Retiree Benefits Booklet

Transcription

1 2015 Retiree Benefits Booklet

2 This Enrollment Guide Is Not A Contract This guide provides a detailed summary of benefits available to City of Gainesville retirees and eligible dependents, as well as laws, procedures, and regulations required to obtain and use such benefits. However, if inconsistencies occur between the contents of this enrollment guide and the contracts, rules, or laws regulating administration of the various programs, the program contract terms and/or appropriate legislation supersede this guide. In some instances, limitations and exclusions may apply. Should you have questions, please contact the City of Gainesville s Risk Management Department. Contact information is included in this booklet. Copies of these documents may be available by request in the Risk Management Department during normal business hours or on the City s Intranet under Risk Management. Front cover photo by Dave Mathia 2

3 Benefits Eligibility City of Gainesville Retirees and their dependents are eligible to enroll in the City s health insurance plan and/or as a Retiree, you also have the option of choosing a Medicare Supplemental Plan through the City. Dependents must meet certain eligibility criteria to be considered. The following is a list of eligible dependents: A spouse (a husband or wife who is joined in marriage to a retiree by a ceremony recognized by the laws of the Federal Government) A natural child A domestic partner (registered with the City of Gainesville) A legally adopted child under age 26 or a child, under the age of 26, for whom you have guardianship (permanent or deemed permanent for insurance purposes) A stepchild under age 26 permanently residing with the retiree and supported by the retiree A child up to the age of 26, unless they have access to their own group coverage, without eligibility rules other than the definition of dependent above. They do not have to be students, or living with you. Repeat, all children up to the age of 26, married or single are now eligible for coverage on their parents health plan. A child 26 years or older who is incapable of self-support due to mental or physical disability; and who has a permanent disability. All benefits begin on the first of the month, following eligibility, except in certain life events. No Retiree may have an individual policy and be the dependent of another employee/retiree for health insurance. 3

4 D e p e n d e n t E l i g i b i l i t y D o c u m e n t a t i o n R e q u i r e m e n t s Dependents For Spouse For Removal of Spouse/Child For Natural Child(ren) For Adopted Child(ren) For Disabled Child (26 years and older) Foreign Adoptions For Step-Child(ren) For Court-Ordered Support For Guardianship For Domestic Partner For Termination of Domestic Partner Documentation Required Copy of marriage certificate. If previously married, death certificate or divorce decree. None at Open Enrollment. Court decree within 30 days of decree during the contract year. Child s birth certificate (showing the parent-child Relationship to retiree and/or spouse). Placement papers signed by the courts. Physician verification of permanent disability. Adoption papers signed by the courts; visa showing date of entry to USA. Child s birth certificate (showing parent-child relationship with retiree s spouse); copy of marriage certificate. State affidavit; copy of signed court order requiring retiree to provide support for health coverage. Court ordered guardianship deemed permanent for insurance purposes. City of Gainesville Domestic Partner Affidavit (notarized within 30 days of approval and only during Open Enrollment None at Open Enrollment; City of Gainesville Notice of Termination within 30 days of termination. Social Security number and date of birth must be provided for all dependents. Failure to submit the dependent s Social Security number will result in termination/denial of coverage. No documentation is required at Open Enrollment to delete a dependent. All documentation should contain the retiree s name and Social Security number. 4

5 Health Insurance Regardless of your present coverage under the Retiree Health Insurance plan, you will be allowed to opt out of the plan and re-enter only one time at a future date. To do so you must contact the Risk Management Department. *City of Gainesville Code of Ordinances Article XII Retiree Health Insurance Program and Trust Fund Medicare There is no rate reduction in your City Health Insurance upon reaching Medicare eligibility. However to receive the most benefit through both Medicare and the City s Retiree Health insurance you need to elect Medicare Part B. At age 65, Medicare will be your primary insurance and the City s coverage will become secondary which is why you need to sign up for Part B. Reminder: You need to sign up for Medicare A & B close to your 65th birthday, even if you will not be retired by that time. (If you are getting Social Security benefits when you turn 65, your Medicare Hospital Benefits start automatically.) If you are covered under the City s Health Insurance then there is no need to elect Medicare Part D (pharmacy benefits). Life Insurance The City of Gainesville paid for life insurance for you while you were an active employee of the City. When you retired this benefit reduced to 1/2 of what it was while you were an active employee (up to a maximum of $25,000). Each year on the anniversary of your retirement this benefit reduces approximately $5,000 per year until it reaches $5,000, at which point it will remain until such time as your beneficiary applies for the benefit following your death. The beneficiary of your City life insurance policy is listed on the card you completed while still employed with the City. If you have a change to whom you wish your life insurance to be paid, please update your beneficiary card ASAP through the Risk Management Department ( ) where all claims must be filed. A certified copy of your death certificate stating the cause of death is needed for processing the claim. Retiree Health Savings (RHS) If you have an RHS account, the money deposited into the account went in tax-free, the earnings on the account grew tax-free, and the best part is, when you make a withdrawal for qualified medical, dental, vision, or long -term care expenses, the reimbursements from the account are tax-free. A qualified expense is any out of pocket expense related to your health plan such as a deductibles, co-pays, noncosmetic dental and vision services. Reimbursement can be made for the account holder and any eligible dependents. Post Tax Pension Plan Contributions At retirement you were given a letter stating the amount you had paid in already taxed contributions. In order to determine the amount of tax-free income you can claim each year, you or your tax preparer should obtain IRS PUBLICATION 575, PENSION & ANNUITY INCOME. This publication explains how you can determine the amount of your total retirement income that is taxable and the amount of your retirement income that is not taxable. If you have lost your letter indicating your contributions contact Risk Management ( ) and you will be given your post tax contributions again. Rehired Retirees The City of Gainesville s defined benefit plans are qualified pension plans subject to the Internal Revenue Code and Income Tax Regulations. These laws and regulations require actual retirement (i.e., termination of employment) before a member may receive a retirement benefit. Retirement benefit payments will not be issued to City employees who do not legitimately retire. As a retiree you may be rehired by the City of Gainesville, however your retirement and new employment applications will be reviewed for compliance under all laws and regulations. As a rehired retiree you will begin as a new member of the pension plan and earn credited service towards an additional retirement benefit. Your prior service credit may not be used towards your reemployment. As a rehired retiree you may not purchase any additional credit for service performed prior to reemployment and you will not be entitled to a disability retirement. You will be entitled to all benefits offered to regular active employees. In some areas there is a one year waiting period prior to becoming eligible for reemployment. Page 7 5

6 Changes In Family Status You may change your voluntary benefits during the open enrollment period. You can also change your coverage during the year but only if the application to change coverage is submitted within 30 days of your family status change because of: marriage; divorce*; birth, legal adoption, placement for adoption or custody change of an eligible child; death of a spouse or eligible child, or a dependent s leaving the household as a result of a custody agreement; or changes in the spouse s employment which affects his/her eligibility for benefits under another employer s group benefits plan. Coverage will be effective the date of the change in family status. An adjustment of the premium for the level of coverage change will be deducted from your paycheck. Presently, complete and return the Health Status Change Form, located on the intranet and at the Risk Management office. *Anyone removed from the policy is entitled to COBRA (see COBRA Continuation Coverage). Facts About Your Insurance Coverage for Mental or Physically Disabled Dependent To provide coverage for a dependent who is incapable of self-support because of a mental or physical incapacity, a retiree must provide complete documentation from a physician of the permanent disability. ID Cards After your Open Enrollment Application is processed and an eligibility file is sent to each insurance carrier, your ID card and member booklet will be mailed to your home address by the insurance company. The ID card should be placed in your wallet for easy access at all times. Be sure to read the member booklet carefully, and keep it in a safe place for easy reference. The retiree booklet will provide detailed information on how to use your insurance benefits. You will not receive a new ID card unless you make a change in your coverage. Reimbursable claims should be filed only with your insurance carrier, not the City of Gainesville. NOTE: If you order a new health insurance card and need medical care prior to receiving your new ID card, please contact the insurance carrier for assistance. 6

7 Frequently Asked Questions I have not received my enrollment package. What do I do? Please contact the vendor (contact information inside of booklet) and request that your enrollment package be mailed to you. How much time do I have to enroll? The Open Enrollment Period is from November 1, 2014 through 6pm November 30, 2014 for all City of Gainesville retirees. What are considered Qualifying Life Events? Qualifying Life Events include, but are not limited to: newborn children, marriage, divorce, and dependent loss of coverage. When does all information have to be submitted to the Employee Benefits office? All Open Enrollment supplemental documents are due to the Risk Management Department no later than November 30, What are the time frames associated with my current coverage vs. new coverage plans? Your current coverage continues through December 31, The next Coverage Plan Year is January 1, December When will the Open Enrollment Meetings be held this year? November 5, 2014 at 10am and 6pm (City Hall) November 10, 2014 at 10am (GPD-Hall of Heroes) November 13, 2014 at 10am (GPD-Hall of Heroes) 7

8 Health The City of Gainesville offers its employees a very comprehensive health plan. Presently, the third party administrator is Florida Blue. For 2015, there is only one health plan - BlueOptions. BlueOptions offers covered participants the ability to choose any medical provider they wish. However, participants can maximize their benefits by choosing Network Blue in-network medical providers who participate in the Florida Blue PPO provider network. Summary of Plan Please see your group plan description for extensive detail of the coverage offered under the health plan. In the event of any discrepancy between this summary and the official plan document, the official plan document will govern. IN NETWORK Calendar Year Deductible (CYD) $600 Calendar Year Deductible - Family *only effects contracts with 3 or more members Primary Care Office Visits Family Practice General Practice Internal Medicine Pediatrician Specialty Office Visits-Except Some Mental Health Services $1800 OUT-Of NETWORK In Network - $15.00 co-pay Out of Network - $600 CYD & 40% coinsurance In Network -$600 CYD & 20% insurance Out of Network-$600 CYD 40% insurance Well Care Services at Primary Care or Specialist Discuss Your Needs with Your Doctor Diagnostic and Screening Services subject to Age and Gender Appropriate medical guide lines. Examples: Annual Physical, OB/GYN annual visit, Stress Test, Diagnostic Laboratory Test, PSA tests, etc. Mammogram Colonoscopy - Routine (screening) Procedures only Inpatient Hospital Care In Network - No Member Cost Unlimited annual benefit Out of Network - 40% coinsurance; No Deductible Paid at 100% of the allowance. You may use any provider In Network - Member pays $0 for physician charges or facility charges for screenings only. Out of Network payable at 100% of allowance; facility fee subject to $600 CYD and 40% coinsurance In Network Facility: *Option 1 $750 Co-payment *Option 2 $ 1,000 Copayment Provider services for mental health $50 per day co-pay Physician: $600 CYD & 20% co-insurance Out of Network - $600 CYD & 40% coinsurance Outpatient Hospital Care Mental Health/Substance Abuse, Physician Services (at locations other than office, hospital & ER) Primary Care Physician Specialist In Network Facility.* *Option 1 $150 Co-payment *Option 2 $250 Co-payment In Network -$600 CYD & 20% co-insurance Out of Network $600 CYD & 40% co-insurance $15 copayment $50 copayment Option 1 North Florida Regional Medical Center Option 2 Shands Hospital at University of Florida 8

9 Emergency Room In Network - Urgent Care Centers Facility: $250 co-pay Physician: $600 CYD & 20% coinsurance Out of Network - Facility: $250 co-pay Physician: $600 CYD & 40% coinsurance $30 copay Out of Network $600 Out of Network deductible and 40% coinsurance of the allowance Combined Therapy and Spinal Manipulations Note: Maximum Calendar Year Benefit 75 services May have medical guidelines MAXIMUM OUT OF POCKET Individual/Family Aggregate Once met, medical services are paid at 100% for the remainder of the Calendar Year, including Pharmacy In Network - $600 CYD & 20% coinsurance Out of Network - $600 CYD and 40% coinsurance In Network - $4,000//$7,500 Out of Network - $5,000/ $10,000 Free Standing Surgical Center Imaging / X-ray Services - Independent Diagnostic Facility Lab Services performed at Quest Diagnostics Lab Services performed anywhere that is not Quest Diagnostics (Hospital lab, physician's office, etc.) Pharmacy Pharmacy - Generic Pharmacy - Preferred Brand Pharmacy - Non-Preferred Brand Self Injectable Drugs / Diabetic Supplies In Network - Facility: $100 co-pay Physician: $600 CYD & 20% coinsurance of allowance Out of Network $600 Out of Network deductible and 40% coinsurance of the allowance In Network - Diagnostic services - $50 co-pay (Except for AIS) Advanced Imaging Services (AIS) - $125 co-pay Examples: MRI, MRA, PET, CT, or Nuclear Medicine (Includes the test and the reading) Out of Network $600 CYD & 40% coinsurance Patient Pays $0 Out of Network - $600 CYD & 40% coinsurance All Labs other than Quest Diagnostics are considered Out-of-Network $150 deductible $10.00 or actual drug cost (if less) $30.00 or actual drug cost (if less) $50.00 or actual drug cost (if less) Subject to Generic, Preferred Brand or Non-Preferred Brand Co-pay at the Pharmacy EXCLUDES Non-covered charges INCLUDES Calendar Year Deductible Coinsurance responsibility Pharmacy Co-payments Mail Order Pharmacy: Get 90 days of medication for the cost of 2 monthly copayments. It s like buying 2 and getting 1 month FREE. $20 Generic, $60 Preferred Brand, $100 Non-Preferred Brand 90-Day Supply for Maintenance Drugs only. The mail order program requires payment of co-pays even if the total cost of the drug is less than the co-pay. 9

10 Medicare Supplements, Drug Coverage and Advantage Plan In order to provide better customer service to our retirees, the City of Gainesville is expanding its offerings to our Retirees by offering a subsidy towards supplemental Medicare plans. These plans underwritten by Florida Blue include traditional Medicare Supplements that provide coverage in Medicare Parts A & B gaps. You will have a choice of three supplements that will cover Part A copays, B deductible and co-insurance and excess charges. In addition, you will be able to select a Medicare Part D plan and have the option of two Medicare Advantage Programs. Election of an alternative Medicare Option is not an election to opt out of the City of Gainesville s Retiree Health Plan. This election will allow eligible retirees to utilize the City s premium subsidy towards one of the Medicare Options offered by the City. In most cases, this will lower your cost of health insurance. Actual reductions are dependent upon your retiree health contribution provided by the City of Gainesville. 10

11 Defined Benefit Pension Plans The City of Gainesville currently provides for its employees two Employee Defined Benefit Pension Plans. The two plans are the Consolidated Police Officers and Firefighters Retirement Plan, which covers all Firefighters and Police Officers, and the General Employees Pension Plan Annuity Options Retirement Annuity Options Life Annuity with 10 Year Life & Certain Life Annuity Joint and Survivor Joint and Last Survivor Consolidated Pension Plan Certified Firefighters and Police Officers Description One hundred percent benefit payable to the retiree. Upon death of retiree, all benefits stop except in the event the retiree has not received a retirement benefit for 10 years, this benefit will continue to the named beneficiary or beneficiaries until benefits have been paid for 10 years following retirement. One hundred percent of benefit payable to the retiree. Upon death of retiree, all benefits stop. Actuarial reduced benefit payable to the retiree, based upon a 10 year Life & Certain benefit. At retiree's death only, two-thirds (2/3) of retiree's benefit is payable to a designated beneficiary for the remainder of the beneficiary's life. Actuarial reduced benefit payable to the retiree, based upon a 10 year Life & Certain benefit. At the death of either the retiree OR beneficiary, whoever remains living shall receive benefits based upon the elected percentages for the remainder of the survivor s life 100% of benefit continues 75% of benefit continues 66 2/3% of benefit continues 50% of benefit continues Retirement Annuity Life Annuity Options Joint and Survivor Retirement Annuity Options Joint and Last Survivor Social security General Employees Pension Plan Cost of Living Increases (COLA) Actuarial reduced benefit payable to the retiree, based upon a Life Annuity benefit. At retiree's death only, two-thirds (2/3) of retiree's benefit is payable to a designated beneficiary for the remainder of the beneficiary's life. General Pension Plan Actuarial reduced benefit payable to the retiree, based upon a Life Annuity benefit. At the death of either the retiree OR beneficiary, whoever shall remain living shall receive 2/3 of the retiree s benefit for the remainder of the survivor s life. Designed to provide a more or less level income for life. Retiree receives a higher City benefit (over and above Life Annuity benefit) before age 65, and a lesser City benefit after age 65. However, at age 65 City benefit plus Social Security benefit will approximately equal pre-65 income. COLA increases are reflected on your October retirement check (issued October 31) following your birthday. These increases will be implemented according to the ordinance provisions governing your retirement benefit as stated in the City of Gainesville s Code of Ordinances at the time of your retirement. Survivor Benefits General Pension Plan One hundred percent of benefit payable to the retiree. Upon death of retiree, all benefits stop. The Risk Management Department should be informed shortly after either your death or your joint annuitant s death. Your beneficiary will be informed if any future benefits are payable and if any forms need to be completed. Your estate is entitled to the full monthly benefit paid at the end of the month of your death. Example Retiree dies April 2, the full monthly retirement will be paid to the estate or beneficiary. Page 8 11

12 Employee Health Services Open Monday through Thursday Excluding Holidays 7:00 am to 6:00 pm Phone: Fax: Employee Health Services provides many FREE and low cost benefits available to help reduce out of pocket health care expenses. Employee Health Services will not be your primary health care provider. See the Nurse Practitioner for Acute Care Visits BY APPOINTMENT ONLY. Urgent Care Visits (Treatment for): Sore Throat Ear Infections Flu Symptoms Dizziness Rashes Urinary tract infections Lacerations Many common generic medications prescribed during your visit are available for $4.00 each. S.W.E.E.T.S. Program Diabetes Management Program Participation provides FREE monthly diabetic testing supplies, and waives the co-payment for generic medications used to treat diabetes, high blood pressure, and high cholesterol. -Available to all employees, retirees and dependents on the health plan. Laboratory Testing Employees, retirees and retiree spouses are eligible for one (1) FREE health panel (includes electrolytes, iron, kidney and liver functions, glucose, and lipids) and one (1) FREE PSA for men 40 years old annually without a prescription. Blood Pressure & Blood Sugar Checks Live a healthier life. Monitor your blood pressure and blood sugar. Available FREE of charge by appointment. Physical Exams All employees are eligible for a 5 year physical beginning at age 30, then every 5 years thereafter. Injections *FREE Tetanus Vaccines *Hepatitis A and B vaccines (small fee) *FREE Flu shots annually during October thru December (pending availability). Additional lab tests are available. Please call to check availability and to make an appointment. Wellness Services The City of Gainesville values the wellness of its employees. The City s Wellness Program offers a team of professionals to assist employees and their families establish and maintain a healthy lifestyle. This team includes experts in several areas: exercise physiology and athletic training. Exercise Specialist Services FREE Wellness Center Memberships Personalized Exercise Program Design Fitness Testing Body Composition Evaluations Group Exercise Classes Health Education Classes Athletic Training & Ergonomics Injury Assessment Injury Rehabilitation Injury Management Brace Fitting Crutch Fitting Reconditioning Fitness Assessment Ergonomic Assessment and Training Back Injury Prevention School PROClub Available to ALL employees enrolled on the health plan. Between the months of February and October, participants earn points for certain healthy lifestyle activities. Earn enough points and those points translate into a $ rebate of health insurance premiums. The rebate is usually paid in early December. Well care points are awarded for completing any service covered under adult well care. Registration for participation in PROClub is required each year. 12

13 Important Contacts If you have any questions about any of your benefits, please contact representatives at the telephone numbers listed below: City of Gainesville Risk Management Department (352) Employee Health Services (352) MEDICAL Florida Blue - BlueOptions PPO WEBSITE DEFERRED COMPENSATION, ROTH IRA, RETIREE HEALTH SAVINGS ICMA RC WEBSITE Adam Ferguson