2012 PEBB Retiree Benefits

Transcription

1 2012 PEBB Retiree Benefits PEBB Outreach and Training for WEA-Retired

2 Welcome Through the Health Care Authority, eligible retiring public employees: Have access to comprehensive health insurance coverage Have a one-time opportunity to enroll in or defer coverage Must complete an enrollment form no later than 60 days after employer-sponsored or COBRA coverage ends 2

3 Agenda Eligibility for Retiree Benefits Enrollment/Procedural Requirements Deferring Coverage Payment Options Duration of Coverage Coverage Options Medical for Medicare Eligible Retirees Medical for Non-Medicare Eligible Retirees Dental Contact Information 3

4 4 Eligibility

5 Benefits Eligibility (WAC ) Washington state-sponsored retirement systems: TRS Teacher s retirement system SERS School employees retirement system PERS Public employees retirement system Higher education retirement plans (e.g. TIAA-CREF) LEOFF Law enforcement officers and fire fighters retirement systems PSERS Public safety employees retirement system JRS State judges/judicial retirement systems WSPRS State patrol retirement systems 5

6 Eligibility Requirements Eligibility requirements for retirees: Must be vested in a Washington-state sponsored retirement plan Must be eligible to retire under a Washington state-sponsored retirement plan Must immediately begin to receive a monthly retirement plan payment, with the following exceptions DRS determines a lump-sum payment is required because the monthly retirement plan payment is below the minimum payment Members of Plan 3 retirement plans are eligible if they meet their retirement plan s age requirement and length of service when employer-sponsored insurance ends 6

7 Eligibility Requirements (continued) Exceptions (continued): Permanently and totally disabled employees are eligible if they start receiving or defer a monthly disability retirement plan payment Employees not retiring under a Washington state-sponsored retirement plan must Meet the same age and years of service requirements had the person been employed as a member of either PERS 1 or 2 for the same period of employment 7

8 COBRA A Bridge to Retiree Benefits COBRA (Consolidated Omnibus Budget Reconciliation Act) is an extension of current employer benefits, paid by the employee, and generally available for up to 18 months Employees may use COBRA coverage as a bridge to PEBB retiree eligibility (WAC ) If elect to use COBRA as a bridge to retirement, employee is required to enroll in COBRA coverage Must enroll in or defer PEBB retiree coverage no later than 60 days after COBRA coverage ends 8

9 Dependent Eligibility Eligible Dependents: Spouse Washington state-registered domestic partners (RCW ) Both person are members of the same sex; or Opposite sex where one partner is at least 62 years of age Children through age 25 Dependents with disabilities (HCA approval required) Extended dependents (HCA approval required) 9

10 10 Enrollment and Procedural Requirements

11 Request Information Approximately 60 days before your employer-sponsored benefits or COBRA coverage ends Request PEBB s Retiree Enrollment Guide Complete the health insurance options card provided in your pension packet from DRS Return the completed card to the PEBB Program Or, call the PEBB Program at

12 Request Information The PEBB Program will send you a Retiree Enrollment Guide The guide includes: Plan information Enrollment forms Long-term care information Auto/home insurance information The Retiree Enrollment Guide is also available on the PEBB website: Click on the Thinking About Retirement link. 12

13 Medicare Coordination If you are retiring at age 65: About 90 days before you retire, contact Social Security Administration to enroll in Medicare Part A and Part B If you are retiring after age 65 and you deferred Medicare Part B: About 90 days before you retire, contact Social Security Administration to enroll in Medicare Part B You and your eligible dependents must enroll in Medicare Parts A and B, if entitled 13

14 New Retiree Enrollment Procedures No later than 60 days after your employer-sponsored or COBRA coverage ends Return the completed retiree enrollment forms Retirees not eligible for Medicare must include documentation that verifies the dependent is an eligible dependent A list of acceptable dependent verification documents are available on the PEBB website: Retirees eligible for Medicare must include a copy of any Medicare cards showing enrollment in Medicare Parts A and B If COBRA coverage is ending, proof of loss may be required 14

15 New Retiree Enrollment Procedures The application will be reviewed for compliance with Eligibility and procedural requirements according to Washington Administrative Code (WAC ) PEBB retiree coverage begins The first of the month following the loss of employer-sponsored or COBRA coverage Payment for coverage begins The first of the month following the loss of employer-sponsored or COBRA coverage 15

16 Enrollment Reminders Retiring employees must meet all eligibility and procedural requirements of WAC Must submit appropriate forms to enroll in or defer coverage no later than 60 days after your school district employersponsored or COBRA coverage ends This is a one-time opportunity to enroll in or defer PEBB coverage If you defer, you must be enrolled in The comprehensive employer-sponsored coverage of your spouse or Washington state-registered domestic partner who is still working A federal retiree medical plan (e.g., Tricare) as a retiree or dependent 16

17 Enrollment Reminders Retiree and enrolled dependents must enroll in and maintain Medicare Parts A and B, if entitled A checklist for school district employees who are retiring or separating is available on the PEBB website: 17

18 18 Deferring Enrollment

19 Deferring Enrollment (WAC ) PEBB-eligible retirees may defer enrollment at or after retirement if the retiree Returns to work and has other comprehensive employer-sponsored coverage Is covered under the comprehensive employer-sponsored coverage of a spouse or Washington state-registered domestic partner who is still working Is enrolled as a retiree or dependent in a federal retiree medical plan (e.g., Tricare) Enrollment in other employer-sponsored coverage must be continuous from the time of deferral until the time of enrollment 19

20 Deferring Enrollment (continued) To defer health plan enrollment, the retiree Must submit the Retiree Election Form to the PEBB program no later than 60 days after the date the retiree becomes eligible to apply for PEBB coverage If a retiree defers enrollment, they also defer enrollment for all eligible dependents Failure to defer or enroll within 60 days forfeits the right to enroll in PEBB retiree benefits in the future 20

21 Enrollment after Deferral Appropriate forms Must be submitted no later than 60 days after the date the other employer-sponsored coverage ends Retiree must provide proof that coverage was continuous during deferral period Send first payment with the enrollment form, unless you choose to have premiums deducted from your monthly pension check Retirees who defer due to federal retiree coverage have a one-time opportunity to enroll in PEBB coverage 21

22 22 Payment Options

23 Premium Payment Options Pension deduction Automatic bank withdrawal Personal check or money order VEBA (Volunteer Employee Benefit Association) account VEBA is the responsibility of the retiree Check with your benefits office to learn more (Payment is made to the WA State Treasurer not to the individual health plans) 23

24 24 Duration of Coverage

25 When Retiree Coverage Ends Subscribers Retiree coverage lasts indefinitely, as long as premiums are paid in full Dependents As long as the dependent meets the eligibility requirements of WAC

26 Surviving Dependents In the event of the death of the retiree The eligible surviving spouse* may continue coverage indefinitely as long as premiums are paid in full (WAC ) Dependents may continue coverage until they lose eligibility under WAC The surviving spouse* and/or eligible dependents must notify PEBB no later than 60 days after the retiree s death to enroll in or defer retiree coverage *Spouse includes WA state-registered domestic partners 26

27 27 Coverage Options

28 Coverage Options Coverage options include Medical and Dental coverage Medical only coverage (there is no dental only option) Dependents must be enrolled in the same coverage as the retiree Plans are available with county, nationwide, and worldwide coverage There are no pre-existing condition waiting periods 28

29 29 Medicare Eligible Retirees Medical Plan Options

30 Medical Plans Available Medical Plans for Medicare Eligible Retirees Group Health Medicare Advantage or Original Medicare* Kaiser Permanente Senior Advantage* Uniform Medical Plan Medicare (administered by Regence BlueShield of Washington) Available nationwide and worldwide Medicare Supplement Plan F (administered by Premera BlueCross) Medicare Supplement Plan F does not provide prescription drug coverage *See the Plans Available by County section of the Retiree Guide for availability 30 Medicare Eligible Retirees

31 Medical Plans Medicare eligible retirees who Choose Group Health and cover family members that are not eligible to enroll in Medicare Retiree is enrolled in the Medicare Advantage or Original Medicare, based on availability in their area Covered family members, not eligible for Medicare, will have a choice of Group Health Classic or Group Health Value Choose Kaiser and cover family members that are not eligible to enroll in Medicare Retiree is enrolled in the Senior Advantage plan, based on availability in their area Covered family members, not eligible for Medicare, are enrolled in Kaiser Classic 31 Medicare Eligible Retirees

32 32 Non-Medicare Eligible Retirees Medical Plan Options

33 Medical Plans Available Medical Plans for Retirees not Eligible for Medicare Group Health Classic, Value, and CDHP* Kaiser Permanente Classic and CDHP* Uniform Medical Plan Classic and CDHP Available nationwide and worldwide *See the Plans Available by County section of the Retiree Guide for availability 33 Non-Medicare Eligible Retirees

34 Medical Plans - CDHP Consumer-Directed Health Plan (CDHP) has two components High deductible health plan Health Savings Account (HSA) HealthEquity, Inc. will administer the HSA accounts CDHPs offered by Group Health, Kaiser, and Uniform Medical Plan 34 Non-Medicare Eligible Retirees

35 Medical Plans - CDHP High Deductible Health Plan Lower monthly premiums Member pays more out-of-pocket before the plan pays 100% Similar benefit plan structure as traditional plans Preventive care visit covered at 100% When you see a network provider Regular office visits and diagnostics Vision coverage Prescription drug coverage Prescription drug copayments/coinsurance apply to the out-of-pocket maximum for all CDHPs 35 Non-Medicare Eligible Retirees

36 Medical Plans - CDHP Health Savings Account (HSA) A tax-exempt savings and spending account used to pay for qualified medical expenses HCA deposits a portion of your monthly premium into the HSA account each month $58.33 deposited per month for a total of $700 per year for an individual subscriber $ deposited per month for a total of $1,400 per year for a subscriber with at least one family member enrolled on the account 36 Non-Medicare Eligible Retirees

37 Medical Plans - CDHP Health Savings Account (HSA) Retiree may make additional deposits into the account by sending directly to HealthEquity, up to the annual maximum IRS Maximum annual deposits for 2012 $3,100 for an individual $6,250 for a subscriber with at least one family member enrolled on the account Catch-up provision for individuals age 55 or older Additional $1,000 for the year may be deposited 37 Non-Medicare Eligible Retirees

38 Medical Plans - CDHP Health Savings Account (HSA) Funds belong to the retiree and carry over from year-to-year Funds are used to help pay for qualified medical expenses Retiree is responsible for managing the funds and maintaining records Keep receipts and Explanation or Benefits (EOB) in the event of an IRS audit 38 Non-Medicare Eligible Retirees

39 Medical Plans - CDHP IRS Eligibility for an HSA Must enroll in a qualified high-deductible health plan (CDHP) Cannot have other health coverage that is not a qualified highdeductible health plan Cannot be enrolled in Medicare, or have a dependent enrolled on their account enrolled in Medicare Cannot be claimed as a dependent on someone else s tax return Cannot have received care from the VA or one of their facilities, including prescription drugs, within the last 3 months Cannot be enrolled in Tricare 39 Non-Medicare Eligible Retirees

40 Medical Plans - CDHP Eligibility for an HSA (continued) If retiree has a VEBA account and chooses to participate in the CDHP Must make the VEBA a limited-purpose VEBA prior to enrolling in the CDHP Check with your VEBA administrator May continue to use the limited-purpose VEBA for qualified dental and vision expenses 40 Non-Medicare Eligible Retirees

41 Is a CDHP right for you? Only you can answer that question Review annual healthcare expenses Talk to the plan HealthEquity offers Information on their website: Customer service representatives 24/7 at PEBB offers Resource Guide, retirement video, and other information on their website: Consult with a qualified tax professional to discuss your individual situation 41 Non-Medicare Eligible Retirees

42 42 Dental Plans

43 Dental Plans Dental plans available to all retirees Uniform Dental Plan (administered by Washington Dental Service) DeltaCare Willamette Dental Retirees who elect dental coverage must Enroll in medical Maintain enrollment in dental for at least 2 years, but may change plans each year All family members enrolled on your account will be enrolled in dental 43

44 44 Contact Information

45 Resources PEBB Customer Service PEBB website Available on the website School District Retirement Checklist Thinking about Retirement Retiree Enrollment Guide Enrollment forms Contact the health plans at the numbers listed on the inside front cover of the retiree guide 45