Group Retiree Medical


Any Size Group
Base Benefits (co-pay)
Base Benefits (no co-pay)
Optional Benefits
Enhanced Benefits
How Deductibles Work
Areas & Rates
Part D LEP

Documents

Any Size Group

Seniors Choice is designed for any size group and will go down to one life. When using Seniors Choice for Retirees it can be used for TEFRA or Non-TEFRA groups.

Every employer should be asked the following question:

Do you offer any kind of Medical Insurance program for your retirees age 65 or over?

Most of the time the answer will be no! Especially with groups that have less than 100 Employees.

If you are one of these employers that does not offer a retiree medical plan, please take a look at Seniors Choice Group Retiree Medical Plan.

  • There is no premium contribution required by the employer
  • No minimum enrollment required
  • It can be completely voluntary (retiree paid)
  • Bill can be sent directly to the retiree
  • By signing the Employer Trust Agreement you are making available another option that your retirees will not have otherwise

Base Benefits (Co-Pay)

2019 GROUP RETIREE MEDICAL PLAN BENEFITS (CO-PAY)
ANNUAL PLAN DEDUCTIBLE OPTIONS

$0 – $100 – $150 – $250 – $500 – $750 – $1000 – $1500 – $2000 – $2500 – $3000 – $4000

MEDICARE PART A
HOSPITALIZATION
Semi-private room and board, general nursing and miscellaneous services and supplies.
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First 60 days All but $1,364 $1,364 Part A Deductible $0 After You Have Satisfied Your Annual Plan Deductible
Days 61 through 90 All but $341 per day $341 per day
Days 91 through 150 (60 lifetime reserve days) All but $682 per day $682 per day
Additional 365 days $0 100% of Medicare
Eligible Expenses
Private Duty Nursing Benefits Available with Seniors Choice Optional Plans
SKILLED NURSING FACILITY
You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital.
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First 20 days All approved amounts $0 $0 After You Have Satisfied Your Annual Plan Deductible
Days 21 through 100 All but $170.50 per day Up to $170.50 per day
Days 101 and after $0 $0 100%
Additional Skilled Nursing Facility Benefits Available with Seniors Choice Optional Plans
BLOOD
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First three pints $0 100% $0 After You Have Satisfied Your Annual Plan Deductible
Additional Amounts 100% $0

 

MEDICARE PART B
MEDICAL SERVICES
In or out of the hospital and Outpatient Hospital Treatment – All Part B services covered after Annual Plan Deductible has been satisfied and the co-payment amount has been paid. Medicare Part B deductible is included in the Annual Plan Deductible.
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First $183 of Medicare approved amounts $0 $185 *Co-pay After You Have Satisfied Your Annual Plan Deductible
Remainder of Medicare approved amounts 80% 20%
Part B Excess Charges – above
Medicare approved amounts		 $0 100%
Medical Services Co-Payment Amounts by Service
Doctor’s Office Visit per visit $10 Co-pay
X-rays or Lab Work in Doctor’s Office per visit $10 Co-pay
X-rays or Lab Work in Outpatient Facility per visit $20 Co-pay
Outpatient Services per visit $20 Co-pay
Durable Medical Equipment $10 Co-pay
*Co-payments apply after the Annual Plan Deductible has been satisfied
EMERGENCY ROOM
SERVICES YOU PAY
Emergency Room Professional Services per visit for non-hospital admission
(Applies to both co-pay and no co-pay plans)		 $100 Co-pay
BLOOD
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First three pints $0 100% $0 After You Have Satisfied Your Annual Plan Deductible
Additional Amounts 80% 20%
CLINICAL LABORATORY SERVICES
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
Blood tests for Diagnostic Services 100% 0% $10 After You Have Satisfied Your Annual Plan Deductible

 

MEDICARE PARTS A & B
HOME HEALTH SERVICES
Covered when provided by a Medicare certified Home Health Agency.
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
Limited to reasonable and necessary
part-time or intermittent skilled care		 100% $0 $0 After You Have Satisfied Your Annual Plan Deductible
Health equipment not limited to hospital beds, oxygen and medical supplies for use at home 80% 20%
At Home Recovery Benefits Available with Seniors Choice Optional Plans
FOREIGN TRAVEL EMERGENCY CARE
Benefits provided for Medicare approved expenses during first 60 days of a trip outside USA. After a $250 calendar year deductible, Seniors Choice Plan pays at 80%, up to $50,000 lifetime maximum.
All Medicare deductibles are included in plan deductible(s).
Co-payments apply after the Annual Plan Deductible had been satisfied.

Medical Coverage Underwritten by:
Guarantee Trust Life Insurance Company

Prescription Coverage Provided by:
Humana

 

Base Benefits (No Co-Pay)

2019 GROUP RETIREE MEDICAL PLAN BENEFITS (NO CO-PAY)
ANNUAL PLAN DEDUCTIBLE OPTIONS

$0 – $100 – $150 – $250 – $500 – $750 – $1000 – $1500 – $2000 – $2500 – $3000 – $4000

MEDICARE PART A
HOSPITALIZATION
Semi-private room and board, general nursing and miscellaneous services and supplies.
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First 60 days All but $1,364 $1,364 Part A Deductible $0 After You Have Satisfied Your Annual Plan Deductible
Days 61 through 90 All but $341 per day $341 per day
Days 91 through 150 (60 lifetime reserve days) All but $682 per day $682 per day
Additional 365 days $0 100% of Medicare
Eligible Expenses
Private Duty Nursing Benefits Available with Seniors Choice Optional Plans
SKILLED NURSING FACILITY
You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving the hospital.
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First 20 days All approved amounts $0 $0 After You Have Satisfied Your Annual Plan Deductible
Days 21 through 100 All but $170.50 per day Up to $170.50 per day
Days 101 and after $0 $0 100%
Additional Skilled Nursing Facility Benefits Available with Seniors Choice Optional Plans
BLOOD
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First three pints $0 100% $0 After You Have Satisfied Your Annual Plan Deductible
Additional Amounts 100% $0

 

MEDICARE PART B
MEDICAL SERVICES
In or out of the hospital and outpatient hospital treatment – All Part B services covered after Annual Plan Deductible has been satisfied and the co-payment amount has been paid. Medicare Part B deductible is included in the Annual Plan Deductible.
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First $183 of Medicare approved amounts $0 $185 $0 After You Have Satisfied Your Annual Plan Deductible
Remainder of Medicare approved amounts 80% 20%
Part B Excess Charges – above
Medicare approved amounts		 $0 100%
EMERGENCY ROOM
SERVICES YOU PAY
Emergency Room Professional Services per visit for (non-hospital admission) $100 Co-pay
BLOOD
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First three pints $0 100% $0 After You Have Satisfied Your Annual Plan Deductible
Additional Amounts 80% 20%
CLINICAL LABORATORY SERVICES
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
Blood tests for Diagnostic Services 100% 0% $0 After You Have Satisfied Your Annual Plan Deductible

 

MEDICARE PARTS A & B
HOME HEALTH SERVICES
Covered when provided by a Medicare certified Home Health Agency.
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
Limited to reasonable and necessary
part-time or intermittent skilled care		 100% $0 $0 After You Have Satisfied Your Annual Plan Deductible
Health equipment not limited to hospital beds, oxygen and medical supplies for use at home 80% 20%
At Home Recovery Benefits Available with Seniors Choice Optional Plans
FOREIGN TRAVEL EMERGENCY CARE
Benefits provided for Medicare approved expenses during first 60 days of a trip outside USA. After a $250 calendar year deductible, Seniors Choice Plan pays at 80%, up to $50,000 lifetime maximum.
All Medicare deductibles are included in plan deductible(s).

Medical Coverage Underwritten by:
Guarantee Trust Life Insurance Company

Prescription Coverage Provided by:
Humana

 

Optional Benefits

GROUP RETIREE OPTIONAL MEDICAL BENEFITS
ADDITIONAL SKILLED NURSING
Covered after SC Plan deductible, from 101 through 365 days; up to $125 per day
PRIVATE DUTY NURSING
Covered after SC Plan deductible, $100 per 8 hour shift; 30 shifts per calendar year
AT HOME RECOVERY
Covered after SC Plan deductible, up to $40 per visit and 7 visits per week; $1600 calendar year maximum
COMPREHENSIVE WELLNESS
Subject to a calendar year maximum benefit amount of $250 (not subject to a plan deductible)
Wellness Care includes, but is not limited to:

  • Alternative health care such as massage and acupuncture
  • Dental and vision check-ups
  • Annual physical examinations
  • Chronic disease self-management programs
  • Alcohol dependency, substance abuse prevention and violence prevention counseling
All Medicare deductibles are included in plan deductible(s).
Co-payments apply after the Annual Plan Deductible had been satisfied.

Medical Coverage Underwritten by:
Guarantee Trust Life

Prescription Coverage Provided by:
Humana

 

Enhanced Benefits

Click on either selection below for detailed information

EPIC Hearing
The EPIC Hearing Service Plan (HSP)
The Nation’s first true Hearing Healthcare Benefit Program

  • National Network of local Ear Physicians and Audiologists
  • Testing, Evaluations and Hearing Aid fittings by licensed Audiologists
  • Brand name Hearing Aids – Savings of 35% to 65%
  • All Levels of Technology and Hearing Aid Styles
  • Reduced Costs on Services & Products
  • Assistance coordinating health plan benefits and Hearing Aid allowances to maximize savings
  • Toll free telephone support throughout the process
  • All payments are to EPIC HSP to ensure controlled fees
  • Flexible Payment plan through GE Financial Services/Care Credit
  • No Administrative forms or paperwork to fill out
  • HSP price booklet lists all makes and models for major brand hearing aids, allowing consumers to price shop & compare their savings

 

EPIC PROVIDERS

Ear Professionals International Corporation (EPIC) is the nation’s largest coalition of hearing healthcare Physicians and Audiologists. EPIC Physicians have pioneered and developed most of the current treatment methodologies and interventions, working together with the best Audiologists in the nation, recognized for their extensive professional education and experience in diagnostic techniques and rehabilitative interventions.

 

STEPS TO ACCESSING HEARING CARE/HEARING AID(S) THROUGH EPIC
  • Call 866-956-5400 toll free and speak with a Hearing Counselor to asses your need to receive your HSP booklet
  • The HSP price booklet outlines all Plan benefits – including pricing – in detail
  • EPIC coordinates your Hearing Health Care from start to finish. The EPIC payment process allows you to maximize your service and eliminate administrative paperwork.
  • As the third party administrator, all payments and billings are centralized and coordinated by EPIC HSP for hearing aid benefits and services.
  • EPIC manages tailored offerings to help those on a fixed income, through various non-profit and state programs.
For more information please call 866-956-5400 or visit our website at EPICHearing.com
Feel free to send us an email at: HSPAdmin@EPICHearing.com
Outlook Vision Services

How Deductibles Work

Seniors Choice Group Retiree Medical Plans allow the member to choose their own deductible.

When services are obtained from a physician or facility that accepts Medicare, the member first meets their plan deductible and then benefits are paid per the benefit summary.

The Medicare deductibles are paid by the plan. Please see the example below for an illustration of how the plan works:

 

 

EXAMPLE

Enrolled in Seniors Choice $500 Deductible Plan Option

Medicare Part B (Outpatient Charges)

Medicare Part B Deductible is $183. This must be satisfied before Medicare pays 80%.

The Seniors Choice Plan Deductible includes a $183 Medicare Part B Deductible

Member incurs $1,000 in Physician’s Services

Member’s Out-of-Pocket Calculation
Physician’s Services $1,000
Subtract Medicare Part B Deductible (Member pays this amount) $183
Remaining Balance $817
Subtract the 80% that Medicare Pays ($653.60)
Amount Remaining After Medicare Pays (Member pays this amount) $163.40
Member’s Total Out-of-Pocket $346.40

 

Of the original $1,000 charges for Physician’s Services, $653.60 has been paid by Medicare with the remaining $163.40 the responsibility of the member.

 

Remaining Annual Deductible Calculation
Seniors Choice Annual Plan Deductible $500
Subtract Out-of-Pocket amount paid by Member which includes the Medicare Part B Deductible ($346.40)
Remaining Annual Plan Deductible $153.60

 

Medicare Part A (Inpatient Charges)

 

Member incurs $200 in Inpatient charges.

Member’s Out-of-Pocket cost would be $200.

This $200 would satisfy part of the Seniors Choice Annual Plan Deductible.
$300 of the Original $500 Annual Plan Deductible would remain to be used across both Medicare Part A and Part B.

 

Areas & Rates

Click on either selection below for detailed information