state retiree health benefits program
DESCRIPTION
State Retiree Health Benefits Program. Department of Human Resource Management Office of Health Benefits. Eligibility. Must be a retiring state employee receiving an immediate (not deferred) VRS annuity or periodic benefit from an ORP vendor - PowerPoint PPT PresentationTRANSCRIPT
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State Retiree Health Benefits Program
Department of Human Resource Management
Office of Health Benefits
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EligibilityMust be a retiring state employee receiving an immediate (not deferred) VRS annuity or periodic benefit from an ORP vendorMust have been eligible for state coverage as an active employee at the time of retirement (not Extended Coverage)Must enroll within 31 days of retirement date
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Not EligibleCoverage is declined at retirement (except waiver)Enrollment is not completed within 31 days of retirementRetirement benefit is deferredCoverage is cancelled
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Coverage Begins
The first day of the first full month of retirement
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Eligible DependentsSame as active
employees, e.g.,Legal spouseUnmarried biological, legally adopted or step-childrenChildren in court-ordered sole permanent custody of retireeAdult children with a disability
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Plan Choices
Non-Medicare PlansMedicare Plans
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Current Non-Medicare Plans
COVA Care Basic or with optional benefits Out-of-Network (Medical & Behavioral Health) Expanded Dental Out-of-Network and Expanded Dental Vision, Hearing and Expanded Dental Out-of-Network, Vision, Hearing and Expanded
DentalCOVA HealthAware Basic or with optional benefits Expanded Dental and or Vision
Regional Plan – Kaiser Permanente (Northern Virginia, Fredericksburg, MD, DC)COVA High Deductible Health Plan (HDHP)TRICARE Supplement Plan for military retirees and their spouses/surviving spouses
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Current Medicare PlansAdvantage 65Advantage 65 with Dental/VisionAdvantage 65-Medical OnlyAdvantage 65-Medical Only with Dental/Vision
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Retiree Group MembersVRS Service RetireesVRS Disability RetireesORP RetireesLocal RetireesVSDP/LTD ParticipantsSurvivors Annuitant Non-Annuitant
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Changes Allowed at Retirement
Enroll from active waive into single coverageDecrease membershipWaive to active/retiree coverage as dependent (and return in the future per plan provisions)Plan changeDecline/cancel coverage – no return to program
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Not Allowed at Retirement
Increase in membership (unless there is a consistent, simultaneous qualifying mid-year event)
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Allowable Changes After Retirement
Changes Consistent with Qualifying Mid-Year EventsMembership reduction (prospective)Cancellation (prospective)Open Enrollment (non-Medicare only)Medicare plan changes (prospective)
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Required Change
To a Medicare-coordinating plan immediately upon Medicare eligibility
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Medicare Eligibility
At age 65Prior to age 65
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Original Medicare Plan
Medicare Part A – Hospital InsuranceMedicare Part B – Medical InsuranceMedicare Part D – Medicare Outpatient Prescription Drug Program
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Premium Cost
Retiree pays the full cost of coverageHealth insurance credit if eligible
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Premium PaymentVRS Deduction (post-tax) for VRS retirees with monthly benefit sufficient to cover premiumDirect Bill – all others Automatic Bank Draft
or on-line payments for Anthem plan participants
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Non-Medicare Plan Premiums - 7/1/15—6/30/16
PLAN SingleTwo-
Person Family
COVA Care Basic $619 $1,148 $1,662
CC w/Out of Network $634 $1,168 $1,690
CC w/Expanded Dental $646 $1,199 $1,740
CC w/Vision/Hearing/Exp Dental $662 $1,226 $1,776
CC w/Out of Net/Exp Dental $661 $1,219 $1,768
CC w/Out of Net/Vision/Hearing/Exp Dental $677 $1,246 $1,804
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Non-Medicare Plan Premiums - 7/1/15—6/30/16
PLAN SingleTwo-
Person FamilyCOVA HealthAware $566 $1,051 $1,517COVA HealthAware w/Exp Dental $592 $1,102 $1,594COVA HealthAware w/Exp Dental & Vision
$601 $1,117 $1,614
COVA HDHP $465 $864 $1,262COVA HDHP w/ Exp Dental $491 $915 $1,339Kaiser $573 $1,054 $1,536TRICARE $61 $120 $161
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Medicare Plan Premiums - 2016
PLAN Single
Advantage 65 $293
Advantage 65 w/Dental & Vision $322
Advantage 65 – Medical Only $154
Advantage 65 – Medical Only w/Dental & Vision $183
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How Does Advantage 65 Work – (2016)?
M edicare Pays (2015) Advantage 65 PaysHospital Inpatient (Part A) 60 days hospital after deductible Part A deductible except for f irst $100Skilled Nursing (Part A) Additional 30 days hospital (except coinsurance) Part A Coinsurance
60 hospital lifetime reserve days (exc. coinsurance)100% of allow able charge for eligible expenses for an 20 days at Medicare skilled nursing facility ("SNF") additional 365 days80 additional days at SNF (exc. coinsurance)
Physician and Other Services (Part B) Generally 80% of Medicare-Approved Amount Part B Coinsurance, but not Deductibleafter annual Deductible
Outpatient Prescription Drug (Part D) Basic or enhanced benefit, if enrolled Enhanced Part D plan (if M edical Only Plan selected, no outpatient prescription drug benefit*)
Dental Benefits $0 Optional BenefitRoutine Vision Benefits $0 Optional Benefit
Brief Summary of Advantage 65 Benefits
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Advantage 65 Enhanced Medicare Part D Plan
FormularyDeductibleTiers and Coverage StagesNo “Doughnut Hole”Catastrophic benefitExcluded Drugs
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Resources
DHRM Web Sitewww.dhrm.virginia.gov
Retiree Fact Sheets