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Shopper’s Guide Table Of ContentsHow To Have a Successful Open Enrollment .3COBRA Rates For Non-State Agencies .25Terms You Need To Know .4Active Employee’s Optional Life Insurance: TOBACCO-FREE.26What’s Important For 2009? .5Active Employee’s Optional Life Insurance: TOBACCO USER .27Eligibility Rules . 6-7Retired Employee’s Optional Life Insurance: TOBACCO-FREE .28Benefits At-A-Glance. 8-13Retired Employee’s Optional Life Insurance: TOBACCO USER .29Benefit Fairs Sites & Dates .14Other Insurance Rates .30Enrollment Area Map For Plan Year 2009 .15PEIA’s Premium Conversion Plan .31Managed Care Plans’ Enrollment Areas .16Commonly Asked Questions . 31-34Active Employee Monthly Premiums . 17-18Premium Conversion Plan Form .34Non-State Agency: Premiums . 19-20Advance Directives for Health Care Decision-making .35Non-Medicare Retiree Premiums . 21-22Combined Medical Power of Attorney and Living Will .36Medicare Retiree Benefits/Premiums . 23-24To Learn More . Back CoverCOBRA Rates For State Agencies, Colleges, Etc. .25Public EmployeesInsurance AgencyState Capitol Complex, Bldg 5, Rm 10011900 Kanawha Boulevard, EastCharleston, West Virginia 25305-0710
2The Fine PrintThis Shopper’s Guide is not intended to be a formal statementof benefits. It is designed to provide general information aboutthe available plans. It is intended to be a first step in helpingyou choose the most appropriate health benefit plan for youand your family.Questions about particular benefits, limitations, costs, providers,or restrictions, should be directed to the individual plans foranswers. If you enroll in a managed care plan, the plan you selectwill send you an “evidence of coverage” booklet with morecomplete details of your benefits.PEIA cannot guarantee the quality of services offered by thevarious plans, so please gather information and make yourdecision carefully. Before enrolling, assure yourself that the planyou choose offers a level of care and convenience with whichyou and your family will feel comfortable.Also be aware that the continuing participation of managed carenetwork providers is not guaranteed throughout the Plan Year. Ifa provider chooses to withdraw from a managed care network,the member may be required to receive services from anotherparticipating provider.We have tried to ensure that the information in this booklet isaccurate. If, however, a conflict arises between this Guide andany formal plan documents, laws or rules governing the plans,the latter will necessarily control.No More RegionsAs of July 1, 2008, PEIA will no longer determine premiums by the policyholder’s region of residence. We’ll be using onepremium rate for the entire state. You’ll notice the change when you look at the premium charts, since you won’t seecharts for Region 1 and Region 2, anymore; now there’s just one chart for the whole state.
3How to Have a Successful Open Enrollment1. Read through “What’s Important for 2009” to get a quick overview of the changes for the coming Plan Year.2. Review the side-by-side comparison of the plans. You’ll see plan names across the top of the chart, and many healthcare services listed down the side. Just find a service you or your family members use, and read across the chart tosee how much you’ll have to pay for that service under each plan. In the Benefits At-A-Glance charts we let youknow which benefits may have limits, and direct you to the plans for details.3. Check the map on page 15 and chart on page 16 to be sure you’re eligible to enroll in the plan you want. The PEIAPPB Plan is available in all areas. Remember, you must live in a county marked on the charts on page 16 to enrollin an HMO or PPO plan.4. Check the premium table for your employer type (State agency, county board of education, non-State agency,retiree, etc.) and for the type of coverage you have (employee only, family, etc.) to find the premium for the planyou want.5. Remember that Carelink and PEIA health coverage premiums and optional life insurance premiums are based onyour tobacco-use status. For family coverage, all enrolled family members must have been tobacco-free byJanuary 1, 2008, to qualify for the discounted (Preferred) premium. The Health Plan does not offer a tobacco-freepremium discount. PEIA may review medical records to check tobacco use.6. If you want to change plans or change your tobacco status, go to www.wvpeia.com and click on the Online OpenEnrollment button.a. If you used the site last year, just enter your e-mail address and password to enter the site. If you’ve forgottenyour password, click on “Forgot Password?”b. If you didn’t use the site last year, click on “Need to Register?” and follow the instructions. Make any changes orplan selections you wish. Remember, you must access the site and make your choices before midnight onApril 30, 2008.7. If you need to make a change and don’t have internet access, see your benefit coordinator or call PEIA for aTransfer Form.
4Terms You Need To KnowAnnual Out-Of-Pocket Maximums — Each plan has limits on what you are required to pay in out-of-pocket expenses for medical services andprescription drugs each year. You’ll find details in the Benefits At-A-Glance charts.Coinsurance — The percentage of the allowed amount that you pay when you use certain benefits.COBRA — Gives employees rights to continue health insurance coverage after employment terminates. See your Summary Plan Description for full details.Coordination of Benefits (COB) — Health plans use COB to determine which plan will pay benefits first, and to make sure that together they do notpay more than 100% of your bill. Be sure to ask the managed care plans about COB before you make your choice.Copayment — A set dollar amount that you pay when you use services.Deductible — The dollar amount you pay before a plan begins paying benefits. Not all services are subject to the deductible, so check the Benefits At-AGlance charts.Explanation of Benefits (EOB) — Forms issued by health plans when medical claims are paid. Most HMOs do not issue EOBs for in-network care. If youneed an EOB, talk to the HMO to see how you can get the paperwork you need.Health Maintenance Organization (HMO) — HMOs manage health care by coordinating the use of health care services through PCPs. If you join anHMO, you’ll pick your PCP from their list, and then you’ll receive all of your non-emergency care from network providers. Ask the HMOs about their rules.Lifetime Maximum Benefit — Each plan has a maximum it will pay for a member in a lifetime. You’ll find details in the Benefits At-A-Glance charts.MAPD (Medicare Advantage Prescription Drug Plan) — Medicare retirees benefits are administered through Coventry Health Care’s AdvantraFreedom Plan. Please read more about this new program on page 23 of this booklet.Managed Care Plans — The plans that PEIA contracts with to provide care to members who choose to enroll. The managed care plans we currently havecontracts with are Carelink and The Health Plan.Medical Home — This is a program in the PEIA PPB Plans. By selecting a provider as your medical home, you will receive discounted copays on office visitsand establish a central location for your medical care.PEIA Preferred Provider Benefit Plans (PPB) — The two self-insured PPO plans offered by PEIA that cover care based on where you live, and where youreceive your care. To determine which out-of-state providers are PPO providers, call Wells Fargo TPA at 1-888-440-7342. For full details of the benefits,see your Summary Plan Description.Pre-Existing Condition Limitations — If you make a change during open enrollment, you and your covered dependents will face no limitations onpreexisting medical conditions, regardless of what plan you join. New employees who enroll in a managed care plan after the open enrollment period willhave no preexisting condition limitations if they enroll during the calendar month of or the two calendar months following employment. New employeeswho enroll in the PEIA PPB Plan during the calendar month of or the two calendar months following the date of employment will have no preexistingcondition limitations, as long as they had other comparable health coverage in the 62 days prior to the time they enroll for PEIA PPB Plan coverage.Primary Care Physician (PCP) — A provider in a network who coordinates members’ health care. PCPs are usually family doctors, general practicephysicians, internists, or pediatricians. Some plans allow OB/GYNs to be PCPs for women in the plan. PCPs must provide coverage for their practices 24hours-a-day, 7 days-a-week so you can reach them if you need care.Public Employees Insurance Agency (PEIA) — The State agency that arranges for health and life insurance benefits for West Virginia’s publicemployees. PEIA administers the PEIA PPB Plans, and contracts with all of the managed care plans that are offered to public employees.
5What’s Important For 2009?PEIANo More Annual Tobacco Affidavits! Beginning with this Open Enrollment,you won’t have to complete a tobacco affidavit every year. PEIA and Carelinkwill still base premiums on tobacco status, and you’ll need to complete anaffidavit if your status changes, but from year to year we will assume there’sbeen no change. If you were tobacco free last year, and you don’t send us anaffidavit, we will assume you’re tobacco free again this year.No More Automatic Mailing of Tobacco Affidavit/Transfer Forms! Since you’renot required to send us a tobacco affidavit, and very few people change plansfrom year to year, we’ve decided not to mail the Tobacco Affidavit/TransferForm to every member this year. This mailing costs PEIA tens of thousandsof dollars, and since very few members would actually use the form, we’rescrapping the process.So what if you need to make a change? There are several ways to take care ofit.1. If you have internet access at work or at home, log onto PEIA’s OnlineEnrollment website and manage your account. You can change plans, add,change or remove dependents, or change your tobacco status. Once you’veregistered on the site you can check back in at any time to manage youraccount.2. If you don’t have internet access, you can see your benefit coordinator orcall PEIA for a form.No More PPOs. PEIA has chosen to stop offering the Carelink and Health PlanPPO options due to lack of enrollment. Both Carelink and the Health Plan willstill offer their HMOs. If you are a member of one of those PPO plans we willsend you a transfer form, since you will have to make a plan choice. If you donot submit a transfer form, you will be transferred to the PEIA PPB Plan A onJuly 1, 2008.Eligibility Audits. PEIA will be conducting eligibility audits during Plan Year2009 to verify that all enrolled dependents are eligible for coverage, and toverify tobacco status. We encourage you to take a close look at your eligibilityinformation during the open enrollment to correct any extraneous informationbefore the audits begin.s 4HERE ARE NO PLAN DESIGN CHANGES FOR (-/ 0LAN ! (-/ 0LAN " FOR 0LANYear 2009.s 4HE (EALTH 0LAN WILL NO LONGER BE OFFERING OUR 00/ PLAN 00/ MEMBERS THATwant to remain with The Health Plan will need to choose between our HMOPlan A or HMO Plan B.s /VER 4HE #OUNTER MEDICATIONS /4# #ALL 4HE (EALTH 0LAN OR VISIT US ON THEweb at www.healthplan.org regarding certain OTC medications. These OTCMEDICATIONS MAY BE COVERED AT A COPAY OR REDUCED COSTS Go to www.healthplan.org to visit The Health Plan on the web. The HealthPlan invites you to take advantage of the wealth of information and servicesoffered here to enhance your well-being. A number of links to variouswellness and disease management sites are found there.CARELINKPreventive Care Services are now 100% covered with no office visit co-paymentfor HMO Plan A. These are services with a preventive diagnosis. Servicesinclude annual routine physicals, routine preventive colonoscopy, well-baby/well-child visits, annual gynecological exam and routine mammograms.The HMO deductible is reduced to a single and family amount rather than a permember/person amount.The Prescription Drug plan has seen big changes for the coming plan year:s 4IER 'ENERIC CO PAYMENT REDUCED TO .O ANNUAL LIMITs 4IER 0REFERRED "RAND CO PAYMENT INCREASED TO s 4IER .ON 0REFERRED "RAND CO PAYMENT INCREASED TO s !NNUAL LIMIT ON DRUGS FOR 4IER 0REFERRED "RAND AND 4IER .ON 0REFERREDBrand. Plan payments will be limited to an annual maximum of 5,000 forretail and mail-order combined.Mail-order ninety (90) day supply prescriptions will continue to be dispensedas follows: one (1) co-payment for Tier 1-Generic; two (2) co-payments for Tier2-Preferred Brand; and three (3) co-payments for Tier 3-Non-Preferred Brand.Retail is dispensed with one (1) co-payment per thirty (30) day supply.THE HEALTH PLANVision benefits will have a new provider network offered through anagreement with VSP’s WellVision Program. The annual routine exam copayment and reimbursement levels will remain the same. The network ofdoctors that must be used is the VSP Signature Network, which has doctorsthroughout West Virginia. For a listing of doctors visit the website atwww.vsp.com or contact VSP at 1-800-877-7195.The Health Plan is the only not-for-profit HMO in West Virginia. It is WestVirginia’s first and oldest HMO. The Health Plan maintains its ExcellentAccreditation from the National Committee for Quality Assurance (NCQA). Lessthan 20% of all HMOs across the country receive this Excellent Accreditation.s 4HE (EALTH 0LAN S SERVICE AREA HAS EXPANDED 7E ARE NOW OFFERED IN #ALHOUNand Webster counties in West Virginia.Carelink offers the Passport Program for dependents who are enrolled in oneof our plans and live outside the Carelink service area. The dependent may beattending school or living with another parent outside the service area. ThePassport Program offers these members services from providers in our CoventryHealth Care National Network. Call Customer Service at 1-800-348-2922 fordetails.
6Eligibility RulesThis section offers general information about eligibility that you may need during Open Enrollment. For complete details, please refer to your PEIASummary Plan Description. It’s on the web at www.wvpeia.com.Who is eligible to transfer or enroll?Current Members. Current enrollees in any PEIA-sponsored managed care plan or the PEIA PPB Plan or PEIA-sponsored life insurance only (no healthinsurance), may join any plan.Eligible Non-Members. An employee or retiree who is eligible for benefits may enroll in any plan for which they qualify during Open EnrollmentPeriod.Medicare. If you or any enrolled dependents have Medicare as your primary health coverage (or will at any time during the plan year) you may not joina managed care plan. Your only option for PEIA-sponsored Medicare supplement coverage is the Coventry Advantra Freedom Plan. If either you or yourenrolled dependents become Medicare-primary while enrolled in a managed care plan, you must notify PEIA. Generally, Medicare is primary when thepolicyholder is retired. If you have more questions about when Medicare is primary, call the Open Enrollment Helpline.Eligible Dependents. You and your enrolled dependents must all live in the enrollment area of a plan to be eligible to enroll for that plan’s benefits.The only exception to this rule is made for full-time students living out of the area. You may enroll the following dependents:ss9OUR LEGAL SPOUSE UNLESS YOU ARE ENROLLED AS A 3URVIVING EPENDENT 9OUR UNMARRIED BIOLOGICAL OR ADOPTED CHILDREN UNDER AGE PROVIDED THEY MEET EITHER THE )23 DElNITION OF A hQUALIFYING CHILDv OR hQUALIFYINGrelative” below:A qualifying child must meet these requirements:1. Relationship. The taxpayer’s unmarried child or stepchild (whether by blood or adoption).2. Residence. Has the same principal residence as the taxpayer for more than half the tax year. Exceptions apply, in certain cases, for children ofdivorced or separated parents, and other special instances.3. Age. Must be under the age of 19 at the end of the tax year, or under the age of 24 if a full-time student for at least five months of the year, orbe permanently and totally disabled at any time during the tax year.4. Support. Did not provide more than one-half of his/her own support for the tax year.ORA qualifying relative must meet these requirements:1. Relationship. The taxpayer’s unmarried child or stepchild (whether by blood or adoption) who has the same principal abode as the taxpayer forthe taxable year and is a member of the taxpayers’s household.2. Support. For whom the taxpayer provides over one-half of the individual’s support for that calendar year.3. Qualifying Child. Is not an otherwise “qualifying child” of the taxpayer or of any other taxpayer for any portion of the tax year.Married children are not eligible for coverage.
7Two Public Employees Who Are Married To Each Other, and who are both eligible for benefits under PEIA may elect to enroll as follows:1. as “Family with Employee Spouse” in any plan.2. as“Employee Only” and “Employee and Child(ren)” in the same or different plans (remember, you’ll have two out-of-pocket maximums andtwo deductibles if you enroll this way).3. as “Employee Only” in the same or different plans if there are no children to cover (again, you’ll have two out-of-pocket maximums and twodeductibles if you enroll this way).You may both be policyholders in the same plan, but only one may enroll the children. All children must be enrolled under the same policyholder.To qualify for the Family with Employee Spouse premium, both employees MUST have basic life insurance. The Family with Employee Spouse premiumdiscount will not be granted unless both employees are basic life insurance policyholders in the plan.Retired or Retiring Deputy Sheriffs Under Age 55.Premium rates for all plans are substantially higher than those listed in this guide. Contact PEIA or your benefit coordinator for details of the premium rates.Eligibility RulesRetiring Employees: If you are considering retiring during the plan year, your choice this open enrollment will be an important one. At the time ofretirement you may drop dependents from your coverage (if you so choose), or you may drop health coverage completely, but you may not change plansduring the plan year unless you move outside a managed care plan’s enrollment area or unless you’ll be eligible for Medicare — age 65 or disabled — inwhich case you may be transferred to the Coventry Advantra Freedom Plan.Transferring Employees: If you transfer between State agencies during the plan year, remember that you can only change plans if you transfer out of theenrollment area of the plan you’re currently in. The PEIA PPB Plan doesn’t have a limited enrollment area, so if you’re in it, you’ll stay in it for the entireyear, regardless of where you are transferred. Transfer from a State agency to a non-State agency may permit a change in coverage.Mid-Year Plan Changes: The only time you can change plans during the plan year is if you move out of the enrollment area of your plan so that accessingcare is unreasonable. Since the PEIA PPB Plan has an unlimited enrollment area, you will not be permitted to transfer out of it during the plan year, even ifyou move.Physician Withdrawal From A Plan: If your PCP withdraws from a plan you must choose another PCP. A physician’s departure does not qualify you tochange plans. Although most networks are stable, a physician can choose to withdraw from any plan at any time with 60 days’ notice, so you need to beaware of that possibility when you make your selection.Death or Divorce: If you are in a managed care plan and a death or divorce occurs in the middle of a plan year, to continue coverage, you must remainin the plan you were in at the time of the death or divorce for the balance of the plan year. You can only change plans during the plan year if the affecteddependents move out of the enrollment area of the plan so that accessing care is unreasonable.Terminated Coverage: If your coverage terminates due to loss of employment or cancellation of coverage, you MUST cease using your medical ID card.Any claims incurred after the termination date will be the responsibility of the person incurring the claims, and may be considered fraud.SPECIAL ENROLLMENT: If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance orgroup health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that othercoverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within themonth of or the two months following the date your or your dependents’ other coverage ends (or after the employer stops contributing toward the othercoverage).In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and yourdependents. However, you must request enrollment within the month of or the two months following the marriage, birth, adoption or placement foradoption. To request this special enrollment or obtain more information, contact your benefit coordinator or call 1-888-680-7342.
8Benefits At-A-Glance(This is a limited benefit. One or more of the plans has specific limitations on this benefit. Check with the plans for details.
9Benefits At-A-Glance(This is a limited benefit. One or more of the plans has specific limitations on this benefit. Check with the plans for details.
10Benefits At-A-Glance(This is a limited benefit. One or more of the plans has specific limitations on this benefit. Check with the plans for details.
11Benefits At-A-Glance(This is a limited benefit. One or more of the plans has specific limitations on this benefit. Check with the plans for details.
12Benefits At-A-Glance(This is a limited benefit. One or more of the plans has specific limitations on this benefit. Check with the plans for details.
13Prescription Drug Benefits
14Benefit Fairs Sites and Dates 2008April 79:00am-2:00pmCharlestonState Capitol ComplexBuilding 7, Conference Room CApril 1610:00am-1:30pmMorgantownWVU Alumni CenterDurrett HallApril 73:00pm-7:00pmCharlestonCharleston Civic Center200 Civic Center DriveApril 163:00pm-7:00pmMorgantownRamada InnI-68 Exit 1, U.S. 119 NorthApril 83:00pm-7:00pmWeirtonHoliday Inn350 Three Springs DriveApril 173:00pm-7:00pmHuntingtonBig Sandy Superstore ArenaOne Civic Center Drives -AY ) HAVE A COPY OF YOURprovider directory?April 91:00pm-7:00pmWheelingNorthern Community CollegeMarket StreetApril 213:00pm-7:00pmBeckleyTamarack Conference CenterOne Tamarack Parks )F MY 0#0 DOES NOT WANT TO REFERme to a specialist and I believe Ineed one, what are my options?April 103:00pm-7:00pmParkersburgComfort Suites of ParkersburgI-77 and WV 14 (Exit 170) Mineral WellsApril 223:00pm-7:00pmFlatwoodsDays Inn200 Sutton LaneApril 143:00pm-7:00pmMartinsburgHoliday Inn300 Foxcroft AvenueApril 239:00am-2:00pmFairmontFairmont State College1201 Locust AvenueApril 153:00pm-7:00pmRomneySouth Branch InnU.S. Route 50Q&AHere are some questions youmight want to ask the planrepresentatives at the Benefit Fairs(or call their toll free lines).s (OW DO YOU DElNE A MEDICALemergency? How do I report it?s -AY ) HAVE A COPY OF YOUR DRUGformulary? Are there specialrestrictions I should know about?
15Enrollment Area Map For Plan Year 2009This map shows theenrollment areas forCarelink and Health PlanHMOs. You must live withinthe enrollment area of aplan to be eligible to enrollin that plan.The PEIA PPB Plan isavailable in all areasnationwide; it does nothave a limited enrollmentarea, so although it hasa symbol on this map itis available in all othercounties and states, too.You’ll also see the locationsof the benefit fairs markedon the map with a so you can find the onenearest you.
16Managed Care Plans’ Enrollment AreasThis chart lists the counties in which the managed care plans may enroll members. YOU MUST LIVE in one of these counties to be eligible to join amanaged care plan.
17Monthly Premiums: Employee or Employee/ChildPremiums for employees of State agencies, colleges and universities and county boards of education are based on the employee’s annual salary. Thepremiums listed here are charged monthly. For the PEIA PPB Plans, the out-of-network deductible and out-of-pocket maximum amounts are double thein-network amounts listed below.* To qualify for the Tobacco-free Preferred Premium for all of Plan Year 2009, you and all enrolled family members must have been tobacco free by January 1, 2008. If your tobacco status hasnot changed, you do not need to complete a Tobacco Affidavit. We will assume your status has not changed from the last plan year.Note: You can do your enrollment online at any time April 1-30, just go to www.wvpeia.com and click on the “Online Open Enrollment” button. If you used the site last year, just enter youre-mail address and password and proceed. If you don’t remember your password, choose “Forgot Password?” If you didn’t use the site last year, click on “Need to Register?” and follow theinstructions.
18Monthly Premiums: Family or Family/Employee SpousePremiums for employees of State agencies, colleges and universities and county boards of education are based on the employee’s annual salary. Thepremiums listed here are charged monthly. For the PEIA PPB Plans, the out-of-network deductible and out-of-pocket maximum amounts are double thein-network amounts listed below.* To qualify for the Tobacco-free Preferred Premium for all of Plan Year 2009, you and all enrolled family members must have been tobacco free by January 1, 2008. If your tobacco status hasnot changed, you do not need to complete a Tobacco Affidavit. We will assume your status has not changed from the last plan year.Note: You can do your enrollment online at any time April 1-30, just go to www.wvpeia.com and click on the “Online Open Enrollment” button. If you used the site last year, just enter youre-mail address and password and proceed. If you don’t remember your password, choose “Forgot Password?” If you didn’t use the site last year, click on “Need to Register?” and follow theinstructions.
19Non-State Agency: PEIA PPB PlansNon-State agencies are counties, cities, towns, and other government bodies and agencies that qualify for coverage under PEIA pursuant to the WestVirginia Code. By law, these agencies determine how much of the total monthly PEIA premium will be paid by their active employees. Employees shouldcheck with their employer to determine what their monthly employee contribution will be for the various plans and coverage types.PEIA has made it the employee’s option to choose PEIA PPB Plan A or Plan B or any of the managed care plans available in your area, although youremployer may choose to limit the amount paid toward the premium. Check with your benefit coordinator to see how much (if any) your employer will bepaying toward the premium for the plan you’ve chosen.The chart below details the premiums, deductibles and out-of-pocket maximums for the two PPB plan options. Remember that the out-of-networkdeductible and out-of-pocket maximum amounts are double the in-network amounts listed in the charts.Premiums, Deductibles and Out-of-Pocket Maximums* To qualify for the Tobacco-free Preferred Premium for all of Plan Year 2009, you and all enrolled family members must have been tobacco free by January 1, 2008. If your tobacco status hasnot changed, you do not need to complete a Tobacco Affidavit. We will assume your status has not changed from the last plan year.Note: You can do your enrollment online at any time April 1-30, just go to www.wvpeia.com and click on the “Online Open Enrollment” button. If you used the site last year, just enter youre-mail address and password and proceed. If you don’t remember your password, choose “Forgot Password?” If you didn’t use the site last year, click on “Need to Register?” and follow theinstructions.
20Non-State Agency: Managed Care Plans"E SURE TO READ THE INFORMATION ON THE PREVIOUS PAGE To enroll in one of the managed care plans listed below, you must live in the plan’s enrollment area. Check the chart on page 16 to see if you qualify forthe plan you’re considering. The PEIA PPB Plans’ enrollment area is unlimited, so you will not find it on the chart.The Health Plan does not offer discounted premiums to tobacco-free members.Premiums, Deductibles and Out-of-Pocket Maximums* To qualify for the Tobacco-free Preferred
MAPD (Medicare Advantage Prescription Drug Plan) — Medicare retirees benefits are administered through Coventry Health Care's Advantra Freedom Plan. Please read more about this new program on page 23 of this booklet. Managed Care Plans — The plans that PEIA contracts with to provide care to members who choose to enroll. The managed care plans we currently have contracts with are .
