or your hearing aid coverage provided by the Trust. Those benefits will continue with the same carrier and coverage that you have today.

I certainly understand, Aetna Medicare Advantage may not be right for everyone. And if you decide it’s not right for you, you can disenroll by calling Retiree Health Care Connect (1-866-637-7555) before November 30. But I would encourage you to give us a try. Because the Trust allows you to make a plan change mid-year. This means that if you decide you do not like the Aetna plan in April, you can go back to your current medical plan.

It is important to note, if you make a plan change in the middle of the year, any deductible and out of pocket amounts met for the plan year will not carry over. This means deductible and out of pockets amounts will reset if you choose to make a plan change during the plan year.

So, what’s next? Before your new plan starts on January 1, 2018, you’ll receive a letter in November confirming your enrollment in the plan. You’ll also receive a new ID card to use when getting all medical services. And you’ll get a welcome kit that helps you get the most from your plan. This kit includes an Evidence of Coverage with full plan coverage details and it’ll also explain how to get a provider directory. Sometime between November and February you may also receive a welcome call from Aetna. We’ll call to see if you have any questions about the transition to your new plan or to see if you may qualify for benefits that can help you manage a medical condition or situation.

We are excited for you to start enjoying your new plan…

…and all of the benefits we’ve discussed today.

Before we end this video, I want to bring your attention to a final program, and that’s our Continuity of Care program. We know there may be retirees who are currently in an active course of treatment. But what does that mean? Let me give you some examples. Maybe you are undergoing chemotherapy treatment, or you’re getting injections from your doctor, or maybe you’re planning a surgery for after the first of the year.

If you feel you might be in an active course of treatment and you’re concerned the transition to the Aetna Medicare Advantage plan may disrupt your care, please give us a call.
1-855-406-4062 (TTY: 711), Monday through Friday, 8 a.m. to 6 p.m. all time zones). We have a team of nurses dedicated to making sure your care isn’t disrupted as a result of this change.  

Thank you so much for your time today. We hope you enjoy your new plan.

We’ve included some frequently asked questions starting on page 20 of your brochure. You can always call us  with other questions or you can go online (1-855-406-4062 (TTY: 711), Monday through Friday, 8 a.m. to 6 p.m. all time zones uawtrust.aetnamedicare.com) to learn more. Just look at the contact information on the back cover of your brochure. We look forward to joining you on your health journey in 2018.

GRP_4004_1155  10/2017

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