Connecticut State Teachers Retirement Board Health Plan. Administered by Stirling Benefits, Inc 2013

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1 Connecticut State Teachers Retirement Board Health Plan Administered by Stirling Benefits, Inc 2013

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3 1/3 Active 1/3 Retiree 1/3 State of CT

4 TRB subsidies Retirees receive either: Local Board subsidy $110 per retiree or spouse per month $220 per month if not eligible for Medicare Or TRB coverage subsidy Two thirds (66%) of the cost of Medical & RX Once join TRB plan, TRB no longer pays local board

5 TRB -- Who is eligible?

6 To obtain Medicare Need 40 Quarters of Eligible Employment, or Married 10 years to someone who has 40 quarters Part A -- paid by Medicare Part B -- Cost Share with Retiree Pre 1987 hires may not have 40 quarters TRB members don t need Part D

7 Medical Prescription Dental Vision and Hearing

8 TRB plan process No Network No paper claims to file Any provider that accepts Medicare Claims paid by Medicare first, then sent electronically to Stirling Benefits

9 TRB Medical Covers what Medicare allows Same as Blue Cross High Option No network, No Copayments, No preexisting Condition limitations No individual underwriting Picks up remainder after Medicare pays Coverage the same everywhere in the US and Puerto Rico

10 Claim Examples under Medicare Under Medicare, doctors either accept assignment (agree to accept Medicare allowance as full payment) or do not accept assignment (can charge up to 15% more than Medicare allows). Assigned claims Un Assigned Claims Doctor Charge $130 $130 Medicare Allows $100 $100 Medicare Pays $80 $80 TRB Pays $20 $20 15% Extra Billing - $15 TRB Pays - $12 Member Pays $0 $3

11 New for 2013 Shingles vaccine covered 80 % - maximum reimbursement $200 Aetna dental members offered discounts Discounts for some gym memberships, weight loss programs, hearing devices, acupuncture, chiropractic, vitamins, herbal and nutritional supplements

12 Out of Country In-Patient Hospital 30 days at 100% Physician s charges paid at 80% Non-Emergency Only 20% for services usually covered by Medicare Cannot be used for experimental procedures.

13 Rx Benefits Administered by CVS Caremark $250 Annual Deductible per Person Maximum Out-of- Pocket is $1,000 ($250 deductible + $750 of cost share) 100% benefits for the remainder of the year

14 Retiree Payments for Rx Generic Drugs Preferred Drugs Non- Preferred Acute at Pharmacy 5% 20% 30% Maintenance at Mail Order Maintenance at Pharmacy 5% 20% 30% 10% 25% 35%

15 Lifetime Maximums Unlimited maximum on Hospitalizations Unlimited maximum on Basic Medical Unlimited maximum on Prescriptions $1 M max on a small portion of remaining claims (totaling about 3% of the total claims) Applies to: out of country, extra 15% on unassigned Medicare claims, extra 20 days of skilled nursing care No member has ever hit $100,000 under the $1M limit, much less $1M

16 Dental $43.00 / Month Administered by Aetna Dental $50 annual deductible 100% cleanings 80% basic restorative 50% Major Restorative $2,000 annual maximum In or Out-of-Network coverage

17 Vision & Hearing $5.00 / Month Vision Exams: $75 every 12 months $100 toward frames and $60 - $200 allowance for lenses every 24 months $120 toward contacts per calendar year Hearing Aids: $750 every three years

18 Medical / Rx $99 $112 $125 $124 $117 Medical/Rx & Dental Medical / Rx Dental Vision & Hearing $144 $160 $74 $173 $160 $149 $165 $179 $180 $165

19 How members enroll Fill out one form per person (Stirling or TRB website) Send form with proof of Medicare to TRB (not to Stirling) Must be received by the 25 th of the second month preceding coverage (May 25 for July 1) Cancel current Board of Education coverage

20 For More Information Stirling Benefits, Inc. 20 Armory Lane, Milford, CT (203) , ext. 0, StirlingBenefits.com Teachers Retirement Board 765 Asylum Avenue, Hartford, CT (800) , fax: (860) , CVS CareMark (800) Aetna Dental (855) Medicare (800) Medicare.gov

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22 Who s on what plan? Local School Plan TRB Plan Under age 65 6, or older 9,755 19,225 Total 16, Source: 2012 TRB Cavanaugh Macdonald Actuarial Report As of July 1, 2012

23 Ø Governed by the Connecticut Teachers Retirement Board (TRB) Ø Administered by Stirling Benefits Ø Began service to TRB in 1996 Ø Service company, not an insurance company Ø Based on the Blue Cross High Option

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