PERS Health Insurance Program. Important information for new retirees

Transcription

1 PERS Health Insurance Program Important information for new retirees

2 Health Insurance Program Enrollment Opportunities The following enrollment opportunities, as defined in OAR , mark the only enrollment opportunities available. Be sure to read each section carefully. Retirees and their spouses or dependent children who do not choose to enroll in a PHIP health plan during one of these enrollment periods will lose their opportunity to enroll in PHIP. Retirees and dependents must meet eligibility requirements.

3 New retirees New retirees can enroll within 90 days of their retirement. Coverage will be effective on your retirement date (if you apply before your retirement date or the date of your PERS disability approval letter) or on the first day of the month after your application is received within 90 days from your retirement date (if you apply after your retirement date or the date of your PERS disability approval letter). Initial Medicare eligibility PERS retirees can enroll within 90 days of their initial Medicare eligibility if they are enrolled in both Medicare Parts A and B. You are required to retain both Medicare Parts A and B to be enrolled in a PHIP Medicare plan. Enrollment in a PHIP Medicare plan includes enrollment in a PHIP Medicare Part D Prescription Drug Plan. Coverage will take effect on the date your initial Medicare coverage becomes effective as long as you enroll before the date of your Medicare eligibility. Coverage will take effect on the first day of the month after your completed application is received if you apply after the date of your initial Medicare eligibility. Medicare disability Your eligibility to enroll in Medicare Parts A and Part B, due to Social Security Disability, becomes effective the first day of the 25th month after your Social Security Disability benefits begin. In this instance, becoming Medicare eligible due to disability is considered your initial Medicare eligibility. The 90-day initial Medicare eligibility enrollment opportunity will apply in this circumstance. If you miss this opportunity, becoming Medicare eligible at age 65 will not be a new opportunity to enroll in a PHIP health plan unless you have had 24 months of continuous employer-sponsored coverage immediately preceding enrollment in PHIP. Continuous group coverage You may enroll within 30 days of loss of employer-sponsored group coverage or any time as long as you have been covered under another employer-sponsored group health plan for 24 consecutive months immediately preceding enrollment in PHIP. PHIP coverage will be effective the first of the month after employer-sponsored group coverage ends, if loss of coverage is the reason for enrolling, and your Enrollment Request form is received prior to that loss of coverage. If the PHIP Enrollment Request Form is received after the loss of coverage date and within the 30-day timeline, the effective date will be the first of the month after the Enrollment Request Form is received. Verify your coverage end date with your employer to ensure that you enroll with PHIP on the correct effective date to avoid a lapse in coverage. Dependent enrollment Spouses and dependent children can be enrolled during any of the enrollment periods available to retirees. If a dependent experiences an enrollment opportunity after the retiree is enrolled, he or she will be eligible to enroll under the retiree s account. New dependents can also be enrolled within 30 days of becoming a dependent (e.g., through marriage, child birth). All dependents must be enrolled in the same health plan as the retiree. If the retiree has Medicare coverage and the dependent has non-medicare coverage, their coverage must still be with the same health plan. Survivor continuation of coverage Surviving spouses and eligible dependent children who are not enrolled in PHIP at the time of a retiree s death are eligible to enroll within 90 days after the retiree s date of death, within 30 days from loss of continuous employer-sponsored group coverage or within 90 days of Medicare eligibility. Dependents must meet eligibility requirements. Dental enrollment You are eligible to enroll in a PHIP dental plan only if you also have PHIP medical coverage. If anyone in your family wants dental coverage, everyone who is enrolled in a PHIP medical plan must also be enrolled in a PHIP dental plan. Enrollment in a PHIP dental plan must be made under the same enrollment opportunities as the PHIP medical plan.

4 The PERS Health Insurance Program (PHIP) offers medical and dental insurance coverage for all retirees, their spouses, and dependents who meet the eligibility requirements. When planning your retirement, review all health coverage options available through your or your spouse s employer to determine the best health coverage option for you. Health Plan Information PHIP contracts with four different health plan carriers and two dental carriers. All health plans include prescription drug coverage. In selecting a health or dental plan, your primary residence (not mailing address) must be within the United States and the plan s service area. Each health plan offers Medicare and non-medicare coverage for eligible Public Employees Retirement System (PERS) retirees and eligible family members. Medicare Plan Options Kaiser Permanente A Health Maintenance Organization (HMO) Medicare Advantage plan available for PERS members who live within the Kaiser Permanente service area. PERS retirees living in California also can join Kaiser Permanente however, benefits will differ from those offered to retirees that reside in Oregon. Moda Health The traditional Medicare supplement plan is available to Medicare members living within the United States. Members who reside in the state of Oregon have a second option with the PERS Moda Health PPORX Preferred Provider Organization (PPO) Medicare Advantage plan. PacificSource Health Plan Offers one Medicare Advantage plan to Medicare members living in Central Oregon, parts of Eastern Oregon and the mid-columbia Gorge as well as the following counties: Coos, Curry, Crook, and Lane. Providence Health Plan Offering two Medicare Advantage plans for Oregon members permanently residing in Benton, Clackamas, Columbia, Crook, Deschutes, Hood River, Jefferson, Lane, Linn, Marion, Multnomah, Polk, Washington, Wheeler, and Yamhill counties and for those members in Clark County, Washington. The Providence Medicare Align Group (HMO) plan offers the richest benefits, while the Providence Medicare Flex Group Health Maintenance Organization-Pointof-Service (HMO-POS) plan offers you the flexibility to use in- and out-of-network providers. Non-Medicare Plan Options Kaiser Permanente offers two non-medicare plans for members residing in the Kaiser Permanente service area; a traditional HMO plan and an HMO plan with a deductible. Moda Health offers two PPO plans for non-medicare retirees and dependents. The state in which you reside will determine the PPO network to utilize for in-network services. PacificSource Health Plan offers two Point-of-Service (POS) non-medicare plans for members residing in the areas noted above for Medicare members. Providence Health Plan offers two non-medicare PPO plans with access to in- and out-of-network providers for members residing in the areas noted above for Medicare members. Medicare Part D (prescription drugs) Enrolling in a PHIP Medicare plan automatically enrolls you in a PHIP Medicare Part D Prescription Drug Plan. You cannot be enrolled in another Medicare Part D Prescription Drug Plan while enrolled under a PHIP plan, or you will be disenrolled from all PHIP coverages. Once disenrolled, you cannot re-enroll in PHIP unless you experience a new enrollment opportunity. Dental Coverage PHIP offers two dental plans: Kaiser Permanente and Delta Dental of Oregon. You must be enrolled under a PERS medical plan in order to enroll in a PERS dental plan. You can enroll under either dental plan, regardless of your PHIP medical plan selection. However, for Kaiser Permanente dental, you must reside in the Kaiser Permanente dental plan service area.

5 After Enrollment Premium Payments Your monthly premium can be paid in one of the following ways: y Automatic deduction from your PERS pension y Automatic withdrawal from your checking or savings account Only one payment option is allowed per PHIP account. Plan Change PHIP offers an annual plan change period from October 1 to November 15. During the plan change period, you can change your medical and/or dental plan to another plan available within your residing area. The annual plan change period is not an opportunity to add dental coverage or dependents. Plan changes made during this period become effective January 1 of the following year. If you are enrolled and do not want to change plans, no paperwork is required. Snow Bird The Snow Bird option allows members enrolled in any PHIP Medicare Advantage plan to change their health plan to the Moda Health Medicare Supplement Plan while temporarily living outside their Medicare Advantage plan s service area. Members must plan on temporarily living outside the service area for more than 60 days for this option to apply. Service areas For complete information about the service areas for any of our health plans, you can visit the PHIP website at Travel benefits All health plans offered include a benefit for travel. For information about coverage while traveling outside the United States, please visit Cost of PHIP health plans Health insurance premium rates are contracted annually and change January 1 of each year. Different rate combinations apply, depending on you and your dependents Medicare and/or subsidy contribution eligibility. For information about rates, benefits, and premium subsidy eligibility visit or contact PHIP customer service at the number provided on the back of this brochure.

6 PERS Health Insurance Program (PHIP) In Portland: Toll-free: Fax: or Mailing address: P.O. Box 40187, Portland, OR This brochure is for general informational purposes only and is not intended to provide legal advice. If there is any conflict between this brochure and federal law, Oregon law or administrative rules, the law and administrative rules shall prevail. Published by PERS Health Insurance Program (10/17)