2015 County of Kern Retiree Health Benefits

Transcription

1 2015 County of Kern Retiree Health Benefits IMPORTANT * IMPORTANT * IMPORTANT Important items to note: Health benefits do not continue automatically upon retirement. The retiring employee MUST apply for retiree coverage. You must have at least 5 years of Kern County qualified service to enroll in retiree health benefits. Retiring employees should apply for retiree health benefits at the CAO-Health Benefits Division approximately one month before their retirement date. Anyone wanting retiree coverage must apply before the end of the 30 day grace period following the permitting event (e.g. retirement date, loss of group coverage). Anyone who does not apply by the expiration of their grace period loses eligibility until the next open enrollment. Retiree open enrollment is usually held each Fall, but is not a guaranteed annual event. If there is any gap in health benefits coverage, the retiree may not be eligible in the future for any County contribution toward retiree health benefit coverage. Retiree plans and policies may be updated from time to time. Any questions about current health benefits should be directed to the CAO-Health Benefits Division at (661) Visit our website at for additional information.

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3 TABLE OF CONTENTS Checklist... 1 Non-County options... 2 Important Notices... 3 Enrollment Instructions... 4 How much will health benefits cost?... 5 What is COBRA?... 5 COBRA Rates... 6 Estimate Work Sheet... 7 Examples... 8 County Contribution Reminders Stipend Program... 9 Supplement Program (Retiree Health Premium Supplement Program) Premiums paid in advance Update delay Partial month coverage Adult Children MediCare Retiree Health Benefits Policy Rates and plan summary information (chart): Under 65 Plans Over 65 Plans Overview of available plans Plan summaries Under 65 Plans Over 65 Plans Dental plan information Contact information... 43

4 Retiring Employee Health Benefits Checklist It is suggested that you do the following about one month prior to your retirement date. The grace period to enroll expires 30 days after retirement. 1) Medical Plan: IF you wish to have County retiree medical benefits after you retire, complete the medical plan(s) enrollment form(s) for the plan(s) you are selecting and turn in to the CAO-Health Benefits Division located at 1115 Truxtun Avenue, 1st Floor in Bakersfield, CA. Over age 65: Anyone over age 65 enrolling in County retiree health benefits will need to have or obtain Medicare Part A and Part B. Medicare may require you to bring a form to this office so they have all the information they need. This applies to the retiree and any dependents being enrolled in County retiree medical coverage. 2) Dental Plan: IF you wish to have County dental benefits after you retire, you have two choices: (1) enroll in County retiree HMO dental by completing an enrollment form and submitting with your County retiree medical form, or (2) continue your current employee dental coverage for 18 months through COBRA by responding to the COBRA notice that is mailed to your home after your retirement date. 3) Vision plan: The County does not offer a vision plan to retirees. You may continue your current vision coverage for 18 months through COBRA by responding to the COBRA notice that is mailed to your home after your retirement date. 4) Planning Meeting (Optional, but highly recommended): The County Administrative Office Health Benefits Division holds planning meetings which provide you with the information and forms you need to make decisions about your health benefits after retirement. Please call (661) to reserve a seat in a meeting. 5) Cost (Optional): You may estimate the cost of your retiree coverage by using the Estimate Worksheet that is posted on click on the Retiree Health Benefits link. Other non-county dental/vision options (over) 1

5 The following are programs available in the community to Kern County retirees, but are NOT County sponsored. REOKC programs: The Retired Employees of Kern County (REOKC) is a local association authorized under IRS section 501(C)(4) whose membership is limited to former employees of the County of Kern, and whose income is devoted exclusively to charitable, educational, or recreational purposes. REOKC offers certain supplemental insurance programs to their members. REOKC members have monthly luncheon meetings during which speakers present information of interest to the members. Retirees may join the association by contacting REOKC at PO Box 2592; Bakersfield Ca or ing info@reokc.org. Insurance programs offered by REOKC include dental, vision and other programs. Please contact Pacific Group Agencies, Inc. for more information at 1(800) or VSP vision program: VSP offers an individual vision plan in the Kern County area. If you are interested, call Sharon at Sidles, Duncan & Associates at (512) Medicare: Medicare is administered by CMS (Centers for Medicare and Medicaid services). The County cannot counsel members about Medicare. Please contact Medicare at MediCare if you have questions about Medicare. Management and KCFFU retirees ONLY: Questions about the PEHP should be directed to Nationwide Retirement Services at 1(877) , option 4 or go to: click on Employee/Retiree Benefits, then click on PEHP. PLEASE DO NOT CALL Kern County Health Benefits or Kern County Employees Retirement Association (KCERA) about the programs on this page. S:\HLTHBEN\Forms & Booklets\Retiree\Retiring Employee.doc 2

6 COUNTY ADMINISTRATIVE OFFICE MEMORANDUM John Nilon County Administrative Officer TO: FROM: SUBJECT: RETIRING EMPLOYEES HEALTH BENEFITS DIVISION Retiree Health Benefits The County Administrative Office-Health Benefits Division administers health benefits for Kern County retirees. If you have questions about health benefits upon retirement, please direct those questions to the CAO-Health Benefits Division, not to the Kern County Employees Retirement Association. Several important points to note: As a retired County employee, you are generally entitled to purchase County retiree health plan coverage if you had at least five (5) years of Kern County service and you receive a monthly pension check from the Kern County Employees Retirement Association. Health benefits do NOT continue automatically upon retirement. You must request enrollment. We recommend that you complete and turn in your enrollment papers about one month before retirement. You must enroll in retiree health coverage before the 30 day grace period expires or you will lose eligibility until the next open enrollment and you may lose County contributions. The County may contribute toward the cost of medical health benefits coverage through two programs: the Retiree Stipend Program and the Retiree Health Premium Supplement Program. This packet contains information about those programs. The County dental plan available to retirees is the Liberty Dental HMO. You may enroll in this plan at the time you retire by completing appropriate forms at the CAO-Health Benefits division. If you are currently enrolled in Liberty Dental PPO and wish to temporarily continue that coverage instead, it may be purchased through COBRA for a period (usually 18 months) following retirement. There is NO County vision plan for retirees. Vision coverage may be purchased through COBRA for a period (usually 18 months) following retirement. General questions about health plan coverage can be obtained from the CAO-Health Benefits Division by calling (661)

7 COUNTY ADMINISTRATIVE OFFICE MEMORANDUM John Nilon County Administrative Officer TO: FROM: SUBJECT: RETIRING EMPLOYEES HEALTH BENEFITS Retiree Health Plan Coverage - Enrollment Instructions As a retired County employee, you are generally entitled to purchase health plan coverage if you receive a pension check from the Kern County Employees Retirement Association and have at least 5 years of Kern County service. Deadlines: You should review the information in this packet immediately because you should select a plan and complete enrollment approximately one month before you retire. There is a grace period which expires 30 days after your retirement date. If you do not enroll by the end of the grace period, you will lose eligibility until the next open enrollment. The County Administrative Office-Health Benefits Division has information about the plans, and enrollment for most plans is completed at the CAO-Health Benefits Division. See the blue page in this packet for summary information. For detail or technical coverage information, you will need to call the plans directly at the phone numbers listed. If you enroll by meeting with a plan representative, you should make certain that the person enrolling you is aware that you are a KERN COUNTY RETIREE and ask that they submit a copy of your enrollment form to the CAO-Health Benefits Division. Contacts and phone numbers for each of the plans is as follows: Plan Contact Phone All plans General information and enrollment forms Bi-eekly meetings, call for a reservation Kern County Health Benefits (661) For detail or technical coverage questions: Anthem Blue Cross (Senior Secure, Silver & Gold) Anthem Blue Cross Customer Service- Information only (800) Health Net (Seniority Plus) Health Net (POS/COB) Kaiser Permanente County of Kern EPO plan County of Kern POS plan Kern Legacy Health plan GEMCare Health Plan Health Net Customer Service Health Net Customer Service Fatima Leal Customer Service Customer Service Customer Service Customer Service (800) (800) (661) (888) (855) (855) (661)

8 How much will retiree health benefits cost? This packet describes your retiree health benefit choices, the cost and how the County contribution programs work. The total monthly cost of your retiree health benefits is determined by: - which plan(s) you select - whether you enroll dependents, and how many are enrolled The County may contribute toward the cost of your retiree health benefits through two programs: - the stipend and - the supplement If you turn to the blue page, it lists the monthly cost for each plan that is offered. Once you select your retiree plan(s), you can begin to complete the Estimate Worksheet, which is the purple page. The following pages, which describe the stipend and supplement programs, will provide the County contribution information you need to complete your estimate of cost for retiree health benefits. What is COBRA? COBRA is short for the Consolidated Omnibus Budget Reconciliation Act of It is a federal law that provides that certain employees, retirees, spouses, former spouses and dependent children have the right to temporary continuation of health coverage at the group rate if coverage is lost due to a specified reason, like retirement. You will automatically be mailed a COBRA notice a short time after you retire. It will list the medical, dental and vision plan you were enrolled in as an active employee and it will offer you the right to purchase that coverage through COBRA. The letter will be sent to you from the County s COBRA administrator, Administrative Solutions, Inc (ASi). The County does not pay any part of coverage purchased through COBRA. If you enrolled in County retiree medical coverage, you don t also need COBRA medical. If you enrolled in County retiree dental coverage, you don t also need COBRA dental. 5

9 COBRA Rates Effective January 1, 2015 NOTE: COBRA coverage will only be offered for the plan(s) for which the member(s) just lost coverage. COBRA MONTHLY PREMIUMS Single Two-party Family ACTIVE PLANS MEDICAL: County of Kern POS plan & Rx $ $1, $ 2, County of Kern EPO plan & Rx $ $ $ 1, Kaiser Permanente & Rx $ $ $ 1, Kern Legacy Health Plan & Rx $ $ $ DENTAL: Liberty Independence PPO dental $ $ $ Liberty Dental COBALT Plus plan $ $ $ VISION: VSP $ 5.77 $ 9.54 $ RETIREE PLANS MEDICAL: County of Kern POS plan & Rx $ $ 1, $ 2, County of Kern EPO plan & Rx $ $ 1, $ 2, Kern Legacy Health Plan & Rx $ $ 1, $ 1, DENTAL: Liberty Dental CA40-R plan $20.40 $34.68 $51.00 The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) provides that certain former employees, retirees, spouses, former spouses and dependent children have the right to temporary continuation of health coverage at the group rate if coverage is lost due to specified reasons COBRA Administrator: Administrative Solutions, Inc. Mailing address: P O Box 5809, Fresno CA Phone: (866)

10 ESTIMATE WORKSHEET Estimating Retiree Health Benefits Cost Premium for plan selected A $ If split enrollment, premium for 2 nd plan selected B $ Total Monthly Premium A + B $ Less County contribution(s): Subtract Stipend (if eligible ) (-) $ Subtract Supplement (if eligible ) (-) $ YOUR MONTHLY MEDICAL COST $ Split enrollment is only allowed if one or more members is Medicare eligible and one or more members is not Medicare eligible. Stipend is $39.75, if single coverage is selected; $53.69 if two-party coverage is selected, and $61.50 if family coverage is selected. Refer to the Retiree Health Premium Supplement information. Please check with the CAO Health Benefits Division before relying on your determination of this benefit. NOTE: This worksheet is provided for you to estimate retiree health costs. Do not rely on this estimate. The CAO- Health Benefits Division can review your estimate but cannot guarantee your Supplement Premium amount until your years of service are certified by KCERA (Retirement Association) when you retire. PREMIUM HISTORY The information below reflects the single premium on the County s self insured medical plan for recent years $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ (a) $ $ $ $ (b) $ $

11 EXAMPLES Estimating Retiree Health Benefits Costs (Based on 2015 Premiums) Retiree John Smith has more than 25 years of qualified service when he retires from active County service, so he will receive the maximum 2015 Supplement benefit, which is $ Example 1: Retiree selects the County of Kern POS plan for himself only: Premium for plan selected (single): $ If split enrollment, premium for 2 nd plan selected $ 0.00 TOTAL MONTHLY PREMIUM $ Less County contribution(s): Subtract Stipend (single) (-) $ Subtract Supplement (if eligible) (-) $ RETIREE MONTHLY MEDICAL PAYMENT $ Example 2: Same information except Retiree Smith includes a dependent on his coverage: County of Kern POS plan covering 2 members: the total premium change to $1, the stipend would change to (2-party) $ Retiree Smith would pay monthly for 2-party County POS coverage $ Example 3: Retiree Smith elects the County of Kern EPO plan instead of the County of Kern POS plan. If he covers just himself, the plan is free. If he covers a spouse, the calculation of cost is: County of Kern EPO plan with 2-party coverage: the total premium would change to $ 1, the stipend would change to (2-party) $ Retiree Smith would pay monthly for 2-party County EPO coverage $ At any time, if the premium cost is more than Retiree Smith s supplement ($737.66) and the stipend ($39.75 single or $53.69 two party), Retiree Smith will pay the difference. The supplement will cease when Retiree Smith turns 65. If Retiree Smith enrolls in the retiree dental plan, he will also pay the full cost of the dental plan. 8

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13 COUNTY ADMINISTRATIVE OFFICE MEMORANDUM John Nilon County Administrative Officer TO: RETIRING EMPLOYEES FROM: Health Benefits Division * * S T I P E N D * * SUBJECT: Retiree Stipend Program The County provides a monthly stipend to County retirees to help defray the premium cost of medical insurance under a County plan. ELIGIBILITY In order to be eligible to receive the stipend, you must be a Kern County (not special district) retiree and: choose continuous retiree medical coverage with the County, OR have purchased medical coverage through the County for the last three (3) consecutive years without benefit of the stipend. If you discontinue coverage through the County at any time, you will not be immediately eligible to receive the stipend should you re-enroll during an open enrollment period. The three year waiting period may be waived if the retiree provides proof of continuous group coverage through another group program. CURRENT BENEFIT The monthly amount of the stipend is based on how many persons are covered. If the retiree alone is covered (single), the County Stipend amount is $ If the retiree plus one dependent is covered (two-party), the County Stipend amount is $ If the retiree plus two or more dependents are covered (family), the County Stipend amount is $ Retiree Stipend Coverage Selected Single Two-party Family Stipend Amount $ $ $

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15 COUNTY ADMINISTRATIVE OFFICE MEMORANDUM John Nilon County Administrative Officer TO: RETIRING EMPLOYEES FROM: Health Benefits Division * * S U P P L E M E N T * * SUBJECT: RETIREE HEALTH PREMIUM SUPPLEMENT PROGRAM EMPLOYEE PAYROLL DEDUCTION RETIRE HLTHBEN SUPP BACKGROUND The County provides a monthly stipend to all County retirees to help defray the premium cost of medical insurance under a County plan. The current amount of the stipend is $39.75 (single), $53.69 (two-party), or $61.50 (family). While the stipend does assist in paying for the cost of retiree medical insurance, it was recognized by the County and the employee unions that additional measures were necessary to assist retirees under age 65 in paying for insurance premiums. The Retiree Health Premium Supplement Program originated as a negotiated item for all employee unions with the intent of helping to pay for retirees' medical insurance premiums under the County's medical plan. The following table outlines the 2015 monthly premium contribution for the medical plans available for retirees under age PLAN YEAR SINGLE TWO PARTY FAMILY County of Kern POS Plan $ $ 1, $ 2, County of Kern EPO Plan $ $ 1, $ 1, Kern Legacy Health Plan $ $ 1, $ 1, HealthNet HMO $ 1, $ 2, $ 2, Kaiser Permanente HMO $ $ 1, $ 2, These rates are in effect beginning January 1, 2015, but it is assumed that these premiums will increase annually. ELIGIBILITY In order to be eligible to receive the supplement, you must: choose retiree medical coverage with the County upon retirement, have worked for the County (not a special district) for at least 20 continuous** years of service, take active retirement from service (since separating from service and deferring your retirement to a later date will make you ineligible for the program.), be at least 50 years of age, but no greater than 64 years of age at retirement, and have contributed to the program by payroll deduction during the qualified years of employment. Note that if you began work for the County at age 45, you will never be eligible for the supplement. ** Continuous service means years worked for Kern County during which the employee was earning retirement credit. However, years worked prior to a break in service will NOT be counted for this program unless the break in service is either: less than one year in length or occurred after July 1, In other words, a break in service longer than one year in length prior to July 1, 1994 will cause all time worked prior to the break to be ineligible time. 11

16 Years of service is calculated in accordance with the policies of the Kern County Employees Retirement Association, except that the only years counted for this program are years of actual County benefitted service (i.e., certain types of retirement service credit, such as prior public service, military time, Golden Handshake credit, County extra-help time, are NOT counted). Service begins at the date of entry into the retirement system, so years of service for this program will not exceed years of service for retirement credit. Retirement for work-related disability: If you are granted a service-connected disability retirement by the Kern County Employees Retirement Association, you will qualify for the full benefit under this program if you: have five years of qualified County service, have applied for the disability retirement prior to separating from County service, contributed to the program by payroll deduction during employment., and enroll in retiree medical coverage with the County upon retirement. BENEFIT AMOUNT The supplement amount that the County will contribute is calculated at the time of retirement and does not change after that, even though premiums do increase. The base amount of the supplement is equal to the then current employee medical premium for single coverage under the County of Kern POS Plan premium at the time of retirement. The base amount is multiplied by a percentage between 50 and 100, depending on years of service. (See actual amounts below.) In no event will the amount of supplement paid plus the amount of stipend paid ever be greater than the 100% of the monthly medical premium. CURRENT BENEFIT For illustrative purposes, the following chart shows the current amount of the supplement based on the number of years of service at retirement and the 2015 monthly County f Kern POS Plan premium for an individual employee. The amount used as the basis for calculating the permanent supplement amount will be the County of Kern POS Plan medical premium for an individual employee at the time of retirement. Once the supplement is calculated, it is fixed. That amount, limited to medical premium due, will be available to the retiree monthly until age 65 or until health coverage with the County ends. (Note: You will continue to receive the stipend after age 65 as long as you remain continuously enrolled.) For employees retiring on or after January 1, 2015 Full Years of Service Amount of Supplement $ $ $ $ $ $ NOTE: If you terminate employment, retire before age 50 or retire after age 64 you will not be reimbursed for any amount you may have paid into this program. 12

17 Retirement Health Benefits -- Reminders Retiree Premiums Paid in Advance When you participate in Kern County Retiree Health Benefits, the premium is deducted monthly from your KCERA pension check. The premium is deducted on the pension check that is issued before the month your premium covers. For instance, the premium deduction (labeled KC Health ) on your August 31 st pension check is for your September insurance premium. Please note that if your pension check is not large enough to deduct your insurance premium, you will be asked to pay premiums directly to Health Benefits on a quarterly basis. The first deduction for your premiums will include more than one month. For example, If you retire on January 11 th and receive your first pension check on January 31 st, your insurance deduction on January 31 st will be for January and February coverage (i.e., 20 days of January plus the month of February). If you retire on January 11 th and receive your first pension check on February 28 th,your insurance deduction on February 28 th will be for January, February and March coverage (i.e., 20 days of January plus the months of February and March). Deductions on future pension checks will be for your regular monthly premium amount. Coverage delay between active and retiree coverage period updates When Health Benefits receives notice through the payroll system that you are retiring, a termination of your active Health Benefits coverage is processed. (Normally, your employee health benefits end on the last day of the bi-weekly period during which you work your last hours.) Retiree coverage is not activated in the system until your retirement has been confirmed by KCERA. It is at that time that all systems are updated with your retiree coverage. Your retiree coverage is effective the day after your active benefits end, so there will be no gap in coverage. (Note that normally no gap in coverage is allowed.) Coverage is made effective retroactive to the day after active benefits ended. However, there might be a short period of time between these updates during which the system reflects your coverage as closed because the retroactive update has not been processed. If you will need services that require your coverage to be active in the system (e.g., you have a serious health condition that requires constant care) during that period, contact the CAO-Health Benefits Division before you retire to request a Coverage Transition Request form. As long as we have your retiree health benefits application and your completed Coverage Transition Request form on file in this office we can request early verification from KCERA that you have applied for retirement and will be receiving a monthly pension check. Once verified, your medical coverage can be opened early to obtain the needed service. Continued 13

18 Partial month coverage for month in which you retire If you are not changing plan administrators: Coverage will start on the retiree plan the day after your active coverage ends. The cost of the partial month will be pro-rated based on the number of days you are covered as a retiree on this plan. If you are changing plan administrators: If you select a retiree plan other than your current plan, the new plan coverage will become effective the 1 st of the month following the latter of: 1) your retirement date, or 2) the date the enrollment form is received in the CAO-Health Benefits office. During the time between your active coverage ending and your new retiree plan coverage starting, you will be covered on the retiree plan that has the same plan administrator that you had on your active plan. This bridges your coverage until the new plan starts. Bridge coverage will usually be for one partial month. The maximum time allowed is one partial month plus one full month, depending on when your enrollment forms are received in the CAO-Health Benefits Division. The cost of this bridge coverage will be calculated using the retiree premium for the plan you are enrolled in for the bridge coverage. The cost of the partial month will be pro-rated based on the number of days you are covered as a retiree on this plan. Items of Interest A few things are different for retirees. Some examples are listed here. Adult child dependents: In general, HealthCare Reform does not apply to retiree health plans. So, the old eligibility rules still apply to dependents of retirees. For instance, children age 19 or older must have already been covered on a County plan and they must be full-time students or permanently disabled. Children age 23 or older must be permanently disabled. Members with Medicare: For Medicare eligible retiree members, Medicare coverage will usually be primary coverage. Almost always, Medicare eligible members should make sure their Medicare Part A and Part B are in effect by the time they transition from active employee coverage to County retiree coverage. Medicare eligible members age 65 or older are only allowed to select an Over 65 plan. Members with Medicare eligibility due to disability (under age 65) also have some Under 65 choices, but County self-insured plans will ONLY pay benefits after Medicare has paid as primary. Plan differences: The Retiree benefits may not be exactly the same for active and retired members. For instance, the retiree Point-of-Service plan has slightly higher co-payments than the active plan for brand name prescription drugs. You Must Apply for Retiree Coverage Reminder: You must apply for retiree coverage no later than 30 days after your retirement date. If you do not apply, you will not have retiree health benefits and you will not be able to apply for such coverage until the next retiree open enrollment. It is recommended that you submit enrollment forms to Health Benefits approximately one month prior to your retirement date. 14

19 COUNTY OF KERN Retiree Health Benefits Policy PURPOSE It is the intention of this policy to provide guidelines for administration of the County s retiree health plans. This policy is specifically intended to direct the administration of retiree health plans in a manner that will be of greatest benefit for participants while maintaining efficiency and effectiveness in the provision of such service. In recognition of the responsibility to assure the fair and consistent administration of the County's retiree health plans, the Kern County Board of Supervisors adopts this policy. APPLICATION This policy applies to all persons who request participation in the County of Kern health benefit plans offered to retirees. This policy is intended to establish administrative policies for the County only. Each plan offered to retirees maintains policies and rules regarding eligibility and coverage of participants and dependents. This policy is not intended to change any policies maintained by any of the providers of such plans. Any portion(s) which conflict(s) will be governed by the individual plan's policy. RETIREE RESPONSIBILITIES Retirees are responsible to submit completed enrollment forms and other documents as necessary for requested coverage and coverage changes. Retiring employees are encouraged to apply for County retiree health benefits approximately one month prior to the effective date of their retirement, but have up to a 30 day grace period following the date of retirement to apply for such coverage. If enrollment requests are not made by the end of the grace period, the retiree must wait for the next open enrollment to enroll. Retirees are responsible to pay for their coverage under the County plans, usually by deduction from their pension check (see Cash Pay retiree in the Definitions section for the one exception). If a participant pays any portion of their health benefits cost by check and the check is returned unpaid, the participant will be required to pay the current returned check fee in effect for the County. Any application for coverage is an authorization to deduct amounts due from a retiree s pension check. As applicable, retirees are responsible for notifying the CAO-Health Benefits Division of any changes in eligibility for Medicare, and to make any necessary plan changes required by such change in eligibility. County retiree health benefit participants may be required to enroll in Medicare Part A and Part B as soon as they are eligible. As applicable, retirees will not enroll in more than one plan which requires assignment of Medicare, nor will a retiree enroll in an individual (Non-County) plan requiring assignment of Medicare without first canceling any similar County plan. Retirees are responsible to direct questions about their Medicare to the Centers for Medicare & Medicaid (CMS), which is the US federal agency which administers Medicare. Retirees are additionally responsible for notifying the CAO-Health Benefits Division of any changes in their address. 15

20 Any retiree who does not comply with any item in this policy is subject to immediate suspension and/or cancellation of all benefits at the discretion of the County Administrative Officer and the retiree will be responsible to make payment for coverage provided prior to the cancellation. COUNTY RESPONSIBILITIES AND GUIDELINES It is the County s responsibility to process documents received in a timely manner and adhere to rules established by the providers of the individual County Plans and policies adopted by the Board of Supervisors. Situations which are not specifically described by the Plan Document or the policy will be processed in a consistent manner. The Retiree health plan documents and this eligibility policy shall be interpreted by the County Administrative Officer in accordance with its terms and their intended meaning. If due to errors in drafting, a provision does not accurately reflect its intended meaning, as demonstrated by consistent interpretations by the County Administrative Officer or other evidence of intention, the provision shall be considered ambiguous and shall be interpreted in a fashion consistent with its intent. POLICY ELIGIBILITY Effective June 22, 2010 a retiree must have had a minimum of five years of qualified Service Credit in the Kern County Employees Retirement Association to participate in Kern County Retiree health benefits. This service credit must have been earned for Kern County service covered by the Kern County Employees Retirement Association, and cannot be Golden Handshake credit, reciprocal time or time purchased for Prior Public Service or military time. The retiree, or the beneficiary of the retiree, must receive a monthly pension check from the Kern County Employees Retirement Association. Any retiree who is currently enrolled as of June 22, 2010 in a Kern County retiree medical plan who had less than five (5) years of qualified service credit, will be allowed to remain enrolled as long as they remain continuously enrolled on or after June 22, Eligibility to participate in County self-insured medical plans will be determined by the member s final retirement employer as of the date of their retirement under KCERA. A pension recipient who receives pension money only because of a Qualified Domestic Relations Order ( QDRO ), because they are divorced from a retiree, is not eligible to participate in Kern County retiree health benefits. Special District retirees (as defined later in this policy) must also meet the following requirements to be eligible: A Special District retiree may not participate in a County self-insured plan which is not available to that Special District s active employees. A Special District retiree, or the beneficiary of the retiree, is eligible to participate in any County retiree plans IF the retiree retires from a district that is currently a Qualified Special District (see Definitions). A Special District retiree, or a beneficiary of the retiree, is eligible to participate in ONLY the fully insured plans if the retiree retired from a district that is currently a Non-Qualified Special District. As described in the action authorized by the Board of Supervisors on January 26, 2010 retirees of the Kern County Superior Court who retired on or after January 1, 2001 may not participate in County self-insured plans after December 31, This is due to the Kern County Superior Court removing active employees from participation in such plan and offering them alternative coverage. 16

21 Any Special District which ends enrollment of their active employees in the County s self-insured plan will immediately disqualify any retirees of that district from continuing their participation in the County s self-insured plan. At the time the Special District ends their active enrollment, any affected retirees will be given the opportunity to enroll in any insured plans offered, subject to the enrollment rules of the plans. Beginning June 22, 2010, should there be any retirees that were not identified at the time benefits were terminated for active employees of a Special District, such retirees will be given a 60 day period to switch plans from the date they are later identified. A retiree of the Kern County Firefighters Association, or a beneficiary of such a retiree, who would be ineligible because he/she does not receive pension pay from the Kern County Employees Retirement Association, will be eligible to participate in the County self-insured plan. As of June 2010 there is one remaining qualified beneficiary who is eligible because of this provision, and this provision will expire when this person ceases to participate. CHANGES IN ENROLLMENT Requests for changes should be received by the CAO-Health Benefits Division by the 5 th day of the month preceding the requested effective date. Cancellations: Cancellations of coverage will be allowed at any time during the plan year. A disenrollment form must be completed by the retiree. If the retiree disenrolls, all dependents must also be disenrolled. The cancellation will be effective on the 1st day of the following month provided the disenrollment form is received by the County Administrative Office-Health Benefits Division early enough to notify affected carriers by the 1 st day of the following month. The request must always be received before last day of the current month. Coverage may NOT be canceled retroactive to the 1 st of the month in which the request is received. If the request is received after the 5 th day of the month, the retiree may still have a deduction from their pension check which will be refunded. Refunds may take up to 6-8 weeks following the cancellation request. Cancellations of participation in medical coverage may terminate eligibility for future County contribution through Supplement and Stipend plans. Plan Transfers: Transfers between County Plans will ONLY be allowed: 1) during Open Enrollment; 2) when a participant changes his/her permanent place of residence to a location outside their current County Plan's service area; 3) at the time a participant s Medicare Parts A and B become effective; OR 4) for compelling reasons under unusual circumstances which are not related to treatment episodes. Under items (2) and (34) the effective date of the change will be the 1st day of the following month if the proper documentation is received by the County Administrative Office-Health Benefits Division early enough to notify affected carriers by the 1 st day of the following month, but receipt can never be later than the last day of the current month. Coverage may not be changed retroactive to the 1 st of the month in which the request is received. If the request is received after the 5 th day of the month proceeding the change month, the retiree may have an incorrect deduction from their pension check. Underpayments are due immediately and overpayments will be refunded. Refunds may take up to 6-8 weeks following the transfer request. Enrollments: Enrollments in plans will ONLY be allowed: 1) during Open Enrollment; and 2) within the 30 day period following, and consistent with, a Qualifying Event. For enrollments based on Qualifying Events, coverage will become effective the 1 st day of the month following the latter of: 1) the Qualifying Event, or 2) the receipt of enrollment documents by the CAO-Health Benefits Division. However, if the Qualifying Event is retirement and active employee health benefits are in force on the date of retirement, coverage will become effective on the day following the day active health benefits end. Also, if the enrollment request is for the County self-insured POS medical plan and is based on the retiree acquiring a new dependent through birth or adoption, coverage will become effective on the Qualifying Event date. 17

22 PARTIAL MONTH COVERAGE In most instances, partial month coverage is not allowed. However, partial month coverage is provided for newly retiring employees and Qualifying Events involving the retiree acquiring a new dependent through birth or adoption. The following applies to the month in which someone retires: If a retiring employee is not changing plans/administrators, coverage will start on the retiree plan the day after active coverage ends. The cost of the partial month will be pro-rated based on the number of days covered as a retiree on this plan. If the retiring employee is changing plans/administrators, by selecting a retiree plan other than the current active employee plan, the retiring employee will have continuous coverage, but the following rules determine when each plan s coverage begins and ends. The new plan s coverage will become effective the 1st of the month following the latter of: 1) the retirement date, or 2) the date the enrollment form is received in the CAO-Health Benefits Division office. During the time between active coverage ending and the new retiree plan coverage starting, the retiring employee will be covered on the retiree plan that has the same plan administrator that the retiring employee had on their active plan. This bridges the coverage until the new plan starts. Bridge coverage will usually be for one partial month. The maximum time allowed is one partial month plus one full month, depending on when the enrollment forms are received in the CAO-Health Benefits Division. The cost of this bridge coverage will be calculated using the retiree premium for the plan the retiring employee is enrolled in for the bridge coverage. The cost of the partial month will be pro-rated based on the number of days covered as a retiree on this plan. RETIREE STIPEND The retiree stipend is available to 1) a Kern County (not Special District) retiree currently receiving the stipend who remains continuously enrolled in a County plan; OR 2) a Kern County (not Special District) employee who retires from service (not deferred retirements), enrolls upon retirement and remains enrolled continuously thereafter in a County plan; OR 3 ) a Kern County (not Special District) retiree who re-enrolled and has been continuously enrolled in a County plan for three years without benefit of the County stipend contribution; OR 4) a Kern County (not Special District) employee who retires, but postpones enrollment in County retiree health benefits until a qualifying event which is related to loss of other employer group insurance and who then remains enrolled continuously thereafter in a County plan. Under this last option, the retiree must provide documentation that there has not been ANY gap in employer group coverage between the date active County health benefits ended and the date the County retiree health benefits began. RETIREE HEALTH PREMIUM SUPPLEMENT PROGRAM This program will be governed by the Retiree Health Premium Supplement Program plan document and that plan document shall prevail in the event of any inconsistencies between the language herein and that plan document. Service Connected Disability Retirement ( SCDR ): This section applies to participants who had already separated from County service at the time a Service Connected Disability Retirement ( SCDR ) is granted. This section does not apply to retirees who are already collecting the 100% Supplement benefit based on 25 or more years of service, as their benefit does not change. If the participant is currently enrolled in County retiree health benefits and is receiving the Supplement benefit at less than the 100% benefit level, and the SCDR would increase the Supplement benefit to the 100% benefit level, the increased Supplement benefit will begin the 1 st of the month following the date the SCDR was granted. 18

23 The amount will be based on the Supplement rates in effect on the date the participant originally retired for service. If the participant is currently enrolled in County retiree health benefits and is receiving no Supplement benefit, and the SCDR would add the Supplement benefit at the 100% benefit level, the new Supplement benefit will begin the 1 st of the month following the date the SCDR was granted. The amount will be based on the Supplement rates in effect on the date the SCDR was granted. If the participant is not currently enrolled in County retiree health benefits, and the granting of the SCDR (Qualifying Event) causes the Supplement benefit to be paid by the County, coverage and County Supplement contribution will begin the 1 st of the month following the later of: 1) date the SCDR was granted or 2) the date the retiree requests enrollment within the 30 day grace period. The amount will be based on the Supplement rates in effect on the date the SCDR was granted. Loss of Supplement due to break in County retiree health benefits coverage: Generally, a break in County retiree health benefits coverage will cancel all future Supplement benefits. However, if a County retiree can provide acceptable written documentation which establishes that they have had other employer group coverage for the entire time they were without County retiree health benefits coverage, the Supplement benefit can be reinstated upon proper re-enrollment in County retiree health benefits coverage. In this instance, the documentation must show that there has not been ANY gap in employer group coverage between the date County health benefits ended and the date of re-enrollment in County retiree health benefits. SPLIT ENROLLMENT A retiree will be allowed to select a different County Plan for his/her dependent(s) than he/she selects for him/herself ONLY IF 1) the retiree is not Medicare eligible and at least one of his/her dependents is Medicare eligible OR 2) the retiree is Medicare eligible and at least one of his/her dependents is not Medicare eligible. A retiree and his/her dependents collectively will not be allowed to participate in more than two plans at any given time. OVER 65 PLAN/UNDER 65 PLAN Over 65 plans are those plans which require a participant to have Medicare parts A & B (generally applies to participants over the age of 65 years, but also applies to persons under age 65 if they are disabled and Medicare eligible). Under 65 plans are those plans which do not require a participant to have Medicare (generally applies to participants under the age of 65 years). Under 65 plans do not allow participants who are age 65 or older. If someone is under age 65, but has Medicare due to disability, they may be allowed to stay in an Under 65 plan until they reach age 65 if the plan allows, but may be subject to additional rules of the plan or Medicare. For instance, once a retiree becomes eligible for Medicare, the County self-insured plans will only pay as secondary plans when allowed by Medicare. Additionally, Medicare may later impose penalties if retirees do not enroll upon initial eligibility for Medicare. Questions about Medicare should be directed to the Centers for Medicare & Medicaid Services (CMS), which is the US federal agency which administers Medicare. RETIREE DENTAL COVERAGE Any retiree who draws a monthly pension check from KCERA may enroll in retiree dental coverage. The full cost of retiree dental coverage is paid by the retiree. If a new retiree requests enrollment in COBRA dental and retiree dental, retiree dental will not be put in force. When the COBRA dental coverage expires, the retiree may enroll in retiree dental if the request is made within 30 days of the COBRA end date. 19

24 NOTICES Notices to retirees relating to County Plans (other than open enrollment notices) shall be deemed to have been made upon deposit into U.S. Mail by the County. The notice will have first class postage affixed and will be addressed to the retiree at the address listed in the Health Benefits master file at the time of mailing. Notices to retirees regarding open enrollment will be made by deposit of such notice into U.S. Mail by the County with postage affixed. Such notice will be addressed to retirees at the address on file with the Kern County Employees Retirement Association at the time the notice is prepared. Notices to the County shall be mailed or delivered to: Kern County Administrative Office; Health Benefits Division; 1115 Truxtun Avenue, 1st floor, Bakersfield, CA DEFINITIONS Beneficiary of a Retiree: A person who was married to an eligible retiree, or was a dependent child of the retiree, when the eligible retiree died. Beneficiaries who will continue to receive a monthly pension benefit from the Kern County Employees Retirement Association after the death of the retiree are eligible to participate in County retiree health benefits. However, on or after June 22, 2010, if a beneficiary remarries, the new spouse and any of the new spouse s dependents will not be eligible to join Kern County retiree health benefits. Additionally, former (divorced) spouses of deceased retirees, and the spouse s children, are specifically excluded from the definition of a beneficiary of a retiree for purposes of retiree health plan eligibility and may not participate. Cash Pay or Non-Payroll retiree: A retiree, or beneficiary of a retiree, will pay for County retiree health benefits by payroll deduction from their Kern County Employees Retirement Association pension check. The ONLY time payment will be accepted otherwise is IF the pension check is not large enough to make the full deduction. These members will then become Cash Pay or Non-Payroll members, and will submit payment quarterly to the CAO-Health Benefits Division as directed. Late payment will result in cancellation of coverage at the discretion of the County Administrative Officer. County Plans: Any health plans administered by the County of Kern Administrative Office on behalf of retired members of the Kern County Employees' Retirement Association. Day: A day is defined as a calendar day. Medicare Eligible: Being Medicare eligible means the retiree or dependent is eligible to enroll in Medicare Part A and Part B. This may be because they have reached age 65 or because they have been granted Medicare Part A and Part B due to a disability before reaching age 65. All questions about Medicare should be directed to the Centers for Medicare & Medicaid Services (CMS), which is the US federal agency which administers Medicare. Open Enrollment: A period designated annually by the CAO-Health Benefits Division during which changes in coverage under County Plans may be made by participants. Qualified Domestic Relations Order (QDRO): A Qualified Domestic Relations Order is a legal document pertaining to divorced members. Qualifying Event: A Qualifying Event may also be referred to as a Permitting Event in the County of Kern active employee Health Benefits Eligibility Policy. A Qualifying Event will include 1) a change in family status (marriage, birth or death of dependent, etc.) as defined by the County s Health Benefits Eligibility Policy; 20