Health and Dental Insurance Questions/Answers for Retirees

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1 Health and Dental Insurance Questions/Answers for Retirees What happens with my health insurance if I continue to work full-time beyond age 65? As an active full-time employee working beyond the age of 65, your health insurance will continue under the APS health insurance plan as any other active employee until you retire. However, Social Security requires that you enroll in the Medicare Part A Plan. There is no monthly cost for Medicare Part A. If my spouse turns 65 while I am still actively employed, what happens to their health insurance? Your spouse s coverage will continue under the APS health insurance active plans until you retire. However, Social Security requires that your spouse enroll in the Medicare Part A Plan. There is no cost to Medicare Part A. Will I have health insurance coverage during retirement under an APS group plan? In most cases, retirees are able to continue health and/or dental insurance into retirement as a lifetime benefit. Will my spouse and/or children be able to continue health and/or dental insurance coverage during my retirement under my APS group plan? A spouse/and or dependent children must be covered under an APS plan for a minimum of 5 consecutive years prior to your retirement in order to continue coverage under your APS Plans as dependents. What happens to my spouse and/or children s health/dental coverage if they have not been covered for 5 consecutive years prior to my retirement? Your spouse and/or dependent children will be offered coverage under COBRA for up to 36-months. The alternative is you may research a health insurance plan through the Affordable Healthcare website at What happens to my children s coverage upon my retirement? If your dependents have been covered for a minimum of 5 consecutive years, your children will remain covered under your APS plan until age 26. At age 26, over-aged dependents are offered COBRA at full cost for up to 36 months. If I do not elect to continue medical and/or dental insurance at the time of my retirement, can I elect coverage at a later date? No, once you or your spouse or children cancel coverage under an APS plan at the time or your retirement or during your retirement, there is no future opportunity to re-enroll at a later date. Page 1

2 What happens to my family s coverage in the event of my untimely death? Your spouse will be offered continued insurance as a lifetime benefit at the full cost. Your children will be offered continued insurance until the age of 26 at full cost. At age 26, over-aged dependents are offered COBRA at full cost for up to 36 months. If I do not elect medical and/or dental insurance at the time of my retirement, can I elect coverage at a later date? No, once you or your spouse or children drop coverage under an APS plan, there is no future opportunity to reenroll at a later date. Will my spouse/dependents and I be able to continue to participate in my Cigna plan once I retire? In most cases, if you and your eligible dependents are not Medicare eligible. How do I pay my monthly Cigna premium? In some cases, the premium can be deducted from your monthly pension check. In some cases, you must pay your monthly premium directly to Arlington Public Schools. **When can I sign up for Medicare Part A & Medicare Part B? **If you're eligible when you turn 65, you can sign up during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. When I retire, I will be over 65, what will happen to my Cigna health insurance? You must enroll in Medicare Parts A & B through Social Security or Medicare at least days before retirement. You will no longer be eligible for the Cigna Health Insurance Plans once you retire. During your retirement consultation from Arlington Public Schools, you will receive a United Healthcare (UHC) Senior Supplement Insurance packet. The packet will contain three enrollment forms. o One enrollment form will be to enroll in the medical portion of the plan; supplement to Medicare Part B. o The remaining two forms will be to enroll in the prescription portion of the plan; Medicare Part D, the Rx Plan through UHC. Once the forms are completed, they must be mailed directly to United Healthcare for processing. The forms must not be returned to Arlington Public Schools. If you are a Kaiser participant, during your retirement consultation from Arlington Public Schools, you will receive a will receive the Kaiser Medicare Plus packet to complete. Page 2

3 What happens to my Cigna coverage once my spouse and I turn 65 post retirement? You will no longer be eligible for the Cigna Health Insurance Plans. It is required that you and your spouse enroll in Medicare Part A and Medicare Part B prior to your respective 65 th birthdates. You will automatically be offered a supplement Plan under the United Healthcare Senior Supplement Plan before your respective 65 th birthdate. The packet will be mailed to your home address directly from UHC. The packet will contain three enrollment forms. o One enrollment form will be to enroll in the medical portion of the plan; supplement to Medicare Part B. o The remaining two forms will be to enroll in the prescription portion of the plan; Medicare Part D, the Rx Plan through UHC. Once the forms are completed, they must be mailed directly to United Healthcare for processing. The forms must not be returned to Arlington Public Schools. How do I know if my enrollment forms have been accepted by United Healthcare? United Healthcare will issue to you by mail under separate covers to the address APS has on file: A Welcome Kit A medical supplement ID card A prescription ID card A medical invoice A prescription invoice Can the monthly UHC premium be deducted from my monthly pension check? If your monthly Cigna health insurance premiums are being deducted from your pension check, it will automatically be stopped by APS. The United Healthcare premium payments cannot be deducted from your monthly pension check. However, with each invoice, there will be information to complete to have United Healthcare deduct the monthly premium from your personal bank account, if you choose. Once you have setup auto pay with UHC, it will remain in effect until you cancel it. Under Medicare, what are Medicare Part A, Medicare Part B and Medicare Part D? Medicare Part A = Hospitalization Medicare Part B = Outpatient services 80% after $147 annual deductible (2015) Medicare Part D = Rx Drug prescription program Page 3

4 What happens to the Medicare coverage when I enroll in the UHC Plan? Medicare will be your primary insurance coverage; UHC will be your secondary insurance coverage. All claims will be paid by Medicare first. After the 2015 Medicare annual $147 deductible is met, office co-pays are $20/primary care doctor and $20/specialist for covered services. Medicare will pay 80% of covered medical expenses. Medicare will then submit the balance of the claim to UHC. UHC will pay 20% of covered medical expenses. When I visit the doctor, what health insurance card will I present? When visiting your doctor, always present BOTH your Medicare ID card and the United Healthcare Senior Supplement ID card. How do I know if my doctors will accept United Healthcare? Your primary insurance coverage will be Medicare. If your doctor accepts Medicare, you do not have to be concerned about a United Healthcare network of physicians. How are my claims paid? Your physician will submit the claim to Medicare for processing. In turn, Medicare will forward the balance of the claim to United Healthcare for processing. You will not have to coordinate the two insurance plans yourself. Claims processing are automatically coordinated behind the scenes between the two insurance plans. Are there co-pays for doctor s office visits? Medicare has an annual deductible of $147 (2015). Once the annual deductible has been met, office visit co-pays are $20 for primary care physicians and for specialist. What is the co-pay for specialist physician s office visit? Medicare has an annual deductible of $147 (2015). Once the annual deductible has been met, office visit co-pays are $20 for specialist. My spouse is under 65, will he/she be covered under the United Healthcare Plan? No, this Plan is only for those who are Medicare eligible. Spouses under 65 will continue to be covered under the Cigna Plan until the first day one of their 65 th birth month. I am under 65 but my spouse is over 65. How will we be covered? You will continue to be covered under the Cigna Plan until you turn age 65; your spouse will enroll in the United Healthcare Senior Supplement Plan. Page 4

5 What is the cost of health insurance after I retire? The cost of health insurance for retirees is based on full-time years of service with APS, level of coverage and the health insurance plan in which you are enrolled. Monthly premiums for retirees can be found on the APS website. How are my prescriptions covered under the UHC Plan? Prescriptions are covered under the Medicare Part D portion of the Plan. You may purchase medications at the pharmacy and through the mail-order program. A sample list of medications covered can be found in the United Healthcare packet. The 2015 cost for covered medications purchased at the pharmacy can range from $10 to $40 for a 31- day supply. The 2015 cost for covered medications purchased through the mail-order program can range from $20 to $80 for a 90-day supply. Is there a Customer Service number to call to ask questions directly to UHC? UHC Senior Supplement Customer Service UHC/Medicare Rx Customer Service I am a Kaiser Permanente-HMO participant? Can I continue this coverage into retirement? Yes, in most cases, if you and your eligible dependents are not Medicare eligible. How is my Kaiser monthly premium paid? In some cases, the deduction can be taken from your monthly pension check. In some cases, the premium must be mailed directly to Arlington Public Schools each month. What happens to my Kaiser Permanente HMO plan once my spouse and I turn 65 post retirement? Kaiser will automatically send you and your spouse before your respective 65 th birthday offering you the Kaiser Medicare Plus Plan. The packet will contain a five (5) part enrollment form. o Part 1 will be to fill in your personal demographic information o Part 2 will be to fill in your Medicare information o Part 3 will be to fill in your Kaiser primary care physician s information o Parts 4 & 5 are signature pages Once the forms are completed, they must be mailed directly to Kaiser for processing. The forms must not be returned to Arlington Public Schools. Page 5

6 How do I know if my enrollment forms have been accepted by Kaiser Medicare Plus plan? Kaiser will issue to you by mail to your home address: A Welcome Kit An ID card How do I pay my monthly Kaiser Medicare Plus premium? In some cases, the premium can be deducted from your monthly pension check. In some cases, you must pay your monthly premium directly to Arlington Public Schools. If I am a Kaiser Permanente-HMO plan participant and I move outside of the Kaiser service area during my retirement what happens to my insurance? You must contact APS to update your address: If you, spouse, dependents are under 65, you will then be offered the opportunity to enroll in one of the Cigna Plans for you and your family. If you and/or spouse are over 65, you will then be offered the United Healthcare Senior Supplement plan. Coverage is always based on the Retiree s enrollment. What happens with my Delta Dental coverage? Retirees are eligible to elect to continue their Delta Dental coverage. What is the cost of the Dental coverage once I retire? The cost is based on the coverage level you elect; Retiree only Retiree and spouse Retiree and child(ren) Retiree and family Reminder: Retirees and their covered dependents, when first eligible (typically at age 65 or earlier if receiving Social Security disability benefits) must enroll and continue active participation in Medicare Parts A & B. Failure to enroll for Medicare Part A & B will jeopardize health insurance benefits and will result in claims being denied. Please remember to update your address and phone number with APS if you move. Page 6

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