SDMC RETIREE HEALTH INSURANCE OPTIONS. Pre and Post Age 65

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1 SDMC RETIREE HEALTH INSURANCE OPTIONS Pre and Post Age 65

2 This information has been provided to you to help you understand your retirement benefit options prior to meeting with the Benefits Staff. At your scheduled meeting, you will be asked to make a decision as to which benefits you would like to maintain post retirement. The Benefits Specialist will be happy to answer your questions along the way. Retirement is an exciting time and it is our goal to help you enjoy every step of the process. Please let us know how we may assist you further! HAPPY RETIREMENT!!!

3 Retirees are allowed to continue health insurance, dental and vision post retirement as long the employee is enrolled in this coverage at the time of retirement. The retiree will pay the entire premium for coverage since there is no longer board contribution towards premiums. Retirees are offered either $5,000 or $10,000 in retirement life insurance. This is a term policy that has no cash value. It is guaranteed issue with no health questions asked. AFLAC policies may be maintained directly through AFLAC. Insurance premiums may be deducted through the FRS monthly pension or by paying directly to the SDMC Finance department through Automatic Draft payment. PRE AGE 65

4 FLORIDA BLUE PLANS MONTHLY INSURANCE PREMIUM GOLD SILVER BRONZE RETIREE $607 $571 $525 RETIREE + SPOUSE $1,335 $1,256 $1,156 RETIREE + CHILD(REN) $1,092 $1,027 $947 RETIREE + FAMILY $1,820 $1,712 $1,576 PRE AGE 65 4 TIER PLAN

5 DENTAL AND VISION MONTHLY INSURANCE PREMIUMS Retiree Life Insurance Monthly Insurance Premium $5000 $7.61 $10,000 $15.22 DENTAL HIGH DENTAL LOW VISION PREMIER VISION BASIC RETIREE $46.56 $26.86 $12.11 $8.81 RETIREE + SPOUSE $87.80 $51.24 $24.27 $17.64 RETIREE + CHILD(REN) $96.44 $56.58 $30.16 $21.66 RETIREE + FAMILY $ $81.00 $42.19 $30.32 PRE AGE 65 AND POST AGE 65

6 Retirees over the age of 65 must enroll in Medicare Part A and B. If you are not currently enrolled in Part B at the time of retirement, the Employee Benefits staff will assist you with completing the Part B paperwork. As a retiree age 65 or older, you have the option to remain on Florida Blue or elect one of the two Medicare Advantage plans that are currently offered through Aetna. The School District currently has over 500 Medicare eligible retirees participating on one of the two Aetna Medicare Advantage Plans. POST AGE 65

7 The following slides represent a brief description of the two Aetna Medicare Plans offered by the District. As outlined, please note that the medical coverage is identical between the two plans. The only difference between the Aetna Enhanced and Basic Plans are related to the pharmacy drug coverage. The Enhanced plan is not subject to the Coverage Gap period (Donut Hole)and maintains a standard copay structure while in the Coverage Gap. The Basic Plan is subject to the Coverage Gap period (Donut Hole) and will have adjusted pricing while in the Coverage Gap. Premium differences reflected between the two plans are only due to the pharmacy differences. AETNA MEDICARE ADVANTAGE PLANS

8 Coverage Aetna Basic Plan Aetna Enhanced Plan Premium $ $ Deductible $0 $0 Primary Care Physician Visit 15% of Medicare eligible expenses 15% of Medicare eligible expenses Specialist Visit 15% of Medicare eligible expenses 15% of Medicare eligible expenses Annual Out of Pocket Maximum $2,000 $2,000 Inpatient Coverage $500 Copay per stay (includes hospital and related physician charges) $500 Copay per stay (includes hospital and related physician charges) Emergency Room $50 Copay $50 Copay Routine Care (Wellness) $0 $0 Durable Medical Equipment 15% of Medicare eligible expenses 15% of Medicare eligible expenses Diabetic Supplies $0 $0 Hearing Aid Reimbursement $500 every 36 months $500 every 36 months Fitness Benefit Silver Sneakers Silver Sneakers

9 Aetna Basic Plan- Pharmacy Aetna Enhance Plan***- Pharmacy Coverage Prior to the GAP Your Cost Your Cost Tier 1 Preferred Generic $5 Copay Generic $10 Copay Tier 2 Non-Preferred Generic $20 Copay Non-Preferred Generic $10 Copay Tier 3 Preferred Brand $40 Copay Preferred Brand $20 Copay Tier 4 Non-Preferred Brand $75 Copay Non-Preferred Brand $35 Copay Tier 5 Specialty 33% Specialty $35 Copay Coverage during the GAP** Your Cost Your Cost Tier 1 Preferred Generic 44% Generic $10 Copay Tier 2 Non-Preferred Generic 44% Non-Preferred Generic $10 Copay Tier 3 Preferred Brand 35%** Preferred Brand $20 Copay Tier 4 Non-Preferred Brand 35%** Non-Preferred Brand $35 Copay Tier 5 Specialty 44%/35%** Specialty $35 Copay Coverage during the Catastrophic Phase Your Cost All Tiers $0 Copay $0 Copay Your Cost *This is not a full list of covered benefits. See the plan details and benefit summary for additional details. ** The Medicare Coverage Gap Discount Program will provide manufacturer discounts on brand name drugs to Part D Enrollees who have reached the coverage gap and are not already receiving Extra Help. A 50% discount on the negotiated price (excluding the dispensing fee) is available for those brand name drugs from manufacturers that have agreed to pay the discount (this is reflected with the 40%) ***The Aetna Enhanced Pharmacy Plan is a Tier $plan. Comparisons were adjusted to a tier 5 plan only for comparison purposes.

10 There are three phases of prescription benefits in the Medicare D drug plans offered by the School District. Phase 1: Initial Coverage Limit in 2018 the Initial Coverage Limit will be $3, 750. Once you and your Part D Plan have spent a combined amount of $3,750 for covered drugs, you will enter the coverage gap period and your cost sharing may change. Phase 2: Prescription coverage while in the gap- (BASIC PLAN) Generic Drugs- you will pay 44% of the full cost at retail for Generic drugs until you reach the end of the coverage gap. Brand-Name Drugs- You will pay 35% coinsurance after a 50% manufacturerpaid discount on the drug s full price has been applied. (Enhanced plan continues to pay the copay amount prior to the coverage gap.) Phase 3: Catastrophic Coverage after exiting the gap- You will remain in the coverage gap until your 2018 total out-of-pocket spending reaches $5, At that point, the coverage gap ends and your drug plan will pay ALL cost of your covered drugs. UNDERSTANDING THE MEDICARE PART D COVERAGE GAP (DONUT HOLE)

11 You are almost there! Please be sure that you come prepared with all Beneficiary Information including address and Social Security Number of the person that you name as beneficiary. You will also want to bring a check book to pay for any premiums owed prior to FRS Deductions or Direct Payment is set up. RELAX, HAVE FUN, AND ENJOY YOUR TIME! You are in good hands! LAST STEPS BEFORE