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FAQs
Retiree H&W -
Frequently Asked Questions
Change in Retiree Coverage
General
Questions (for all retirees)
Preferred Provider Questions (for retirees not eligible for
Medicare)
Change In Retiree Coverage
How will the change affect
me?
Beginning
12/31/2023, you will no longer be offered health coverage through
the Alaska Electrical Health and Welfare Fund Retiree Health Plan.
Instead, you’ll have the option to purchase coverage through Via
Benefits marketplace.
If you qualify
for a Trust subsidy, the Fund will establish a Health Reimbursement
Arrangement (HRA) for you and your eligible spouse.
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Why is Alaska Electrical Health & Welfare Fund making this change?
The board of
trustees of the fund
regularly evaluates the benefit programs that the fund offers,
with the goal of providing quality benefits at the right
cost. With the high cost of health care in Alaska, accessing a
nationwide individual plan marketplace
offers substantial cost savings for the fund’s retirees and
for the fund while still providing comprehensive coverage for you
and your family.
Via benefits
offers insurance options from private carriers as well as state and
federal marketplaces. Purchasing
insurance through Via Benefits will provide greater choice
for retirees.
You’ll have many
more plan options to choose from so you can find coverage to fit
your needs and budget. Depending on where you live (since
marketplace costs vary by state), it may turn out to be
less expensive
if you are currently over-insured.
Should your
situation change, you can always select a different plan through Via
Benefits each year during the open enrollment period.
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What support is Alaska Electrical Health & Welfare Fund providing to
help me?
The Alaska
Electrical Health & Welfare Fund has partnered with Via Benefits
Insurance Services to provide you with dedicated support for your
health care plan decisions. You’ll have personalized support through
Via Benefits to help you make an informed and confident choice.
If you
are pre- age 65:
-
Visit
https://marketplace.viabenefits.com/Alaskato see your
coverage options, rates and to enroll. You can also enroll by
calling 1-800-849-4163 (TTY: 711) and speaking with a benefit
advisor.
-
Their licensed
benefit advisors will help retirees explore medical and
prescription options.
-
Via Benefits
will make outreach calls during this transition. If Via Benefits
calls you, your local phone service provider may not display
“Via Benefits” as the caller ID. It may appear in caller ID as
“Unknown Caller,” “Extend Health,” or as “1-866-322-2824.” If
you are concerned about the authenticity of the call you
receive, you may call Via Benefits directly at 1-800-849-4163.
If you are Medicare eligible:
-
Visit
https://my.viabenefits.com/Alaska to see your coverage
options, rates and to enroll. You can also enroll by calling
1-800-849-4158 (TTY: 711) and speaking with a benefit advisor.
-
Via Benefits
will make outreach calls during this transition. If Via Benefits
calls you, your local phone service provider may not display
“Via Benefits” as the caller ID. It may appear in caller ID as
“Unknown Caller,” “Extend Health,” or as “1-866-322-2824.” If
you are concerned about the authenticity of the call you
receive, you may call Via Benefits directly at 1-800-849-4158.
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What is an HRA?
The Fund has established the
Alaska Electrical Retiree Health
& Welfare Fund Health Reimbursement Arrangement (HRA)
to
subsidize retiree medical
coverage cost. An HRA, or health
reimbursement arrangement, is a health care spending account (like a
bank account) offered by the Fund. The subsidy can only be used for
qualified health care expenses and premium amount. At the end of
each year, any unused amounts revert to the Fund. If
you qualify for a subsidy, you and your eligible spouse can use your
HRA to receive reimbursement for some or all of your premiums for
your new health coverage through Via Benefits as well as eligible
medical expenses and prescriptions.
Note: If you are eligible, you must opt into the Alaska Electrical
Health & Welfare Fund HRA before you enroll in health coverage
through Via Benefits.
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What is the Medicare
marketplace?
The Medicare
marketplace refers to all the coverage choices insurance companies
across the country make available to Medicare-eligible retirees. The
Medicare marketplace is separate from state marketplaces connected
with the Affordable Care Act. The marketplace can offer expanded
choices at affordable prices by leveraging the buying power of
millions of retirees who they enroll for coverage.
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What
HRA contribution amount should I be expecting?
Alaska
Electrical Health & Welfare Fund has provided your HRA allocation to
Via Benefits, and the amount is included in the Introduction to Via
Benefits Guide you should receive in the mail. You can call and ask
Via Benefits directly:
·
Pre-Age 65 retirees can call
1-800-849-4163 (TTY: 711)
·
Medicare eligible retirees can
call 1-800-849-4158 (TTY: 711)
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Do I have to
use Via Benefits to buy coverage?
No.
Via
Benefits has expanded capability to help you manage your healthcare
and reimbursements. To activate your HRA, you must opt-into funding
with Via Benefits. If you desire you may enroll with a local
broker, directly through federal or state-based marketplace, Via
Benefits is here to be your advocate, perform cost analysis of HRA
vs. PTC, opt-in to your funding election; support you during your
enrollment, and then post-enrollment with advocacy. Regardless of
where you enroll, Via Benefits will be your reimbursement
administrator and you will need to submit proper documentation from
your healthcare carrier to be reimbursed.
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Will other health care companies be contacting me to sell coverage?
You may receive
calls from other companies trying to sell you coverage. Via Benefits
is the preferred option of Alaska Electrical Health & Welfare Fund.
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How do I enroll?
There is a
different process for enrollment depending on whether you are pre-65
or Medicare eligible.
If you
are pre-age 65:
During the
enrollment period, which begins November 1, 2023, you can view
available plans on the Via Benefits marketplace. You can also speak
with a licensed benefits advisor for personalized help finding
coverage that fits your health and financial needs.
Visit
https://marketplace.viabenefits.com/Alaska starting November
1 to see your coverage options, rates and to enroll. You can also
enroll by calling 1-800-849-4163 (TTY: 711) and speaking with a
benefits advisor. During enrollment, if you qualify, you’ll also
choose the funding option that is best for you (Alaska Electrical
Health & Welfare Fund HRA or the Federal subsidy).
If you
are Medicare eligible:
Via Benefits
will assist you in finding an insured individual Medicare
supplemental plan and if you qualify, assist in administering your
Health Reimbursement Arrangement. You must complete a pre-enrollment
Medicare assessment and complete an enrollment appointment with Via
Benefits to enroll.
Call Via Benefits at
(800)
849-4158 Monday through Friday 4:00 a.m. to 3:00 p.m. AKDT
to complete your pre-enrollment Medicare Assessment and schedule an
appointment to complete your enrollment.
ALL RETIREES MUST TAKE ACTION TO ENROLL BY DECEMBER
15 TO RECEIVE RETIREE COVERAGE EFFECTIVE JANUARY 1, 2024.
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How long does enrollment for Medicare supplemental insurance take?
The
“Introduction to Via Benefits Guide” you will receive shortly will
give you information on the online tools available through Via
Benefits. You may be able to complete your enrollment online in an
hour. If you would like a benefit advisor’s help, plan on
about 45 min. to complete your Medicare assessment, and then
additional time of up to 30 min. to complete your applications.
Your call may be shorter if you complete your personal profile in
advance.
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If I’m Medicare eligible, do my dependent and I need to enroll in
the same plans?
No. You and your Medicare-eligible covered
dependent can choose to enroll in different plans.
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Can I keep the Alaska Electrical Health & Welfare Trust Group Health
Coverage for 2024?
No, the Alaska
Electrical Health & Welfare Fund Retiree Group Health Plans are
terminated effective January 1, 2024. You’ll need to find your
coverage option through Via Benefits for 2024 and beyond.
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What happens
if I miss the enrollment period?
If
you are pre-age 65:
If you miss your enrollment window of November 1 – December 15,
2023, you will be able to enroll until January 15, 2024 but the
carrier will request proof of the loss of group coverage and your
first effective coverage date would be February 1, 2024. Individual
coverages may not be backdated like group coverage, so you will not
have coverage until you enroll in a new coverage, which will be
effective, the first of the following month e.g. February 1 or March
1. If you do not enroll by Feb 28, 2024 you will not have a
valid enrollment period to gain access to health coverage until
November 1 – December 15, 2024 unless you have a qualifying life
change event (see below for more details).
If you
are Medicare eligible:
If you miss your enrollment window of October 1 – December 31, 2023,
you can still enroll but will be uncovered starting January 1, 2024.
Individual coverages may not be backdated like group coverage, so
you will not have coverage until you enroll in a new coverage, which
will be effective, the first of the following month e.g. February 1
or March 1. If you do not enroll by Feb 28, 2024 you will not
have a valid enrollment period to gain access to health coverage
until Medicare open enrollment dates, unless you have a qualifying
life change event (see below for more details).
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If I don’t like the plan I enrolled in, when can I change?
Every
year, the Open Enrollment Period allows you to change your
individual or family plan. This generally occurs November 1 through
December 15.
Sometimes your life changes, and you need to update your health
insurance even though it isn’t the annual Open Enrollment Period.
Here are a few events that might qualify you for a 60-day Special
Enrollment Period (SEP):
-
Your
marital status changes
-
You
lose your medical plan due to an insurance carrier terminating
your plan
-
You
move outside the area covered by your medical plan
-
Other events and circumstances can also make you eligible for
the SEP. If you choose a plan by the fifteenth of the month,
your plan can start the first day of the next month.
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What can I expect
to pay for my new plan?
What you will
pay depends on the type of plan you select. Beginning November 1,
you’ll be able to see the costs of the plans available to you using
the Via Benefits online tools, or a licensed benefit advisor can
work with you to understand the costs – and the benefits – of the
different plan options.
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Can I continue to
see my current doctor?
It depends on
the plan you choose. We understand the importance of doctor-patient
relationships, so your Via Benefits advisor will work with you to
help find plans that include your providers in their networks.
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Can I
continue to use the same insurance carrier?
In many
cases, yes, you can. However, group medical plans usually work
differently than individual plans. Carriers have different plans and
networks by location, and this can sometimes mean the plan will not
operate the same, even though the insurance carrier is the same. You
may discover another insurance carrier offers a plan that is a
better fit for you. Via Benefits will help you compare your options.
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Can I contribute to a Health Savings Account (HSA) if I enroll in a
high-deductible health plan?
An HSA
allows you to set aside tax-free money to pay for eligible medical
expenses. They are available with qualified high-deductible health
plans, which may be available to you. The law does not allow you to
have a Health Reimbursement Arrangement and contribute to an HSA at
the same time. If you opt into the Alaska Electrical Health &
Welfare Fund HRA, make sure you don’t also contribute to an HSA or
you may have to pay penalties to the federal government. Note, if
you already have an HSA, you can still use those dollars for
eligible medical expenses you incur under your new individual plan.
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What if I live in more than one state?
If you
live in more than one state during the year, you’ll want to keep the
following in mind:
·
If
available, a PPO might be your best option because you can see
out-of-network providers
·
Your
plan will cover care at in-network rates for true emergencies
regardless of where you are
·
You are
unlikely to find individual plans with national plan networks (but
you may find a plan that contains a national pharmacy network)
·
Look for
a plan in the region where your primary providers are
·
You may
be able to use your regular provider’s telehealth options when
traveling
·
If you
prefer to have access to in-network providers near both residences,
you have these options:
1) You
may switch plans when you arrive at your secondary residence and
will qualify for the Permanent Move Special Enrollment Period
(downside: out-of-pocket costs toward your deductible and out-of-
pocket maximum do not transfer between plans)
2) You
may enroll in two plans at once, just not two marketplace plans at
once – you must choose at least one off-marketplace plan (downside:
you’d have to pay two premiums, and your out-of-pocket costs will
not transfer between plans)
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Will
Via Benefits be available to assist me next year?
Yes. Via
Benefits advisors are available throughout the year pre and post
enrollment. When you purchase a plan through Via Benefits, their
advisors continue to be your advocate if you stay enrolled. If your
medications or needs change, or you move, you may contact Via
Benefits any time to help you determine if your plan is still the
right one for you.
When you become
Medicare eligible, Via Benefits can also assist you in transitioning
to a Medicare supplemental plan.
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Are my options and rates affected by my current or past health?
No, not if you
enroll in an individual plan during your enrollment period and
before your current health coverage expires. During this time,
insurers cannot deny your application or charge you more because a
doctor has treated you for a health condition.
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General Questions
(for all retirees)
How many times do I have to fill out the Annual Medical/Dental
Update form?
The Plan requires that an
Annual Medical/Dental Update Form
be updated once every twelve months or whenever the patient’s
information changes. . If you cannot remember when each family
member’s form expires, and you anticipate using the Plan within the
coming year, you may download the form in January and fill one out
for each covered family member.
An
updated
Annual Medical/Dental
Update Form for the patient must be on file at the
Administrative Office for any claims to be processed. If the
Annual Medical/Dental Update Form is not current, the participant
will be requested to fill one out and the claim will be not be paid
until the form is completed.
The most common cause for a delay in
processing a claim is that the patient does not have a current
Annual Medical/Dental Update Form on file.
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How long do I have to
file a claim?
The
Plan accepts claims for medical services for one year from the date
of service.
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What is pre-authorization and
why does my procedure need to be pre-authorized?
The Plan will only cover procedures and treatments
that are medically necessary. Pre-authorization is a medical
review by an independent group of physicians to determine whether a
procedure or treatment is medically necessary. The Plan has
contracted with Aetna to perform this function.
Click on the link below for more information:
Medical
Pre-Authorization
To pre-authorize your procedure, have your physician
or health care provider call Aetna at 1-888-632-3862 option 3.
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Yes, effective January 1, 2003, all retirees are required to use the
prescription drug plan in order to take advantage of lower
negotiated rates at the Caremark network of pharmacies.
Click here to learn how to save money by using Caremark.
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Do
my prescription co-pays apply to my medical deductible?
No,
your prescriptions DO NOT apply to your medical deductible.
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Mail order is a cost-effective way to obtain medications you take on
an on-going basis. Mail order prescriptions are filled in 90 day
increments (even if the script is for a year). To fill a new
prescription, you must submit a
Mail Order Form
and provide an original doctor’s script which indicates whether a
brand name drug or a generic is appropriate.
When you need a refill, simply call
Caremark at (866) 818-6911 or log on to their website,
www.caremark.com
to reorder. Your prescription will be sent to you via the US
Postal Service or through a delivery service if special handling is
required.
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Why should I use generic drugs instead of brand name drugs?
Once
a drug patent has expired, other companies may start to sell the
same drug under another name. The generic drugs are not
normally advertised, helping to keep their costs to a minimum.
Generic drugs are
required by the federal Food & Drug Administration to have the same
quality, strength, purity, and stability as brand name drugs.
By using generic drugs when they are available, you can receive the
same quality of health care for less money - and these savings can
be used to offset other health care expenses to help keep premiums
low. Please ask your doctor and pharmacist if a generic is
available for your prescription.
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Are travel expenses covered?
Travel to the nearest facility will
be reimbursed by the Plan if treatment is unavailable locally and it
is medically necessary. If the member traveling is a minor,
the Plan will reimburse travel for one parent or guardian to
accompany the minor. The Plan will also reimburse travel for
one companion to assist an adult member if the member is
incapacitated due to a medical condition and will need assistance.
Please note that the Plan does not
reimburse for ground transportation or room and board. This means
that car rentals, motels/hotels, parking, and cab fares are not
covered expenses.
For reimbursement for travel
expenses, you must submit a letter of medical necessity from your
current physician, a copy of the ticket(s) with the dates and costs
of travel, and the boarding pass(es) as proof that the travel took
place. Travel benefits are subject to medical deductible and
eligibility requirements.
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If You or
Spouse are Eligible for Medicare
Part
A of Medicare covers general hospital expenses and Part B covers
physicians and medical expenses. If you are eligible for Medicare
and fail to enroll, BENEFITS UNDER THE RETIREE MEDICAL PLAN(S) WILL
BE REDUCED AS THOUGH YOU WERE ENROLLED IN BOTH PARTS A AND B OF
MEDICARE. This means benefits would be paid on assumption that you
are enrolled in both parts A and B of Medicare; and if you have not
enrolled, you could incur significant uncovered out-of-pocket
expenses. We strongly encourage all retirees to contact Social
Security to determine the procedures and timetables for enrollment
in Medicare.
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If you or
Spouse are Eligible for SilverScript
SilverScript is a
Medicare Part D Prescription Drug Plan with additional coverage
provided by Alaska Electrical Health & Welfare Fund. The plan is
offered by SilverScript® Insurance Company which is affiliated with
CVS Caremark®, Alaska Electrical Health & Welfare Fund’s
current
pharmacy benefit manager. SilverScript® has a contract with Medicare
to offer prescription drug coverage.
SilverScript combines a standard Medicare Part D prescription drug
plan with additional coverage provided by Alaska Electrical Health &
Welfare Fund to close the gaps between the standard Part D plan and
your current coverage. Click on the links below for more
information. Click on the links below for more information.
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May Medicare-eligible participants use the Wellness and Minor Care
program?
Expenses normally covered by Medicare are not covered under the
Wellness and Minor Care Plan.
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Preferred Provider Questions (for retirees not eligible for
Medicare)
What is the penalty for using a non-preferred provider (within the
Municipality of Anchorage)?
If you use a health
care provider within the Municipality of Anchorage that is a not a
preferred provider, the Plan will base your reimbursement on the
preferred provider rate and will then reduce your regular
reimbursement rate by 20%. In addition to these reductions, a
$1,000 penalty will be imposed to each inpatient admission to a
non-preferred provider.
For
example, you live in Anchorage and need to have a certain treatment.
The preferred provider charges the Plan $100 for this type of
treatment. A non-preferred provider in South Anchorage charges
$200 for this type of treatment. You have already met your
deductible for the year and the Plan usually reimburses at 75%.
If you have this treatment at a
preferred provider, the Plan will pay $75 ($100 X 75%). Your
out-of–pocket expense will be $25.
If you have treatment at the
non-preferred provider, the Plan will pay $55. First, the $200
expense is marked down to the preferred provider rate of $100, then
the reimbursement rate is reduced by 20%. ($100 X 55%) Your
out-of-pocket expense will be $155.
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Who are my preferred providers in the Municipality of Anchorage?
Your preferred
providers within the Municipality of Anchorage are as follows:
Service
Needed |
Preferred
Provider |
Inpatient hospital stays
|
Alaska Regional Hospital |
Outpatient lab and x-ray services |
Alaska Regional Hospital
|
Physical therapy services |
Chugach Physical Therapy
|
|
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What
area does the Municipality of Anchorage include?
The Municipality of Anchorage is comprised of the area from Girdwood
to the Knik River Bridge including the Anchorage bowl area.
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How
do I know where my labs and x-rays are being sent?
Ask! It is your responsibility, as
a plan participant, to educate your physician(s) and medical care
providers, as well as your dependents, regarding your preferred
providers. Let your physician know who your preferred
providers are and he/she will make arrangements for labs and x-rays
to be performed at your preferred provider.
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What is Aetna's Choice POS II ?
Aetna's Choice POS II is a nationwide group of contracted
preferred providers that offer considerable discounts to the Plan
for use of their facilities, groups, and doctors. When you select a
preferred provider from the Aetna's Choice POS II network, you ,
your dependents, and the Fund will have access to discounted pricing
from providers that are part of the Aetna network. You may review
Aetna's Choice POS II
website, to find a provider near you.
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What is the penalty for using a non-preferred provider (outside the
Municipality of Anchorage)?
The Plan uses Aetna's Choice POS II. If you use a facility that is
not Aetna's Choice POS II and it is within 25 miles of a Aetna's
Choice POS II provider, the Plan will reduce your reimbursement rate
by 20%. You can search for a Aetna's Choice POS II provider near you
on Aetna's
Choice POS II
website
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