Transcript Creating A More Educated Georgia

Board of Regents of the
University System of Georgia
2011 Healthcare for Retirees
“Creating A More Educated Georgia”
1
Agenda














Carrying Coverage into Retirement
Coordination with Medicare
Future Retirees Medicare Part B
Medicare D – Pharmacy Benefits
Prescription Plan Changes
Alternative Network
Healthcare Reform
Tobacco Use Surcharge
Cigna Life Insurance Plan Enhancements
Premium Overview & Rate Information
Coverage - Out-of-Country
Retiree Option Change Period
Qualifying Events
Permissible Healthcare Plan Changes
“Creating A More Educated Georgia”
2
Carrying Coverage into Retirement
Effective November 1, 2002, to be eligible for retirement from the University System
of Georgia (USG), an employee must meet one of the following four (4) conditions at
the time of his/her separation from employment, regardless of the retirement plan
elected by the employee:


An employee must have been employed by the USG for the last ten
(10) years in a regular, benefitted position and have attained age 60;
or
An employee must have at least 25 total years of benefitted service
established with a State of Georgia sponsored retirement plan, of
which the last five (5) years of employment must have been
continuous and with the USG; or
“Creating A More Educated Georgia”
3
Carrying Coverage into Retirement


An employee must have at least 30 total years of benefitted service
established with a State of Georgia sponsored retirement plan, of
which the last five (5) years of employment must have been
continuous and with the USG; or
An employee must be deemed to be totally and permanently disabled,
as documented through the receipt of disability benefits from Social
Security or from the TRS, following 9.5 years of continuous service to
the USG in a regular, benefitted position.
An individual who has retired from another State of Georgia sponsored
Retirement plan may not count such retirement service toward meeting the
eligibility criteria for retirement from the USG.
“Creating A More Educated Georgia”
4
Coordination with Medicare
• BOR plan pays healthcare benefits after
Medicare has paid their portion.
• A retiree age 65 or older has the option to
select the PPO Plan, the HSA PPO (HDHP)
Plan or the Kaiser Permanente Senior
Advantage Plan.
“Creating A More Educated Georgia”
5
Future Retirees Medicare Part B
•
•
•
All future retirees and spouses will be
required to pay full cost of insurance for not
enrolling in Medicare Part B.
After January 1, 2011, all retirees and
spouses reaching age 65 will have the option
to either enroll in Medicare Part B or pay the
full cost of system provided insurance.
Current Medicare eligible retirees who are not
enrolled will be grandfathered in and will
continue to pay the $100 per month
surcharge.
“Creating A More Educated Georgia”
6
Medicare Part D –
Pharmacy Benefits
• Medicare Part D provides subsidized drug coverage.
• Kaiser Permanente Senior Advantage provides an integrated
benefit covering hospital, physician and drug costs.
• Kaiser Permanente will automatically serve as Medicare Part
D provider to existing Kaiser Senior Advantage members.
• If you currently have an existing Part D plan and enroll in
Senior Advantage, your existing Part D Plan will automatically
be cancelled by Medicare.
• Customer service is available to answer your questions at
404-233-3700, or 1-800-232-4404.
“Creating A More Educated Georgia”
7
Prescription Plan Changes
The following Medco changes are effective January 1, 2011:
• $5.00 co-pay increase for brand name drugs
• Specialty Pharmacy Program – Effective January 1,
2011 for access to certain specialty medications,
employees will be directed to use Accredo, Medco’s
Specialty Pharmacy Program.
• Medicare B Coordination Program – Medco will work
with BCBS to better manage the coordination of
pharmacy benefits for USG retirees.
“Creating A More Educated Georgia”
8
Prescription Plan Changes
(continued)
•
Generic Waiver Co-Payment Program
- New generic claims not filled within last 12 months
- Any brand name prescription presented at mail
- Any generic prescription moved to mail
- Any new generic prescription submitted at mail
- One patient can get more than one (1) waiver
- Waivers are offered by patient/drug
- Existing brand name prescription at mail which
becomes available as generic during waiver period is
not eligible to receive a co-pay waiver
“Creating A More Educated Georgia”
9
Alternative Network
• The new alternative network is a voluntary
option for both PPO and HDHP plans
• The Blue Open Access POS Network is a
statewide provider network in Georgia
• Blue Open Access members are not required
to select a Primary Care Physician (PCP)
• Members will have access to specialty care
directly from any In-Network Physician
“Creating A More Educated Georgia”
10
Healthcare Reform
• Dependent coverage to age 26 (no other
employer coverage available)
• No health FSA/HRA/HSA reimbursement for
non-prescribed drugs
• No lifetime dollar limits
• No pre-existing condition limitations for
children up to age 19
“Creating A More Educated Georgia”
11
Tobacco Use Surcharge
A $50 per month tobacco use surcharge will be
added to the monthly premium if you use tobacco
products.
• Smoking cessation classes are available
• Tobacco surcharge will be removed when the
employee completes the tobacco cessation
requirements.
• http://www.usg.edu/hr/benefits/health_insurance
“Creating A More Educated Georgia”
12
Cigna Life Insurance Plan
Enhancements
• Terminal Illness Benefit to Basic and Voluntary
Life Programs
• Identity Theft Program to Voluntary AD&D
Program
• Cigna’s Health Reward Program
• Cigna’s Will Preparation Program
“Creating A More Educated Georgia”
13
Premium Overview &
Rate Information
Healthcare Plan
% Increase Over 2010
Rates
BCBS PPO Traditional
9.7%
BCBS PPO Alternative
Priced at 2010 rates
BCBS HDHP Traditional
BCBS HDHP Alternative
9.7%
Priced at 2010 rates
BCBS HMO
Kaiser HMO
9.7%
8.3%
BOR Dental Employee paid
10%
Go to the following link for rate information:
http://www.usg.edu/hr/benefits/health_insurance/
“Creating A More Educated Georgia”
14
Coverage – Out-of-Country
Out-of-Country
• BlueCard Worldwide
* Medical assistance for inpatient, outpatient, and professional
services from healthcare providers worldwide.
* 24 hours a day, 7 days a week, 365 days a year
* BlueCard Access Line 1-800-810-BLUE (2583) inside U.S. or
call collect 1-804-673-1177 outside U.S.
* Claim Form – 1-800-810-BLUE (2583) or
www.bcbs.com/bluecardworldwide/index.html
* Claim – Prescription Drugs
BCBSGA, P.O. Box 7728, Columbus, GA 31908
“Creating A More Educated Georgia”
15
Retiree Option Change Period



The USG retiree annual change period is generally held during the fall
of each calendar year.
The USG retiree annual change period will coincide with the same 30
calendar-day time frame designated as the USG open enrollment
period for active, eligible employees.
The institutional HR/Personnel Office, from which the individual
retires, will advise the retiree of the specific dates for his/her annual
change period.
A retiree will not be permitted to participate in the annual change period
unless he/she elected to take healthcare coverage into retirement at the
time of his/her separation from employment with the USG.
“Creating A More Educated Georgia”
16
Retiree Option Change Period
During an annual retiree change period, an eligible retired employee may
elect to:



Drop or discontinue healthcare coverage;
Participate in a different healthcare plan option; and/or
Reduce his/her level of coverage.
During the annual change period, a retiree shall not be permitted to add
Healthcare coverage, or, increase the level of coverage that he/she took
Into retirement, unless it is the result of one of four (4) qualifying events.
Following institutional approval, any change in retiree healthcare coverage
will become effective within 30 days of the qualifying event; not at the
beginning of the next plan year.
“Creating A More Educated Georgia”
17
Qualifying Events




A USG retiree will be permitted to make a change in the level of
healthcare coverage that he/she took into retirement, if he/she has a
qualifying event.
The change in retiree healthcare coverage must be consistent with the
qualifying event.
A retiree will be required to provide proper documentation to justify a
requested benefits coverage change to the institutional HR/Personnel
Office from which he/she retired. A retiree must request a coverage
change within 30 days of the qualifying event.
Appropriate documentation, specific to the qualifying event, must be
presented to your campus HR/Personnel Office before a change in
healthcare plan coverage will be granted or approved.
“Creating A More Educated Georgia”
18
Qualifying Events
There will be only four (4) instances of a qualifying event that a USG institution
may consider in granting a change in the level of healthcare coverage for a USG
retiree:





Medicare eligibility; or
The addition of a dependent(s) because of marriage, birth, adoption
or a Qualified Medical Child Support (QMSCO) ; or
The loss of a dependent(s) health benefit coverage through a change
in a spouse’s group coverage, through COBRA coverage, through
Medicare, or through Medicaid; or
A change in a spouse’s employment status that affects coverage
eligibility under a qualified health plan.
Marriage or divorce.
“Creating A More Educated Georgia”
19
Qualifying Events
PLEASE NOTE:
For each of the four (4) qualifying events that were previously identified, one must
file a timely request with the HR/Personnel Office from which he/she retired. For
instances other than a qualified medical child support order (QMSCO), “timely”
means within thirty (30) days of the qualifying event.
A failure to complete a change form within thirty (30) days of a qualifying event will
prohibit one from making such changes. Unless otherwise noted, the effective date
for changes in healthcare coverage will be the first day of the month following the
institutions approval.
“Creating A More Educated Georgia”
20
Qualifying Events
A Qualified Medical Child Support Order (QMSCO) is a court-ordered
remedy resulting from a divorce, legal separation, annulment, or
change in legal Custody. A QMSCO requires that an individual
Provide healthcare coverage for an enrolled dependent(s) that has
been approved by the court. The court order and effective date of
healthcare plan coverage for a court-designated enrolled
dependent(s) must be presented to the institutional HR/Personnel
Office from Which an individual retired, within ninety (90) days for
the court’s decision.
“Creating A More Educated Georgia”
21
Permissible USG Retiree
Healthcare Plan Changes
Please be reminded that retiree healthcare premiums are
not paid with pre-tax dollars. Therefore, a retiree may
reduce his/her healthcare coverage, or, discontinue
his/her healthcare coverage at any time during the plan
year. If you wish to reduce your healthcare coverage, or,
if you wish to discontinue your healthcare coverage,
please submit your request in writing to the HR/Personnel
Office from which you retired.
“Creating A More Educated Georgia”
22
Questions ??
“Creating A More Educated Georgia”
23