focus Retiree Open Enrollment What s New for You in FY17? Open Enrollment is May 11 th to May 25 th Open Enrollment Information Meetings

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1 Retiree Open Enrollment focus What s New for You in FY17? It s here again! This May s Open Enrollment is the opportunity for pre-medicare retirees and Medicare retirees to make insurance changes. Any change will be effective July 1, Here is some important news regarding the County s retiree health plans: Premiums Premiums for health insurance are changing. Please review the charts on pages 6 & 7 to see your new share of the monthly premium. Delta Dental coverage stays exactly the same with no premium increase. Any plan or premium changes for the Kaiser Medicare Plus plan and the AmWINS Medicare Supplement Plan will not be known until the fall of Any changes will not be effective until January 1, Health Plan Change Highlights Good news! There are no changes to the out-ofpocket maximums for any of our health plans. Cigna Plans Telemedicine Service available Prescription Drug Formulary changes Life Insurance Coverage and Rate Changes in your April 2016 Pension Payment Basic Life If you turned 65 after April 1, 2015, your basic life insurance coverage will reduce from $10,000 to $8,000 Supplemental Life Open Enrollment Information Meetings Monday, May 16 th at 10 a.m. Central Library Auditorium 1015 N. Quincy Street, Arlington, VA Wednesday, May 18 th at 4 p.m. Online Webinar Details to be provided at If you turned 65 after April 1, 2015, your supplemental life insurance coverage reduces to $10,000 and your premium deduction will change accordingly Supplemental life insurance premiums are based on your age, and rates are divided into five-year bands until you reach age 70. If you have changed age bands since April 1, 2015 (e.g., age 59 to 60), your new deduction will reflect the higher premium. Open Enrollment is May 11 th to May 25 th

2 Open Enrollment Actions P A G E 2 During Open Enrollment, if you are a pre-medicare retiree you may: Switch from Cigna to Kaiser or vice versa Choose a different Cigna plan Add/drop eligible dependents Enroll in or cancel dental coverage During Open Enrollment, if you are a Medicare participant you may: Switch from AmWINS to Kaiser Medicare Plus or vice versa Add/drop eligible dependents Enroll in or cancel Delta Dental coverage Are You Eligible to Participate? Who is eligible to participate in this Open Enrollment? You must meet one of the criteria below: Retiree and/or dependent who is currently enrolled in Cigna or Kaiser Retiree and/or dependent who is currently enrolled in AmWINS or Kaiser Medicare Plus Retiree who retired after 6/30/2008, who is not currently enrolled in a County plan, but who can demonstrate continuous medical coverage in another plan How Do I Make Insurance Changes? Visit and click on Open Enrollment to access all of the enrollment forms, rate charts, and plan summaries for our health and dental plans. To make changes please fill out the appropriate enrollment forms Submit completed forms via mail or by May 25 th : Arlington County Human Resources ATTN: Benefits 2100 Clarendon Blvd., Suite 511 Arlington, VA OR benefits@arlingtonva.us Subject: Open Enrollment All changes are effective July 1, No changes? Then you have nothing to do this Open Enrollment! Questions? Call us at option 1 or your questions to benefits@arlingtonva.us Turning 65? Welcome to Medicare! Please remember that if you participate (as a retiree or a dependent) in an Arlington County Retiree Health Plan, when you turn 65 you must enroll in Medicare Part B in order to continue to receive medical coverage through the County. Questions? Call Benefits at option 1.

3 P A G E 3 Pre-Medicare Plans Overview Kaiser Permanente Signature HMO Provides one-stop medical care at Kaiser facilities throughout the DC metro area Preventive Care covered at 100% Coverage for non-kaiser providers only in cases of emergency Most economical plan in terms of monthly premiums and copays Cigna All Cigna Plans Offer: Open Access Plus (OAP) network a national network of providers and facilities No referrals needed for specialist care Preventive Care covered at 100% Emergency and Urgent Care covered 24/7 worldwide Prescription drug coverage is the same for all three plans Three tiers: generic, preferred brand, nonpreferred brand Certain generic drug are FREE via mail order. Review the Cigna formulary on the retiree website. Mail order required for most maintenance medications If your doctor prescribes a non-preferred brand name drug, you may be required to try a generic or preferred brand drug before the more expensive drug is authorized Delta Dental Use any licensed dentist for your dental care Save money when you use a dentist who participates in the Delta Dental Premier or Preferred network The plan pays: 100% of reasonable and customary fees for preventive care and diagnostic services (e.g., cleanings and x-rays) 80% for Basic Services (e.g., fillings) 50% for Major Services (e.g., crowns) Annual calendar year for Basic and Major Services of $55 individual/$110 family Plan pays maximum of $1,500 per calendar year What are the differences among Cigna plans? Open Access Plus In-Network (OAP IN) Coinsurance Choose doctors, health professionals and facilities that are within the Cigna OAP national network (no coverage for out-of-network providers) You pay 10% of the allowable cost for services; the plan pays for 90% Lowest premiums of all Cigna plans No Out-of-pocket maximum (OOPM) is $2,250 individual/$4,500 family.* This is the lowest OOPM across all plans. Open Access Plus IN (OAP IN) Copay Choose the doctors, health professionals and facilities that are within the Cigna OAP national network (no coverage for out-of-network providers) You pay a flat dollar copay for services No Out-of-pocket maximum is $6,600 individual/ $13,200 family* Open Access Plus (OAP) Most expensive premiums across all plans Choose any doctors, health professionals or facilities that are in or out-of-network Select a provider within the Cigna OAP national network and pay 10% of the allowable cost for services Pay a when you select an out-ofnetwork provider; the County pays 70% of allowable charges after the is met Out-of-pocket maximums are: in-network $2,250 individual/$4,500 family; and out-ofnetwork $3,250 individual/$6,500 family *Monthly premium deductions do not count toward your out-of-pocket maximum To see if your provider is in the OAP network: Go to and Click on Find a Doctor Fill in your search criteria and Click Search If OAP is listed under Plans Accepted, your provider is in-network.

4 Changing Plans May Impact Out-of-Pocket Maximum The out-of-pocket maximum (OOPM) is a financial safety net required by the Affordable Care Act to protect you against catastrophic medical bills. The OOPM is the most you will pay out-of-pocket during the calendar year for covered health services. Once you meet the OOPM, the plan pays 100% for the rest of the calendar year. Your Out-of-Pocket dollars are tracked on a calendar year basis. Every January 1 st, you start at $0 and begin to refill your bucket until your reach the OOPM for your plan. From To OOPM Impact Cigna Plan Different Cigna Plan Any out-of-pocket expenses WILL count toward the OOPM for the new plan Kaiser Cigna Expenses incurred in the old plan WILL NOT count Cigna Kaiser toward the OOPM for the new plan. On July 1 st, your OOPM starts at $0 with your new insurance and will Non-County plan Either Cigna or Kaiser reset again on January 1 st. Introducing! There s never a good time to get sick or hurt, but why does it always seem to happen in the middle of the night or on the weekend when the doctor s office is closed? Telemedicine could be the answer! MDLIVE is Cigna s new partnership that provides members with access to primary care and pediatric doctors anytime and anywhere. MD Live provides video, phone or on-demand access to US board-certified doctors. It s a convenient and affordable way for you to get quality healthcare and prescriptions for non-emergency medical issues. Register online before you get sick. Visit Registration begins June 15 th. Welcome packets will be sent in the mail to all Cigna subscribers with more information This service is available to our Cigna subscribers effective July 1 st When should I use MDLIVE? For non-emergency medical issues When you are traveling When it s inconvenient to leave your home or office How much will it cost? $30 on the Cigna OAP-IN Copay plan 10% of the contracted rate on the Cigna OAP-IN Coinsurance plan about $3.80 There is a pending charge of $38 on your credit card while your Cigna coverage is confirmed. Cigna Formulary Changes Coming July 1, 2016 Cigna will be making some minor changes to the Prescription Drug Formulary effective 7/1/2016. A formulary is the list of drugs covered under the plan. Formulary changes are one way to help manage the rising costs of prescription drugs. What this means for members is that some drugs may change from preferred to nonpreferred, and some will no longer be covered. Less than 100 of our members are impacted by the upcoming changes, and they will receive a letter from Cigna explaining their options sometime in May. Please read the letter carefully and discuss your options with your doctor.

5 Service FY17 Pre-Medicare Health Plan Options Out-of-Pocket Costs (excluding premiums) Effective Juy 1, 2016 Kaiser Copay Plans Coinsurance Plans Cigna OAP IN In-Network Only Cigna OAP IN In-Network Only Annual Deductible* $0 $0 $0 $0 Out-of-Pocket Maximum** $3,500 Individual $9,400 Family $6,600 Individual $13,200 Family PCP Office Visit $20 $30 Specialist Office Visit $40 $60 Physical Therapy $40 $45 $2,250 Individual $4,500 Family ($8 - $12) *** ($20 - $30)*** ($8 - $12)*** Cigna OAP In-Network Out-of-Network $2,250 Individual $4,500 Family $300 Individual $600 Family $3,250 Individual $6,500 Family 30% Coinsurance after 30% Coinsurance after 30% Coinsurance after Preventive Care No Charge No Charge No Charge No Charge No Charge Inpatient Hospital $200/admission $500/admission Outpatient Surgery/ Procedures Specialty Imaging (MRI, CT Scan) $100/visit $250/visit $75/test $100/visit Urgent Care $40/visit $75/visit Emergency Room $150/visit $200/visit Prescription Drugs- Retail (generic/preferred/ nonpreferred) Prescription Drugs Mail Order 90 day supply $15 / $30/ $55 KP $20 / $45 / $60 Network $30 / $60 / $110 ($400 - $2,000)*** ($80 - $559)*** ($50 - $200)*** ($30 - $100)*** ($50 - $200)*** $10 / $30 / $55 $10 / $30 / $55 $10 / $30 /$55 $20 / $60 / $110 Certain generics available at $0 via mail $20 / $60 / $110 Certain generics available at $0 via mail $20 / $60 / $110 Certain generics available at $0 via mail $250 plus 30% Coinsurance $250 plus 30% Coinsurance 30% Coinsurance after after after In-Network coverage only In-Network coverage only NOTE: All Cigna plans use the Open Access Plus (OAP) network. This is a national network of providers. * Annual Deductible member must pay this amount out-of-pocket before the plan will cover services. ** Out-of-Pocket Maximum (OOPM) the Plan will pay 100% for covered services after a member reaches this limit. The OOPM is tracked on a Calendar Year basis and resets every January 1 st. Monthly premiums do not count toward reaching the annual OOPM. *** These are estimated average ranges for your out-of-pocket costs. Your actual costs may vary. P A G E 5

6 P A G E 6 Medicare Plans Overview Retirees and their dependents who participate in the County health insurance plan must enroll in Medicare Part B when they turn 65 in order to continue on a County health plan. At age 65, Medicare becomes your primary health insurance and the County plan provides access to coverage beyond traditional Medicare through our Kaiser Medicare Plus Plan or the AmWINS Medicare Supplement Plan. Both plans are used in conjunction with Medicare Parts A and B, and provide you with Part D prescription drug coverage. Kaiser Medicare Plus Plan Only available to enrollees in the Washington DC Metropolitan area. One-stop medical services at Kaiser facilities; referral required for network hospitals and specialists $10 copay for in-network Medicare-covered primary and specialist office visits Diagnostic hearing exam covered; $10 copay for routine eye exams Retail prescription drug copays of $10/$33/$45/$95 (Tier 1, Tier 2, Tier 3, Tier 4) AmWINS Medicare Supplement See any provider who accepts Medicare No Part B to meet $20 Primary and $40 Specialist office visit copays Coverage for routine hearing and vision exams Retail prescription drug copays of $10/$30/$55 (Tier 1, Tier 2, Tier 3) Coverage summaries are available at and click on Open Enrollment 2016 Medicare Plans Monthly Premium Rates - Retired before 1/15/12 Rates Effective January 1, 2016 December 31, 2016

7 FY17 Retiree Premium Rates Retired before 1/15/12 (Pre-Medicare Plans; Monthly Premiums Effective July 1, 2016) P A G E 7

8 P A G E 8 FY17 Retiree Premium Rates Retired on or after 1/15/12 (Pre-Medicare Plans; Monthly Premiums Effective July 1, 2016) Questions about Open Enrollment? HR Benefits Customer Service at , Option 1 Benefits@arlingtonva.us