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2013 MEDICAL PLAN COMPARISON FOR MEDICARE ELIGIBLE RETIREES
This summary contains only a partial, general description of the medical plan benefits and does not constitute a contract. Consult your Medical Summary Plan Description and/or the Certificate of Coverage to determine governing contractual provisions, including procedures, exclusions, pre-certification requirements and limitations related to the medical benefits offered by Loral. Health Net
UnitedHealthcare
Cigna PPOR Medical Plan
Seniority Plus ( f
ecure Horizons/Pacificare)
(Secondary Plan to Medicare - see Page 3 for basic information as to how BENEFITS
$6700/member
HOSPITAL SERVICES
AMBULATORY SERVICES
$10 Copay/visit
MENTAL HEALTH / SUBSTANCE ABUSE
PREVENTIVE CARE
0% (100% Covered for certain immunizations) 100% Covered (does not include Well Baby) 2013 MEDICAL PLAN COMPARISON FOR MEDICARE ELIGIBLE RETIREES
Health Net
gna PPOR M
dical Plan
ealthcare
Seniority Plus
OTHER SERVICES COVERED
(160 visits / year)
$10 Copay (diagnosis & treatment)
PRESCRIPTION DRUGS
30 day supply / $10 Copay for Generic; $25 Copay for Preferred Brand; $50 Copay for Non-preferred Brand. Pre-authorization may be required for: Gleevec, Ana-Kit*, Retin-A (age 46 or older), Epipen (including Jr.)*, Glucagen*, Glucagon*, Avita,Imitrex*, Stadol NS*, Enbrel, Lariam, Trovan, Zoming(including ZMT)*, Zyvox, All Non-Fomulary: $35 copay
compounds*, Serostim & Growth Hormone prescriptions*. *When 50% Coverage, unless specifically covered on the No Coverage, unless specifically covered on the 90 day supply / $20 Copay for generic; $63 Copay for Preferred Mail Order - Generic: $20 Copay (no annual maximum); Brand; $150 Copay for Non-preferred Brand. Pre-authorization may be required for some drugs; see www.cigna.com for details. Non-Fomulary: $70 copay
Mandatory Mail Order After 3 Consecutive VISION CARE
VISION SERVICE PLAN (VSP)
Health Net
UnitedHealthcare
When you receive services from a VSP participating provider Scheduled reimbursement from non-VSP providers $15 Copay after cataract surgery There is no
copayment for Medicare-covered eyewear (one pair
of eyeglassed or contact lenses after each cataract
surgery)
$15 Copay after cataract surgery There is no
copayment for Medicare-covered eyewear (one pair
$120 allowance + 20% off amount over your allowance of eyeglassed or contact lenses after each cataract
surgery)
$15 Copay after cataract surgery There is no
copayment for Medicare-covered eyewear (one pair
of eyeglassed or contact lenses after each cataract
surgery)
$120 allowance + 15% off cost of contact lens exam (fitting & exam) $100 Allowance (in lieu of eyeglass lenses) This summary contains only a partial, general description of the medical plan benefits and does not constitute a contract. Consult your Medical Summary Plan Description and/or the Certificate of Coverage to determine governing contractual provisions, including procedures, exclusions, pre-certification requirements and limitations related to the medical benefits offered by Loral. 2013 MEDICAL PLAN COMPARISON FOR MEDICARE ELIGIBLE RETIREES
PLAN REQUIREMENTS
In order to participate in the Loral Retiree Medical Plan (the Plan), you must be eligible for Medicare Part A and must elect Medicare Part B. THE PLAN COORDINATES WITH MEDICARE ON A "NON-DUPLICATION" BASIS
As the secondary insurer, the Loral Retiree Medical Plan (the Plan) coordinates its benefits with Medicare on a "non duplication" basis. Non-duplication means that when the Plan is the secondary payer, the total benefits paid - by both the primary insurer (Medicare) and the Plan - will never be more than what the Plan would have paid as the primary payer. The Loral Retiree Medical Plan will always consider what is first paid by Medicare, your primary insurer. The Loral Plan will then reduce its own routine reimbursement by the total amount paid by Medicare and any other coverage you have that pays primary to the Plan. How are medical services not covered by Medicare treated? Certain types of service are not covered by Medicare. These include certain preventive services, care received outside the United States, certain chiropractic services, prescription drug coverage and in-patient hospital care in excess of the benefit period covered under Medicare Part A. If these services are covered under the Loral Retiree Medical Plan, then you will be reimbursed for their cost, subject to the Plan's routine provisions. The Plan will be the primary insurer, in these special circumstances. For these services, your Plan reimbursements will be higher if you use an In-Network provider. How coordination with Medicare generally affects your out-of-pocket costs. The Plan's coordination with Medicare may not reduce your out-of-pocket costs. In certain cases, the coordination with Medicare benefits causes no reimbursements to be paid under the Loral Retiree Medical Plan. This is because Plan benefits are reduced by the amount that Medicare pays. However, please know that because Medicare is primary, Loral's retiree health costs are lower - and therefore your monthly contributions are lower as well. Medicare coverage lowers your own cost of coverage under the Loral Retiree Medical Plan. For full details on how this plan coordinates with Medicare, please see the Loral Retiree Health Benefits chapter on the Loral Retiree website - http://www.loralrsc.com. Be sure to log on to Medicare’s web site - http://www.medicare.gov - for current Plan Benefits and Rates.

Source: http://sslalumni.com/downloads/2013_post65_retiree_medical_plan_comparison_chart_111912.pdf

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