City of Marietta Retiree Benefits Enrollment Guide. January 1, 2016 December 31, 2016

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1 2016 City of Marietta 2016 Retiree Benefits Enrollment Guide January 1, 2016 December 31, 2016

2 Table of Contents Topic Page Benefit Options for How to Enroll 4 Educational Meetings 5 Medical and Rx Coverage 6 11 Medical Center 12 Preventive Services Dental 15 Vision Medicare 18 Smoking Cessation 19 Contacts 20 Call Center 21 Disclosures Retirees may sign up for the City of Marietta Human Resources E Mail List at NOTICE: If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please see page 25 for more details.

3 BENEFIT OPTIONS FOR 2016 Benefit options for plan year 2016 The City of Marietta s 2016 Benefits Open Enrollment will be held from October 26 November 13. Medical, dental, and vision changes will be processed through BSWIFT, our online enrollment system serviced by ShawHankins. It's as easy as visiting the website, cityofmarietta.bswift.com. Eligible retirees will be able to review their current benefits and other important plan information. Please take the time to carefully weigh the plans available, and choose the option that is best for you. If you have questions or need assistance, please contact your HR Department or ShawHankins Service Center. HR and ShawHankins will be available at the Educational Meeting on October 27 and on November 2 6 to assist with enrollment and questions. The following benefit changes will take effect January 1, 2016: Medical Plan Retirees age 65 or older will now carry insurance through Aetna. This plan has been enhanced. Dental Plan We will keep the existing dental plan, but will also offer a buy up plan that covers child orthodontia. The BCBS GA Legacy dental network will change to the Prime/Complete network. Optional Vision Plan We will continue offering vision coverage through Avesis for 2016, but will now offer a buy up plan in addition to the current vision plan. Making Changes to Your Benefits To make benefit changes as a result of your Life Status Change or Family Status Change as allowed under Section 125 of the IRS Code, you must: Notify your ShawHankins Benefits Representative within 30 days of the date of the qualifying event. Provide proof of your status change event. Submit your enrollment change via BSWIFT. The Most Common Status Changes: Marriage, divorce, legal separation Birth or adoption Change in your or your spouse s work status that affects your benefits or an eligible dependent s benefits Change in health coverage due to your spouse s annual Open Enrollment period Change in dependent eligibility status Change in eligibility for you or a dependent for Medicaid or Medicare Receipt of a Qualified Medical Child Support Order, or other court order Death of your spouse or covered child Eligibility Eligible retirees may receive health benefits and flexible ancillary benefits. Eligible dependents are classified as: Your legal spouse Biological children up to age 26 Step children as long as the biological parent remains in the eligible retiree s household Foster child(ren) or adopted child(ren) up to age 26 3

4 HOW TO ENROLL How to Enroll in Benefits for the 2016 Plan Year Beginning plan year 2016, eligible retirees will enroll in or make changes to all benefits through the BSWIFT enrollment portal. Eligible retirees will access this online system by going directly to Please follow these directions for the benefits enrollment: Your username is the first letter of your first name, your last name and your year of birth. Example JSmith1945 Your password is your employee ID number Once logged in your will be prompted to create a new password. At this point you are ready to update your information and enroll in your benefits. Please be sure to have your reference materials on hand for review. It is very important that you have the names, dates of birth and SSNs for your family members on hand for the enrollment as you will need to enter this information into the system. You will need to make sure all your personal information is up to date, including your address, phone number, and address. All plan documents are located in the document center on the BSWIFT portal. As part of the IRS compliance in completing the IRS Form 1095C to report health insurance coverage, it is very important to completely update bswift with all dependent information, including dependents SSNs. ShawHankins and the Human Resources Staff will be available to assist you during the Enrollment Assistance Period November 2 to 6. The Enrollment Assistance Period is part of the larger open enrollment from October 26 through November 13. If you do not make elections through the online system, your coverage will roll over for the 2016 plan year. You will not be permitted to make changes after the open enrollment period, unless you experience a qualifying event. 4

5 EDUCATIONAL MEETINGS Benefits Fair and Open Enrollment Dates Date and Time Place Monday, October 26 *Online Only* Open Enrollment begins Tuesday, October 27 Benefits Educational Meeting 1 PM 2 PM Council Chambers 205 Lawrence Street NE Marietta, GA Council Chambers on 1 st floor Monday November 2 7am 5pm Benefits Fair and Enrollment Assistance Custer Park Fitness Center: 545 Kenneth E. Marcus Way Marietta, GA Tuesday, November 3 Friday, November 6 Enrollment in person Assistance Fire Station #1 112 Haynes Street Conference Room Marietta, GA Friday, November 13 Online Only open enrollment ends 5

6 MEDICAL COVERAGE Pre Medicare Eligible For 2016, you may elect medical coverage with Blue Cross Blue Shield of Georgia. You have a BCBS POS plan option. Grandfathered eligible retirees may also choose to remain on the BCBS PPO plan. Key Benefit Lifetime Maximum Deductible Coinsurance Out of Pocket Maximum BCBS GA POS Plan In Network Unlimited $750 per person $2,250 per family 80% plan / 20% member $6,600 per person $13,200 per family Out of Pocket Maximum includes deductible, coinsurance and copays Office Visit Copays Primary Care Physicians Specialty Care Physician Urgent Care Facilities Routine Preventive Care Inpatient Hospital Facility Services, Physician s Visits/Consultations, Professional Services $35 $40 $75 No charge Plan pays 80% after deductible Outpatient Facility Services, Professional Services Hospital Emergency Room Plan pays 80% after deductible $200 per visit copay; copay waived if admitted 6

7 MEDICAL COVERAGE Pre Medicare Eligible CONTINUED PPO Plan Grandfathered Retirees Key Benefit In Network Out of Network Lifetime Maximum Unlimited Deductible $800 per person $2,400 per family $1,200 per person $3,600 per family Coinsurance 80% plan / 20% member 70% plan / 30% member Out of Pocket Maximum $6,600 per person $13,200 per family No Maximum Office Visit Copays Primary Care Physicians Specialty Care Physician Urgent Care Facilities Plan pays 80% after deductible Plan pays 70% after deductible Routine Preventive Care Inpatient Hospital Facility Services, Physician s Visits/Consultations, Professional Services No Charge Plan pays 80% after deductible Plan pays 70% after deductible Plan pays 70% after $300 copay per admit & deductible Outpatient Facility Services, Professional Services Plan pays 80% after deductible Plan pays 70% after deductible Hospital Emergency Room Plan pays 80% after deductible Some employees have expressed concerns regarding the availability of the Blue Cross Blue Shield network outside of Georgia. Well, there is great news! Open Access POS Plan members are able to access the national BlueCard PPO network. With this national network, you will receive the same in network benefits with any participating BlueCard PPO providers, regardless of location. The BlueCard PPO network gives employees access to doctors, hospitals, and other health care providers across the country. How to locate a BCBS Doctor nationwide; Visit Click on Find a Doctor or Hospital, located on the right hand side of the screen. Choose BlueCard PPO network Then, to find a doctor, hospital, or other health care provider and corresponding map with directions, simply follow the steps outlined on the screen. 7

8 RX COVERAGE Pre Medicare Eligible PHARMAVAIL PharmAvail is the pharmacy provider for BCBS Plan Participants PharmAvail Prescription Drug Benefit BCBS POS Plan BCBS PPO Plan RX Calendar Year Deductible None $200 per person/ $600 max per family Retail Pharmacy 30 Day Supply Tier 1 Tier 2 Tier 3 Tier 4 Specialty Drugs $10 $40 $65 10% to $200 max 20% 25% 30% N/A Retail Pharmacy 90 Day Supply Tier 1 Tier 2 Tier 3 Tier 4 Specialty Drugs $20 $80 $130 Not Available Coinsurance applies 8

9 MEDICARE ADVANTAGE Medicare Eligible The Aetna Medicare Advantage PPO plan combines Medicare parts A, B and D and supplemental medical coverage, so you don t have to manage separate plans with multiple member ID cards. Key Benefit Lifetime Maximum Deductible Coinsurance Maximum Annual Out of Pocket Limit Office Visits Primary Care Physician Specialty Care Physician Urgent Care Facilities Routine Preventive Care Inpatient Hospital Facility Services, Physician s Visits/Consultations, Professional Services Medicare Advantage Plan PPO Network Unlimited None 80% plan / 20% member $2,400 per person $5 $10 $35 No Charge $250 per admit copay Outpatient Facility Services, Professional Services $100 copay Hospital Emergency Room $65 Prescription Drugs Rx Deductible Tier 1 Tier 2 Tier 3 Mail Order 90 day supply None $10 $25 $40 2 x copay *80% coinsurance only applies to certain services like dialysis, most others are covered 100% after the applicable copay. Please see plan details. 9

10 2016 RETIREE MEDICAL PREMIUMS (Note: Premiums may differ based on date of hire, years of service, and year of retirement.) Non Medicare eligible, hired prior to August 14, 1991 Plan Type Monthly Premium Comments Single POS $0 Family POS $ Single PPO $0 Family PPO $2, City pays 100% Single POS and Single PPO. Family rate is paid by employee 100%, but frozen at retirement. Non Medicare eligible, hired August 14, 1991 October 31, 2006 *Employees hired November 14, 1996 October 31, 2006 are not eligible for PPO Plan Type Monthly Premium Comments 20+ Years of Service Single POS Family POS Single PPO* Family PPO* Years of Service Single POS Family POS Single PPO* Family PPO* Years of Service Single POS Family POS Single PPO* Family PPO* <10 Years of Service Single POS Family POS Single PPO* Family PPO* $0 $ $0 $2, $81.06 $ $ $2, $ $ $ $2, $ $1, $ $2, City pays 100% Single POS and Single PPO if hired 8/14/ /13/1996. Family rate is paid by employee 100%, but frozen at retirement. City pays 80% Single POS and Single PPO if hired 8/14/ /13/1996. Single rate is frozen at retirement. Family rate is paid by employee 100%. City pays 50% Single POS and Single PPO if hired 8/14/ /13/1996. Single rate is frozen at retirement. Family rate is paid by employee 100%. Employee pays 100% for single and family rates. 10

11 2016 RETIREE MEDICAL PREMIUMS CONTINUED (Note: Premiums may differ based on date of hire, years of service, and year of retirement.) Non Medicare eligible, hired after October 31, 2006 Plan Type Monthly Premium Comments 20+ Years of Service Single POS Family POS Years of Service Single POS Family POS $60.80 $1, $ $1, City pays 85% Single POS (rate not frozen at retirement). Family rate is paid by employee 100%. Employee pays 100% for single and family rates. <10 Years of Service N/A Not eligible to purchase insurance. Medicare eligible, Aetna Medicare Advantage (PPO) Plan Type 20+ Years of Service or Hired Before 8/14/1991 Retiree Spouse Years of Service Retiree Spouse Years of Service Retiree Spouse <10 Years of Service Retiree Spouse Monthly Premium $0 $ $61.05 $ $ $ $ $

12 MEDICAL CENTER Be Healthy: Wellness and Health Care Support The City of Marietta cares about you and your family s health! That s why we offer comprehensive coverage for wellness benefits and health care support when you need it. Take advantage of these programs to keep you and your family healthy throughout the year: Preventive exams covered under the health care plans at 100%! Take action and proactively manage your health before a serious medical condition occurs. Schedule an appointment 24 hours a dayby calling or online at (access code CMGC3) City of Marietta Employee Medical Center: Location 268 Lawrence Street, Marietta, GA Eligible Retiree Medical Center Primary, urgent and preventive care Laboratory testing Flu shots Treatment for chronic health conditions Hours of Operation Mondays: Tuesdays: Wednesdays: Thursdays: Fridays: Saturdays: 8am 5pm 7am 1pm 8am 2pm 8am 2pm 8am 1pm 8am 12pm What are the benefits to you? No more long stays in the waiting room No out of pocket expense Increased convenience and access More one on one time with the doctor 12

13 PREVENTIVE SERVICES Remember to get preventive care! Getting regular checkups and exams can help you stay well and catch problems early. It may even save your life. Our health plans covers 100% of the services listed in this preventive care section, when you get these services from in network physicians. Preventive versus diagnostic care What s the difference? Preventive care helps protect you from getting sick. Diagnostic care is used to find the cause of existing illnesses. For example, say your doctor suggests you have a cancer screening because of your age. That s preventive care. On the other hand, say your doctor suggests a screening or testing to see what s causing your symptoms. That s diagnostic care and you may need to pay part of the cost. Here is an overview of the types of preventive services. Child Preventive Services (birth through 18 years) Preventive care physical exams are covered. So are the screenings, tests and vaccines listed here. The preventive care services listed below may not be right for every person. Ask your doctor what s right for you. Screening Tests (depending on age) May Include: Behavioral counseling to promote a healthy diet Blood Pressure Cholesterol and lipid level Depression Development and behavior Hearing Height, weight and body mass index (BMI) Hemoglobin or hematocrit Lead Testing Newborn Obesity, including counseling Oral (dental health) Sexually transmitted diseases Vision Immunizations: Diphtheria, tetanus and pertussis (whooping cough) Haemophilus influenza type B (Hib) Hepatitis A Hepatitis B Human papilloma virus (HPV) Influenza (flu) available at CareHere Medical Center Measles, mumps and rubella (MMR) Meningococcal (meningitis) Pneumococcal (pneumonia) Polio Rotavirus Varicella (chicken pox) 13

14 PREVENTIVE SERVICES Contd. Adult preventive care (19 years and older) Preventive care physical exams are covered. So are the screenings, tests and vaccines listed here. The preventive care services listed below may not be right for every person. Ask your doctor what s right for you. Preventive physical exams Screening tests and services (depending on your age) may include Aortic aneurysm screening (men who have smoked) Blood pressure Bone density test to screen for osteoporosis Breast cancer, including exam and mammogram Breastfeeding support, supplies and counseling (female) Cholesterol and lipid (fat) level Colorectal cancer, including fecal occult blood test, barium enema, flexible sigmoidoscopy, screening colonoscopy and CT colonography (as appropriate) Contraceptive (birth control) counseling and FDA approved birth control methods that need a prescription (female) Depression Eye chart test for vision Hearing Height, weight and BMI HIV screening HPV (female) Intervention services (includes counseling and education): Behavioral counseling to promote a healthy diet Counseling related to aspirin use for the prevention of cardiovascular disease (does not include coverage for aspirin) Genetic counseling for women with a family history of breast or ovarian cancer Primary care intervention to promote breastfeeding Screening and behavioral counseling related to alcohol misuse Screening and behavioral counseling related to tobacco use Screening and counseling for interpersonal and domestic violence Screening and counseling for obesity Pelvic exam and Pap test, including screening for cervical cancer Prostate cancer, including digital rectal exam and PSA test Screenings during pregnancy (including, but not limited to, gestational diabetes, hepatitis, asymptomatic bacteriuria, Rh incompatibility, syphilis, iron deficiency anemia, gonorrhea, chlamydia and HIV) Sexually transmitted infections Immunizations Diphtheria, tetanus and pertussis (whooping cough) Hepatitis A Hepatitis B HPV Influenza (flu) Meningococcal (meningitis) MMR Pneumococcal (pneumonia) Varicella (chicken pox) Zoster (shingles) 14

15 DENTAL COVERAGE Dental coverage is provided through Blue Cross Blue Shield for Keep in mind that you ll pay less if you use an in network dentist. Regular preventive care visits to your dentist can help protect your overall health. Studies have linked gum disease to problems in other areas of the body. In fact, studies by the Centers for Disease Control and Prevention show there may be a link between oral infections and diabetes, heart disease, stroke, and preterm, low weight births. Your Dental Coverage The dental plan now utilizes the Prime & Complete network. To locate participating providers, go to BCBS Base Dental In Network Out of Network Annual Maximum Deductible (Single/Family) Diagnostic/Preventive Services $1,000 per person BCBS Base Dental Plan $25/$75 $25/$75 100% 100% Basic Benefit Services 80% 80% Major Benefit Services 50% 50% BCBS Buy Up Dental In Network Out of Network Annual Maximum Deductible (Single/Family) Diagnostic/Preventive Services $1,500 per person BCBS Buy $25/$75 Up Plan $25/$75 100% 100% Basic Benefit Services 80% 80% Major Benefit Services 50% 50% Orthodontia (Child Only) Orthodontia Lifetime Maximum 50% 50% $1,000 per person *Deductible does not apply to diagnostic/preventive services. *12 month waiting period for Orthodontics if you do not enroll when first eligible for this plan. 15

16 VISION COVERAGE Optional Vision Coverage is provided through Avesis. The Avesis network includes thousands of provider locations. To find a network provider near you, visit avesis.com. Did you know? Regular vision exams can help detect signs of: Diabetes High cholesterol Tumors Thyroid disorders Neurological disorders Vision doctors can also help treat and manage: Cataracts Corneal diseases Diabetic retinopathy (damage to the blood vessels of the retina due to diabetes) Glaucoma Macular degeneration (damage to the center of the retina, usually due to old age) Avesis Base Vision Plan Avesis Vision In network Out of network reimbursement Exam $10 copay $35 Standard Lenses Covered in full after $25 Copay $25 single $40 bifocal $50 trifocal Frames $50 wholesale allowance $45 Contact Lenses $130 allowance $130 Medically Necessary Contact Lenses Paid in full $250 Laser Vision Correction $150 one time + 25% discount Avesis Buy Up Vision Plan Avesis Vision $150 one time In network Out of network reimbursement Exam $10 copay $45 Standard Lenses Frames Covered in full after $15 Copay $65 wholesale allowance $40 single $60 bifocal $80 trifocal $75 Contact lenses $150 allowance $150 Medically necessary Paid in full $250 contact lenses Laser vision correction $300 one time + 25% discount $300 one time 16

17 VISION COSTS Weekly Retiree Avesis Base Vision Plan Employee + Spouse Employee + Children Family $1.44 $2.52 $3.02 $3.74 Monthly Retiree Employee + Spouse Employee + Children Family $6.24 $10.91 $13.10 $16.22 Weekly Retiree Avesis Buy Up Vision Plan Employee + Spouse Employee + Children Family $1.58 $2.79 $3.24 $4.07 Monthly Retiree Employee + Spouse Employee + Children Family $6.85 $12.07 $14.03 $

18 MEDICARE I m turning 65 this year and still actively working. What do I need to do? If you re turning 65 this year you ll be getting a Medicare Enrollment kit giving you the option to enroll in Medicare Parts A, B as well as Medicare Part D. You ll be getting the kit 60 to 90 days before your birthday. Please read the Medicare materials carefully. It helps you to know all you can when you make a decision about enrolling in Medicare. If you re actively working and you get health insurance through your employer, the coverage will be your primary insurance. Medicare will be your secondary coverage. Your coverage as an active employee is considered Creditable Coverage for Medicare Parts B and D. As long as you re enrolled in health coverage through the City of Marietta as an active employee, you won t be penalized if you put off enrolling in Medicare Parts B and D until your retirement. For more information, visit the Medicare website at: or contact the Human Resources office. 18

19 SMOKING CESSATION Ready to stop smoking? Here s how to get help. Taking care of your health is important and we d like to help you do that. If you smoke, one of the best ways to improve your health is to stop smoking. On average, adults who smoke die 13 to 14 years earlier than nonsmokers. Tobacco use remains the leading preventable cause of disease, death, and disability in the United States. Even secondhand tobacco smoke is deadly. It contains chemicals such as formaldehyde, ammonia, arsenic, carbon monoxide and lead. Each year, about 3,400 nonsmoking adults die of lung cancer and another 46,000 nonsmokers die from heart disease, all as a result of breathing secondhand smoke. Take a look at all the health benefits of quitting: Within 20 minutes: Your heart rate drops. Within 12 hours: The carbon monoxide level in your blood is normal. Within 2 weeks to 3 months: Your circulation improves and your lung function returns to normal. Within 1 to 9 months: Your coughing and shortness of breath decrease. Within 1 year: Your risk of heart disease is about half that of a tobacco user. Within 5 years: Your risk of stroke equals that of a non tobacco user. How to find the right quit program for you The program that works best for you may be different from the program that works best for someone else. So talk to your doctor, who s one of your best resources for finding programs that meet your total health needs. Your doctor can talk about over the counter and prescription medications available. TIP: Studies show that stop smoking programs that work best are those offered through a facility or doctor and include therapy and social support. Resources City of Marietta CareHere Medical Center American Lung Associationquitterinyou.org Knock Out Nicotine American Cancer Society 800 ACS 2345 cancer.org 19

20 CONTACTS Benefit Customer Service # Carrier Health (855) Blue Cross Blue Shield of Georgia Health (800) Aetna Dental (877) Blue Cross Blue Shield of Georgia Vision (800) Avesis Non Medicare Pharmacy (800) PharmAvail City of Marietta Benefit Information (770) ShawHankins Call Center (800) customerservice@shawhankins.com 20

21 The ShawHankins Service Center is available for additional support! Call Our partnership with the ShawHankins Service Center can provide our employees with much of the same information as the benefits office. What can they assist with? Understanding Your Benefits: The Service Center can assist you with questions regarding your many plan options and benefits, including deductibles, copayments and coinsurance. They can also explain any applicable waiting periods, elimination periods and eligibility rules. Annual Enrollment Information: The Service Center can provide you details about when open enrollment begins and ends and if your plan designs or payroll deductions are changing. Enrollment Process Support: The Service Center can provide you general instructions regarding online enrollment or completing any applicable paper forms. Locating Network Providers: Staying in network saves everyone money. The Service Center can help you locate network providers for medical, dental and vision coverage, whether you are at home or away. Order ID cards: The Service Center can contact your Dental or Vision insurance carrier directly and order a replacement card for you. Claim Resolution and Research: The Service Center can help you understand your Dental or Vision Explanation of Benefits (EOB) as well as contact those insurance carriers on your behalf. They can assist in appealing a denied dental or vision claim or help you request a Prior Authorization (PA) from your dentist as may be required by your dental carrier. Explain Section 125 Cafeteria Plans: The Service Center can explain qualifying events regulated by the IRS as described by your Summary Plan Description (SPD). They can help to clarify the time frames and life events allowed by your plan. The ShawHankins Service Center is located in Marietta, Georgia and is staffed with friendly, knowledgeable individuals ready to answer your questions! 21

22 DISCLOSURE NOTICES Premium Assistance Under Medicaid and the Children s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren t eligible for Medicaid or CHIP, you won t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial KIDS NOW or to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren t already enrolled. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at or call EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, Contact your State for more information on eligibility 22

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24 To see if any other states have added a premium assistance program since January 31, 2015, or for more information on special enrollment rights, contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services EBSA (3272) , Menu Option 4, Ext

25 Important Notice from The City of Marietta About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with The City of Marietta and about your options under Medicare s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. The City of Marietta has determined that the prescription drug coverage offered by the BCBS POS, BCBS PPO, and Aetna Medicare Advantage plans is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current The City of Marietta coverage will be affected. If you do decide to join a Medicare drug plan and drop your current The City of Marietta coverage, be aware that you and your dependents will be able to get this coverage back, but only during an eligible enrollment period. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with The City of Marietta and don t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. 25

26 For More Information About This Notice Or Your Current Prescription Drug Coverage Contact the person listed below for further information at NOTE: You ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through The City of Marietta changes. You also may request a copy of this notice at any time. For More Information About Your Options Under Medicare Prescription Drug Coverage More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. You ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: Visit Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help Call MEDICARE ( ). TTY users should call If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at or call them at (TTY ). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). From: January 1, 2016 December 31, 2016 Name of Entity/Sender: The City of Marietta Contact/Position Office: Cynthia Sanh Benefits Manager Address: 205 Lawrence St. Marietta, GA Phone Number: