Congratulations on

Your Lane County

Retirement!

Retirement Benefits Guide The following is a brief summary of the County retiree benefit plans. In all cases the actual language of the Lane County Administrative Procedures Manual (APM), Labor Agreements and plan documents govern.

Updated July 2020

Table of Contents

Summary of Retirement Benefits .............................................................................................. 1

Benefit Contact Information ...................................................................................................... 2

County Paid Retiree Health Insurance ....................................................................................... 3

Self-Pay Retiree Health Insurance .............................................................................................. 4

COBRA Dental ............................................................................................................................ 4

Final Paycheck ........................................................................................................................... 5

Time Management .................................................................................................................... 5

Proof of PERS Retirement .......................................................................................................... 5

Medicare and County Paid Retiree Health Insurance ................................................................. 5

Dependent Coverage ................................................................................................................. 6

PERS Guidelines for Working after Retirement .......................................................................... 6

Life Changes ............................................................................................................................... 6

Insurance Continuation Payment Process ................................................................................. 7

Health and Dental Enrollment/Change Form .......................................................................... 8

Authorization Agreement for Pre-arranged Charges ................................................................. 9

1

Summary of Retirement Benefits This document is intended to be a brief summary of benefits available to eligible Lane County retirees and in all cases any contracts and plan documents govern.

Medical

Health insurance for eligible retirees is offered through PacificSource Health Plans. You have 60 days from the termination of your active group coverage to enroll in the coverage. If you have specific questions about the plan, contact Benefit Resource Center. Note: Eye exam coverage is not provided.

Dental

Dental coverage is available for eligible retirees under COBRA, and can be elected for up to 18 months. You have 60 days from the date of your COBRA notice, or your last day worked, whichever is later, to elect COBRA.

Live Well Center

The Live Well Center is available for eligible (pre-65) retirees, spouses and dependents (ages 2 and up) who are enrolled in the Lane County health plan.

Health Savings Account

Eligible retirees enrolled in the High Deductible Health Plan will receive $1,500 annually in a Health Savings Account (HSA). HSAs are administered by Optum.

Flexible Spending Account

Your Flexible Spending Account (FSA) eligibility will end at the end of the month in which you retire. If you elect COBRA your account balance will be extended as long as you continue to make the agreed upon monthly payment (including 2% administrative fee). Your Benny Card will be deactivated upon termination.

Benefit Resource Center

Benefit Resource Center (BRC) will help you with your specific questions including covered services, claim processes and appeals, and prescriptions.

Life Insurance

Group term life and accidental death and dismemberment coverage ends on your last day worked. You can continue the coverage by completing an enrollment application and mailing it directly to the life insurance carrier. You have 31 days from your last day worked to apply for portability coverage.

EAP Inova Employee Assistance Program (EAP) provides confidential professional counseling, financial advising, legal consultation, work-life balance services for eligible retirees.

Deferred Compensation

Contact TIAA before you retire to set up recurring distributions, consolidate retirement savings, and manage your portfolio. To defer additional money from your last paycheck to your Deferred Compensation account, contact Lane County Central Payroll.

PERS Lane County Central Payroll automatically updates PERS with retirement information within 3 weeks following the pay period in which you retire.

QVI Risk Solutions

QVI Risk Solutions processes retiree and COBRA payments. If you are required to pay for retiree health insurance or COBRA, you may set up automatic recurring payments between your bank and QVI. Otherwise, you will need to send a check to QVI each month that a premium is due.

2

Benefit Contact Information

PACIFICSOURCE HEALTH PLANS – Group #G0020828

Hours: 7:30 am – 5:00 pm

Customer Service (888) 977-9299 (541) 684-5582

DELTA DENTAL (formerly MODA) – Group #10001718

Hours: 7:30 am – 5:30 pm

Customer Service (877) 277-7280

WILLAMETTE DENTAL GROUP – COBRA Group #OR63B

Hours: 8:00 am – 5:00 pm

Appointments (800) 461-8994

Patient Relations (800) 460-7644

LIVE WELL CENTER – Marathon Health

Hours: 8:00 am – 5:00 pm

Appointments (541) 603-7930

Monday - Friday Website www.marathon-health.com/myphr HEALTH SAVINGS ACCOUNT – Optum

Customer Service (877) 470-1771

Website https://mycdh.optum.com/

FLEXIBLE SPENDING ACCOUNT – PacificSource Administrators

Customer Service (541) 485-7488

Email psacustomerservice@pacificsource.com

BENEFIT RESOURCE CENTER

Hours: 8:00 am – 5:00 pm

Customer Service (877) 738-7874

Monday - Friday Email 4ourBRC@usi.biz

EMPLOYEE ASSISTANCE PROGRAM – Inova

Customer Service (800) 346-0110

Website inova.org/EAP

DEFERRED COMPENSATION 457(b) & 401(a) – TIAA

Customer Service (800) 842-2638

Website www.tiaa.org

PERS

Customer Service (888) 320-7377

Website oregon.gov/PERS

QVI RISK SOLUTIONS

Customer Service (800) 408-9717 (541) 312-8512

PACIFIC BENEFITS CONSULTANTS (not sponsored by Lane County) Medicare supplements (541) 484-6624

LANE COUNTY CONTACTS

HR Benefits Customer Service (541) 682-3660

Email BenefitsandWellness@co.lane.or.us

Front Desk (541) 682-3124

Central Payroll (541) 682-4200

3

County Paid Retiree Health Insurance Review your Labor Agreement or the APM to determine your eligibility for County-paid retiree health insurance.

Eligibility Eligibility for County paid retiree health insurance is based on five main criteria: 1) date of hire, 2) years of service, 3) age, 4) proof of retirement under PERS, and 5) your Labor Agreement or the APM.

Dependents County paid retirees may elect to continue coverage for eligible dependents currently listed on your active group coverage, if the retiree does so at the time of retirement, remains enrolled continuously and as long as they are not enrolled in Medicare. Dependents cannot be enrolled in the plan after retirement has begun. (Please refer to Dependent Coverage section for newly acquired dependents)

Cost A retiree eligible for County paid health insurance receives paid monthly medical premiums for their lifetime, and pays a reduced rate for eligible dependents. Rates are subject to change during the annual renewal process, and retirees will be notified in writing of rate changes. Plan type must be the same plan type elected under active coverage.

One Two Three+

Co-Pay Plan ($35 co-pay)

$0 $753 $1,394

High Deductible Health Plan

$0 $495 $917

Enrollee

Enrollee + Spouse

Enrollee + Child Enrollee +

Family

Prime Plus Plan $0 $882 $591 $1,411

Length of Coverage Retiree coverage may continue until Medicare eligibility (usually age 65, following 24 months of Social Security Disability and/or by legislative change). For dependent children, coverage may continue until they are no longer considered dependents by the plan. County paid retirees enrolled on Medicare will be reimbursed for Medicare Part B premiums and a portion of a Medicare Supplement they choose. More information about Medicare reimbursements will be mailed to the retiree 1-3 months prior to Medicare eligibility (usually first of the month in which retiree turns 65).

4

Self-Pay Retiree Health Insurance State law provides for a public sector retiree’s right to continue health insurance coverage by paying monthly premiums to Lane County, even if they are not eligible for County Paid retiree health insurance.

Eligibility Must provide proof of retirement under PERS. Dependents Self-pay retirees may elect to continue coverage for eligible dependents currently listed on your active group coverage, if the retiree does so at the time of retirement, remains enrolled continuously and as long as they are not enrolled in Medicare. Dependents cannot be enrolled in the plan after retirement has begun. (Please refer to Dependent Coverage section for newly acquired dependents)

Cost Rates are subject to change during the annual renewal process, and retirees will be notified in writing of rate changes. Plan type must be the same plan type elected under active coverage.

One Two Three+

Co-Pay Plan ($35 co-pay)

$842 $1,595 $2,236

High Deductible Health Plan

$554 $1,049 $1,471

Enrollee

Enrollee + Spouse

Enrollee + Child Enrollee +

Family

Plus Plan $735 $1,617 $1,326 $2,146

Length of Coverage Retiree and spouse coverage may continue until Medicare eligibility (usually age 65, following 24 months of Social Security Disability and/or by legislative change). For dependent children, coverage may continue until they are no longer considered dependents on the plan. There are no negotiated benefits for self-pay retirees who are enrolled on Medicare.

COBRA Dental Retiree dental insurance falls under COBRA continuation coverage, and may be elected for up to 18 months following retirement. You have 60 days from the date of your COBRA notice, or your last day worked, whichever is later, to elect dental under COBRA. Rates are subject to change during the annual renewal process, and retirees will be notified in writing of rate changes.

One Two Three+

Willamette Dental Group $61 $107 $170

Delta Dental $52 $92 $145

5

Final Paycheck Provided you have given a two week written notice of your intended retirement date to your supervisor and department payroll staff, your final paycheck will be issued on or after 4 p.m. on your last day of employment. This final paycheck will include all accrued leave payouts and wages. You may elect to change your tax deductions on your final paycheck.

Time Management Generally, employees can elect to sell up to 200 hours of Time Management during three calendar years prior to their earliest retirement date under PERS. Reference your Labor Agreement or contact Central Payroll if you have questions.

Proof of PERS Retirement Proof of PERS retirement is required for County paid retirees and some self-pay retirees. Failure to provide proof of PERS retirement within four months following retirement can result in cancellation of your benefits. Please provide your PERS Notice of Entitlement which is sent to you prior to receiving your first PERS retirement check. In most cases you will receive this document within 90 days following your County retirement date. You may also provide other PERS documentation showing that you are collecting retirement benefits. A statement that your application packet has been received does not meet the proof of PERS retirement criteria.

Medicare and County Paid Retiree Health Insurance Medicare eligibility is the earliest of one of the following:

1) The first of the month in which the retiree becomes age 65, or as determined by Social Security. 2) The first of the month after receiving 24 months of Social Security Disability benefits. 3) As determined by legislative change.

Eligible retirees will receive a quarterly reimbursement including: 1) monthly premium cost for Medicare Part B, and 2) up to $64 per month for a Medicare Supplement. This reimbursement applies only to retirees covered by the County paid health insurance plan and is subject to change based on current rates. Retiree must provide initial proof of enrollment and cost, and annually thereafter.

The reimbursement schedule is as follows:

Premiums Paid During: Are Reimbursed During: January, February, March April April, May, June July July, August, September October October, November, December January

The County will send you a Medicare Packet a few months prior to your Medicare eligibility or upon notification of your eligibility for Medicare prior to age 65.

6

Dependent Coverage You may elect health insurance for your eligible dependent(s) under certain circumstances.

Spouse/Domestic Partner (DP) A spouse/DP may be enrolled on your retiree health insurance if they are currently listed on your active group coverage at one of two opportunities:

1) The first of the month following your retirement (at the time of retirement). 2) The first of the month after acquiring a new dependent.

You may enroll your spouse/DP, currently listed on your active group coverage, on your health insurance as long as they are not enrolled on Medicare and they remain enrolled continuously. You may enroll your newly acquired dependents within 60 days of their eligibility. Your spouse/DP may remain on the coverage by paying monthly premiums until they become eligible for Medicare. If you become eligible for Medicare prior to your spouse/DP, they will need to complete a new enrollment form to remain on the health insurance. Monthly premium rates are subject to change, and enrollees will be notified in writing of rate changes.

Dependent Children Dependent children may remain on your health insurance through the month in which they reach age 26. See health insurance handbook for information about continued coverage for a disabled adult child.

PERS Guidelines for Working after Retirement Every individual’s situation is different, so specific questions should be directed to PERS and or your own legal counsel. If you return to employment with a PERS-covered public employer after retirement, Oregon statutes impose certain limitations on that employment. Your retirement benefits may stop if you violate the number of hours you work. If you decide to return to work with a PERS-covered employer after retirement, you can control the number of hours you work and whether you comply with or violate the limitation. You must comply with the rules necessary to maintain PERS benefits, not Lane County. PERS recommends that you track the hours you work to avoid exceeding the work-hour limitations for each calendar year. The rules vary according to the position you hold and which PERS-covered employer you work for. Visit the PERS website for a list of limitations and exceptions. After you retire, keep PERS informed of your correct mailing address.

If you are considering an extra help or temp position with Lane County immediately after you retire, you need to delay your start date until the start of the next pay period or the beginning of the following month, whichever is LATER.

Life Changes Enrollees must provide written notice to Lane County within 30 days of the following:

1) Retiree becomes eligible for Medicare prior to age 65 2) There is a change in enrolled dependent eligibility 3) If your mailing address, email or phone number changes

Failure to do so can result in suspension of your health insurance.

7

Insurance Continuation Payment Process QVI Risk Solutions Lane County partners with a reputable vendor to process payments for retiree and COBRA plans.

Customer Service: (800) 408-9717 (541) 312-8512

Mailing Address: QVI Risk Solutions, Inc. P.O. Box 7199 Bend, OR 97708

First payment for continuation coverage If you elect continuation coverage, you must make your first payment no later than 45 days after the date of your election. This is the date the election notice is postmarked, if mailed. If you do not make your first payment for continuation coverage in full within 45 days after the date of your election, you will lose all continuation coverage rights under the Plan. You are responsible for making sure that the amount of your first payment is correct. You may contact QVI to confirm the correct amount of your first payment.

Periodic payments for continuation coverage After you make your first payment for continuation coverage, you will be required to make periodic payments for each subsequent coverage period. The amount due for each coverage period for each qualified beneficiary is shown in this notice. The periodic payments can be made on a monthly basis. Under the Plan, each of these periodic payments for continuation coverage is due on the first day of the month for that coverage period. If you make a periodic payment on or before the first day of the coverage period to which it applies, your coverage under the Plan will continue for that coverage period without any break. The plan will not send periodic notices of payments due for these coverage periods.

Grace periods for periodic payments There is no grace period for your initial payment. Although periodic payments are due on the dates shown above, you will be given a grace period of 30 days after the first day of the coverage period to make period payment. Your continuation coverage will be provided for each coverage period as long as payment for that coverage period is made before the end of the grace period for that payment. If you fail to make a period payment before the end of the grace period for that coverage period, you will lose all rights to continuation coverage under the plan.

Your first payment and all periodic payments for continuation coverage should be sent to QVI Risk Solutions.

QVI Risk Solutions will set up automatic insurance premium payments through transfers from your checking or savings account. Please complete the enclosed Authorization for Pre-arranged Charges form. Automatic payments are withheld from your account on the 20th of the month prior to the month due. For example, February’s premium is withheld on January 20th. You may need to submit payment or you may be reimbursed through the mail if current authorization is not on file. In the event of insufficient funds or closed accounts, QVI will contact you to collect funds. If funds cannot be collected within the 30 day grace period your coverage will be cancelled retroactively back to the end of the month in which coverage was paid in full. Coverage cannot be reinstated.

8

Health and Dental Enrollment/Change Form Please type or print legibly in ink. Complete all applicable sections.

Please complete sections 1 – 8 and return to Lane County. This form is not valid unless signed. Section 1 – Purpose of this Form

Enrollee Select Either:

MEDICAL ONLY

MEDICAL AND DENTAL

DENTAL ONLY

Retiree Type: County Paid HB2430 (PERS Retiree)

ERA (Early Retirement Alternative)

Retiree Plans: Retiree Plan type must be the same as elected under Active Coverage, unless you are moving outside of the service area.

Section 2 - Enrollment Information Qualifying Event Date (mm/dd/yyyy) Active Group Coverage End Date (mm/dd/yyyy) Continuation Enrollment Effective Date (mm/dd/yyyy)

Enrollee Last Name First M.I.

Mailing Address City State ZIP code

Physical Address (required if enrolling in the HDHP w/HSA Account) City State ZIP code

Home Phone No. Email Address Union/Association (only medical plans included in union agreement may

be selected)

Gender Male Female

Marital Status Married Single Registered Domestic Partnership Unregistered Domestic Partnership (requires affidavit)

Other Section 3-Medical Plan Selection – PacificSource Group # G0020828

COBRA – Co-Pay Plan

COBRA – High Deductible Health Plan

COBRA – Plus Plan

Class Code (internal use only)

RETIREE – Co-Pay Plan

RETIREE – High Deductible Health Plan

RETIREE – Plus Plan

Class Code (internal use only)

Section 4 – COBRA Dental Plan Selection for current enrollees

Dental Plan Delta Dental Willamette Dental Group Section 5 - Enrollee and Eligible Dependents You Wish to Enroll

Proof of Eligibility required for dependents not previously verified

Name Eligibility Docs

Gender

Birth Date

Social Security Number (Required) Section 111 of Public Law 110-173

First and Last Name of Primary Care Practitioner

(Required for Co-Pay Plan) Enrollee

Spouse or Domestic Partner

Dependent Child

Dependent Child

Dependent Child

If you or your spouse/domestic partner are a court-ordered guardian of any dependent listed above, identify and provide proof:

Name(s):_ Grandchild Niece/Nephew Sibling Foster Other:_

Lane County Internal Audit Only

PacificSource (fax & email) Dental (fax & email) QVI (fax & email) Update Billing

9

Section 6 – Child Custody Information If you are enrolling children of a previous relationship, you must complete this section. Also, list court ordered coverage in Other Coverage section above.

Child’s Name

Whose Child Joint

Custody Custodial

Parent Name Custodial Parent

Address Custodial Parent

Phone No. Name Responsible for

Insurance (court order) Yours

Spouse/

Domestic Partner

Yes

No

Yours

Spouse/

Domestic Partner

Yes

No

Section 7 - Other Coverage Medicare – If you or any person on this application has Medicare, indicate coverage: Part A Part B Part D

Name Original Effective Date

Medicare No. (include alpha prefix) Reason for Medicare Entitlement

Age ESRD Disability Dual Entitlement Current or Prior Coverage Information – Do you or any person listed on this application have, or previously had health coverage in the last 24 months? No Yes

If yes, complete the following. Name(s) Carrier Date of coverage Will Coverage Continue? Type of Coverage

Carrier Name:

Policy No.:

Phone No.:

Begin:

End:

Yes

No

Dental–Does plan cover pediatric dental? _Yes _No

Medical Vision

Carrier Name:

Policy No.:

Phone No.:

Begin:

End:

Yes

No

Dental–Does plan cover pediatric dental? _Yes _No

Medical Vision Married or Domestic Partner – Is your spouse or domestic partner employed? Yes No If yes, self-employed? Yes No

Section 8 - Acknowledgement and Declaration I acknowledge and understand that my health plan may request or disclose health information about me or my dependents (persons who are listed for benefits coverage on this enrollment form) from time to time for the purpose of facilitating healthcare treatment, payment, or for business operations necessary to administer healthcare benefits; or as required by law.

Health information requested or disclosed may be related to treatment or services performed by: A physician, dentist, pharmacist, or other physical or behavioral healthcare practitioner; A clinic, hospital, long term care, or other medical facility; Any other institution providing care, treatment, consultation, pharmaceuticals or supplies, or: An insurance carrier or group health plan.

Health information requested or disclosed may include, but is not limited to: claims records, correspondence, medical records, billing statements, diagnostic imaging reports, laboratory reports, dental records, or hospital records (including nursing records and progress notes).

This acknowledgement does not apply to obtaining information regarding psychotherapy notes. A separate authorization will be used for this information.

Fraud Warning: A person may be guilty of Insurance fraud if he submits an application containing false or deceptive information with either the intent to defraud, or the knowledge that he is facilitating a fraud. I affirm that the answers given in this application are complete and correct.

Enrollee Signature: Date:

10

Authorization for Pre-arranged Charges Health Insurance Continuation

Direct Payments or Direct Deposits

Part I Participant Information Participant’s Last Name First Name M.I. Telephone Number

Mailing Address City State Zip

Email Address

Part II Debit or Credit

I (we) authorize QVI Risk Solutions, Inc, authorized representative of Lane County, Oregon to initiate (check one) Debit (Deduct pre-arranged charges from the Bank or Credit Union indicated below) Credit (Deposit pre-arranged charges to the Bank or Credit Union indicated below) entries to my (our) Checking Account Savings Account (check one) In the event funds are deposited in error into my account, I authorize QVI Risk Solutions, Inc. to debit my account not to exceed the original amount of the credit (deposit). I understand that all deposits or credits are made through the automated clearing house (ACH) and are subject to the terms and limitations of the ACH as well as my financial institution. I understand it is my responsibility to check my account for deductions or reimbursements.

Part III Bank or Credit Union Information Bank or Credit Union Name (Institution) City State Zip

Transit/Routing/ABA number (first nine digits encoded on bottom left side of check)

Account Number Start Date (mm/yy)

Part IV Authorization

This authorization is to remain in full force and effect until QVI Risk Solutions, Inc., on behalf of Lane County, has received written notification from me of my desire to terminate this agreement in such time and in such manner as to give QVI Risk Solutions, Inc. and Institution a reasonable opportunity to act on it. Lane County reserves the right to cancel participation at any time.

Participant’s Name (please print) Participant’s Signature Date

Att

ach

Vo

ided

Ch

eck

Her

e

For account transfers: 1) Authorization must be received by the 10th of the month prior to the month of coverage. For example, to pay July premiums authorization for ACH transfer must be received no later than June 10th. 2) Payment will be processed on or around the 20th of each month for the following month’s premiums. For example the July premiums will be deducted from your account on or around June 20th. You may need to submit payment or you may be reimbursed through the mail if current authorization is not on file.

Please return this form to: QVI Risk Solutions, Inc., P.O. Box 7199, Bend, OR 97708