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Retiree H&W - Frequently Asked Questions

Change in Retiree Coverage

• How will the change affect me?
• Why is Alaska Electrical Health & Welfare Fund making this change?
• What support is Alaska Electrical Health & Welfare Fund providing to help me?
• What is an HRA?
• What is the Medicare marketplace?
• What HRA contribution amount should I be expecting?
• Do I have to use Via Benefits to buy coverage?
• Will other health care companies be contacting me to sell coverage?
• How do I enroll?
• How long does enrollment for Medicare supplemental insurance take?
• If I’m Medicare eligible, do my dependent and I need to enroll in the same plans?
• Can I keep the Alaska Electrical Health & Welfare Trust Group Health Coverage for 2024?
• What happens if I miss the enrollment period?
• If I don’t like the plan I enrolled in, when can I change?
• What can I expect to pay for my new plan?
• Can I continue to see my current doctor?
• Can I continue to use the same insurance carrier?
• Can I contribute to a Health Savings Account (HSA) if I enroll in a high-deductible health plan?
• What if I live in more than one state?
• Will Via Benefits be available to assist me next year?
• Are my options and rates affected by my current or past health?

General Questions (for all retirees)

• How many times do I have to fill out the Annual Medical/Dental Update form?

• How long do I have to file a claim?

• What is pre-authorization and why does my procedure need to be pre-authorized?

• Must I use Caremark for my prescription drugs?

• Do my prescription co-pays apply toward my medical deductible?

• How do I mail order prescriptions?

• Why should I use generic drugs instead of brand name drugs?

• Are travel expenses covered?

• If you or spouse are eligible for Medicare?

• If you or spouse are eligible for SilverScript?

• May Medicare-eligible participants use the Wellness and Minor Care program?

Preferred Provider Questions (for retirees not eligible for Medicare)

• What is the penalty for using a non-preferred provider (within the Municipality of Anchorage)?

• What area does the Municipality of Anchorage include?

• Who are my preferred providers in the Municipality of Anchorage?

• How do I know where my labs and x-rays are being sent?

• What is Aetna's Choice POS II ?

• What is the penalty for using a non-preferred provider (outside the Municipality of Anchorage)?

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. 

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.

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.

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.

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.

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)

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.

You may receive calls from other companies trying to sell you coverage. Via Benefits is the preferred option of Alaska Electrical Health & Welfare Fund.

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.

 

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.

No. You and your Medicare-eligible covered dependent can choose to enroll in different plans.

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.

 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).

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.

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.

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.

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.

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.

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)

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.

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.

The Plan accepts claims for medical services for one year from the date of service.

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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No, your prescriptions DO NOT apply to your medical deductible.

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.

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.

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.

• SilverScript Announcement (Oct 2019, effective Jan 1, 2020)

• SilverScript (Medicare Part D & CVS Health) FAQs

Expenses normally covered by Medicare are not covered under the Wellness and Minor Care Plan. 

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 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.

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.

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