Intel Retiree Health Program 2013 Enrollment Guide
Table of Contents The Purpose of this Guide...2 The Purpose of this Guide Congratulations on your retirement from Intel. This Enrollment Guide will outline the medical and prescription drug benefit options available to you and provide important information about your SERMA. You have 30 days from your retirement date at Intel to enroll in IRMP. This 30-day period is your enrollment period. It is important that you take time to evaluate your healthcare coverage needs and, if appropriate, make an election during this enrollment period. If you do not make an election during this 30-day enrollment period, your next opportunity to enroll in IRMP will be the next Annual Enrollment. 1 Where Can You Get Help? Contact an Intel Health Benefits Center representative at (877) GoMyBen (466-9236) for answers to your questions about: Enrollment IRMP SERMA The Intel Health Benefits Center is available Monday through Friday, 7 a.m. to 5 p.m. (Pacific). When calling the Intel Health Benefits Center you will be prompted to enter your password. If you have forgotten your password, or haven t created one yet, just Annual Enrollment typically occurs October/November each calendar year and plan election made during Annual enrollment say representative will be effective January and your 1 of call the next will be year. routed You may to have a representative an opportunity to change who can plans help you. outside of representative Annual Enrollment who if you can experience help you. a qualified change in status. Also if you do not enroll during this enrollment period, you are required to provide proof of continuous coverage. See the Intel Retiree Medical Plan Summary 1 Plan Description for more information. Annual Enrollment typically occurs October/November each calendar year and plan election made during Annual enrollment will be effective January 1 of the next year. You may have an opportunity to change plans outside of Annual Enrollment if you experience a qualified change in status. Also if you do not enroll during this enrollment period, you are required to provide proof of continuous coverage. See the Intel Retiree Medical Plan Summary Plan Description for more information. Where Can You Get Help?...2 A Message from Richard Taylor...3 Retiree Health Programs Overview...4 Sheltered Employee Retiree Medical Account (SERMA)...5 Considering Coverage Outside of Intel? Here Are Some Key Questions to Ask...6 Intel Retiree Medical Plan (IRMP) Overview...7 IRMP CIGNA Coinsurance...8 IRMP CIGNA Indemnity with Rx...9 IRMP CIGNA Indemnity without Rx... 10 A Note on How the CIGNA Indemnity Plans Work...11 Aon Hewitt Navigators: A Resource for Medicare-Eligible Retirees... 12 Making Your Enrollment Elections... 13 Appendix... 14 2013 IRMP Premiums... 15 This guide is intended to satisfy the requirement to provide a summary of material modifications and should be kept with your IRMP Summary Plan Description (SPD). The information in this guide is a summary of your benefits and is not intended to take the place of or change official plan documents in any way. In the event of any discrepancy between the information in this guide and the 2013 Intel Retiree Medical Plan SPD, the SPD will prevail. Intel reserves the right to modify, change, or discontinue benefit plans at its sole discretion. 2
A Message from Richard Taylor Intel Retiree, Congratulations on your retirement from Intel! As the executive sponsor for the Intel Retiree Organization, I want you to know that Intel is committed to providing retirees with the flexibility needed to make the best healthcare decisions possible. One of the benefits you receive as an Intel retiree is a Sheltered Employee Retiree Medical Account (SERMA). Your SERMA is based on your years of services and allows you the flexibility to reimburse yourself for eligible medical, dental, and vision coverage if you choose to purchase coverage outside of Intel. To find out your current SERMA balance, contact the Intel Health Benefits Center at (877) GoMyBen (466-9236), or visit the My Health Benefits website. Also, as a retiree, you have access to the Intel Retiree Medical Plan, which provides healthcare plan options based on your eligibility for Medicare. This guide is your overview and reference for your Intel Retiree Medical Plan benefits. It contains useful information to help you make an informed choice. As you approach your enrollment options, I d ask that you invest the time and attention to make an informed decision for you and your family. I encourage you to use the decision support resources available, including the Intel Health Benefits Center and Aon Hewitt Navigators (for Medicare-eligible retirees). These resources can help you navigate the options available and help you get the information necessary to make the right decisions. Healthcare decisions are some of the most important choices we make for ourselves and our families. We hope we ve give you all the information and support you need in this process. Again, congratulations on retirement and reaching such a wonderful milestone in your career. Best, Richard Taylor, Senior Vice President, Human Resources Intel Corporation Richard Taylor Senior Vice President, Human Resources Intel Corporation 2013 Retiree Health Program 3
Retiree Health Programs Overview Intel s retiree health program has two elements: 1. Sheltered Employee Retirement Medical Account (SERMA) SERMA is provided to help purchase health insurance for you and your eligible dependents once you have retired from Intel and have met the eligibility requirements. When you retired from Intel as a U.S. employee, Intel established a SERMA 2 for you. You may use your SERMA credits to pay for Intel Retiree Medical Plan premiums or you may reimburse yourself for eligible non- Intel sponsored healthcare premiums. For more information on SERMA, go to page 5. 2. Intel Retiree Medical Plan (IRMP) The IRMP is the medical plan available from Intel Corporation to eligible retirees and their eligible dependents. The plan is designed to provide access to comprehensive medical coverage for: Retirees and their eligible dependents who are Medicare-eligible (typically, age 65 and over); or Retirees and their eligible dependents who are unable to purchase health insurance coverage elsewhere due to a medical condition (IRMP does not exclude coverage for pre-existing conditions). If you are not Medicare-eligible (typically if you under age 65 you are not eligible for Medicare), you may enroll in the CIGNA Coinsurance Plan. For more information go to page 8. If you are Medicare eligible, you may enroll in either the CIGNA Indemnity Plan with RX or the CIGNA Indemnity plan without Rx. The difference between the plans is the with Rx plan includes a prescription drug benefit where as the without Rx plan does not. For more information, go to pages 9-10. If you are enrolling your dependents in IRMP; please review the eligibility rules on page 7. The IRMP may not be the best plan for all retirees. Retirees under age 65, who are healthy, can often purchase health insurance that costs much less than the comprehensive coverage offered by the IRMP. 2 For information on your SERMA balance, contact the Intel Health Benefits Center at (877) GoMyBen (466-9236), or online at www.intel.com/go/myben under Your Spending Account tab. For additional information and program details see information in the Intel Pay, Stock and Benefits Handbook, Retirement Chapter. For detailed information on the IRMP plan, see the IRMP Summary Plan Description (SPD) document or Contact the Intel Health Benefits Center at (877) GoMyBen (466-9236). 4
Sheltered Employee Retiree Medical Account (SERMA) SERMA: The Flexibility to Spend Your Healthcare Dollars How You See Fit You have the ability to use SERMA to pay for all or part of your IRMP premium, or to reimburse yourself for the cost of other eligible health insurance premiums. With the ability to pay for the plan that best meets your needs, SERMA can increase your health insurance options and help you make the most out of your SERMA credits. Using SERMA for Non-Intel Sponsored Healthcare Premiums You may use your SERMA credit to reimburse yourself for premiums paid for you and your eligible dependents until you exhaust your account. Eligible reimbursements may include premium payments for: Individual health insurance Individual dental insurance Individual vision insurance Other employer retiree group plans COBRA Medicare Medigap Long-term care If you are enrolled in IRMP, you may also use your SERMA credit toward other eligible healthcare premiums. For example, if you are on the IRMP plan and your spouse is enrolled in a non-employer sponsored medical plan, you may now use your SERMA toward both your IRMP premium and your spouse s non-intel premium expenses. For information on your SERMA balance, contact the Intel Health Benefits Center at (877) GoMyBen (466-9236), or online at www.intel.com/go/myben under Your Spending Account tab. The Your Spending Account website allows you to: View your SERMA account balance Submit claims (you have the option to submit claims online, by fax, or by mail) Check the status of your claims Learn more about eligible expenses Using SERMA for IRMP If you are enrolled in IRMP, you may use your SERMA credits to offset your monthly premium until you exhaust your account. During this Enrollment period you may elect how much of your IRMP premium you would like paid from your SERMA each month; 25%, 50%, 75%, or 100%. Your IRMP premium payments will be paid directly from your SERMA; you do not need to submit a claim for reimbursement. The percentage you elect will apply to both you and your enrolled dependent s premiums. If you chose a SERMA contribution other than 100 percent, you are responsible for paying the remainder of the premium cost. Frequently Asked Questions Q: Can I be enrolled in IRMP and use my SERMA to purchase other insurance as well? A: Yes, new in 2013 you can enroll in IRMP and also request SERMA reimbursement for eligible premiums such as the MetLife Dental Plan. Q: Can I use SERMA to purchase coverage for my spouse or dependent children? A: Yes, you can use your SERMA to purchase individual insurance for yourself, your spouse, and your eligible dependent children. Q: If I want to remain enrolled in IRMP, may I use SERMA to purchase other coverage for my family? A: Yes, if you are enrolled in IRMP you may use SERMA towards IRMP premiums for yourself, while also requesting reimbursement for eligible non-irmp premiums for your dependents. Q: I am enrolled in my spouse s employer group medical plan. Can I use SERMA to pay the premium? A: No, you may not use SERMA to reimburse yourself for another company s active employee group coverage. 2013 Retiree Health Program 5
Considering Coverage Outside of Intel? Here Are Some Key Questions to Ask. As you explore your health benefit options, here are some key items you should consider as you make your decision on what the best health plan option is for you and your family. METLIFE OFFERS DENTAL COVERAGE MetLife is offering voluntary dental plans to Intel Retirees. These plans offer access to comprehensive dental coverage. You will be receiving communications directly from MetLife on when and how to enroll. You may use your existing SERMA balance to reimburse yourself for any eligible dental premium. First consider your personal situation: Are you currently undergoing any treatment that may be disrupted as a result of a change in health plans? Do you have a pre-existing medical condition which could result in denial or limitation of medical coverage? Are you taking any prescription medications? Does the plan have a list of approved drugs? If yes, are the drugs you are taking covered? Are you taking any specialty drugs? Are you receiving treatment from either an inpatient or outpatient facility? If yes, are these facilities participating in the plans you may be considering? If you are not currently undergoing any treatment, is there treatment planned for the future? (For example do you have a planned outpatient surgery?) What is important to you: provider choice (primary care/specialist), out of pocket cost, monthly premium cost, drug coverage, etc.? Does the plan have service area or residency limitations? (Hint: this is typical with an HMO or Medicare Advantage Plan.) Financial considerations: What is the monthly premium? What is your monthly healthcare budget? (Be sure to include premium and out of pocket cost which includes copays/coinsurance for provider visits and prescription drugs obtained on a regular basis.) Does the plan include an annual out of pocket maximum? Does the plan include any pre-existing medical benefit limitations? Does the plan include a prescription benefit, routine vision benefit, chiropractic care or any other services you currently receive? If no, is there an option to add it? Providers do not accept all plans. If you don t want to change providers you should understand what benefit plans your providers accept. Here are a few recommended questions to ask our providers: Ask provider if they participate in the plan(s) you are considering. Ask provider, as a specialist, which plan provides the best ease in use (i.e., less paperwork, easy to get authorizations). Ask provider if plan covers treatment facilities they generally use (outpatient services such as radiation, chemo, other lab or x-ray facilities as well as inpatient). Ask provider to share their experience with plans (if they participate in multiple). Does the plan provide a good transition in care, i.e., no disruption in current treatment plan? (a good transition in care plan ensures you do not experience any disruption in service or treatment). 6
Intel Retiree Medical Plan (IRMP) Overview Using SERMA for IRMP If you are enrolled in IRMP, you may use your SERMA credits to offset your monthly IRMP premium until you exhaust your account. During this enrollment period you may elect how much of your IRMP premium you would like paid from your SERMA each month; 25%, 50%, 75%, or 100%. The percentage you elect will apply to both your and your dependent s premiums. If you choose a SERMA contribution other than 100 percent, you are responsible for paying the remainder of the premium cost. Your IRMP premium payments will be paid directly from your SERMA; you do not need to submit for reimbursement. See Appendix for additional details on IRMP premium and SERMA contributions. IRMP Member Eligibility Make Sure Your Family Members Are Eligible for Coverage Intel s medical plans have specific requirements for who can be covered as an eligible dependent. It is your responsibility to ensure that only your eligible dependents are enrolled and to make necessary adjustments if needed. If you are Medicareeligible and your eligible dependent is not, or vice-versa, the Medicare-eligible person will be eligible to enroll in one of the IRMP Indemnity options, and the non-medicareeligible person will be eligible to enroll in the CIGNA Coinsurance plan. For a complete description of the dependent eligibility requirements, refer to the IRMP Summary Plan Description (SPD). For a copy of the SPD, contact the Intel Health Benefits Center at (877) GoMyBen (466-9236), or visit the Your Resources tab on the Intel Health Benefits website, at www.intel.com/go/myben. Proof of Continuous Healthcare Coverage (HIPAA Certificate) May Also Be Required If you do not enroll in IRMP during the 30-day enrollment period following your retirement from Intel, or at the end of Intel COBRA coverage, you will be required to provide a HIPAA certificate when you enroll in IRMP during a future Annual Enrollment. Generally, in order to enroll in the IRMP, you and your eligible dependents are required to provide a HIPAA Certificate showing proof of continuous healthcare coverage for the previous 18 months. The HIPAA Certificate must be received by the Intel Health Benefits Center within 30 days of your enrollment. Be Well by Choosing a Healthy Lifestyle Intel has partnered with the Mayo Clinic, a world-renowned medical group operated by the Mayo Foundation, to provide you a convenient and confidential way to understand and evaluate the state of your health. The Mayo Clinic Health Assessment is voluntary and available at no cost to you. You can use the Mayo Clinic website anytime during the year. Step 1: Start with an Initial Health Check Obtain your health check measurements from your healthcare provider. Your health check measurements should include cholesterol and glucose levels, as well as your height, weight, and blood pressure. Step 2: Complete the Mayo Clinic Online Questionnaire Use your health check results to complete the online Mayo Clinic Health Assessment questionnaire at www.intel.mayoclinic.com (you will need to create a user name and password to access the site.) The assessment takes about 20 minutes. The results will be available to you online immediately in the form of a Personal Health Report. Step 3: Review your Results The information in your Mayo Clinic Personal Health Report will contain recommendations and directions to improve and/or maintain your health. It will outline any health risks you may have and link you to Mayo Clinic and Intel-based programs and tools to address these risks. Your Privacy is Our Promise Intel understands the importance of your privacy and is committed to making sure your personal information remains private and completely confidential. You will interact with and share personal information directly with Mayo Clinic. Intel will only receive information pertaining to individual health in an aggregated and unidentified form for use in the design of health and wellness programs. 2013 Retiree Health Program 7
IRMP CIGNA Coinsurance What You Need to Know Before You Enroll in this Plan: Retirees and dependents who are not eligible for Medicare (typically those who are under the age of 65) can enroll in the IRMP CIGNA Coinsurance Plan. Retirees, who are healthy, can often purchase individual health insurance that costs much less; contact your local health insurance agent or State s Department of Insurance for health insurance information and pricing. 2013 Monthly Premium You Only Spouse 3 Only Child(ren) 4 Only You + Spouse You + Child(ren) Spouse + Child(ren) You + Spouse + Child(ren) $896 $1,792 $2,688 3 Spouse definition includes eligible Domestic Partners. 4 Same price for child or multiple children. IRMP CIGNA Coinsurance Plan Benefit Summary Additional details available at www.intel.com/go/myben or in the IRMP Summary Plan Description (SPD); call the Intel Health Benefits Center at (877) GoMyBen (466-9236) to request the IRMP SPD. In-Network Out-of-Network Deductible $600 Individual/$1,200 Family $600 Individual/$1,200 Family There is a separate deductible for in-network and out-of-network care Out-of-Pocket Maximum $3,000 Individual/$6,000 Family Medical Services 20% coinsurance 40% coinsurance (e.g., office visit, hospital inpatient, outpatient, ancillary services) Vision Exam $0 copayment Reimbursed up to $42 Eyeware Limits apply $25 copayment for lenses $130 allowance for frames or contacts Lens reimbursement: Single $40; Bifocal $60 Trifocal $80; Lenticular $125 Frame reimbursement: $70; or, Contact reimbursement: $130 Prescription Benefit Retail (34-day supply) Mail (90-day supply) Retail Penalty 5 (34-day supply) Generic $10 $20 $20 6 Preferred Brand Non-Preferred Brand Formulary (list of plan approved drugs) 20% coinsurance $25 minimum/$60 maximum 40% coinsurance $40 minimum/$100 maximum 20% coinsurance $62.50 minimum/$150 maximum 40% coinsurance $100 minimum/$250 maximum Please review at www.medco.com/intel 5 Penalty applies after the first two purchases of a maintenance (long-term) prescription at a retail pharmacy. 6 The out-of-pocket costs beyond the standard benefit will not apply towards deductible/out-of-pocket maximums. 50% coinsurance 6 $25 minimum 50% coinsurance 6 $40 minimum 8
IRMP CIGNA Indemnity with Rx What You Need to Know Before You Enroll in this Plan: Retirees and dependents that are eligible for Medicare can enroll in the IRMP CIGNA Indemnity with Rx Plan. This plan includes prescription drug coverage. If you enroll in this plan, you do not need to purchase a Medicare Part D program to provide prescription drug benefits. This plan coordinates with Medicare which means that it will only provide a benefit for services not covered by Medicare. See note on page 11 and the examples on pages 18-19. Medicare Part D Creditable Coverage Disclosure Notice If you, your spouse or domestic partner are Medicare-eligible, the Creditable Coverage Disclosure Notice is included in this packet. The notice contains important information that notifies you whether or not your current plan provides you coverage that is at least equivalent to Medicare Part D plan. 2013 Monthly Premium You Only Spouse 7 Only Child(ren) 8 Only You + Spouse You + Child(ren) Spouse + Child(ren) You + Spouse + Child(ren) $545 $1,090 $1,635 7 Spouse definition includes eligible Domestic Partners. 8 Same price for child or multiple children. IRMP CIGNA Indemnity Plan with Rx Benefit Summary Additional details available at www.intel.com/go/myben or in the IRMP Summary Plan Description (SPD); call the Intel Health Benefits Center at (877) GoMyBen (466-9236) to request the IRMP SPD. Also refer to Medicare Part A & B (www.medicare.gov). Medicare Indemnity Plan Deductible Part B deductible may apply $500 Individual/$1,000 Family Medical Services 20% coinsurance 20% coinsurance (e.g., office visit, hospital inpatient, outpatient, ancillary services) Vision Exam Not covered $0 copayment Eyeware Limits apply Not covered $25 copayment for lenses $130 allowance for frames or contacts Prescription Benefit Retail (34-day supply) Mail (90-day supply) Retail Penalty 9 (34-day supply) Generic $10 $20 $20 10 Preferred Brand $20 $40 $40 10 Non-Preferred Brand $30 $60 $60 10 Formulary (list of plan approved drugs) Please review at www.medco.com/intel 9 Penalty applies after the first two purchases of a maintenance (long-term) prescription at a retail pharmacy. 10 The out-of-pocket costs beyond the standard benefit will not apply towards deductible/out-of-pocket maximums. Resources Available to Help You: Aon Hewitt Navigators is an optional resource offered through Hewitt, to help Medicare-eligible retirees navigate the complex health insurance market. This service is available at no cost to you. To contact Aon Hewitt Navigators, call the Intel Health Benefits Center at (877) GoMyBen (466-9236) and select the Aon Hewitt Navigators option. 2013 Retiree Health Program 9
IRMP CIGNA Indemnity without Rx What You Need to Know About This Plan Before You Enroll: Retirees and dependents who are eligible for Medicare can enroll in the IRMP CIGNA Indemnity without Rx Plan. This plan does not cover prescription drugs. If you enroll in this plan, it is recommended that you purchase a Medicare Part D program to obtain prescription drug benefits. This plan coordinates with Medicare which means that it will only provide a benefit for services not covered by Medicare. See note on page 11 and the examples on pages 18-19. Medicare Part D Creditable Coverage Disclosure Notice If you, your spouse or domestic partner are Medicare-eligible, the Creditable Coverage Disclosure Notice is included in this packet. The notice contains important information that notifies you whether or not your current plan provides you coverage that is at least equivalent to Medicare Part D plan. 2013 Monthly Premium You Only Spouse 11 Only Child(ren) 12 Only You + Spouse You + Child(ren) Spouse + Child(ren) You + Spouse + Child(ren) $175 $350 $525 11 Spouse definition includes eligible Domestic Partners. 12 Same price for child or multiple children. IRMP CIGNA Indemnity Plan without Rx Benefit Summary Additional details available at www.intel.com/go/myben or in the IRMP Summary Plan Description (SPD); call the Intel Health Benefits Center at (877) GoMyBen (466-9236) to request the IRMP SPD. Also refer to Medicare Part A & B (www.medicare.gov). Medicare Indemnity Plan Deductible Part B deductible may apply $500 Individual/$1,000 Family Medical Services 20% coinsurance 20% coinsurance (e.g., office visit, hospital inpatient, outpatient, ancillary services) Vision Exam Not covered $0 copayment Eyeware Limits apply Not covered $25 copayment for lenses $130 allowance for frames or contacts Prescription Drugs Not covered Not covered Resources Available to Help You: Aon Hewitt Navigators is an optional resource offered through Hewitt, to help Medicare-eligible retirees navigate the complex health insurance market. This service is available at no cost to you. To contact Aon Hewitt Navigators, call the Intel Health Benefits Center at (877) GoMyBen (466-9236) and select the Aon Hewitt Navigators option. 10
A Note on How the CIGNA Indemnity Plans Work The IRMP CIGNA Indemnity plans assume you are enrolled in Medicare Part A and B. The plans will only cover eligible expenses not covered by Medicare. After you reach the plan deductible, the plan then pays a percentage of covered charges (based on Medicare allowable charges), your coinsurance amount is 20 percent or a copayment based on the service received (see plan compare for details). Below are two examples of how the plan works: Example: You have met your annual IRMP deductible. You visit your doctor and the bill is $100. Medicare considers $65 of the charge an allowable Medicare reimbursement. Doctor submits bill $100 Medicare allowable on this bill $65 Medicare Pays 80% of allowed amount $52 (65 x.80) Your coinsurance amount (20% of allowed amount) $13 (65 x.20) IRMP CIGNA Indemnity Plan pays $0 Your Total Out-of-Pocket $13 Why does the plan pay $0? The IRMP CIGNA Indemnity plan reimburses 80 percent of the $65 allowed by Medicare. The IRMP CIGNA Indemnity amount is reduced by the amount paid by Medicare. In this case, since the CIGNA s benefit of $52 (80 percent of $65) is the same amount paid by Medicare, therefore, the amount paid by the IRMP CIGNA Indemnity plan is $0. Example: You have not met your annual IRMP deductible and are hospitalized. The bill is $50,000. Medicare considers $11,951 of the charge an allowable Medicare reimbursement. Hospital submits bill $50,000 Medicare allowable $11,951 This is the maximum amount the provider may charge for the services provided. Medicare pays $10,795 Your Medicare Deductible $1,156 This is the amount you would owe the provider if you were not enrolled in IRMP. Your IRMP Cigna Plan deductible $500 Allowable amount applied to IRMP $ 656 Your coinsurance amount (20% of allowed amount) $131.20 (656 x.20) IRMP Cigna Indemnity Plan pays (80% of allowed amount) $524.80 (656 x.80) Your Total Out-of-Pocket on IRMP Indemnity $631.20 The $500 deductible plus the $131.20 coinsurance. If you are enrolled in IRMP your total out of pocket cost for this hospitalization is $631.20 vs. $1,156 if you were only enrolled in Medicare. In this example, Medicare pays $10,795, the IRMP Cigna Indemnity plan pays $524.80, and you pay $631.20. Benefits of the IRMP Cigna Indemnity Plans Once you have met the Indemnity plan out-of-pocket maximum, the plans will pay 100 percent of your eligible expenses. Also the plans will cover some non-medicare eligible expenses such as vision and for those enrolled in IRMP w/rx, prescription drugs. 2013 Retiree Health Program 11
Aon Hewitt Navigators: A Resource for Medicare-Eligible Retirees 15 Good Health Pays Off In More Than One Way The healthy choices you make can help you live a longer, healthier life, and reduce your overall healthcare costs. Given the substantial investment you make in your health coverage, it makes sense to use your plan well and make healthy lifestyle choices. Use Your Preventive Care Benefits Taking advantage of preventive care such as annual exams and health screens allows you to keep yourself on the road of good health by addressing health issues before they become more serious. Aon Hewitt Navigators is an optional resource offered to help Medicare-eligible retirees navigate the complex health insurance market. This service is available at no cost to you. Aon Hewitt Navigators works with many insurance companies, which allows them to offer unbiased, expert advice. They will work with you to compare many plans to find coverage that is right for your specific healthcare needs and budget. To contact Aon Hewitt Navigators, call the Intel Health Benefits Center Monday through Friday at (877) GoMyBen (466-9236) and select the Aon Hewitt Navigators option. If you choose to participate in IRMP, you can help reduce your costs by: Accessing in-network care 13 instead of out-of-network care. 14 Costs are higher for you and for Intel when you use out-of-network providers. Accessing a primary care provider before going to a specialist. Scheduling an in-office doctor appointment instead of using the emergency room for minor injuries or routine care. Using the nurse line (800) 468-3510 has no cost to retirees, and nurses can assist you in determining the type of care you should seek. Requesting generic drug(s) or using mail order service (or both). 13 In-network care providers, such as physicians and hospitals, have contracted with the provider s network to provide services at a discounted rate. 14 Out-of-network care providers have not contracted with the provider s network. 15 Aon Hewitt Navigators is a service offered through Aon Hewitt, not an Intel sponsored program. 12
Making Your Enrollment Elections You have 30 days from the date of your retirement from Intel to enroll in IRMP. This is your enrollment period. The My Health Benefits website will provide you tools and resources to allow you to prepare, understand, and enroll in the IRMP. You can access the website from www.intel.com/go/myben. You will need to login with your User ID and password. If you are accessing the site for the first time, you will be asked to create a User ID and password to login. To create your User ID, select Register as a New User and follow the instructions. You will be asked to create a password and answer a series of security questions. You can also make your elections over the phone by contacting the Intel Health Benefits Center at (877) GoMyBen (466-9236). How to Enroll in IRMP: Click the Enroll button. Then click the medical plan. Select the plan option you want to enroll in. Save your choices by selecting the Complete Enrollment button. Print a copy of your confirmed elections for your records. You can visit the My Health Benefits website at any time to view your elections. You may also make changes to your elections multiple times during your enrollment period. There are certain changes not available on the web. You must call the Intel Health Benefits Center to complete your enrollment if: You have dependents with split eligibility (i.e., one who is Medicare eligible and one who is not Medicare eligible). You are enrolling in IRMP for the first time. You have experienced a qualifying changein-status event (e.g., marriage). When Do Benefit Election Changes Take Effect? The benefit elections you make during this enrollment period will become effective as of the day of your retirement. The next opportunity for you to make IRMP or Sheltered Employee Retiree Medical Account (SERMA) changes will be during next year s Annual Enrollment, or if you experience a qualifying change-in-status event during the year. You will be required to provide proof of 18 months of continuous health coverage (see page 7). If You Elect Coverage Other than IRMP You are encouraged to explore options outside of IRMP to get the best value for your healthcare dollars. However, if you choose not to enroll in IRMP, you may be required to show proof of continuous health coverage if you have a qualifying reason to enroll at a later date (see page 7). As You Explore Obtaining Health Insurance Outside of Intel, Please Be Aware: Companies selling individual health insurance typically require a review of your medical history that could result in a higher premium or a denial of coverage. You may wish to contact your local health insurance agent or your state s Department of Insurance to assist you in selecting and enrolling in a health insurance plan. Have Questions: Call the Intel Health Benefits Center at (877) GoMyBen (466-9236), if you do not remember your password state the word representative until you reach a live agent. Need Help? To explore your Health Insurance options call (877) GoMyBen (466-9236) If you are not Medicare-Eligible, an Intel Health Benefits Center representative will help you explore coverage options in your area. If you are Medicare-Eligible, call the number above and select the Aon Hewitt Navigators option. A representative will help you find and enroll in a Medicare supplemental plan that is right for you. If you have questions regarding the CIGNA plans, call (800) 468-3510 or visit CIGNA online at www.mycigna.com If you have questions regarding Medicare, call (800) 633-4227 or visit Medicare online at www.medicare.gov If you have questions regarding prescription drug coverage, call Medco at (800) 899-2713 or visit Medco online at www.medco.com 2013 Retiree Medical Enrollment Guide If you have questions regarding your vision coverage, call EyeMed at (866) 798-9193 or visit EyeMed online at www.eyemedvisioncare. com/intel 13
14 Appendix: Intel Retiree Medical Plan Benefit Summary and Premiums with SERMA Contributions
2013 IRMP Premiums and SERMA Contribution The following charts provide you a glance of the monthly and annual cost of the IRMP premiums and how much you would pay if you elect SERMA to pay for a portion of your premium. Non-Medicare (typically under age 65) IRMP CIGNA Coinsurance Plan Monthly SERMA Election You Only 16 Spouse/DP You + 0% (or No SERMA) You + Child(ren) or Spouse/DP + Child(ren) You + Spouse/ DP + Child(ren) $896 $1,792 $1,792 $2,688 25% $672 $1,344 $1,344 $2,016 50% $448 $896 $896 $1,344 75% $244 $488 $488 $672 100% $0 $0 $0 $0 16 You only = Individual coverage of any eligible retiree, spouse or domestic partner, or child. Annually SERMA Election You Only 16 Spouse/DP You + 0% (or No SERMA) You + Child(ren) or Spouse/DP + Child(ren) You + Spouse/ DP + Child(ren) $10,752 $21,504 $21,504 $32,256 25% $8,064 $16,128 $16,128 $27,192 50% $5,376 $10,752 $10,752 $16,128 75% $2,688 $5,376 $5,376 $8,064 100% $0 $0 $0 $0 Medicare (typically age 65 and over ) IRMP Indemnity Plan with Rx Monthly 17 SERMA Election You Only 18 Spouse/DP You + 0% (or No SERMA) You + Child(ren) You + Spouse/ DP + Child(ren) $545 $1,090 $1,090 $1,635 25% $409 $818 $818 $1,226 50% $273 $545 $545 $818 75% $136 $273 $273 $409 100% $0 $0 $0 $0 17 Rounded to the nearest whole number. 18 You only = Individual coverage of any eligible retiree, spouse or domestic partner, or child. Annually SERMA Election You Only 18 Spouse/DP You + 0% (or No SERMA) You + Child(ren) You + Spouse/ DP + Child(ren) $6,540 $13,080 $13,080 $19,620 25% $4,905 $9,810 $9,810 $14,715 50% $3,225 $6,540 $6,540 $9,810 75% $1,613 $3,270 $3,270 $4,905 100% $0 $0 $0 $0 Medicare (typically age 65 and over ) IRMP Indemnity Plan without Rx 2013 Retiree Health Program Monthly SERMA Election You Only 19 Spouse/DP You + 0% (or No SERMA) You + Child(ren) You + Spouse/ DP + Child(ren) $175 $350 $350 $525 25% $131.25 $262.50 $262.50 $393.75 50% $87.50 $175 $175 $262.50 75% $43.75 $87.50 $87.50 $131.25 100% $0 $0 $0 $0 19 You only = Individual coverage of any eligible retiree, spouse or domestic partner, or child. Annually SERMA Election You Only 19 Spouse/DP You + 0% (or No SERMA) You + Child(ren) You + Spouse/ DP + Child(ren) $2,100 $4,200 $4,200 $6,300 25% $1,575 $3,150 $3,150 $4,725 50% $1,050 $2,100 $2,100 $3,150 75% $525 $1,050 $1,050 $1,575 100% $0 $0 $0 $0 15
IRMP CIGNA Coinsurance Benefit Summary (non-medicare) Monthly Premium (individual) $896 BENEFITS In-Network Out-of-Network Annual Deductible $600 individual/$1,200 family $600 individual/$1,200 family (separate from in-network deductible) Out-of-Pocket Maximum $3,000 individual/$6,000 family $3,000 individual/$6,000 family Major Medical Lifetime Maximum Unlimited $2 million out-of-network INPATIENT In-Network Coinsurance applies after deductible is met Out-of-Network Coinsurance applies after deductible is met and is subject to reasonable and customary Inpatient Hospital 20% coinsurance 40% coinsurance Skilled Nursing Facility 20% coinsurance; limited to 100 days per calendar year 40% coinsurance Home Health 20% coinsurance; $5,000 lifetime maximum 40% after deductible is met with a $5,000 lifetime maximum Inpatient Mental Health (preauthorization required) 100% covered 40% coinsurance outpatient In-Network Coinsurance applies after deductible is met Out-of-Network Coinsurance applies after deductible is met and is subject to reasonable and customary Physician Office Visit 20% coinsurance 40% coinsurance Ambulatory Surgical Center 20% coinsurance 40% coinsurance Outpatient Hospital 20% coinsurance 40% coinsurance Occupational and Physical Therapy 20% coinsurance 40% coinsurance Speech/Language Therapy 20% coinsurance 40% coinsurance Ambulance 20% coinsurance 40% coinsurance Emergency Room 20% coinsurance 40% coinsurance Emergency Worldwide Coverage 20% coinsurance 40% coinsurance Urgent Care 20% coinsurance 40% coinsurance Urgent Care Worldwide Coverage 20% coinsurance 40% coinsurance Prosthetic Devices 20% coinsurance 40% coinsurance Mental Health and Substance Abuse 20% coinsurance 40% coinsurance Diagnostic Tests/Lab Services 20% coinsurance 40% coinsurance Routine Outpatient X-Ray Includes Radiation Therapy 20% coinsurance 40% coinsurance Routine Physical 20% coinsurance 40% coinsurance 16
additional BENEFITS Routine Chiropractic Prescription Benefit IRMP CIGNA Coinsurance Benefit Summary (non-medicare) continued Retail (34-day supply) Mail (90-day supply) Retail Penalty 20 (34-day supply) Generic $10 $20 $20 21 Preferred Brand Non-Preferred Brand Formulary (list of plan approved drugs) 20% coinsurance $25 minimum/$60 maximum 40% coinsurance $40 minimum/$100 maximum 20 Penalty applies after the first two purchases of a maintenance (long-term) prescription at a retail pharmacy. 21 The out-of-pocket costs beyond the standard benefit will not apply towards deductible/out-of-pocket maximums. In-Network Coinsurance applies after deductible is met 20% coinsurance; limited to 30 visits per year combined in- and out-of-network 20% coinsurance $62.50 minimum/$150 maximum 40% coinsurance $100 minimum/$250 maximum Please review at www.medco.com/intel Out-of-Network Coinsurance applies after deductible is met and is subject to reasonable and customary 40% coinsurance; limited to 30 visits per year combined in- and out-of-network Routine Podiatry 20% coinsurance 40% coinsurance Non-Emergency Transportation 20% coinsurance 40% coinsurance Acupuncture 20% coinsurance; limited to 30 visits per year combined in- and out-of-network 40% coinsurance; limited to 30 visits per year combined in- and out-of-network Preventive Dental Not covered Not covered Vision Exam $0 copayment; limited to once every 12 months Reimbursed up to $42 Eye Wear Contact Lenses $25 copayment for standard lenses; lenses limited to once every 12 months; frames $130 allowance; limited to once every 24 months $130 allowance for elective; 100% covered; must be medically necessary; preauthorization required; limited to once every 12 months, in lieu of spectacle lenses The following reimbursements apply: single vision $40; bifocal $60; trifocal lenses $80; lenticular lenses $125; frames $70 once every other year $105 allowance for elective; limited to $210 if medically necessary; preauthorization required Routine Hearing 20% coinsurance 40% coinsurance 50% coinsurance 21 $25 minimum 50% coinsurance 21 $40 minimum 2013 Retiree Health Program 17
Medicare 22 IRMP CIGNA Indemnity Medicare-Eligible Monthly Premium (individual) Part B Premium 23 = $115.40 (required for enrollment) CIGNA Indemnity with Rx = $500 CIGNA Indemnity without Rx = $175 BENEFITS Annual Deductible Part B Deductible = $162 $500 individual/$1,000 family See Inpatient Hospitalization section for Inpatient Deductible Out-of-Pocket Maximum Not applicable $2,000 Individual/$4,000 family Major Medical Lifetime Maximum (if applicable) Not applicable $2 million out-of-network INPATIENT Coinsurance applies after deductible is met Inpatient Hospital $1,132 deductible (Days 1-60); $283 (Days 61-90); 20% of Medicare allowable after deductible is met $566 (Days 91-150) Skilled Nursing Facility Pay for each benefit period, following at least a 3-day covered hospital stay; Days 1-20: $0 for each day; Days 21-100: $141.50 for each day (there is a limit of 100 days for each benefit period) 20% of Medicare Allowable after $500 plan deductible 100 days per calendar year Home Health IRMP CIGNA Indemnity Benefit Summary (Medicare) Covered 100% by Medicare There are no copayments for Medicare-covered home health visits Covered 100% by Medicare There are no copayments for Medicare-covered home health visits Inpatient Mental Health 20% of Medicare approved 20% of Medicare allowable after deductible is met outpatient Coinsurance applies after deductible is met Physician Office Visit 20% of Medicare approved 20% of Medicare allowable Mental Health and Substance Abuse 20% of Medicare approved 20% of Medicare allowable Ambulatory Surgical Center 20% of Medicare approved 20% of Medicare allowable Outpatient Hospital 20% of Medicare approved 20% of Medicare allowable Occupational and Physical Therapy 20% of Medicare approved 20% of Medicare allowable Speech/Language Therapy 20% of Medicare approved 20% of Medicare allowable Ambulance 20% of Medicare approved 20% of Medicare allowable Emergency Room/Urgent Care 20% of Medicare approved 20% of Medicare allowable Emergency/Urgent Care Worldwide Coverage Limited coverage outside U.S. 20% of Medicare allowable DME/SUPPLIES/MEDICAL Rx Coinsurance applies after deductible is met Durable Medical Equipment 20% of Medicare approved 20% of Medicare allowable Note: Wigs and hair pieces covered up to $500 per calendar year. Prosthetic Devices 20% of Medicare approved 20% of Medicare allowable Outpatient Injectable: Office-Based 20% of Medicare approved 20% of Medicare allowable 22 2013 Medicare benefits provided. For complete details, visit www.medicare.gov, or call (800) 633-4227. 23 Part B premium is dependent on Income. For complete details please refer to www.medicare.gov. 18
PROCEDURES Diagnostic Tests/Lab Services Medicare 22 Generally 20% of Medicare approved ($0 for certain approved lab services) IRMP CIGNA Indemnity Medicare-Eligible Coinsurance applies after deductible is met 20% of Medicare allowable Routine Outpatient X-Ray includes Radiation Therapy 20% of Medicare approved 20% of Medicare allowable Routine Physical Once during initial six months (MIPPE) 20% of Medicare allowable ADDITIONAL BENEFITS Coinsurance applies after deductible is met Chiropractic Not covered 20% of Plan allowed; limited to 30 visits per calendar year Routine Podiatry Not covered 20% of Plan allowed Non-Emergency Transportation Not covered 20% of Plan allowed Acupuncture Not covered 20% of Plan allowed; limited to 30 visits per calendar year Preventive Dental Not covered Not covered Vision Exam Not covered In-network: 100% covered; limited to once every 12 months Eye Wear Not covered In-network: $25 copay; lenses limited to once every 12 months; frames $130 allowance; limited to once every 24 months Contact Lenses Not covered In-network: $130 allowance; elective; medically necessary covered at 100% preauthorization required; contacts limited to once every 12 months Routine Hearing Not covered 20% coinsurance Hearing Aid Allowance Not covered 20% coinsurance PRESCRIPTION COVERAGE Medicare IRMP CIGNA Indemnity with Rx Medicare Prescriptions are not covered (available via Medicare Part D) See Prescription Benefit Below Out-of-Pocket Max (TrOOP) Prescriptions are not covered (available via Medicare Part D) None See Prescription Benefit Below Formulary (list of plan approved drugs) Prescriptions are not covered (available via Medicare Part D) Please review at: www.medco.com/intel Pharmacy Network Prescriptions are not covered (available via Medicare Part D) Please review at: www.medco.com/intel Prescription Benefit The benefit below applies only to IRMP CIGNA Indemnity with Rx Plan IRMP CIGNA Indemnity Benefit Summary (Medicare) continued Retail (34-day supply) Mail (90-day supply) Retail Penalty 24 (34-day supply) Generic $10 $20 $20 25 Preferred Brand $20 $40 $40 25 Non-Preferred Brand $30 $60 $60 25 24 Penalty applies after the first two purchases of a maintenance (long-term) prescription at a retail pharmacy. 25 The out-of-pocket costs beyond the standard benefit will not apply towards deductible/out-of-pocket maximums. 2013 Retiree Health Program 19
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