2018 Plan Change Meetings
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1 2018 Plan Change Meetings
2 Agenda What is the PERS Health Insurance Program (PHIP)? Health Plans (Medicare / Non Medicare) Providence Health Plans Kaiser Permanente PacificSource Moda Health Question & Answer Medicare Basics and Enrollment PHIP Enrollment Question & Answer
3 What is the PERS Health Insurance Program (PHIP)? PHIP is a group insurance plan specifically designed for retired Oregon public employees and their eligible family members. Currently offering: Health insurance Medicare health plans Non Medicare health plans Dental insurance
4 Health Plans Offered by PHIP Medicare and Non Medicare options: When selecting a PHIP health plan, your primary residence (not mailing address) must be within the United States and the health plan s service area.
5 Dental Plans Offered by PHIP PHIP offers two dental plans: You are eligible to enroll in PHIP dental only if you also are enrolled in PHIP medical If anyone in your family wants dental coverage, the whole family must have dental coverage You can enroll in either dental plan regardless of your medical plan selection Must live in the Kaiser Permanente service area to enroll in the Kaiser dental program
6 Who is eligible for PHIP? A PERS retiree, who is receiving a PERS retirement allowance or benefit, or who received an optional lump sum payment. The spouse of an eligible PERS retiree. A dependent child who is less than 26 years of age and meets the following definitions: A natural child A legally adopted child or a child placed in the home pending adoption A step child who resides in the household of an eligible retiree A grandchild Whose parent resides in the retired member s household and was covered under the retired member s health plan at the time of birth.
7 Who is eligible for PHIP? An overage dependent (26 or older) who is unable to achieve self support through work due to a developmental disability as verified by a physician. A dependent domestic partner who meets the following definitions: Has a relationship and resides with the PERS retiree for a minimum of 12 months; The PERS retiree is providing more than 50% of the financial support; Listed as a dependent on most recent federal tax return; Must provide an Affidavit of Domestic Partnership. An eligible surviving spouse or dependent of an eligible PERS retiree
8 If non PERS spouse is eligible for Medicare before the PERS retiree: Spouse can join PHIP before PERS retiree, contingent on the PERS retiree joining PHIP at their last enrollment opportunity Spouse can wait and enroll in PHIP at the PERS retiree s enrollment opportunity If PERS retiree is eligible for Medicare before the non PERS spouse. PERS retiree can join PHIP before non PERS spouse Non PERS spouse can join later at an enrollment opportunity
9 Value to Retirees Enhanced Medicare Part D and non Medicare Prescription Drug Plan: No deductible No coverage gap (Donut Hole) Annual out of pocket cost will not exceed: For Medicare $5,000 For non Medicare $5,000
10 Value to Retirees Prescription Drug Part D Comparison PHIP Prescription Drug Plan 2018 (Medicare Part D) You pay 40% not to exceed $250 per prescription; No coverage gap After $5,000 you pay $0 Calendar Year Deductible Initial Coverage Coverage Gap (Donut Hole) Catastrophic Coverage Medicare Part D Basic 2018 You pay first $405 You and the Plan pay up to a combined total of $3,750 You pay 44% of generic medications You pay 35% of all other medications Up to $5,000 Generics $3.35 or 5% whichever is greater All other medications $8.35 or 5% whichever is greater
11 Value to Retirees PERS Premium Subsidies: (Available to eligible Tier 1 and 2 PERS retirees enrolled in a PHIP sponsored health plan) Retirement Health Insurance Account (RHIA) Medicare retirees only Subsidy $60 a month, if eligible deduct from premium Retiree Health Insurance Premium Account (RHIPA) State of Oregon non Medicare retirees only Subsidy varies based on state service time PERS retirement date must be the first of the month following termination of state employment Retiree and spouse enroll separately if both are eligible for a subsidy
12 Value to Retirees Annual plan change available (Guaranteed regardless of health status) October 1 st through November 15 th Different than Medicare Annual Enrollment Period (AEP) Changes effective January 1 st To make plan changes, submit two forms Disenrollment form for current plan Enrollment Request form for new plan Not a time to Add dental benefit Add dependents
13 Value to Retirees Member Resources Quarterly Healthwise Newsletter PHIP Website pershealth.com PHIP Health Fairs Dedicated Customer Service
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