At the Retiree Benefits and Health Information Fairs that were held in February and March, we received a number of questions regarding the changes to the Pfizer Retiree Medical Plan that took effect on January 1, 2010, as well as how the new benefits work. Here, we’ve answered the most frequently asked questions from the live and webcast benefits presentations and question and answer sessions. We hope the information in this document helps answer some of your questions. Please keep in mind the fairs were attended by retirees from all of our legacy companies (Pfizer, Warner-Lambert, Pharmacia and Upjohn, Nutrasweet/Searle and Monsanto) and the medical plan changes retirees experienced from 2009 to 2010 were different based on your legacy company. We are committed to continuing to provide you with information that helps you understand your medical coverage, plan for your medical expenses and evaluate your coverage options.
Please note that during the information fairs and through the webcast submissions, we received a number of specific questions about retirees’ contributions to the cost of medical coverage. Refer to the current special edition of PLUS in print, which provides much more detail about the cost of coverage for each of the legacy retiree groups as well as additional information regarding your coverage. You can view the current and previous issues of PLUS in print on PLUS online.
- Why did Pfizer make changes to retiree medical coverage?
As of January 1, 2010, we harmonized the legacy retiree medical plans into a new retiree medical program with the goal of providing competitive retiree benefits that were sustainable for both Pfizer and our retirees for the future.
- Do you expect the new plan and cost structure will change in the future (for example, as Healthcare Reform becomes effective)?
We believe that the new Pfizer Retiree Medical Plan will be a plan that continues to be affordable and sustainable for Pfizer and our retirees for the future. At this point, we do not anticipate making significant changes to the new retiree medical plan as a result of the recently signed Healthcare Reform legislation. When we have more information on the impact of Healthcare Reform on the Pfizer Retiree Medical Plan, we will communicate that information to you.
- Why is there one medical plan option for retirees under age 65, but two medical plan options for retirees age 65 and over?
The coverage options available to retirees were selected in an effort to keep the Pfizer Retiree Medical Plan affordable for retirees and for Pfizer. Once retirees reach age 65, Medicare becomes their primary coverage. Some retirees may find that Medicare Parts A and B meet their needs; therefore, we offer the “Prescription Only” option as a means of providing retirees with the option of only receiving prescription drug benefits through Pfizer-sponsored coverage and medical coverage through Medicare. Pfizer also offers a “Medicare Carve Out” option for those retirees age 65 and over who would like Pfizer-sponsored medical coverage that supplements the coverage provided by Medicare Parts A and B.
- When retirees reach age 65 and become eligible for Medicare, the Pfizer Retiree Medical Plan provides coverage that is secondary to Medicare through the “Medicare Carve Out” option. Why don’t contributions go down more significantly when retirees turn 65?
The way contributions are structured is heavily influenced by the subsidy that each legacy company established for its retirees; therefore, what happens to the contribution when a retiree reaches age 65 depends on the legacy company structure. Keep in mind, a significant portion of the cost of coverage for retirees age 65 and over is the prescription drug benefit, which is the same prescription drug benefit that is offered to retirees under age 65. Refer to the current issue of PLUS in print for more details about your cost of coverage.
- Why is the cost of covering a retiree and a spouse substantially more than the cost of covering only the retiree?
In determining contribution amounts, Pfizer first recognizes the retiree by providing a greater subsidy to the retiree than is provided to spouses and dependents.
- Once retirees reach age 65 and become Medicare eligible, they will be eligible under the “Medicare Carve Out” option. At this point, they cannot drop Pfizer coverage and re-enroll at a later date. Can they, however, switch between the “Medicare Carve Out” and “Prescription Only” options from year to year?
Yes, you can make changes in the option you elect each year during the annual enrollment period. The option to move between plans remains available to you each year as long as you do not drop coverage entirely. Also, if both you and your spouse are Pfizer retirees you can switch from family to individual coverage during annual enrollment (see question 10 for more information).
- Where is information about services covered and not covered by Medicare available?
Medicare Part A pays some of the cost for hospitalization, skilled nursing facilities and home health services. Medicare Part B pays for doctors’ fees, most outpatient hospital services and certain related services. For more information on services covered and not covered by Medicare, refer to the “Medicare & You” handbook on www.medicare.gov or call 1-800-633-4227.
- How does the Medicare Carve Out option work? What services does it cover that are not covered by Medicare?
The Medicare Carve Out option determines what the Pfizer Retiree Medical Plan would pay for a covered service if Medicare were not the primary insurer. The Pfizer plan then pays the difference, if any, between what Medicare has paid and what the Pfizer plan would have paid. Examples where the Medicare Carve Out option covers services beyond those covered by Medicare include:
- Preventive care services, including an annual routine physical exam (see question 11 for more information on preventive care services)
- Hearing exams and hearing aids
- Most chiropractic services
- Most immunizations
- Private duty nursing
- Services incurred outside the U.S.
- Can you explain the difference between the deductible and the out-of-pocket maximum?
The deductible is the amount you must pay each year before the Plan begins to reimburse you for covered services. Once you reach the deductible, the Plan will reimburse you at a rate of 80% of covered services. The out-of-pocket maximumis the most you will be required to pay for covered healthcare services in one calendar year (not including the deductible). Refer to the current edition of PLUS in print for an example.
- My spouse and I are both Pfizer retirees and we currently have family coverage. Can we choose to each elect individual coverage rather than electing family coverage?
Yes, if you choose to, you and your spouse may each have individual coverage instead of family coverage. You may only make this change during annual enrollment. Please note that if you each elect individual coverage, you will each need to satisfy the individual deductible and out-of-pocket maximum. In addition, only one of you may cover any eligible dependent children.
- Where can I find a list of the services that are considered preventive care services and are therefore covered at 100%?
You can find a complete list of covered preventive care services in the Pfizer Retiree Medical Plan Summary Plan Description. You may download the Summary Plan Description on www.hrSourcebenefits.pfizer.com or request a copy by calling hrSource. A few examples of preventive care services covered at 100% include:
- Routine adult physical exams and related diagnostic screenings and immunizations, up to a $500 annual maximum per person
- Colonoscopy
- Sigmoidoscopy
- Mammogram
- Pap smear (papnet and thin prep)
- Immunizations
- Prostate specific antigen (PSA)
- Well woman exam
- Hearing exam
- Bone density test
It is important to note that your doctor must code your services as preventive care in order for the services to be covered at 100% through UnitedHealthcare. Contact UnitedHealthcare for more information on preventive care services.
- I am a retiree with family coverage through Pfizer that currently covers my spouse and me. If I should die, what would happen to the coverage for my spouse?
Following the death of a retiree, eligible surviving spouses will continue to be offered the same coverage each year that they would have been offered if the retiree were still living. Details about surviving spouse coverage can be found in the Pfizer Retiree Medical Plan Summary Plan Description.
- Does Pfizer retiree medical coverage stay in effect if I travel outside the U.S.?
Yes, the Pfizer Retiree Medical Plan covers you wherever you may seek care. However, because Medicare is an insurance program sponsored by the U.S. government, you may not be covered by Medicare when you are overseas. You should contact your carrier (UnitedHealthcare, Medicare or both) prior to your travel to determine the level of coverage provided should you incur services abroad.
- Who determines which providers are in-network?
UnitedHealthcare, the administrator of the Pfizer Retiree Medical Plan, determines the network of providers that applies to retirees under the age of 65. UnitedHealthcare actively works on recruiting physicians and hospitals into its network. Sometimes physicians and hospitals choose not to participate in a particular network. Pfizer evaluates UnitedHealthcare’s network regularly to ensure that Pfizer colleagues and retirees have an adequate number of physicians and hospitals available to them. You can find out whether your physician is in-network by visiting www.myuhc.com/groups/pfizer or by calling 1-800-638-8010.
Note that if you are age 65 or over, your benefits are not impacted by whether or not a provider participates in the UnitedHealthcare network. If you are age 65 or over, it is important, however, that you confirm that your provider accepts Medicare assignment.
MetLife is the administrator of the dental plan and follows the same process as UnitedHealthcare when determining which dental providers to include in its network.
- I didn't enroll in dental coverage during annual enrollment. Can I still enroll for dental coverage?
Pfizer has extended the enrollment period for the dental plan through April 30, 2010. This is a one-time opportunity. After April 30, 2010, if you drop dental coverage, you will not be able to enroll in the plan at a later date.
If you would like more information on dental coverage, call MetLife at
1-800-Get Met8 (1-800-438-6388).
- Can I switch between the two dental options?
Yes. You can change dental coverage options annually during the annual enrollment period, as long as you do not drop dental coverage entirely.
- When I retired, I was told I had a Company-paid life insurance policy. Do I still have that insurance?
The recent changes to retiree medical benefits did not affect life insurance coverage. Retirees who were eligible for life insurance upon retirement remain eligible. You can view the amount of your life insurance coverage on the Health and Insurance page on www.hrSourcebenefits.pfizer.com or by calling hrSource to speak with an hrSource Benefits Specialist.
- How do I report an issue or concern I’m having with a plan administrator or with hrSource?
If you have an issue with a plan administrator or with hrSource, you may escalate that issue by asking to speak with a supervisor while you are on the phone with a representative from the plan administrator or hrSource.
Although this document contains information about the Pfizer Retiree Medical Plan, it is not intended to provide every detail. More information can be found in the Pfizer Retiree Medical Plan Summary Plan Description. While Pfizer expects to continue the benefits described here, it reserves the right to amend, suspend or terminate the Plan at any time, with or without notice, and for any reason.
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