2012 PEBB Retiree Benefits PEBB Outreach and Training for - - PowerPoint PPT Presentation

2012 PEBB Retiree Benefits

PEBB Outreach and Training for

WEA-Retired

Welcome

Through the Health Care Authority, eligible retiring

public employees:

Have access to comprehensive health insurance coverage Have a one-time opportunity to enroll in or defer coverage Must complete an enrollment form no later than 60 days after

employer-sponsored or COBRA coverage ends

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Agenda

Eligibility for Retiree Benefits Enrollment/Procedural Requirements Deferring Coverage Payment Options Duration of Coverage Coverage Options

Medical for Medicare Eligible Retirees Medical for Non-Medicare Eligible Retirees Dental

Contact Information

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Eligibility

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Benefits Eligibility (WAC 182-12-171)

Washington state-sponsored retirement systems:

TRS – Teacher’s retirement system SERS – School employees’ retirement system PERS – Public employees’ retirement system Higher education retirement plans (e.g. TIAA-CREF) LEOFF – Law enforcement officers’ and fire fighters’

retirement systems

PSERS – Public safety employees’ retirement system JRS – State judges/judicial retirement systems WSPRS – State patrol retirement systems

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Eligibility Requirements

Eligibility requirements for retirees:

Must be vested in a Washington-state sponsored retirement

plan

Must be eligible to retire under a Washington state-sponsored

retirement plan

Must immediately begin to receive a monthly retirement plan

payment, with the following exceptions

DRS determines a lump-sum payment is required because the

monthly retirement plan payment is below the minimum payment

Members of Plan 3 retirement plans are eligible if they meet their

retirement plan’s age requirement and length of service when employer-sponsored insurance ends

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Eligibility Requirements (continued)

Exceptions (continued):

Permanently and totally disabled employees are eligible if they start

receiving or defer a monthly disability retirement plan payment

Employees not retiring under a Washington state-sponsored

retirement plan must

Meet the same age and years of service requirements had the person

been employed as a member of either PERS 1 or 2 for the same period of employment

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COBRA – A Bridge to Retiree Benefits

COBRA (Consolidated Omnibus Budget Reconciliation Act) is an extension

• f current employer benefits, paid by the employee, and

generally available for up to 18 months

Employees may use COBRA coverage as a bridge to PEBB

retiree eligibility (WAC 182-12-171)

If elect to use COBRA as a bridge to retirement, employee is

required to enroll in COBRA coverage

Must enroll in or defer PEBB retiree coverage no later than 60

days after COBRA coverage ends

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Dependent Eligibility

Eligible Dependents:

Spouse Washington state-registered domestic partners (RCW 26.60.303)

Both person are members of the same sex; or Opposite sex where one partner is at least 62 years of age

Children through age 25 Dependents with disabilities (HCA approval required) Extended dependents (HCA approval required)

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Enrollment and Procedural Requirements

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Request Information

Approximately 60 days before your employer-sponsored

benefits or COBRA coverage ends

Request PEBB’s Retiree Enrollment Guide

Complete the health insurance options

card provided in your pension packet from DRS

Return the completed card to the

PEBB Program Or, call the PEBB Program at

1-800-200-1004

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Request Information

The PEBB Program will send you a Retiree Enrollment Guide

The guide includes:

Plan information Enrollment forms Long-term care information Auto/home insurance information

The Retiree Enrollment Guide is also available on the PEBB website:

www.pebb.hca.wa.gov. Click on the “Thinking About Retirement” link.

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Medicare Coordination

If you are retiring at age 65:

About 90 days before you retire, contact Social Security

Administration to enroll in Medicare Part A and Part B

If you are retiring after age 65 and you deferred Medicare

Part B:

About 90 days before you retire, contact Social Security

Administration to enroll in Medicare Part B

You and your eligible dependents must enroll in Medicare

Parts A and B, if entitled

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New Retiree Enrollment Procedures

No later than 60 days after your employer-sponsored or

COBRA coverage ends

Return the completed retiree enrollment forms

Retirees not eligible for Medicare must include documentation that

verifies the dependent is an eligible dependent

A list of acceptable dependent verification documents are available on the

PEBB website: www.pebb.hca.wa.gov

Retirees eligible for Medicare must include a copy of any Medicare

cards showing enrollment in Medicare Parts A and B

If COBRA coverage is ending, proof of loss may be required

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New Retiree Enrollment Procedures

The application will be reviewed for compliance with

Eligibility and procedural requirements according to

Washington Administrative Code (WAC 182-12-171)

PEBB retiree coverage begins

The first of the month following the loss of employer-sponsored or

COBRA coverage

Payment for coverage begins

The first of the month following the loss of employer-sponsored or

COBRA coverage

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Enrollment Reminders

Retiring employees must meet all eligibility and

procedural requirements of WAC 182-12-171

Must submit appropriate forms to enroll in or defer coverage

no later than 60 days after your school district employer- sponsored or COBRA coverage ends

This is a one-time opportunity to enroll in or defer PEBB coverage

If you defer, you must be enrolled in

The comprehensive employer-sponsored coverage of your spouse or

Washington state-registered domestic partner who is still working

A federal retiree medical plan (e.g., Tricare) as a retiree or dependent

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Enrollment Reminders

Retiree and enrolled dependents must enroll in and maintain

Medicare Parts A and B, if entitled

A checklist for school district employees who are retiring

• r separating is available on the PEBB website:

www.pebb.hca.wa.gov

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Deferring Enrollment

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Deferring Enrollment (WAC 182-12-205)

PEBB-eligible retirees may defer enrollment at or after

retirement if the retiree

Returns to work and has other comprehensive employer-sponsored

coverage

Is covered under the comprehensive employer-sponsored coverage

• f a spouse or Washington state-registered domestic partner who is

still working

Is enrolled as a retiree or dependent in a federal retiree medical plan

(e.g., Tricare)

Enrollment in other employer-sponsored coverage must be

continuous from the time of deferral until the time of enrollment

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Deferring Enrollment (continued)

To defer health plan enrollment, the retiree

Must submit the Retiree Election Form to the PEBB program no

later than 60 days after the date the retiree becomes eligible to apply for PEBB coverage

If a retiree defers enrollment, they also defer enrollment for all

eligible dependents

Failure to defer or enroll within 60 days forfeits the right to

enroll in PEBB retiree benefits in the future

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Enrollment after Deferral

Appropriate forms

Must be submitted no later than 60 days after the date the

• ther employer-sponsored coverage ends

Retiree must provide proof that coverage was continuous during

deferral period

Send first payment with the enrollment form, unless you choose to

have premiums deducted from your monthly pension check

Retirees who defer due to federal retiree coverage have a

• ne-time opportunity to enroll in PEBB coverage

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Payment Options

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Premium Payment Options

Pension deduction Automatic bank withdrawal Personal check or money order VEBA (Volunteer Employee Benefit Association) account

VEBA is the responsibility of the retiree Check with your benefits office to learn more

(Payment is made to the WA State Treasurer not to the individual health plans)

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Duration of Coverage

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When Retiree Coverage Ends

Subscribers

Retiree coverage lasts indefinitely, as long as premiums are

paid in full

Dependents

As long as the dependent meets the eligibility requirements of

WAC 182-12-260

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Surviving Dependents

In the event of the death of the retiree

The eligible surviving spouse* may continue coverage

indefinitely as long as premiums are paid in full (WAC 182-12-265)

Dependents may continue coverage until they lose eligibility

under WAC 182-12-260

The surviving spouse* and/or eligible dependents must notify

PEBB no later than 60 days after the retiree’s death to enroll in or defer retiree coverage

*Spouse includes WA state-registered domestic partners

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Coverage Options

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Coverage Options

Coverage options include

Medical and Dental coverage Medical only coverage (there is no dental only option)

Dependents must be enrolled in the same coverage as

the retiree

Plans are available with county, nationwide, and

worldwide coverage

There are no pre-existing condition waiting periods

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Medicare Eligible Retirees Medical Plan Options

Medical Plans

Available Medical Plans for Medicare Eligible Retirees

Group Health Medicare Advantage or Original Medicare* Kaiser Permanente Senior Advantage* Uniform Medical Plan Medicare (administered by Regence BlueShield of Washington)

Available nationwide and worldwide

Medicare Supplement Plan F (administered by Premera BlueCross)

Medicare Supplement Plan F does not provide prescription drug coverage

*See the ‘Plans Available by County’ section of the Retiree Guide for availability

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Medical Plans

Medicare eligible retirees who

Choose Group Health and cover family members that are not eligible to

enroll in Medicare

Retiree is enrolled in the Medicare Advantage or Original Medicare, based on

availability in their area

Covered family members, not eligible for Medicare, will have a choice of Group

Health Classic or Group Health Value

Choose Kaiser and cover family members that are not eligible to enroll

in Medicare

Retiree is enrolled in the Senior Advantage plan, based on availability in their area Covered family members, not eligible for Medicare, are enrolled in Kaiser Classic

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Non-Medicare Eligible Retirees Medical Plan Options

Medical Plans

Available Medical Plans for Retirees not Eligible for

Medicare

Group Health Classic, Value, and CDHP* Kaiser Permanente Classic and CDHP* Uniform Medical Plan Classic and CDHP

Available nationwide and worldwide

*See the ‘Plans Available by County’ section of the Retiree Guide for availability

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Medical Plans - CDHP

Consumer-Directed Health Plan (CDHP) has two

components

High deductible health plan Health Savings Account (HSA)

HealthEquity, Inc. will administer the HSA accounts

CDHPs offered by Group Health, Kaiser, and Uniform

Medical Plan

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Medical Plans - CDHP

High Deductible Health Plan

Lower monthly premiums Member pays more out-of-pocket before the plan pays 100% Similar benefit plan structure as traditional plans

Preventive care visit covered at 100%

When you see a network provider

Regular office visits and diagnostics Vision coverage Prescription drug coverage

Prescription drug copayments/coinsurance apply to the out-of-pocket

maximum for all CDHPs

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Medical Plans - CDHP

Health Savings Account (HSA)

A tax-exempt savings and spending account used to pay for

qualified medical expenses

HCA deposits a portion of your monthly premium into the

HSA account each month

$58.33 deposited per month for a total of $700 per year for an

individual subscriber

$116.67 deposited per month for a total of $1,400 per year for a

subscriber with at least one family member enrolled on the account

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Medical Plans - CDHP

Health Savings Account (HSA)

Retiree may make additional deposits into the account by

sending directly to HealthEquity, up to the annual maximum

IRS Maximum annual deposits for 2012

$3,100 for an individual $6,250 for a subscriber with at least one family member enrolled on

the account

“Catch-up” provision for individuals age 55 or older

Additional $1,000 for the year may be deposited

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Medical Plans - CDHP

Health Savings Account (HSA)

Funds belong to the retiree and carry over from year-to-year Funds are used to help pay for qualified medical expenses Retiree is responsible for managing the funds and maintaining

records

Keep receipts and Explanation or Benefits (EOB) in the event of an

IRS audit

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Medical Plans - CDHP

IRS Eligibility for an HSA

Must enroll in a qualified high-deductible health plan (CDHP) Cannot have other health coverage that is not a qualified high-

deductible health plan

Cannot be enrolled in Medicare, or have a dependent enrolled

• n their account enrolled in Medicare

Cannot be claimed as a dependent on someone else’s tax

return

Cannot have received care from the VA or one of their

facilities, including prescription drugs, within the last 3 months

Cannot be enrolled in Tricare

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Medical Plans - CDHP

Eligibility for an HSA (continued)

If retiree has a VEBA account and chooses to participate in the

CDHP

Must make the VEBA a “limited-purpose” VEBA prior to enrolling in

the CDHP

Check with your VEBA administrator

May continue to use the “limited-purpose” VEBA for qualified dental

and vision expenses

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Is a CDHP right for you?

Only you can answer that question

Review annual healthcare expenses Talk to the plan HealthEquity offers

Information on their website: www.healthequity.com/pebb Customer service representatives 24/7 at 1-877-873-8823

PEBB offers

Resource Guide, retirement video, and other information on their

website: www.pebb.hca.wa.gov

Consult with a qualified tax professional to discuss your individual

situation

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Dental Plans

Dental Plans

Dental plans available to all retirees

Uniform Dental Plan (administered by Washington Dental Service) DeltaCare Willamette Dental

Retirees who elect dental coverage must

Enroll in medical Maintain enrollment in dental for at least 2 years, but may

change plans each year

All family members enrolled on your account will be enrolled

in dental

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Contact Information

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Resources

PEBB Customer Service – 1-800-200-1004 PEBB website – www.pebb.hca.wa.gov

Available on the website

School District Retirement Checklist Thinking about Retirement Retiree Enrollment Guide Enrollment forms

Contact the health plans at the numbers listed on the

inside front cover of the retiree guide

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