Intel Retiree Medical Plan

Transcription

1 Annual Enrollment is October 22 through November 9 Intel Retiree Medical Plan 2013 Annual Enrollment Guide Enroll at My Health Benefits Website or call (877) (GoMyBen)

2 The Purpose of this Guide The Annual Enrollment Guide is intended to outline the medical and prescription drug benefit options available to you and to inform you of important plan changes for It is important you take time to evaluate if your current coverage will meet your needs in If you do not make any changes during Annual Enrollment, your current coverage will continue. Where Can You Get Help? Contact an Intel Health Benefits Center representative at (877) GoMyBen ( ) for answers to your questions about: Annual Enrollment IRMP SERMA During Annual Enrollment, the Intel Health Benefits Center will be available Monday through Friday, 7 a.m. to 6 p.m. (Pacific). When calling the Health Benefits Center you will be prompted to enter your password. If you have forgotten your password, or haven t created one yet, just say representative and your call will be routed to a representative who can help you. This guide is intended to satisfy the requirement to provide a summary of material modifications and should be kept with your IRMP Summary Plan Description (SPD). The information in this guide is a summary of your benefits and is not intended to take the place of or change official plan documents in any way. In the event of any discrepancy between the information in this guide and the 2013 Intel Retiree Medical Plan SPD, the SPD will prevail. Intel reserves the right to modify, change, or discontinue benefit plans at any time, at its sole discretion IRMP Annual Enrollment Guide

3 Table of Contents The Purpose of this Guide... 2 Where Can You Get Help?... 2 A Message from Richard Taylor... 4 Defining Your Options... 6 SERMA: Sheltered Employee Retirement Medical Account...6 IRMP: Intel Retiree Medical Plan...6 SERMA: The Flexibility to Spend Your Healthcare Dollars How You See Fit... 7 Using SERMA for Non-Intel Sponsored Healthcare Premiums...7 Using SERMA for IRMP...7 Frequently Asked Questions...7 IRMP CIGNA Coinsurance... 8 IRMP CIGNA Indemnity with Rx... 9 IRMP CIGNA Indemnity without Rx...10 A Note on How the CIGNA Indemnity Plans Work Aon Hewitt Navigators: A Resource for Medicare-Eligible Retirees Making your Annual Enrollment Elections How to Enroll in IRMP Online...13 When Do Benefit Election Changes Take Effect? IRMP Premiums...14 Annual Enrollment is October 22 through November 9 Enroll at My Health Benefits Website or call (877) (GoMyBen) Annual Enrollment: Oct. 22 Nov. 9,

4 A Message from Richard Taylor Dear Intel Retiree, Healthcare costs continue to climb much faster than inflation and unfortunately some of the retiree medical plans will be impacted again this coming year. In 2013, the premiums for the Intel Retiree Medical Plan (IRMP) Coinsurance Plan and the IRMP Indemnity Plan with Prescription Coverage will increase by 9 percent. The premiums for the IRMP Indemnity Plan without prescription coverage will not increase. On the positive side, we are providing you with more opportunities to take control of your SERMA dollars and we are bringing you a new voluntary dental plan option. Since Intel introduced SERMA portability in 2011, the majority of retirees have used SERMA to purchase coverage other than IRMP, saving them quite a bit of money each year. We are now making it possible for retirees to save even more money. Beginning January 2013, retirees who enroll in IRMP plans will also be able use their SERMA balance on non-irmp insurance coverage. This means IRMP members may now submit health insurance premiums for their spouses who have other individual insurance coverage. Since one of our top requests is for dental insurance, MetLife is offering voluntary dental plans to Intel retirees. You will be receiving information directly from MetLife on when and how to enroll. As an additional advantage, you may use your SERMA credits to pay for eligible vision and dental insurance premiums, including the MetLife plan. Richard Taylor, Senior Vice President, Intel Director, Human Resources As you approach this year s Annual Enrollment, I d ask that you invest the time and attention necessary to make an informed decision for you and your family. I encourage you to use the resources available during Annual Enrollment to help you get the information you need to make the right decisions. While Intel can t fully control the external environment and eliminate the escalating cost of healthcare, we each have the ability to help minimize costs and that starts with making informed decisions In good health, Richard Taylor Senior Vice President, Intel Corporation Director, Human Resources SERMA: Sheltered Employee Retirement Medical Account IRMP Annual Enrollment Guide

5 Be Well by Choosing a Healthy Lifestyle Intel has partnered with the Mayo Clinic, a world-renowned medical group operated by the Mayo Foundation, to provide you a convenient and confidential way to understand and evaluate the state of your health. The Mayo Clinic Health Assessment is voluntary and available at no cost to you. You can use the Mayo Clinic website anytime during the year. Step 1: Start with an Initial Health Check Obtain your health check measurements from your healthcare provider. Your health check measurements should include cholesterol and glucose levels, as well as your height, weight, and blood pressure. Step 2: Complete the Mayo Clinic Online Questionnaire Use your health check results to complete the online Mayo Clinic Health Assessment questionnaire at (you will need to create a user name and password to access the site.) The assessment takes about 20 minutes. The results will be available to you online immediately in the form of a Personal Health Report. Step 3: Review your Results The information in your Mayo Clinic Personal Health Report will contain recommendations and directions to improve and/or maintain your health. It will outline any health risks you may have and link you to Mayo Clinic and Intel-based programs and tools to address these risks. Your Privacy is Our Promise Intel understands the importance of your privacy and is committed to making sure your personal information remains private and completely confidential. You will interact with and share personal information directly with Mayo Clinic. Intel will only receive information pertaining to individual health in an aggregated and unidentified form for use in the design of health and wellness programs. Annual Enrollment: Oct. 22 Nov. 9,

6 Defining Your Options When you retired from Intel as a U.S. employee, Intel established a SERMA 1 for you. You may use your SERMA credits to pay for Intel Retiree Medical Plan premiums or you may reimburse yourself for eligible non-intel sponsored healthcare premiums. For more information on SERMA, go to page 7. IRMP: Intel Retiree Medical Plan The IRMP is the medical plan available from Intel Corporation to eligible retirees and their eligible dependents. The plan is designed to provide access to comprehensive medical coverage for: Retirees and their eligible dependents who are Medicare-eligible (typically, age 65 and over); or Retirees and their eligible dependents who are unable to purchase health insurance coverage elsewhere due to a medical condition (IRMP does not exclude coverage for pre-existing conditions). IRMP Member Eligibility Make Sure Your Family Members Are Eligible for Coverage Intel s medical plans have specific requirements for who can be covered as an eligible dependent. It is your responsibility to ensure that only your eligible dependents are enrolled and to make necessary adjustments if needed. If you are Medicare-eligible and your eligible dependent is not, or vice-versa, the Medicare-eligible person will be eligible to enroll in one of the IRMP Indemnity options, and the non-medicareeligible person will be eligible to enroll in the CIGNA Coinsurance plan. For a complete description of the dependent eligibility requirements, refer to the IRMP Summary Plan Description (SPD). For a copy of the SPD, contact the Intel Benefits Center at (877) , or visit the Your Resources tab on the Intel Health Benefits website, at Proof of Continuous Healthcare Coverage (HIPAA Certificate) May Also Be Required Generally, in order to enroll in the IRMP, you and your eligible dependents are required to provide a HIPAA Certificate showing proof of continuous healthcare coverage for the previous 18 months. The HIPAA Certificate must be received by the Intel Health Benefits Center within 30 days of your enrollment date. If you are not Medicare-eligible (typically if you under age 65 you are not eligible for Medicare), you may enroll in the CIGNA Coinsurance Plan. For more information go to page 8. If you are Medicare eligible, you may enroll in either the CIGNA Indemnity Plan with RX or the CIGNA Indemnity plan without Rx. The difference between the plans is the with Rx plan includes a prescription drug benefit. For more information, go to pages 9 and 10. If you are enrolling your dependents in IRMP; please review the eligibility rules on page 6. The IRMP may not be the best plan for all retirees. Retirees under age 65, who are healthy, can often purchase health insurance that costs much less than the comprehensive coverage offered by the IRMP. 1 For information on your SERMA balance, contact the Intel Health Benefits Center at (877) , or online at under Your Spending Account tab IRMP Annual Enrollment Guide

7 SERMA: The Flexibility to Spend Your Healthcare Dollars How You See Fit You have the ability to use SERMA to pay for all or part of your IRMP premium or to reimburse yourself for the cost of other eligible health insurance premiums. With the ability to pay for the plan that best meets your needs, SERMA can increase your health insurance options and help you make the most out of your SERMA credits. What s changing for 2013? SERMA credits may be used for non-employer sponsored dental and vision premiums. SERMA credits may be used to pay for both IRMP premiums and other non-employer sponsored medical premiums at the same time. Using SERMA for Non-Intel Sponsored Healthcare Premiums You may use your SERMA credit to reimburse yourself for premiums paid for you and your eligible dependents until you exhaust your account. Eligible reimbursements may include premium payments for: Individual health insurance Individual dental insurance Individual vision insurance Other employer retiree group plans COBRA Medicare Medigap Long-term care Annual Enrollment: Oct. 22 Nov. 9, 2012 If you are enrolled in IRMP, you may also use your SERMA credit toward other eligible healthcare premiums. For example, if you are on the IRMP plan and your spouse is enrolled in a non-employer sponsored medical plan, you may now use your SERMA toward both your IRMP premium and your spouse s non-intel premium expenses. For information on your SERMA balance, contact the Intel Health Benefits Center at (877) , or online at under Your Spending Account tab. The Your Spending Account website allows you to: View your SERMA account balance Submit claims (you have the option to submit claims online, by fax or by mail) Check the status of your claims Learn more about eligible expenses Using SERMA for IRMP If you are enrolled in IRMP, you may use your SERMA credits to offset your monthly premium until you exhaust your account. During Annual Enrollment you may elect how much of your IRMP premium you would like paid from your SERMA each month; 25 percent, 50 percent, 75 percent or 100 percent. Your IRMP premium payments will be paid directly from your SERMA; you do not need to submit a claim for reimbursement. The percentage you elect will apply to both your and your enrolled dependent s premiums. If you chose a SERMA contribution other than 100 percent, you are responsible for paying the remainder of the premium cost. Frequently Asked Questions Q: Can I be enrolled in IRMP and use my SERMA to purchase other insurance as well? A: Yes, new in 2013 you can enroll in IRMP and also request SERMA reimbursement for eligible premiums such as the MetLife Dental Plan. Q: Can I use SERMA to purchase coverage for my spouse or dependent children? A: Yes, you can use your SERMA to purchase individual insurance for yourself, your spouse, and your eligible dependent children. Q: If I want to remain enrolled in IRMP, may I use SERMA to purchase other coverage for my family? A: Yes, if you are enrolled in IRMP you may use SERMA towards IRMP premiums for yourself, while also requesting reimbursement for eligible non-irmp premiums for your dependents. Q: I am enrolled in my spouse s employer group medical plan. Can I use SERMA to pay the premium? A: No, you may not use SERMA to reimburse yourself for another company s active employee group coverage. METLIFE OFFERS DENTAL COVERAGE MetLife is offering voluntary dental plans to Intel Retirees. These plans offer access to comprehensive dental coverage. You will be receiving communications directly from MetLife on when and how to enroll. You may use your existing SERMA balance to reimburse yourself for any eligible dental premium. 7

8 IRMP CIGNA Coinsurance What You Need to Know Before You Enroll in this Plan: Retirees and dependents who are not eligible for Medicare (typically those who are under the age of 65) can enroll in the IRMP CIGNA Coinsurance Plan. Retirees, who are healthy, can often purchase individual health insurance that costs much less; contact your local health insurance agent or State s Department of Insurance for health insurance information and pricing. What s Changing for 2013? Premiums increasing from $822 to $896 per person Monthly Premium You Only Spouse 2 Only Child(ren) 3 Only You + Spouse Spouse + Child(ren) You + Spouse + Child(ren) $896 $1,792 $2,688 2 Spouse definition includes eligible Domestic Partners. 3 Same price for child or multiple children. IRMP CIGNA Coinsurance Plan Benefit Summary Additional details available at or in the IRMP Summary Plan Description (SPD); call Intel Benefits Center to request the IRMP SPD. In-Network Out-of-Network Deductible $600 Individual/$1,200 Family $600 Individual/$1,200 Family There is a separate deductible for in-network and out-of-network care Out-of-Pocket Maximum $3,000 Individual/$6,000 Family Medical Services 20% coinsurance 40% coinsurance (e.g., office visit, hospital inpatient, outpatient, ancillary services) Vision Exam $0 copayment Reimbursed up to $42 Eyeware Limits apply $25 copayment for lenses $130 allowance for frames or contacts Lens reimbursement: Single $40; Bifocal $60 Trifocal $80; Lenticular $125 Frame reimbursement: $70; or, Contact reimbursement: $130 Prescription Benefit Retail (34-day supply) Mail (90-day supply) Retail Penalty 4 (34-day supply) Generic $10 $20 $20 5 Preferred Brand Non-Preferred Brand Formulary (list of plan approved drugs) 20% coinsurance $25 minimum/$60 maximum 40% coinsurance $40 minimum/$100 maximum 4 Penalty applies after the first two purchases of a maintenance (long-term) prescription at a retail pharmacy. 5 The out-of-pocket costs beyond the standard benefit will not apply towards deductible/out-of-pocket maximums. 20% coinsurance $62.50 minimum/$150 maximum 40% coinsurance $100 minimum/$250 maximum Please review at 50% coinsurance 5 $25 minimum 50% coinsurance 5 $40 minimum IRMP Annual Enrollment Guide

9 IRMP CIGNA Indemnity with Rx What You Need to Know Before You Enroll in this Plan: Retirees and dependents that are eligible for Medicare can enroll in the IRMP CIGNA Indemnity with Rx Plan. This plan includes prescription drug coverage. If you enroll in this plan, you do not need to purchase a Medicare Part D program to provide prescription drug benefits. This plan coordinates with Medicare which means that it will only provide a benefit for services not covered by Medicare. See note/examples on page 11. What s Changing for 2013? Premiums increasing from $500 to $545 per person. Resources Available to Help You: Aon Hewitt Navigators is an optional resource offered through Hewitt, to help Medicare-eligible retirees navigate the complex health insurance market during Medicare Open Enrollment (October 15 to December 7, 2012) and beyond. This service is available at no cost to you. To contact Aon Hewitt Navigators, call the Health Benefits Center Monday through Friday at (877) GoMyBen ( ) and select the Aon Hewitt Navigators option Monthly Premium You Only Spouse 6 Only Child(ren) 7 Only You + Spouse Spouse + Child(ren) You + Spouse + Child(ren) $545 $1,090 $1,635 6 Spouse definition includes eligible Domestic Partners. 7 Same price for child or multiple children. IRMP CIGNA Indemnity Plan with Rx Benefit Summary Additional details available at or in the IRMP Summary Plan Description (SPD); call Intel Health Benefits Center to request the IRMP SPD. Also refer to Medicare Part A & B ( Medicare Indemnity Plan Deductible Part B deductible may apply $500 Individual/$1,000 Family Medical Services 20% coinsurance 20% coinsurance (e.g., office visit, hospital inpatient, outpatient, ancillary services) Vision Exam Not covered $0 copayment Eyeware Limits apply Not covered $25 copayment for lenses $130 allowance for frames or contacts Prescription Benefit Retail (34-day supply) Mail (90-day supply) Retail Penalty 8 (34-day supply) Generic $10 $20 $20 9 Preferred Brand $20 $40 $40 9 Non-Preferred Brand $30 $60 $60 9 Formulary (list of plan approved drugs) Please review at 8 Penalty applies after the first two purchases of a maintenance (long-term) prescription at a retail pharmacy. 9 The out-of-pocket costs beyond the standard benefit will not apply towards deductible/out-of-pocket maximums. Important Note: Intel Annual Enrollment and Medicare Open Enrollment do not occur at the same time. Aon Hewitt Navigators will help coordinate any changes that may be necessary to your Intel elections as a result of your Medicare Open Enrollment elections. Annual Enrollment: Oct. 22 Nov. 9,

10 IRMP CIGNA Indemnity Without Rx What You Need to Know Before You Enroll in this Plan: Retirees and dependents who are eligible for Medicare can enroll in the IRMP CIGNA Indemnity without Rx Plan. This plan does not cover prescription drugs. If you enroll in this plan, it is recommended that you purchase a Medicare Part D program to obtain prescription drug benefits. This plan coordinates with Medicare which means that it will only provide a benefit for services not covered by Medicare. See note/examples on page 11. What s Changing for 2013? Your premiums will remain unchanged for Resources Available to Help You: Aon Hewitt Navigators is an optional resource offered through Hewitt, to help Medicare-eligible retirees navigate the complex health insurance market during Medicare Open Enrollment (October 15 to December 7, 2012) and beyond. This service is available at no cost to you. To contact Aon Hewitt Navigators, call the Health Benefits Center Monday through Friday at (877) GoMyBen ( ) and select the Aon Hewitt Navigators option Monthly Premium You Only Spouse 10 Only Child(ren) 11 Only You + Spouse Spouse + Child(ren) You + Spouse + Child(ren) $175 $350 $ Spouse definition includes eligible Domestic Partners. 11 Same price for child or multiple children. IRMP CIGNA Indemnity Plan without Rx Benefit Summary Additional details available at or in the IRMP Summary Plan Description (SPD); call Intel Health Benefits Center to request the IRMP SPD. Also refer to Medicare Part A & B ( Medicare Indemnity Plan Deductible Part B deductible may apply $500 Individual/$1,000 Family Medical Services 20% coinsurance 20% coinsurance (e.g., office visit, hospital inpatient, outpatient, ancillary services) Vision Exam Not covered $0 copayment Eyeware Limits apply Not covered $25 copayment for lenses $130 allowance for frames or contacts Prescription Drugs Not covered Not covered Important Note: Intel Annual Enrollment and Medicare Open Enrollment do not occur at the same time. Aon Hewitt Navigators will help coordinate any changes that may be necessary to your Intel elections as a result of your Medicare Open Enrollment elections IRMP Annual Enrollment Guide

11 A Note on How the CIGNA Indemnity Plans Work The IRMP CIGNA Indemnity plans assume you are enrolled in Medicare Part A and B. The plans will only cover eligible expenses not covered by Medicare. After you reach the plan deductible, the plan then pays a percentage of covered charges (based on Medicare allowable charges), your coinsurance amount is 20 percent or a copayment based on the service received (see plan compare for details). Below are two examples of how the plan works: Example: You have met your annual IRMP deductible. You visit your doctor and the bill is $100. Medicare considers $65 of the charge an allowable Medicare reimbursement. Doctor submits bill $100 Medicare allowable on this bill $65 Medicare Pays 80% of allowed amount $52 (65 x.80) Your coinsurance amount (20% of allowed amount) $13 (65 x.20) CIGNA Indemnity Plan pays $0 Your Total Out-of-Pocket $13 Why does the plan pay $0? The IRMP CIGNA Indemnity Plan reimburses 80 percent of the $65 allowed by Medicare. The IRMP CIGNA Indemnity amount is reduced by the amount paid by Medicare. In this case, since the CIGNA benefit of $52 (80 percent of $65) is the same amount paid by Medicare, therefore, the amount paid by the IRMP CIGNA Indemnity plan is $0. Example: You have not met your annual IRMP deductible and are hospitalized. The bill is $50,000. Medicare considers $11,951 of the charge an allowable Medicare reimbursement. Hospital submits bill $50,000 Medicare allowable $11,951 This is the maximum amount the provider may charge for the services provided. Medicare pays $10,795 Your Medicare Deductible $1,156 This is the amount you would owe the provider if you were not enrolled in IRMP. Your Out-of-Pocket after Medicare $1,156 Your IRMP Cigna Plan deductible $500 Allowable amount applied to IRMP $ 656 Your coinsurance amount (20% of allowed amount) $ (656 x.20) IRMP Cigna Indemnity Plan pays (80% of allowed amount) $ (656 x.80) Your Total Out-of-Pocket on IRMP Indemnity $ The $500 deductible plus the $ coinsurance. If you are enrolled in IRMP your total out-of-pocket cost for this hospitalization is $ vs. $1,156 if you were only enrolled in Medicare. In this example, Medicare pays $10,795, the IRMP Cigna Indemnity plan pays $524.80, and you pay $ Benefits of the IRMP Cigna Indemnity Plans Once you have met the Indemnity Plan out-of-pocket maximum, the plan will pay 100 percent of your eligible expenses. Also the plans will cover some non-medicare eligible expenses such as vision and for those enrolled in IRMP with Rx, prescription drugs. Annual Enrollment: Oct. 22 Nov. 9,

12 Aon Hewitt Navigators: A Resource for Medicare-Eligible Retirees 12 Aon Hewitt Navigators is an optional resource offered to help Medicare-eligible retirees navigate the complex health insurance market during Medicare Open Enrollment (October 15 to December 7, 2012) and beyond. This service is available at no cost to you. Aon Hewitt Navigators works with many insurance companies, which allows them to offer unbiased, expert advice. They will work with you to compare many plans to find coverage that is right for your specific healthcare needs and budget. Beginning with Medicare Open Enrollment, Aon Hewitt Navigators will be available. Aon Hewitt Navigators will send an introductory kit to eligible retirees prior to the Medicare Open Enrollment period to provide more information on how to use their services. During Medicare Open Enrollment, Aon Hewitt Navigators will be available Monday through Friday, 6 a.m. to 6 p.m. (Pacific). To contact Aon Hewitt Navigators, call the Health Benefits Center Monday through Friday at (877) GoMyBen ( ) and select the Aon Hewitt Navigators option. Aon Hewitt Navigators will continue to be available year-round for those who elect Medicare eligible plans. 12 Aon Hewitt Navigators is a service offered through Aon Hewitt, not an Intel sponsored program IRMP Annual Enrollment Guide

13 Making Your Annual Enrollment Elections If you make no changes, the coverage you have today will automatically continue in The My Health Benefits website will provide you tools and resources to allow you to prepare, understand, and enroll in the IRMP. You can access the website at You will need to login with your User ID and password. If you are accessing the site for the first time, you will be asked to create a User ID and password to login. To create your User ID, select Register as a New User and follow the instructions. You will be asked to create a password and answer a series of security questions. You can also make your elections over the phone by contacting the Intel Health Benefits Center at (877) How to Enroll in the IRMP Online: Click the Enroll button. Then click the medical plan. Select the plan option you want to enroll in. Save your choices by selecting the Complete Enrollment button. Print a copy of your confirmed elections for your records. You can visit the My Health Benefits website at any time to view your elections. You may also make changes to your elections multiple times during Annual Enrollment. There are certain changes not available on the web; you must call the Intel Health Benefits Center to complete your enrollment if: You have dependents with split eligibility (one who is Medicare eligible and one who is not Medicare eligible). You are enrolling in IRMP for the first time. You have experienced a qualifying change-in-status event (such as marriage). When Do Benefit Election Changes Take Effect? The benefit elections you make during this Annual Enrollment period will become effective January 1, The next opportunity for you to make IRMP or Sheltered Employee Retiree Medical Account (SERMA) changes will be during next year s Annual Enrollment, or if you experience a qualifying change-in-status event during the year. You may be required to provide proof of 18 months of continuous health coverage (see page 6). If You Elect Coverage Other Than IRMP You are encouraged to explore options outside of IRMP to get the best value for your healthcare dollars. However, if you choose not to enroll in IRMP, you may be required to show proof of continuous health coverage if you have a qualifying reason to enroll at a later date (see page 6). As You Explore Obtaining Health Insurance Outside of Intel, Please Be Aware Companies selling individual health insurance typically require a review of your medical history that could result in a higher premium or a denial of coverage. You may wish to contact your local health insurance agent or your state s Department of Insurance to assist you in selecting and enrolling in a health insurance plan. Have Questions: Call the Intel Health Benefits Center at (877) If you do not remember your password state the word representative until you reach a live agent. need help? To explore your Health Insurance options call (877) If you are not Medicare-Eligible, an Intel Health Benefits Center representative will help you explore coverage options in your area. If you are Medicare-Eligible, call the number above and select the Aon Hewitt Navigators option. A representative will help you find and enroll in a Medicare supplemental plan that is right for you. If you have questions regarding the CIGNA plans, call (800) or visit CIGNA online at If you have questions regarding Medicare, call (800) or visit Medicare online at If you have questions regarding prescription drug coverage, call Medco at (800) or visit Medco online at Annual Enrollment: Oct. 22 Nov. 9, 2012 If you have questions regarding your vision coverage, call EyeMed t (866) or visit EyeMed online at com/intel 13

14 2013 IRMP Premiums The following charts provide you a glance of the monthly and annual cost of the IRMP premiums and how much you would pay if you elect SERMA to pay for a portion of your premium. Non-Medicare (typically under age 65) IRMP CIGNA Coinsurance Plan Monthly SERMA Election You Only 13 Spouse/DP You + 0% (or No SERMA) or Spouse/DP + Child(ren) You + Spouse/ DP + Child(ren) $896 $1,792 $1,792 $2,688 25% $672 $1,344 $1,344 $2,016 50% $448 $896 $896 $1,344 75% $244 $488 $488 $ % $0 $0 $0 $0 13 You only = Individual coverage of any eligible retiree, spouse or domestic partner, or child. Annually SERMA Election You Only 13 Spouse/DP You + 0% (or No SERMA) or Spouse/DP + Child(ren) You + Spouse/ DP + Child(ren) $10,752 $21,504 $21,504 $32,256 25% $8,064 $16,128 $16,128 $27,192 50% $5,376 $10,752 $10,752 $16,128 75% $2,688 $5,376 $5,376 $8, % $0 $0 $0 $0 Medicare (typically age 65 and over ) IRMP Indemnity Plan with Rx Monthly 14 SERMA Election You Only 15 Spouse/DP You + 0% (or No SERMA) You + Spouse/ DP + Child(ren) $545 $1,090 $1,090 $1,635 25% $409 $818 $818 $1,226 50% $273 $545 $545 $818 75% $136 $273 $273 $ % $0 $0 $0 $0 14 Rounded to the nearest whole number. 15 You only = Individual coverage of any eligible retiree, spouse or domestic partner, or child. Annually SERMA Election You Only 15 Spouse/DP You + 0% (or No SERMA) You + Spouse/ DP + Child(ren) $6,540 $13,080 $13,080 $19,620 25% $4905 $9,810 $9,810 $14,715 50% $3,225 $6,540 $6,540 $9,810 75% $1,613 $3,270 $3,270 $4, % $0 $0 $0 $0 Medicare (typically age 65 and over ) IRMP Indemnity Plan without Rx Monthly SERMA Election You Only 16 Spouse/DP You + 0% (or No SERMA) You + Spouse/ DP + Child(ren) $175 $350 $ 350 $525 25% $ $ $ $ % $87.50 $175 $175 $ % $43.75 $87.50 $87.50 $ % $0 $0 $0 $0 16 You only = Individual coverage of any eligible retiree, spouse or domestic partner, or child. 14 Annually SERMA Election You Only 16 Spouse/DP You + 0% (or No SERMA) You + Spouse/ DP + Child(ren) $2,100 $4,200 $4,200 $6,300 25% $1,575 $3,150 $3,150 $4,725 50% $1,050 $2,100 $2,100 $3,150 75% $525 $1,050 $1,050 $1, % $0 $0 $0 $ IRMP Annual Enrollment Guide

15 Notes Good Health Pays Off In More Than One Way The healthy choices you make can help you live a longer, healthier life, and reduce your overall healthcare costs. Given the substantial investment you make in your health coverage, it makes sense to use your plan well and make healthy lifestyle choices. Use Your Preventive Care Benefits Taking advantage of preventive care such as annual exams and health screens allows you to keep yourself on the road of good health by addressing health issues before they become more serious. If you choose to participate in IRMP, you can help reduce your costs by: Accessing in-network care 17 instead of out-of-network care. 18 Costs are higher for you and for Intel when you use out-of-network providers. Accessing a primary care provider before going to a specialist. Scheduling an in-office doctor appointment instead of using the emergency room for minor injuries or routine care. Using the nurse line (800) has no cost to retirees, and nurses can assist you in determining the type of care you should seek. Requesting generic drug(s) or using mail order service (or both). 17 In-network care providers, such as physicians and hospitals, have contracted with the provider s network to provide services at a discounted rate. 18 Out-of-network care providers have not contracted with the provider s network. Annual Enrollment: Oct. 22 Nov. 9,

16 Copyright 2012 Intel Corporation. All rights reserved. Intel and the Intel logo are trademarks of Intel Corporation in the U.S. and other countries. Printed in USA 0912/LR/HBD/PP/5K Please Recycle CPS# H