Passing the Baton: Transitioning to Retiree Health Benefits

1. Passing the Baton: Transitioning to Retiree Health Benefits Presented by Susan Jones

2. For discussion… • Eligibility • Plan Choices • Program Provisions • Medicare • Overview • Enrollment • Coordination with the State Program • Prescription Drug Coverage

3. Eligibility Must be a retiring state employee receiving an immediate (not deferred) VRS retirement benefit or periodic benefit from an ORP Must have been eligible for state coverage as an active employee at the time of retirement (not Extended Coverage) Must enroll within 31 days of retirement date

4. … and Not Eligible Coverage is declined at retirement (except waiver) Enrollment is not completed within 31 days of retirement Retirement benefit is deferred Coverage is cancelled

5. Coverage Begins… The first day of the first full month of retirement

6. Eligible Dependents Same as active employees • Legal spouse • Children

7. Plan Choices • Non-Medicare Plans • Medicare Plans

8. Current Non-Medicare Plans • COVA Care/COVA Connect • COVA Care/COVA Connect with optional benefits • Out-of-Network • Expanded Dental • Out-of-Network and Expanded Dental • Vision, Hearing and Expanded Dental • Out-of-Network, Vision, Hearing and Expanded Dental • Regional Plan – Kaiser Permanente • COVA HDHP • TRICARE Supplement

9. Non-Medicare Retiree Group

10. Medicare Supplemental Plan Options • Advantage 65 • Advantage 65 with Dental/Vision • Advantage 65 Medical Only • Advantage 65 Medical Only with Dental/Vision

11. Medicare Retiree Group

12. Changes Allowed at Retirement • Enroll from active waive into single coverage • Decrease membership • Waive to active/retiree coverage as dependent (and return in the future per plan provisions) • Plan change • Decline/cancel coverage – no return to program

13. NOT Allowed at Retirement • Increase in membership

14. Allowable Changes After Retirement • Changes Consistent with Qualifying Midyear Events • Membership Reduction (prospective) • Cancellation (prospective ) • Open Enrollment (non-Medicare only) • Certain Medicare-Coordinating Plan Changes (prospective)

15. Required Change To a Medicare-coordinating plan immediately upon Medicare eligibility

16. NOTE: Active Employees If covered based on current employment, Part B can be declined without penalty (no break in creditable coverage for 63 or more days)

17. Medicare 101 • What is it? • How do I get it? • What do I need? • How much does it cost?

18. What is it?Medicare Eligibility • At age 65 • Before age 65 • Disability • End Stage Renal Disease

19. What is it?Original Medicare Plan • Medicare Part A – Hospital Insurance • Inpatient care • Skilled nursing facility • Hospice • Medicare Part B – Medical Insurance • Doctors’ services • Preventive care

20. What is it?Medicare Part D • Outpatient Prescription Drug Coverage

21. What is it?Medicare Part C NOT ORIGINAL MEDICARE • Medicare Advantage Plans • Medicare PPO Plans • Medicare HMO Plans • Medicare Private Fee-for-Service Plans • Medicare Special Needs Plans

22. How do I get it?Enrollment – A, B • If no SSA/RRB benefits, you must actively enroll in A and B • Automatic enrollment if you are already getting SSA/RRB benefits • Declining Part B • Special Enrollment Period • General Enrollment Period • Late Enrollment Penalty

23. How do I get it?Enrollment – D • Initial Enrollment • Special Enrollment • Annual Coordinated Election Period • Late Enrollment Penalty

24. What do I need?To Summarize: • You must have Medicare Parts A and B (Original Medicare)when your retirement begins if you enroll in the State Retiree Health Benefits Program to avoid a gap in coverage! • You can get Part D through or outside of the state program.

25. How much does it cost?Cost for Medicare Only • Part A – usually no cost • Part B - $99.90 for 2012 (unless IRMA) • Part D – cost based on elected plan ($38 average premium—IRMA/LIS)

26. The State Program How does the State Retiree Health Benefits Program work with Medicare? • Plan Provisions • Premium Cost

27. How Does Advantage 65 Work?

28. Enhanced Part D Provisions • Formulary • Exceptions/appeals • Tiers • Excluded Drugs • Coverage Stages • Deductible • Initial • Coverage Gap/Medicare Coverage Gap Discount Program • Catastrophic

29. Medicare Must Approve Part D: • Enrollment • Disenrollment • Only one plan • Penalties

30. Premium Cost • Retiree pays the full cost of coverage • Health Insurance Credit (VRS) if eligible

31. How is Premium Paid? • VRS Benefit Deduction • Direct Bill • Automatic Bank Draft • Online payments

32. July 2012 through June 2013

33. 2013 Premium Cost

34. Your Decision at Retirement… • Is the state program the best choice for me?

35. Resources www.dhrm.virginia.gov • Retiree Fact Sheets www.medicare.gov • 800-MEDICARE www.ssa.gov • 800-772-1213 Medicare COB • 800-999-1118 VICAP • 800-552-3402

36. Questions Thank you!