- Will I be automatically enrolled in the new plan, or do I need to do anything to enroll?
All Medicare-eligible retirees and/or dependents will be automatically enrolled into the plan. There is nothing you need to do to be enrolled.
- Can I stay with the current plan?
No, all Medicare-eligible retirees and/or dependents must change over to Transamerica. Your current plan through United American will no longer be available.
- Can I opt-out of this plan?
We are required by law to give you the choice of opting out of the new plan. Since you are enrolled in the current medical and prescription drug plan it is unlikely that you would not want to participate in this new robust plan. However, you have the option to opt-out and decline this medical and prescription coverage. Nevertheless, if you would like to opt-out, please call County of Fresno – Human Resources: Employee Benefits at (559) 600-1810, option 4.
- Are there any plan changes?
No, the County of Fresno’s new Transamerica Medicare Supplement plan is a match to your current benefits. Below are a few highlights of your new plan:
- Medicare Covered Medical Services are $0 cost to you.
- Foreign Travel $250 deductible, 20% coinsurance for medically necessary emergency care services, $50,000 lifetime maximum.
- Access to RetireeFirst Advocates for assistance with understanding and using your benefits.
- When will I receive my ID card and welcome kit?
Cards and welcome kits should arrive in the month prior to your start date. Retirees and Medicare-eligible dependents will each receive their own card. Please note that each enrollee may not receive their plan information on the same day; this is normal.
- What do I do if I lose my card?
Please call RetireeFirst at (559) 588-4422 (TTY 711) or toll free (833) 236-2092 (TTY 711) and we will obtain a new one on your behalf, mail you a temporary card, and call your pharmacy and/or providers if needed.
- If I leave the plan, will it affect any of my other benefits?
Yes, as the retirees have a combined package with dental and vision coverage.
- How much do I have to pay for the plan?
The County of Fresno can be reached at (559) 600-1810 to answer any billing questions.
- Who do I call if I need assistance with the plan?
Please call RetireeFirst at (559) 588-4422 (TTY 711) or toll free (833) 236-2092 (TTY 711) to reach your dedicated County of Fresno Retiree Advocacy Team, Monday-Friday, 8am-5pm, PST.
Medical Questions
- Is there a medical deductible?
No
- Is there co-insurance or copays?
No
- Does this plan require referrals?
No, this plan does not require referrals.
- Does this plan require pre-certifications?
Some services may require pre-certifications.
- Does this plan have a network?
No, you can go to any willing Medicare provider, hospital, or facility.
- Can I go to my current providers?
Yes, you can see any provider that accepts Medicare and is willing to bill Transamerica.
- Do I still use my Medicare card?
Yes, you will use both your Medicare card and your Transamerica ID Card at your provider’s office.
Prescription Questions
- Is there a prescription deductible?
No, there are no benefit changes to your renewing UnitedHealthcare Prescription Drug Plan.
- Is there co-insurance or copays?
Yes, there are copays associated with your plan. Please refer to the prescription plan design on page 2 of this document to learn more about the costs associated with the plan.
- Are my prescriptions covered?
Most likely yes, the prescription list is a comprehensive formulary just as before. Please call RetireeFirst at (559) 588-4422 (TTY 711) or toll free (833) 236-2092 (TTY 711) if you need help looking up your prescriptions.
- Can I go to the same retail pharmacy?
Yes, there will be no pharmacy disruption as there is no change to the prescription provider. UnitedHealthcare has over 67,000 pharmacies in network.
- Is there a mail order pharmacy?
There is a mail order pharmacy called Optum Rx which can be reached at 1-888-279-1828, TTY 711. You can also call your dedicated RetireeFirst Advocates at (559) 588-4422 (TTY 711) or toll free (833) 236-2092 (TTY 711) with questions about mail order prescriptions.
- Can I still go to the Veterans Affairs (VA) for my prescriptions?
Yes, if you obtain some prescriptions from the VA, you may continue to do so.
- Do I need prior authorizations for certain prescription medicines?
Some prescriptions may require a prior authorization. Please contact RetireeFirst at (559) 588-4422 (TTY 711) or toll free (833) 236-2092 (TTY 711) if you have questions or need assistance with prior authorizations as well as any other requirements such as step therapy, quantity limit, or formulary exceptions.
- What is the catastrophic phase and is there coverage?
The catastrophic phase is a phase of coverage designed to protect you from having to pay very high out-of-pocket costs for prescription drugs. It is the final phase in your prescription drug plan and your copays will be $0. You will remain in this phase for the rest of the plan year. This coverage phase kicks in when you reach a true out of pocket total of $2,000 for prescription drugs. Keep in mind, lifestyle and non-part D prescription drugs do not count toward your out-of-pocket total.
- What is the annual maximum out-of-pocket (MOOP) and how does it work?
Your out-of-pocket costs for prescription drugs reaches $2,000, your copays will be $0. You will remain in this phase of coverage for the rest of the plan year. Keep in mind, lifestyle and non-part D prescription drugs do not count toward your out-of-pocket total.