Memorandum. Employees, Retirees and Survivors. Sarah Kloos, Director of Personnel. Date: September 22, Transition to GIC Health Benefits

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1 Memrandum T: Frm: Emplyees, Retirees and Survivrs Sarah Kls, Directr f Persnnel Date: September 22, 2011 Subject: Transitin t GIC Health Benefits Pursuant t Chapter 67 f the Acts f 2007, and after cnsultatin with and the affirmative vte f yur Public Emplyee Cmmittee, the City f Smerville will be transferring all f its eligible emplyees, retirees and survivrs t Grup Insurance Cmmissin (GIC) health benefits effective January 1, If yu wish t be enrlled in health insurance as f 1/1/12, yu must apply fr cverage during the special GIC pen enrllment perid f Wednesday, Octber 12 Wednesday, Octber 26, Health Insurance Premiums Emplyees, retirees and survivrs cntributin rati will be 15% fr HMO and PPO plans and 25% fr Indemnity plans thrugh June 30, We will send yu a rate chart, GIC Benefit Decisin Guide, and enrllment frms befre the beginning f the pen enrllment perid. Required Dcuments t Enrll in a GIC Health Plan (See Appendix A) When yu enrll in a GIC health plan, yu will need t prvide GIC required dcuments alng with yur enrllment applicatin(s). Please begin gathering the dcumentatin required fr health cverage. A listing f required dcuments that must accmpany yur GIC applicatin is enclsed. Yur failure t prvide this dcumentatin with yur applicatin will cause the GIC t reject yur applicatin. If yu need dcuments frm lcal gvernments r curts, please start t assemble that infrmatin right away. Please have phtcpies available t expedite the prcessing. 1

2 GIC Health Plan Benefit Infrmatin We will be sending yu a GIC Benefit Decisin Guide cntaining an verview f yur health plan ptins alng with enrllment frms befre the pen enrllment perid. Infrmatin is als available n the GIC s website: We encurage yu t research yur ptins, cntact plans yu are cnsidering t find ut infrmatin n ther benefits nt utlined n the GIC website r in the guide and t determine if yur dctrs and hspitals are in their netwrk. If yu inquire f yur dctr, be specific when naming a Plan such as Tufts Health Plan Navigatr r Tufts Health Plan Spirit. Be sure t check that yu reside within a plan s service area and als find ut which cpay tiers yur dctrs and hspitals are in. Health plan phne numbers and website addresses are listed in the Guide and the GIC s website ( Health Fair A health fair will take place n Mnday, Octber 17th frm 12:30 5 PM at the Medfrd High Schl Gymnasium, 489 Winthrp Street, Medfrd, MA At this fair, yu will be able t meet and speak with representatives frm the varius GIC health plans as well as GIC staff. Yu will als be able t enrll in a health plan at the fair. If yu wish t enrll at the fair, remember t bring the required dcumentatin with yu (Appendix A). Please nte that this is a ne time pprtunity t meet the Vendrs and the GIC staff. GIC Enrllment Sessins- City Hall Please see belw fr the schedule f GIC enrllment sessins. Enrllment sessins will take place in the Aldermanic Chambers in City Hall. Please nte that these sessins will be cnducted by the City f Smerville benefits team nly. 10/11 10, 1, and 3 10/18 10, 1 and 3 10/24 10, 1 and 3 10/12 10, 1, 3 and 5 10/19 10, 1 and 3 10/25 10, 1, 3 and 5 10/13 10, 1, 3 10/20 10, 1, 3 and 5 10/26 10, 1 and 3 Payrll Deductin f Health Insurance Premium Cverage fr GIC will begin January 1, Deductins are taken the mnth prir t cverage. Please see belw fr the breakdwn f payrll deductins. Paycheck dated December 9th fr City weekly Paycheck dated December 30th fr City mnthly Paycheck dated December 6 th fr Schl biweekly 21 pay perids Paycheck dated December 13 th fr Schl biweekly 26 pay perids Paycheck dated December 7 th fr Schl weekly 42 & 52 pay perids Paycheck dated December 29 th fr City and Schl Retirees If yu have nt currently prepaid ne mnth, yu will effectively be paying fr December 2011 and January 2012 during the mnth f December. 2

3 Additinal Infrmatin If yu have any questins regarding this mem, please cntact me either via at r via telephne at Yu may als cnsult: MaryAlice Lally, Jennifer Cmeir, Patricia Kelly in the Benefits Department at x3324 pkelly@smervillema.gv and 3

4 Appendix A Required Dcuments fr GIC Cverage fr All GIC Health Plans If yu are planning t cver yurself nly: There is n dcumentatin needed unless yu are a retiree r survivr age 65 r ver (see Additinal Dcuments fr Retirees sectin belw) If yu are planning t cver a current and/r frmer spuse, yu will need the fllwing: If yu are married Cpy f Certified Marriage Certificate If yu are divrced r legally separated- Fllwing sectins f Separatin Agreement are required: Divrce Abslute Date Signature Page Health Insurance Prvisins Yur Frmer Spuse s Last Knwn Address If yu are planning t cver dependent children, yu will need the fllwing: Dependent Child Cverage (New and Existing) Cpy f Certified Birth Certificate (must have parent/child relatinship listed) Dependent Age Cmplete a Dependent Age Applicatin fr cverage (frm available at the enrllment fair r n the GIC s website) Handicapped Dependent cmplete Handicapped Dependent frm (cntact the GIC fr the frm; als available n GIC website) Adptin Cpy f Adptin Placement Letter Letter must be n Adptin Agency Letterhead and include the fllwing: Name f Adptive Parents Name f Adpted Child Date Child Placed in the Hme Grandchild Cpy f Curt Guardianship Appintment Hwever, if grandchild is a dependent f a dependent under age 19, cpy f grandchild s certified (Lng Frm) birth certificate Dcuments such as marriage certificates and birth certificates can be btained by cntacting the Clerk s Office f the twn in which the event ccurred. Adptin verificatin and Grandchild verificatin infrmatin can be btained by cntacting the adptin agency used r the Clerk f Curt s ffice in the twn in which the event ccurred. We encurage yu t cntact the apprpriate ffices as sn as pssible. There may be a waiting perid t btain infrmatin Additinal Required Dcuments fr Retirees See Next Page 4

5 Additinal Required Dcuments fr Retirees If yu and/r yur spuse are n Medicare, yu will need the fllwing dcumentatin: See abve fr spusal and dependent cverage Phtcpy f Medicare Card (include a cpy f spuse s card if applicable) Phtcpy f yur latest 1099 r a recent letter frm Scial Security stating hw yur mnthly Part B premium is paid (e.g., yu are being directly billed by Scial Security r it is being deducted frm yur Scial Security check). Include this same dcumentatin fr yur spuse, if applicable. If yu and/r yur spuse are ver age 65 and Medicare eligible, but nt enrlled in Medicare, yu will need the fllwing: See previus page fr spuse and dependent cverage In January, yu must enrll in Medicare and send t the GIC the dcument listed abve (third bullet) fr retirees in Medicare During the spring 2012 GIC pen enrllment yu must enrll in a GIC Medicare plan If yu and/r yur spuse are ver age 65 and nt eligible fr Medicare yu will need the fllwing dcumentatin: See abve fr spusal and dependent cverage Recent letter frm Scial Security stating that yu r yur spuse is nt eligible fr Medicare Part A fr free. The clsest Scial Security ffice t the City f Smerville is lcated at: 10 Fawcett St. #1 Cambridge, MA Cmmercial St. Malden, MA