Retired Employee Medicare Plans
Advantage Plans
AvMed Medicare Choice HMO (Miami-Dade and Broward)
- Increase in Rx Initial Coverage Limit to $4,020
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Increase in Healthyperks allowance – $100 rewards for healthy behaviors
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Increase in Part D Catastrophic Coverage co-pays
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Decrease in Rx Tier 3 co-pay (Miami-Dade)
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Decrease in Rx Tier 2 and 3 co-pay (Broward)
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Decrease in Ambulance co-pay (Broward)
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New Preferred pharmacy network with lower copays than Standard pharmacy network
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New Telehealth Doctor visits – $0 copay
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New Hearing aid allowance – $500 per ear
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New Transportation allowance – up to 8 one-way trips
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New Over the Counter Medication allowance – $25 quarterly
AvMed Medicare Circle HMO (Miami-Dade and Broward)
- Decrease in Specialist co-pay (Broward)
- Decrease in Rx Tier 3 co-pay
- Decrease in Ambulance co-pay
- Increase in the Initial Coverage Limit – $4,500
- Increase in Hearing Aid allowance – $600 per ear
- Increase in Transportation allowance – up to 20 one-way trips
- Increase in Eyewear allowance – $350 (Miami-Dade); $300 (Broward)
- Increase in Over the Counter allowance – $50 monthly
Cigna Leon Cares
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Added a 4th pharmacy tier
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Dental – Implants are now covered.
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For a 30-day supply from a retail pharmacy with preferred cost-sharing:
- Drug Tier 1: $0
- Drug Tier 2: $0
- Drug Tier 3: $40
- Drug Tier 4: 33%
- Initial Coverage Limit (ICL) Increase to $7,000 from $4,000
- Maximum Out of Pocket (MOOP) decrease to $3,400 from $6,700
- Quarterly Over the Counter (OTC) benefit increase to $150 from $100
- Telehealth available in 2020
Humana Zero Premium HMO (Miami-Dade, Broward, Palm Beach)
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Addition of $85 Part B Giveback on this plan
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Addition of Routine Chiropractic coverage
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Addition of Wig coverage (medically necessary)
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Decrease in Coverage Gap co-insurances
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Increase in Medical Maximum Out-Of-Pocket
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Increase in Specialist co-pay
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Increase in Inpatient Hospital co-pay
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Increase in Skilled Nursing Facility co-pay
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Increase in Outpatient Hospital co-pay
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Increase in Freestanding Radiological Facility co-pay
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Increase in Ambulance co-pay
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Increase in Durable Medical Equipment (DME) co-pay
- Increase in Rx copays Tiers 2-3
- Increase in Initial Coverage Limit
- Increase in Part D Maximum-Out-of-Pocket (MOOP)
- Increase in Catastrophic Coverage co-pays
Humana National Comprehensive PPO
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Addition of Routine Chiropractic Coverage
- Addition of Routine Podiatry Coverage
- Addition of Routine Hearing Coverage & Hearing Aid Allowance
- Addition of Routine Vision Coverage & Vision Allowance
- Addition of Wig Coverage (medically necessary)
- Decrease in Outpatient Hospital Diagnostic co-pay
- Decrease in Coverage Gap co-insurances
- Increase in Premium
- Increase in Urgent Care co-pay
- Increase in Initial Coverage Limit
- Increase in Part D Maximum-Out-of-Pocket (MOOP)
- Increase in Catastrophic Coverage co-pays
Humana National Traditional PPO (New plan offering for 2020 plan year)
- Co-pay for Office visit (PCP and Specialist)
- Co-pay for Emergency and Urgent Care
- Includes Part D credible programs
- Offering In and Out-of-network benefits
- Set co-pay for In-patient Hospital Care
UnitedHealthcare (UHC) Differential PPO (formerly known as Group National PPO)
- $0 co-pay for Tier 1 medication
- Increase in Premium
- Increase in Initial Coverage Limit
- Increase in Catastrophic Coverage limit
- Lower co-insurance in Rx Tier 1 and Tier 2 in the gap
- No change in deductible
- No change in hospital admission co-pay
UnitedHealthcare (UHC) Passive PPO (formerly known as Premier PPO)
- Increase in Initial Coverage Limit
- Increase in Catastrophic Coverage limit
- Lower Premium
- No change in deductible
- No change in hospital admission co-pay
- No change in office co-pay (PCP and Specialist)
- No change in emergency room care co-pay
- No change in urgent care co-pay
If you are enrolled in one of the below 2019 Medicare offerings, please know that they are no longer being offered. To ensure no lapse in coverage, UHC will default the Medicare recipient to the below corresponding plan. If the new plan, does not meet the Medicare recipient’s needs, please contact UHC at 1-877-870-7923 to cancel or change your enrollment.
2019 Medicare Advantage Plan 2020 UHC Default Plan Premier MAPD UnitedHealthcare Passive PPO MAPD Comprehensive MAPD UnitedHealthcare Differential PPO MAPD Low MAPD Group National PPO
UNITEDHEALTHCARE (UHC) MEDICARE SUPPLEMENT PLANS (DOES NOT INCLUDE MEDICARE PART D):
- Both plan design and premiums are pending approval by the Centers for Medicare and Medicaid Services (CMS)
- Freedom of choosing physicians of your choice
- Introduction of new Supplement Plan – Plan G
- Plan F will only continue to be offered to anyone who became a Medicare recipient prior to 1/1/2020
- Rates are based on the applicant’s date of birth, place of residence and tobacco usage
- Supplements Medicare coverage
NOTE: Pre-65 Medicare recipients are not eligible for the Supplement plans.
UNITEDHEALTHCARE (UHC) PHARMACY PLANS (MEDICARE PART D ONLY):
UHC continues to offer Prescription Drug Plans (PDP). Participants currently enrolled in a PDP only may enroll in any of the School Board sponsored Medicare Group Healthcare plans. The following PDP plans are being offered for the 2020 plan year:
- UHC 4-Tier low option tier 1 gap only coverage
- UHC 4-Tier high option full gap coverage
- UHC 5-Tier Formulary Standard Coverage in Gap
If you are enrolled in one of the below 2019 PDP offerings, please know that they are no longer being offered. To ensure no lapse in coverage, UHC will default the Medicare recipient to the below corresponding plan. If the new plan, does not meet the Medicare recipient’s needs, please contact UHC at 1-877-870-7923 to cancel or change your enrollment.
| 2019 PDP | 2020 UHC Default PDP |
| Premier PDP | UnitedHealthcare 4-Tier High PDP |
| Comprehensive PDP | UnitedHealthcare 4-Tier Low PDP |
| Saver Plus | UnitedHealthcare 5-Tier Standard PDP |
| Preferred PDP |
You must contact the Medicare healthcare company directly for assistance with your enrollment. Proof of Medicare enrollment in both parts A & B must be provided at the time of enrollment.
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AvMed Medicare Choice HMO: AvMed Medicare Circle HMO: |
Enrollment Telephone Number: 1-800-835-6137 (TTY 711) Post enrollment for Member Engagement Center: 1-800-782-8633 (TTY 711) |
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Cigna Leon Cares Medicare Advantage Plan |
1-866-266-8917 (TTY 711); 8 am – 8 pm, 7 days a week |
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Humana Zero Premium HMO |
Enrollment Telephone number: 1-800-824-8242 |
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UnitedHealthcare (UHC): Medicare Advantage Plans Medicare Supplement Plans Prescription Drug Plans (PDP) |
Enrollment Call Center: 1-877-870-7923 |
Enrollment
Your Benefits
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Office of Risk and Benefits Management
1501 N.E. 2nd Avenue, Suite 335
Miami, Florida 33132
Mon - Fri, 8 a.m. to 4:30 p.m. ET
www.dadeschools.net
305-995-7129
FBMC Service Center
Mon - Fri, 7 a.m. to 7 p.m. ET
1-855-MDC-PS4U (1-855-632-7748)