Planning Your Retirement... What about your Health Care benefits

1
Planning Your Retirement...What about your
Health Care benefits?

• Jan Long, PEIA

2
When will you retire?

• If retiring before age 65, health care costs may
  go UP at the time of retirement
• Keep coverage in force
• Non-Medicare retirees stay in the PEIA PPB Plan A
  or the managed care plan of choice.
• Non-Medicare Retiree health insurance premiums
  typically climb 10-11 per year
• If retiring at 65 or older, coverage costs will
  go down.

3
Medicare Is the Issue

• Retirement is not the driver, Medicare
  eligibility is.
• For most people Medicare eligibility happens
• Retired and age 65, regardless of Social Security
  eligibility age
• For someone with a disability, Medicare
  eligibility can happen earlier.
• Managed care options are not available to
  Medicare-eligible retirees (those over 65)
• Must take Medicare Parts A and B upon retirement
  but NOT Part D!!!

4
Lets Look at Non-Medicare

• Deductible the amount you pay before the plan
  begins to pay.
• Copayment flat dollar amount you pay for office
  visits.
• copayments do not count toward the OOPM
• Coinsurance the percentage of a charge for a
  service that is your responsibility.
• If you pay 20 for a service, thats your
  coinsurance.
• Coinsurance counts toward the OOPM.
• Out-of-pocket maximum (OOPM) the running total of
  coinsurance you pay in a year. Once you reach
  the maximum, you dont pay any more out-of-pocket
  for medical care that plan year.

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Non-Medicare Benefits

• Medical deductible is
• 375/individual
• 750/family
• Out-of-pocket maximum is 1,500
• Coverage is the same as active employees
• 10 for preventive care or Medical Home office
  visit
• 15 for other medical home type provider visits
  (general practice, family practice, pediatrician,
  etc.)
• 20 for specialist office visit
• 20 for most other services
• Must use networks

6
Networks

• PEIAs Network consists of
• All WV providers who provide services or supplies
  PEIA participants
• Providers outside WV who participate in
• OneNet in Maryland, Washington, DC, and North
  Carolina
• MMO SuperMed Plus network in Ohio or
• Beech Street in all other states
• Network listings are available from Wells Fargo
  TPA
• If you live in WV or a bordering county
• out-of-state care (beyond bordering counties)
  must be preauthorized to assure highest benefit
  level
• Out-of-state care not preauthorized by Wells
  Fargo TPA is
• paid at 60 (you pay 40)
• the deductible and out-of-pocket maximum are
  doubled

7
Why is the Network Important?

• If you LIVE out of state, be sure to change your
  address
• Youll be treated like you are in WV, as long as
  you use network providers
• If you are TRAVELING outside WV
• Medical emergency covered at in-network level
• Other care - call Wells Fargo TPA to protect your
  benefits
• Want to keep as much care as is reasonable inside
  WV

8
How does the non-Medicare benefit work?
9
Lets Look at Medicare

• Medicare-eligible retirees are in Coventrys
  Advantra Freedom Plan
• Medicare Advantage plan licensed by the federal
  government
• CMS pays Coventry to provide Medicare benefits
• PEIA pays Coventry to provide PEIA benefits
• Some Medicare members dont move immediately
• Retirees who turn 65 during the plan year, and
• Employees age 65 and older who retire during the
  plan year
• Remain with PEIA until the following July 1.

10
Prescription Drug Program

• Deductible is
• 75 single/150 family
• Three-tiered copayment
• Generic 5
• Preferred brand 15
• Non-preferred brand 50
• Common Specialty Medications 50
• Out-of-pocket maximum on drugs
• 1,750 individual
• 3,500 family
• 90-day supply of maintenance drugs
• 90-day supply through mail order or retail
  maintenance network costs 2x the normal 30-day
  copayment
• Some drugs require prior authorization. Doctor
  must talk to RDT

11
Using Accrued Leave

• May either extend insurance coverage or increase
  pension, not both.
• May choose PEIA PPB Plan or any HMO (if not
  Medicare eligible)
• May use for MAPD plan, too, if Medicare-eligible.
• Must go immediately from active employment into
  retirement
• Benefit not available to employees hired on and
  after July 1, 2001
• If using sick leave, the premiums on the
  following pages are paid by your former employer
  (100 if before 7/1/88, and 50 if after 7/1/88)
• Retiree premiums may rise 10-11 per year over
  the next 5 years
• Premium increases do not affect the exchange rate
  on your leave time

12
Calculating Your Benefit

• If your PEIA coverage has been in effect with no
  lapse since
• Before July 1, 1988
• 2 days 100 premium for 1 month single
  coverage
• 3 days 100 premium for 1 month family
  coverage
• After July 1, 1988
• 2 days 50 premium 1 month single coverage
• 3 days 50 premium for 1 month family
  coverage
• Higher Education calculation
• 3¹/3 years teaching service 1 year single
  coverage
• 5 years teaching service 1 year family
  coverage

13
Non-Medicare Premiums PPB Plan
14
Medicare Policyholder Only

• This is single coverage.
• Standard is tobacco user.
• Preferred is tobacco-free.

15
Medicare retiree w/Medicare dependents

• This is family coverage where everyone in the
  family is on Medicare.
• This rate assumes two people on Medicare. If you
  have more than two, subtract 22 for each
  additional Medicare Member
• Each will be treated as an individual
  policyholder, since Medicare does not recognize
  families.

16
Medicare retiree w/non-Medicare dependents

• This is family coverage where at least one person
  in the family does not have Medicare.
• This rate assumes one person on Medicare. If you
  have more than one, subtract 22 for each
  additional Medicare Member
• The Medicare member will have the Medicare
  benefits described previously.
• The non-Medicare family members will remain in
  the PEIA PPB Plan.
• If theres only one non-Medicare family member,
  then
• that persons deductible will be 150, and
• the out-of-pocket maximum will be 500 for that
  person.

17
Survivor Benefits

• If the policyholder dies, the spouse and
  dependent children who were covered at the time
  of death can continue health coverage as
  surviving dependents.
• If the surviving spouse remarries, coverage under
  the survivor benefit terminates
• If the survivor was/is eligible for benefits in
  his/her own right (active or retired public
  employee), then he or she can just pick up
  benefits as the policyholder
• Survivors are not eligible for life insurance
• Survivor premiums are the same as retiree
  premiums
• Fall into the 25 or more years of service
  category
• Survivor CANNOT use the policyholders
  sick/annual leave benefit.

18
Premium and Benefit Assistance

• Program is available to retirees whose income is
  at or below 250 of federal poverty level
• Must provide documentation of income to qualify.
• Premium Assistance pays part or all of the
  premium, depending on income and years of service
• Non-Medicare retirees receive ONLY premium
  assistance, no benefit assistance.
• Medicare eligibles with 15 or more years of
  service may also qualify for Benefit Assistance.
• Reduces out-of-pocket maximum and copayments
• Typically helps retirees who have been retired
  for a while

19
Basic Life Insurance

• Provided by Minnesota Life
• 10,000 decreasing term policy
• drops to 5,000 at retirement
• drops to 2,500 at age 67
• Retiree pays premium for basic life insurance
• Keep your beneficiary up to date

20
Additional Life Insurance

• Coverage up to 150,000 for retirees
• To have 150,000 as a retiree
• Must have had that level or more as an active
  employee OR
• Must submit a statement of health and be approved
  by Minnesota Life
• Optional life may be continued at retirement, but
  not added later
• Be sure you do your life insurance paperwork when
  you retire
• Optional life insurance is decreasing term
  coverage
• Premiums go up
• Coverage goes down as you age
• Premiums are printed in the Shoppers Guide each
  year

21
Retiree Dependent Life Premiums

• Dependent life insurance is available for
  retirees.
• To determine how much dependent life you may have
  at retirement
• Must have had desired level or more as an active
  employee OR
• Must submit a statement of health with
  information about each dependent to be covered
  and be approved by Minnesota Life

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Who to Call

• Wells Fargo TPA [phone]
• questions about PEIA PPB Plan medical claims
  administration, pre-certification and case
  management
• Express Scripts [phone]
• order PPB Plan ID cards or ask questions about
  prescription claims
• PEIA -- [phone]
• eligibility and life insurance
• Visit our website at www.wvpeia.com
• Fringe Benefits Management Co. (FBMC) (800)
  342-8017
• dental and vision benefits for retirees
• Coventry [phone] Advantra Freedom
• questions about medical claims administration,
  pre-certification and case management