Group Medicare Plans

Group Medicare Plans  

OVERVIEW

Introducing Via Benefits from Willis Towers Watson

Trusted advisor for hundreds of thousands of retirees

Via Benefits (formerly known as Extend Health) is a leading provider of retiree health benefit administration services and will give you and your eligible Medicare dependents personalized assistance to help you navigate through your health care options.
 

Sandia has partnered with Via Benefits to offer retirees access to the Sandia-sponsored Humana Medicare Employer HMO Plan in New Mexico, United Healthcare Group Medicare Advantage (PPO) Plan, and the Sandia-sponsored Kaiser Senior Advantage Plan in Northern California. Via Benefits also offers a variety of individual Medicare supplemental medical and prescription drug coverage options.
 

To learn more about these options, please call Via Benefits at 1-888-598-7809 (TTY: 1-866-508-5123), Monday-Friday 7 a.m. – 7 p.m. MT.
 

Sandia YSA Program Summary

Sandia Retiree SPD

Sandia Dental Care Program Summary

Sandia Vision Discount Program Summary

 

As a Sandia medicare-eligible retiree, you have several options for medical and prescription drug coverage available through Via Benefits. Some of your plan options include:

  • Humana Medicare Employer HMO Plan
  • United Healthcare Group Medicare Advantage (PPO) Plan - Effective January 1, 2019
  • Kaiser Senior Advantage
Contact Us

Via Benefits from Willis Towers Watson

 Phone
1-888-598-7809
1-866-508-5123 (TTY)
 Website
www.medicare.oneexchange.com/sandia

 

Blue Cross Medicare Advantage (HMO)

 Phone
1-877-299-1008

 

Presbyterian Senior Care HMO-POS

 Phone
1-505-923-6060 or
1-800-797-5343 (outside Albuquerque)
 Website
www.phs.org/PHS/healthplans/
Medicare2011/EmployerGroup/index.htm

 

Kaiser Senior Advantage Plan (CA)

 Phone
1-800-464-4000
 Website
www.kponline.org

 

Sandia National Laboratories Health Benefits & Employee Services

 Phone
1-505-844-HBES (4237) or
1-800-417-2634 ext. 844-4237
 Website
hbe.Sandia.gov

HUMANA MEDICARE EMPLOYER HMO PLAN

This plan is fully insured through Humana for eligible Medicare-primary participants residing in the Humana Medicare Employer HMO within these New Mexico counties; Bernalillo, San Miguel, Sandoval, Santa Fe, Torrance and Valencia. Benefits are available only from providers who are in the Humana Medicare Employer HMO network.
 

You can obtain information on this plan (including a provider directory, drug formulary list, etc.) by contacting Humana Customer Care at 1-866-396-8810 (TTY: 711) Monday- Friday 6 a.m. - 7 p.m., Mountain Standard Time.
 

Eligibility

This plan is available to Medicare-primary retirees, surviving spouses, LTD terminees, and their eligible Medicare-primary Class I dependents who:

  • Reside in the Humana Medicare Employer HMO service area within New Mexico; which is Bernalillo, San Miguel, Sandoval, Santa Fe, Torrance and Valencia Counties
  • Are enrolled in both Medicare Part A and Part B; and
  • Continue to pay Medicare Part A and Part B premiums


By enrolling in this plan, you will automatically be enrolled in the Medicare Part D prescription drug benefit and will receive all of your prescription drug benefits through this plan.
 

KEY POINTS

  • Primary Care Physician (PCP) is required. You must select a PCP and provide this information to Humana or one will be assigned to you. You can change your PCP at any time. For PCP listings, go to Humana.com to find a doctor or you can contact Humana Customer service for assistance or to request a directory be mailed to you.
  • Unlimited prescription drug coverage is available under this plan.
  • You will be required to assign your Medicare benefits to the Humana Medicare Employer HMO Plan; therefore, you cannot be enrolled in this plan and another Medicare Advantage plan or another Medicare Part D plan at the same time.
  • When you select the Humana Medicare Employer HMO Plan, your regular Medicare benefits are provided by this plan. You must maintain your Medicare Parts A and B enrollment in order to keep your coverage.
  • You must inform Humana Medicare Employer HMO Plan and Via Benefits before moving or leaving the service area.
  • Outside the service area, this plan covers emergency and urgent care. If you are hospitalized in a non-participating hospital for emergency care, you or your family member must call Humana Customer Care within 48 hours (or as soon as reasonably possible).

The UnitedHealthcare® Group Medicare Advantage (PPO) Plan Including Prescription Drug Coverage

Sandia National Laboratories has chosen to offer a UnitedHealthcare Group Medicare Advantage (PPO) plan. Only eligible retirees of Sandia National Laboratories and their eligible dependents can enroll in this plan. You can't get it anywhere else.
 

"Medicare Advantage" is also known as Medicare Part C. These plans have all the benefits of Medicare Part A (hospital coverage) and Medicare Part B (doctor and outpatient care) plus extra programs that go beyond Original Medicare (Medicare Parts A and B).
 

Eligibility

This plan is available to Medicare-primary retirees, surviving spouses, LTD terminees, and their eligible Medicare-primary Class I dependents who:

  • Reside in the state of New Mexico;
  • Are enrolled in both Medicare Part A and Part B; and
  • Continue to pay Medicare Part A (if applicable) and Part B premiums.


By enrolling in this plan, you will automatically be enrolled in the Medicare Part D prescription drug benefit and will receive all of your prescription drug benefits through this plan.
 

You will not be required to enroll in an individual Medicare Part D or pay the additional Medicare Part D premium. You cannot be enrolled in the UnitedHealthcare Group Medicare Advantage (PPO) plan, which include prescription drug coverage and another Medicare Advantage plan or another Medicare Part D plan at the same time.
 

Note: Plans are pending Centers for Medicare & Medicaid Services (CMS) approval
 

Key Points

The UnitedHealthcare Group Medicare Advantage (PPO) plan is a Preferred Provider Organization (PPO) plan. You have access to a national network of providers. You can see any provider (network or out-of-network) at the same cost share, as long as they accept the plan and have not opted out of or been excluded from Medicare.
 

Get access to benefits and programs like:

  • Nurseline: Talk to a nurse when you have a health-related question, 24 hours a day.
  • SilverSneakers®: Stay active and have fun with a fitness program - at no additional cost.
  • Virtual Doctor Visits: See a doctor using your computer, tablet or smartphone using live video chat - anytime day or night.
  • Renew: Explore inspiring lifestyle tips, learning activities, videos, recipes and more through our member-only Health & Wellness Experience
  • UnitedHealthcare® HouseCalls: Get an annual in-home health and wellness visit from one of our health care practitioners at no extra cost.
     

Referrals to specialists are not required.
 

Coverage is available worldwide for emergency and urgent care services
 

You can obtain information on this plan (including a provider directory, drug formulary list, etc.) by contacting UnitedHealthcare® at 1-844-496-0314, TTY 711, 8 a.m. - 8 p.m. local time, 7 days a week.
 

For additional information, refer to the UnitedHealthcare Medicare Advantage Plan benefits information at www.UHCRetiree.com/SandiaRetiree.

Kaiser Senior Advantage

The Kaiser Senior Advantage plan is a Medicare Advantage plan with prescription drug benefits. This plan is fully-insured through Kaiser Permanente for eligible Medicare-primary participants who live in California, within Kaiser-designated service areas.
 

You can obtain information on this plan by contacting Kaiser Permanente Member Services Call Center at 1-800-464-4000, M-F 7 a.m. – 7 p.m., weekends 7 a.m. – 3 p.m., or by visiting www.kponline.org or, for additional information, refer to the Kaiser Senior Advantage Plan Evidence of Coverage and Kaiser Chiropractic Evidence of Coverage at hbe.Sandia.gov. If there are any discrepancies between this and the Evidence of Coverage, then the Evidence of Coverage supersedes.
 

Eligibility

This plan is available to the following who live within a Kaiser-designated service area (currently, Alameda, Contra Costa, Marin, Sacramento, San Francisco, San Joaquin, San Mateo, Solano, and Stanislaus counties are entirely inside a Kaiser service area; service areas for other Northern California counties are determined by specific ZIP codes within those counties).
 

This plan is available to Medicare-primary retirees, surviving spouses, Long-Term Disability (LTD) terminees, and their eligible Medicare-primary Class I dependents. Members must be enrolled in both Medicare Part A and Part B, and continue to pay Medicare Part A (if applicable) and Part B premiums.
 

Key Points

  • Integrated health care with one stop access to medical offices, specialty offices, laboratory, pharmacy, and optical services at each facility
  • Kaiser Permanente providers and facilities must be used. If you access care outside Kaiser Permanente, your services may not be covered, except for emergency and urgent care
  • Self-referral to selected specialty departments; others require a referral from your Plan physician
  • You must reside within a Kaiser Permanente service area to be eligible for the Plan and may only leave the service area for a maximum of 90 continuous days
  • Coverage is available worldwide for emergency and urgent care
  • Medicare benefits must be assigned to Kaiser Permanente. Therefore, you cannot be enrolled in another Medicare Advantage Plan or Medicare Part D Plan at the same time you are enrolled in Kaiser Senior Advantage Plan
  • When you select Senior Advantage, your regular Medicare benefits are provided by Kaiser Permanente. You must maintain your Medicare Parts A and B enrollment in order to keep your Senior Advantage coverage
  • When you select Senior Advantage, you will automatically be enrolled in a Medicare Part D prescription drug benefit. You will receive all of your prescription drugs through the Senior Advantage Plan. You will pay the Senior Advantage prescription drug copays based upon the specific drug and quantity prescribed. You will not be required to pay the additional Medicare Part D premium to Medicare or the Senior Advantage Plan
  • Medicare will not pay for any medical care you receive from a non-Kaiser Permanente health care provider unless you have been referred to the outside provider by a Kaiser Permanente physician. When you enroll in Senior Advantage, you agree to receive all your medical services through Kaiser Permanente, except for emergencies, urgent out-of-area care, or authorized referrals
  • Senior Advantage is designed for people who live in the Kaiser Permanente service area. If you plan to leave the service area for more than 90 days or move permanently outside the service area, you must disenroll from Senior Advantage

FAQs