Retiree Supplemental Guide

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1 The Maryland-National Capital Park and Planning Commission Retiree Supplemental Guide Benefit Year 2016 Page 1

2 TABLE OF CONTENTS Newly Retired Employees 3 Enrollment Instructions for Qualifying Life Events 5 Medical Plans Overview 7 Medical Plan Comparison Chart 10 Prescription Drug Coverage 11 Frequently Asked Questions 14 Income-Related Monthly Adjustment Amount (IRMAA) 17 Benefit Eligibility Chart 20 Plan ID Cards 22 Retiree Coverage 23 Rate Chart 28 Page 2

3 Page 3

4 Newly Retired Employees Benefit Eligibility You are eligible for retiree health benefits if you are eligible to retire on the date you terminate from the Commission (including an early or reduced benefit) and meet the 36- month rule. Once you are retired, when you or your spouse reach age 65 or become eligible for Medicare because of a disability, you must enroll in parts A and B of Medicare in order to remain eligible for the Commission s medical plan in which you are enrolled. If you, and/or your spouse, are already 65 or are already eligible for Medicare due to a disability, you and/or your spouse must enroll in Medicare Parts A and B immediately upon your retirement. 36-Month Rule for Retiree Coverage To be eligible for retiree health benefits (medical, dental, prescription, and vision), an employee and eligible dependents must provide proof of qualifying prior coverage for each plan elected. Qualifying prior coverage is 36 months of continuous coverage in a Commission or other insured plan immediately prior to retirement with the Commission. You as the employee are eligible as a dependent on your spouse s plan under this rule. You do not need to be in the same medical plan for the entire 36-month period. You must show proof of continuous health insurance coverage and similar benefits during the period of coverage with another carrier. Benefits including deductibles and out-of-pocket maximums must be similar. Many medical plans offer discounted plan features such as dental and vision. These discounted features do not qualify as comprehensive health plans. The 36-Month Rule does not apply to the prepaid legal plan, which is 100% retiree funded. Dependent Eligibility Your eligible dependents are eligible for the same plans that you are, provided they also meet the 36-month rule for each benefit. This 36 month evaluation of your dependents must occur at the time that you retire. You must provide satisfactory documentation of your dependent s coverage according to the 36-months rule. However, you may not enroll a dependent in any plan in which you are not also enrolled. If your spouse is still working, he/she may defer enrollment in the Commission plans until he/she stops working. Termination of his/her employment becomes a qualifying event to enroll your spouse in your elected plans. If eligible for Medicare, you and/or your spouse must be enrolled in both parts of Medicare (A and B) in order to be eligible for Commission benefits. Dependent children are subject to all regular dependent eligibility requirements. If your spouse or other dependents become eligible for other coverage including Medicare, you must notify the Health & Benefits Office within 45 days of the initial coverage effective date. Available Benefits during Retirement You may elect any benefits listed for retirees on page 17 of this Benefit Guide. During open enrollment, you may drop or add any benefits. However, if you drop the medical, dental, prescription, and vision plans, you may not later re-enroll unless you show proof of Page 4

5 continuous coverage with a similar plan. Conversely, if you are adding a benefit plan, you must show proof that you were consistently covered for the 36 months period immediately preceding your retirement date through the date you want your plan to be effective with the Commission. Dependent Coverage Following your retirement, changes may be made in your benefits during each subsequent open enrollment. However, after you retire, new dependents are not eligible for coverage under the medical, dental, prescription or vision plans. You may not add a new spouse if you marry or re-marry after retirement nor can you add a domestic partner. Newborn, adopted children and children for whom you obtain legal custody after you retire, also are not eligible to be covered under your plan. Only those dependents that were evaluated for eligibility at the time you retired are eligible for coverage. Page 5

6 Enrollment Instructions for Qualifying Life Events You have 45 calendar days from the date of a qualifying life event to add, delete or change health benefits and/or coverage levels. Coverage begins the 1 st of the month following receipt of the enrollment/change form, as long as receipt is within 45 days of the qualifying event. Qualifying Events / Family Status Changes Open enrollment is your opportunity to enroll in or change benefit plans. It occurs once each year in the fall. Once you enroll, you may not change your elections until the next open enrollment period unless you experience a qualifying life event or family status change. Changes must be consistent with the event or status change. A qualifying event or family status change is any of these events: Your marriage or divorce, annulment, or legal separation; Your child s marriage, divorce or annulment; A birth, adoption or change in a child's custody; A change in your or your spouse's or child s employment status, including part-time, full-time or retirement; A change in your or your spouse's insurance (cost or coverage); Commencement of or return from an unpaid leave of absence taken by you or your spouse; Your dependent child no longer meets the eligibility requirements of a dependent; The death of your spouse, domestic partner or child; Your relocation out of your plan s coverage area; Your domestic partnership ends; Your spouse s open enrollment period; A change in dependent eligibility due to a plan design change; A change in the dependent care arrangements; or A change in eligibility for a Commission plan (i.e. Medicare Complement Plan) If you are affected by a family status change, contact your Benefits Coordinator or the Health & Benefits Office. You will need to provide acceptable, written documentation of the qualifying event and complete an Application for Benefit Enrollment form to change your coverage within 45 days of the event. The change must be consistent with your qualifying event and must be accompanied by documentation sufficient to verify the event. However, you cannot change to a different medical plan or vision option until the next open enrollment period. Failure to submit changes in writing to the Health & Benefits Office within the 45-calendar day period may result in a delay of coverage until the next open enrollment period. If dependents become ineligible and were not removed from your plan, you may be responsible for the cost of single coverage or claims incurred, whichever is greater. Page 6

7 The enrollment instructions are essentially the same as for newly eligible employees except for the following: No retroactive changes will be made; Complete the form with only the changes you are requesting. Participation of individual medical providers and facilities is subject to change without notice. Any provider or facility change is not a qualifying event to change medical plans. Page 7

8 Medical Plans Overview Page 8

9 Medical Plans All four medical plans, Cigna EPO, UnitedHealthcare (UHC) EPO, UnitedHealthcare POS and UHC Medicare Complement, provide adequate coverage for retirees and their dependents by providing coverage that meets or exceeds your medical insurance needs; however there are differences. You can switch to any medical plan for which you are eligible according to the Benefit Plan Eligibility chart. Retirees and Dependents Under 65 Retirees and their dependents under the age of 65 may remain in their current plan or switch to another plan. You and your dependents must be enrolled in the same plan except for the UHC POS plan. If you are in the UHC POS plan and your spouse becomes Medicare eligible due to age or disability, he or she must be moved to the UHC Medicare Complement plan. Or, if you turn 65 before your spouse, or become eligible for Medicare because of a disability then you must be moved to the Complement plan and your spouse and dependents remain under the UHC POS plan. You, your spouse and dependent children may remain under both the UHC EPO and Cigna EPO regardless of age; however Medicare becomes primary for you and/or your spouse when eligible for Medicare. All retirees and spouses must enroll in both Medicare Parts A and B when first eligible or the health plan will assume you have Medicare and pay only what they would have paid as the secondary carrier. Retirees and Dependents 65 and Older Retirees and their dependents 65 and older may remain in their current UHC EPO or Cigna EPO plan or switch between the two EPO plans. You may also switch to the UHC Medicare Complement plan, but dependents not yet eligible for Medicare will be placed in the UHC POS plan. If you are currently in the UHC Medicare Complement plan you may switch to the UHC EPO or the Cigna EPO plan. If you are in the UHC POS plan when you turn 65 and your spouse becomes Medicare eligible, he or she must be moved to the UHC Medicare Complement plan. Or, if you turn 65 before your spouse and you are enrolled then you must be moved to the Complement plan and your spouse and dependents remain under the UHC POS plan. UnitedHealthcare s Medicare Complement Plan If you are over 65 (Medicare eligible), Medicare becomes your primary medical insurance carrier. This means that Medicare will pay benefits first and the M-NCPPC plan pays second. In order to access your Medicare benefits, you must select a doctor who accepts Medicare. The Medicare complement plan is designed to pay your deductibles, co-pays and coinsurances that are not covered by Medicare. Basically, you pay nothing for covered services. If a service is not covered by Medicare, it is not Page 9

10 covered by the Medicare Complement plan. There are very few services that are not covered by Medicare such as acupuncture, services rendered outside of the country, certain diagnostic tests, and some vaccinations. Over the last few years Medicare has been enhanced to cover most services as long as they are medically necessary. It is highly recommended that you review the Medicare & You Handbook for a list of covered services. The Medicare Complement plan is much less expensive than the United Healthcare EPO and Cigna EPO plans, but it is not an inferior plan. Coverage is 100% of all Medicare Part A and Part B deductibles and all coinsurance. As mentioned before, Medicare provides coverage for most services. The majority of retirees are enrolled in the UHC Medicare Complement plan and they have been satisfied with the coverage provided by Medicare. Medicare denied charges are not covered under the UHC Medicare Complement plan other than those emergency care charges incurred while you are out of the country. These out-of-country claims should be paid based on charges. If you exhaust a Medicare benefit, there is no further benefit in the Medicare Complement plan. If you are Medicare eligible and live outside of the United States, you must return to the United States to seek routine treatment, in order for a benefit to be available. Please call MEDICARE ( ) to confirm the coverage or download the Medicare and You booklet from UHC and Cigna EPO As mentioned above, all three plans provide adequate coverage to meet your needs as a retiree; however the EPO plans are more expensive than the Medicare Complement plan because they provide coverage for services that may not be covered by Medicare. This means that if you need a service that is not covered by Medicare and it is covered under the EPO plan, the EPO plans will pay for the service as long as you use an innetwork EPO provider. Such services may be infertility treatments, acupuncture and the purchase of hearing aids. In many cases retirees are paying more than two times the cost for coverage if you elect (one) of the EPO plans. As mentioned before, Medicare provides coverage for most services. You may want to determine whether or not your needs could be met by switching to the Medicare Complement plan. The following chart highlights some of the more common types of services and how they are covered under all three plans available to retirees who are Medicare eligible. Page 10

11 Medical Plan Comparison Chart Procedures UnitedHealthcare EPO Cigna EPO UHC Medicare Complement Acupuncture Yes, covered* Yes, covered* Not covered Allergy Shots Yes, covered Yes, covered Unknown Ambulance Services Yes, covered Yes, covered Yes, covered Annual Physical Yes, covered Yes, covered Yes, covered Exams Bereavement Yes, covered* Not covered Yes, covered* Counseling Chiropractic Care Yes, covered* Yes, covered* Yes, covered* Durable Medical Yes, covered* Yes, covered* Yes, covered* Equipment (DME) Flu Shots Yes, covered Yes, covered Yes, covered Hearing Aids Not covered Not covered Not covered Hearing Tests Yes, covered* Not covered Not covered Home Health care Yes, covered* Yes, covered Yes, covered* In-patient Hospital Yes, covered Yes, covered Yes, covered Care IVF Yes, covered* Yes, covered* Not covered Lifetime Maximum Unlimited Unlimited Unlimited Mammography Yes, covered Yes, covered Yes, covered Mental Health (In- Yes, covered Yes, covered Yes, covered Patent) Mental Health (Outpatient) Yes, covered Yes, covered Yes, covered* Occupational Yes, covered* Yes, covered* Yes, covered* Therapy Physical Therapy Yes, covered* Yes, covered* Yes, covered* Speech Therapy Yes, covered* Yes, covered* Yes, covered* *Many benefits may be covered with limits, such as the following: prior authorization required, limit on the number of visits and a co-insurance portion paid by you and the health plan. Please note that the above list is not exhaustive of the covered services, so you should compare the charts in the Health & Benefits Enrollment Instruction Booklet to the Medicare & You booklet for specific procedures you may need. Medicare doesn t cover emergency treatment outside of the U.S. However, the Medicare Complement will cover medical treatment received outside of the U.S. in emergency situations. Page 11

12 Prescription Drug Coverage Page 12

13 Prescription Coverage There is no prescription coverage in the medical plans. In order to obtain prescription coverage, you will need to enroll in the Commission s prescription plan or the federal Medicare Part D plan if you are Medicare eligible. Each year during open enrollment, a Medicare-eligible prescription drug plan participant will be required to choose between enrolling in the federal government s Medicare Part D prescription plan and the Commission s Caremark plan. Medicare eligible participants cannot be enrolled in both plans. If a Medicare eligible retiree or dependent enrolls in both, the enrollment in the federal government s plan is binding and the participant will be required to dis-enroll from the Commission s prescription plan. It is very important if you are a Medicare eligible retiree, spouse, or survivor that you carefully compare the Commission s prescription drug plan and the Medicare Part D prescription drug plan. You will be able to make a new election every year during open enrollment for one of the two plans. Creditable Coverage Notice The federal government wants to make sure that anyone with a choice between an employer plan and the Medicare Part D plan has information regarding the employer s plan design. Therefore an employer plan must have an in-depth evaluation performed on the plan design and the claims paid performed by actuaries from an outside firm. The Commission will provide the outcome of this evaluation in a written notice to certain employees, retirees or their spouses who are covered by one of the Commission s health plans and Medicare. This notice will help Medicare Part D eligible individuals decide whether or not to enroll in Medicare Part D, based on whether or not the Commission s prescription plan will pay out as much as the Medicare Part D program and the coverage on average is at least as good as Part D. If you are eligible for Medicare Part D and you have questions regarding the Commission s prescription plan, you may contact the Health & Benefits Office at , 1684 or 1685 or via at If you have questions about Medicare Part D, please contact the Centers for Medicare and Medicaid (CMS) at their Internet Site: Page 13

14 Effective January 1, 2015, M-NCPPC implemented SilverScript to manage our prescription drug benefit for Medicare eligible retirees and their dependents. Eligibility Requirements for the SilverScript Prescription Drug Plan: Retiree must have Medicare A or B HICN number (Health Insurance Claim Number) also called Medicare Number Must have physical address Must not be enrolled in another Medicare Part D plan (Annual Election Period Oct 15 th Dec 7 th ) Effective date is always the first of the month Must reside in the United States Dependents are eligible Those who are not Medicare eligible will continue to be covered under the CVS/Caremark plan Do Not Opt-Out of the New Prescription Drug Plan Your new prescription drug coverage is a Medicare Part D prescription drug plan. SilverScript is required to send you a letter giving you a chance to opt out or cancel your enrollment in prescription drug coverage. You will receive this opt out letter from SilverScript. Do not opt out. If you opt out, prescription drug coverage for you and your dependents will terminate. Once you opt out you will not be able to re-enroll unless you provide proof that you had similar coverage elsewhere during the time you were not covered under the M-NCPPC prescription drug program. If you are allowed to re-enroll, you may be subject to a late enrollment penalty If you have any questions, you may contact SilverScript at or log-in to our customized SilverScript portal Page 14

15 Frequently Asked Questions (FAQ s) Page 15

16 Frequently Asked Questions Do I need to fill out any paperwork to enroll? No. You will automatically be enrolled in the plan if you are currently enrolled in the CVS/Caremark prescription plan and you become Medicare eligible. What happens if I choose to opt out of SilverScript? You will lose prescription drug coverage for you and your dependents and may not be able to re-enroll at a later date. What happens if I don t send in a copy of my Medicare ID card? You and/or your dependents will have 90 days after becoming Medicare eligible to submit a copy of your Medicare ID card to us. If you don t submit a copy of your card, your coverage will be terminated under the commercial plan and you may not be eligible for coverage in the future. Will all of my current medications be covered? Yes, if your medications are currently covered under the commercial plan they will remain covered. In very rare cases, a medication may not be covered under the Part D plan; however, the M-NCPPC wrap plan may cover the medication. SilverScript is required to send the member a letter stating that they are subject to a 30-day transition fill. The member should disregard. One of my medications is no longer being covered under SilverScript. Can you please tell me why? It may have been removed from the formulary list. The formulary list is updated throughout the year and the updated list is posted here: Can I continue to use the same pharmacy? Yes, the pharmacy networks are unchanged to the member. Why am I receiving an explanation of benefits every month if the M-NCPPC Wrap Plan is covering all of my medication? The CMS regulations apply for all Part D prescription programs including EGWP that requires them to send an explanation of benefits. Page 16

17 What is a late enrollment penalty (LEP)? Only a handful of members may have a late enrollment penalty. This means you did not enroll in a Medicare Part D plan when you originally became eligible. What do I do if I receive a letter from SilverScript stating that I am not eligible to participate in the plan? In most cases, the reason for this letter is that SilverScript and CMS do not have the same eligibility information (date of birth, correct spelling of your name, Medicare #, address). You should follow the instructions in the letter to correct the eligibility information. What happens if I retire and I m age 65? You will need to apply for Medicare Part A & B and provide a copy of your Medicare ID card to the Health & Benefits Office and you will be moved to the SilverScript plan. You will receive a new prescription drug card. What do I do if my spouse turns 65? Your spouse must apply for Medicare Part A & B and provide a copy of their Medicare ID card to the Health & Benefits department. They will be moved to the SilverScript plan whether or not you are Medicare eligible. Is this plan different from what I have now? No, it is the same plan design that is being offered to our active employees. If Medicare doesn t pay for a drug, it will be covered by the WRAP plan (if it is a covered drug) and paid according to our plan design. Page 17

18 Income-Related Monthly Adjustment Amount (IRMAA) Page 18

19 IRMAA (Income-Related Monthly Adjustment Amount) If your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain limit, you may pay a Part D income-related monthly adjustment amount (Part D-IRMAA) in addition to your monthly plan premium. This extra amount is paid directly to Medicare, not to your plan. The chart below lists the extra amount costs by income. Social Security will contact you if you have to pay Part D-IRMAA, based on your income. The amount you pay can change each year. If you have questions about your Medicare prescription drug coverage, contact your plan. Note The extra amount you have to pay isn t part of your plan premium. You don t pay the extra amount to your plan. Most people have the extra amount taken from their Social Security check. If the amount isn t taken from your check, you ll get a bill from Medicare. You must pay this amount to keep your Part D coverage. If Social Security notifies you about paying a higher amount for your Part D coverage, you re required by law to pay the Part D-Income Related Monthly Adjustment Amount (Part D-IRMAA). If you don t pay the Part D-IRMAA, you ll lose your Part D coverage. Employer coverage and Part D-IRMAA Note You pay your Part D-IRMAA directly to Medicare, not to M-NCPPC. You re required to pay the Part D-IRMAA, even though we pay a portion of your Part D plan premiums. If you don t pay the Part D-IRMAA and get dis-enrolled, you may also lose your retirement coverage and you may not be able to get it back. Things to remember Pay your Part D-IRMAA bill to Medicare as soon as you get it Keep your address current with Social Security, even if you don t get a Social Security check Sign up for Medicare Easy Pay Page 19

20 Part D premiums by income The charts below show your estimated prescription drug plan monthly premium based on your income as reported on your IRS tax return from 2 years ago and last year. If your income is above a certain limit, you'll pay an income-related monthly adjustment amount in addition to your plan premium. If your filing status and yearly income in 2013 was File individual tax return File joint tax return File married & separate tax return You pay (in 2015) $85,000 or less $170,000 or less $85,000 or less your plan premium above $85,000 up to $107,000 above $107,000 up to $160,000 above $170,000 up to $214,000 not applicable above $214,000 up to $320,000 not applicable $ your plan premium $ your plan premium above $160,000 up to $214,000 above $320,000 up to $428,000 above $85,000 up to $129,000 $ your plan premium above $214,000 above $428,000 above $129,000 $ your plan premium If your filing status and yearly income in 2014 was File individual tax return File joint tax return File married & separate tax return You pay (in 2016) $85,000 or less $170,000 or less $85,000 or less your plan premium above $85,000 up to $107,000 above $107,000 up to $160,000 above $170,000 up to $214,000 not applicable above $214,000 up to $320,000 not applicable $ your plan premium $ your plan premium above $160,000 up to $214,000 above $320,000 up to $428,000 above $85,000 up to $129,000 $ your plan premium above $214,000 above $428,000 above $129,000 $ your plan premium Page 20

21 Eligibility & Card Information Page 21

22 Benefit Eligibility Chart by Employee Type Eligible Plans Retirees Under 65 Retirees 65 and Over Medical UnitedHealthcare POS X Not Eligible Medical UnitedHealthcare EPO X X Medical Cigna EPO X X Medical UnitedHealthcare Medicare Complement X X Prescription Caremark X X Vision Vision Service Plan X X Legal Services X X Legal Resources or U.S. Legal Services Inc. Page 22

23 ID Cards You will receive the following ID cards for your plans Name of Plan Type of Plan Are Cards Issued Caremark Prescription Yes CIGNA Open Access Plus In-Network Medical Yes United Concordia Dental Yes UnitedHealthcare Choice POS Medical Yes UnitedHealthcare Select EPO Medical Yes Vision Service Plan Vision No N/A Number of Cards Issued 1 if single 2 if two member or family One for each family member 1 if single 2 if two member or family 1 if single 2 if two member or family 1 if single 2 if two member or family Name(s) appearing on card Employee's name only. Plastic cardholder will indicate level of coverage. Each covered family member will get a card with his/her name on it. Employee's name only. Plastic cardholder will indicate level of coverage. Employee's name and covered dependents. Employee's name and covered dependents. You may print a paper ID card by logging on to vsp.com Legal Services Prepaid Legal Yes 1 card Employee s name Page 23

24 Retiree Coverage Page 24

25 Retiree Coverage Available Benefits during Retirement During open enrollment, you may drop, add or change benefit plans. You may elect any benefits listed for retirees in the Benefit Eligibility chart on page 3 of this brochure; provided you met the 36 month rule for each plan at the time you retired and continued to have coverage since. The only exception is the Legal Resources plan. You can enroll in this plan without having been previously enrolled. However, if you drop the medical, dental, prescription, and vision plans, you may not later re-enroll unless you show proof of continued coverage with a similar plan. Dependent Coverage Following your retirement, changes may be made in your benefits during each subsequent open enrollment. However, after you retire, new dependents are not eligible for coverage under the medical, dental, prescription or vision plans. You may not add a new spouse if you marry or re-marry after retirement nor can you add a domestic partner. Newborn, adopted children, and children for whom you obtain legal custody after you retire, also are not eligible to be covered under your plan. If you retire from the Commission and return as a term-contract employee, you may add eligible dependents including a spouse or domestic partner to an eligible medical plan and the prescription plan. You would be required to terminate your retiree coverage and elect coverage as a term contract at the current premium cost share for term-contract employees. However once you terminate your employment, you may not add those dependents to your retiree coverage. Only those dependents that were evaluated for eligibility at the time you retired are eligible for coverage. For example, your spouse may have similar coverage under another plan at the time you retire. As long as you have had the Health & Benefits Office analyze your spouse s eligibility under the 36 Month Rule at the time you retire and your spouse is determined to be eligible, then you may add your spouse after you retire, provided he/she can provide proof of continuous coverage and similar benefits during the period of coverage with another carrier. A HIPAA certificate will generally be considered acceptable for proof of coverage. This certificate can be requested from the other plan administrator. If you have enrolled a dependent that is later determined to be ineligible for benefits, your dependent will be dis-enrolled from the plan(s). Notice may be given to allow time for your dependent to find other coverage; however at no time will coverage exceed 3 months beyond notification date. You may also be responsible for the premiums and/or claims associated with the period during which your dependent was determined to be ineligible for coverage. Page 25

26 If upon investigation, it is determined that you have not been prudent about ensuring that your dependent is eligible, remains eligible, or becomes ineligible, you may lose your right to further retiree health coverage. If you retire and your domestic partner is eligible to receive benefits under your retiree coverage, you must provide documentation each year during open enrollment to recertify your partner. Because your retiree insurance premiums are deducted from your monthly annuity check on an after-tax basis, you will not have any imputed income as described in the beginning of this book. However, if you participate in the Commission s ICMA-RC RHS plan, you may only be reimbursed for your portion of the health premiums. You may not be reimbursed for the portion of the premiums attributable to your domestic partner and any dependents of your domestic partner, since the IRS currently does not recognize them as eligible dependents. If you have retired and your spouse and other dependents are currently under a non- Commission benefits plan, you will need to have your spouse and other dependents analyzed for eligibility under the 36 Month Rule. Please contact the Health & Benefits Office to have this analysis completed. If the Health & Benefits Office does not already have a copy, you must provide a copy of the marriage certificate and the spouse s birth certificate. 36-Month Rule for Retiree Coverage To be eligible for retiree health benefits (medical, dental, prescription, and vision), an employee and eligible dependents must provide proof of qualifying prior coverage for each plan elected. Qualifying prior coverage is 36 months of continuous coverage in a Commission or other insured plan immediately prior to retirement with the Commission. You as the employee are eligible as a dependent on your spouse s plan under this rule. You do not need to be in the same medical plan for the entire 36-month period. You must show proof of continuous health insurance coverage and similar benefits during the period of coverage with another carrier. Benefits including deductibles and out-of-pocket maximums must be similar. Many medical plans offer discounted plan features such as dental and vision. These discounted features do not qualify as insured plans. The 36- Month Rule does not apply to the prepaid legal plan, which is 100% retiree funded. Page 26

27 Delayed Enrollment The employee and all dependents must be qualified for retiree coverage in each plan, at the time the employee retires, regardless of whether the employee and/or dependent(s) will initially be enrolled, or defer enrollment because they are enrolled in the spouse s plan. If the employee defers enrollment for him of herself and spouse, then later decides to enroll, proof of continuous coverage must be provided for the period of time not covered under the Commission s plans. An employee who is retiring, may add a spouse who is not currently enrolled in a Commission health benefit plan(s) at the time of retirement, so long as the spouse can meet all requirements of the 36 month rule. Delayed enrollment may be for one of more plans. Benefit Changes If any benefits are reduced or if any benefit plans change, no participant is entitled to health benefits (medical, dental, prescription, vision) that he/she was not eligible for as of retirement. Benefit Premium Payments When you retire, your premium payments will be deducted from your monthly annuity check. If your annuity amount is not sufficient to cover all of your benefit premiums, you will be set-up for the Self-Pay Program to make payments. If you retire and are reemployed by the Commission, you must elect all benefits as a retiree and make payments through annuity deductions. If your monthly annuity check is not enough to cover premiums, you will be able to pay your portion through the Self-Pay Program, subject to the program requirements and policies in effect each year. Changing Medical Plans During open enrollment, you may choose from any of the available medical plans. If you move and the medical plan in which you are currently enrolled does not provide coverage at your new location, this becomes a qualifying event for you to elect another medical plan within 45 days of your move. If you are over 65 you may choose any medical plan. If you choose the UnitedHealthcare Choice Plus POS, you will be automatically enrolled in the UnitedHealthcare Medicare Complement plan and your dependents under age 65 will be enrolled in the UnitedHealthcare Choice Plus POS. Vision Options: You may also choose between low, moderate and high vision options, if you were initially eligible for vision coverage as a retiree. Page 27

28 After you retire, you may not add any benefit plans for which you were not eligible at retirement. Employees Eligible to Retire On Their Date of Termination and Postpones Retirement You and your eligible dependents may elect retiree benefits as of your retirement annuity commencement date, providing you meet all requirements of the 36-Month Rule and you are eligible to retire (either a normal or early retirement) as of the date of your termination with the Commission. You will not be eligible for retiree benefits during the period of time you have chosen to defer or post pone your retirement and therefore your annuity payments. You must provide proof of continuous coverage from your termination date to the date you decide to enroll in the Commission s benefit plans as a retiree. Opt-In / Opt-Out Provision The Commission allows covered retirees and their dependents to cancel their existing Commission health insurance coverage and re-enroll at a later date if the retiree and dependents can show proof of similar continuous health insurance coverage and benefits during the period of coverage with another carrier. Continuous coverage does not include Medicare coverage. Re-enrollment can only occur during open enrollment with the exception of a qualifying event (i.e.: loss of spousal coverage, divorce etc.). Benefits, including deductibles, must be similar. For example, a catastrophic coverage plan with a high deductible (i.e.: $5,000) would not be considered a plan with similar benefits. A plan would not be considered high deductible so long as the deductible for an individual does not exceed $3,000. If you are eligible to retire when you terminate your employment with the Commission, you may postpone receiving your annuity to avoid age reduction. You will be eligible to enroll for retiree benefits when you begin to receive your postponed annuity, if you were eligible to continue the retiree coverage in retirement. You must meet the 36 month rule and provide proof of continuous coverage when you retire and again when you begin to receive your annuity. Page 28

29 Current Rates Page 29

30 Retired Employees and Survivors Premium Rates Effective January 1, 2016 Retirees and survivors except for those who are 65 and older and enrolled in the Medicare Complement plan. See below. Cost Share % SINGLE COVERAGE Full Monthly Rate Monthly Commissi on Contributi on Monthly Retiree and Survivor Contributi on $$ Change in Retiree Contributi on From 2015 Monthly COBRA Rates Caremark Prescription 80%/20% $ $ $40.40 $6.40 $ CIGNA Open Access Plus In EPO 80%/20% $ $ $ $10.80 $ UnitedHealthcare Choice Plus POS 80%/20% $ $ $ $0.00 $ UnitedHealthcare Select EPO 80%/20% $ $ $86.80 $0.00 $ United Concordia Dental 80%/20% $36.93 $29.55 $7.38 $0.00 $37.67 Vision Service Plan - Low 80%/20% $3.90 $3.12 $0.78 $0.00 $3.98 Vision Service Plan - Moderate See notes $6.94 $3.12 $3.82 $0.00 $7.08 Vision Service Plan - High See notes $10.13 $3.12 $7.01 $0.00 $10.33 TWO-MEMBER COVERAGE Caremark Prescription 80%/20% $ $ $80.80 $12.80 $ CIGNA Open Access Plus In EPO 80%/20% $1, $ $ $21.60 $1, UnitedHealthcare Choice Plus POS 80%/20% $1, $ $ $0.00 $1, UnitedHealthcare Select EPO 80%/20% $ $ $ $0.00 $ United Concordia Dental 80%/20% $73.85 $59.08 $14.77 $0.00 $75.33 Vision Service Plan - Low 80%/20% $7.83 $6.27 $1.56 $0.00 $7.99 Vision Service Plan - Moderate See notes $13.89 $6.27 $7.62 $0.00 $14.17 Vision Service Plan - High See notes $20.27 $6.27 $14.00 $0.00 $20.68 FAMILY COVERAGE Caremark Prescription 80%/20% $ $ $ $19.20 $ CIGNA Open Access Plus In EPO 80%/20% $1, $1, $ $32.40 $1, UnitedHealthcare Choice Plus POS 80%/20% $1, $1, $ $0.00 $1, UnitedHealthcare Select EPO 80%/20% $1, $1, $ $0.00 $1, United Concordia Dental 80%/20% $ $88.63 $22.15 $0.00 $ Vision Service Plan - Low 80%/20% $11.73 $9.39 $2.34 $0.00 $11.96 Vision Service Plan - Moderate See notes $20.84 $9.39 $11.45 $0.00 $21.26 Vision Service Plan - High See notes $30.41 $9.39 $21.02 $0.00 $31.02 Page 30

31 MEDICARE COMPLEMENT AND SPLIT FAMILY COVERAGE Post65 Retiree and all dependents in the UHC Medicare Complement Plan Single Coverage 80%/20% $ $ $52.20 $3.20 N/A Two Member Coverage 80%/20% $ $ $ $6.40 N/A Family Coverage 80%/20% $ $ $ $9.60 N/A Split Families in the UHC Medicare Complement Plan and POS Plans One in Complement/One in POS 80%/20% $ $ $ $3.20 N/A One in Complement/Two in POS 80%/20% $1, $1, $ $3.00 N/A Two in Complement/One or more in POS 80%/20% $1, $ $ $6.40 N/A Legal Resources 0%/100% $17.00 $0.00 $17.00 ($1.00) U. S. Legal Service - Legal Services 0%/100% $15.50 $0.00 $15.50 $0.00 Notes: Prescription drug coverage is separate from medical plans. Vision: (Commission pays/ Employee pays) Low Option: 80%/20%. Moderate and High Options: 80% of low plan/employee pays balance. Page 31

32 The Maryland-National Capital Park and Planning Commission Health & Benefits Office, Human Resources 6611 Kenilworth Avenue, Suite 404, Riverdale, MD Page 32

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