RETIREE HEALTH COVERAGE WORKSHOP

Transcription

1 RETIREE HEALTH COVERAGE WORKSHOP April 20, 2015 City of San Diego Retirees

2 Fact: The world of health coverage is ever-changing No one has all the answers! Goal: Direct you to the proper resources so you can do your homework and feel confident 2 Team Effort: Your health coverage is administered by the City and processed by SDCERS, in partnership with healthcare providers

3 Meet the Team Me ya Alomar SDCERS Rosa Ceja-Manzo SDCERS Joy Delos Reyes SDCERS Sarah Levy - SDCERS Angelica Aguilar - SDCERS Cathleen Bryant Health Net Kimberly Shields Health Net Charlotte Souza Kaiser Permanente Nancy Voltero Kaiser Permanente Nancy Stadille City Risk Management Department 3

4 Today s Agenda 2015 Open Enrollment Health insurance coverage Insurance allowances and tiers Reimbursement process Health Net overview Kaiser overview Covered California and the new marketplace Medicare overview City of San Diego presentation Questions at the end 4

5 SDCERS Health Overview Me ya Alomar Member Services Manager 5

6 Open Enrollment runs June 1 through June 30 Help Day is June 17 Balboa Park Club Ballroom 10 a.m. to Noon 6

7 Key points for Open Enrollment 7 No change in providers Health Net Kaiser Some rates will go up New enrollment Submit changes No changes nothing to do! All forms due by June 30 Changes outside of Open Enrollment Qualifying events Disenrollments Additions

8 Dental and vision coverage Switching dental plans can only be done during Open Enrollment Limitations on changes outside of Open Enrollment Moving out of state? Contact healthcare provider and SDCERS 6 to 8 weeks prior to moving Options with City-sponsored providers and private insurance 8

9 COBRA (Consolidated Omnibus Budget Reconciliation Act) When you retire or terminate, you enroll in COBRA through the City of San Diego s Risk Management department, not SDCERS You and your dependents may continue COBRA for 36 months (COBRA and Cal-COBRA) 9

10 Insurance Allowances Insurance allowances can only be used to cover health insurance premiums for the retiree Health insurance allowances vary by retirement date Retired prior to October 6, 1980 Retired between October 6, 1980 and June 30, 2009 Retired between July 1, 2009 and March 31, 2012 Retired on or after April 1, 2012 For City-sponsored plans, allowance is applied directly to monthly pension payment If premium cost is greater than allowance, difference is deducted from monthly pension payment 10

11 Retired Prior to October 6, 1980 $1,200 annual allowance ($100 per month maximum) Allowance can be applied to City-sponsored premiums Allowance can be applied to privately secured plan For privately secured plans, allowance can be used to reimburse multiple health insurance expenses, such as: Monthly premiums Medicare Part B and Part D Doctor co-payments Prescription drugs Hospital co-payments 11

12 Retired between October 6, 1980 and June 30, 2009 One allowance No sliding scale based on years of service Allowance can be applied to City-sponsored premiums directly from monthly pension payment Allowance can be applied to privately secured plan 12

13 Why doesn t the 10 percent escalator cover my health care increase? SDMC Section (b)(2): After Fiscal Year 2003, the maximum payment or reimbursement level for Health Eligible Retirees will be adjusted annually based upon the projected increase for National Health Expenditures by the Centers for Medicare and Medicaid Services, Office of the Actuary, for the full-year period ending January 1 before each plan year. No adjustment may exceed 10 percent for any plan year. Code states the annual increase can be up to 10 percent, not that it will be 10 percent each year Projected increase has averaged between 5 percent and 7 percent Last year the increase was 6 percent Since that amount is less than last year s rate increase by Kaiser and Health Net, members pay that difference out of pocket 13

14 Retired between 2009 and 2012 Multiple tiers based on retirement date and representation Allowance can be applied to City-sponsored premiums directly from monthly pension payment Allowance can be applied to privately secured plan 14 Sliding scale based on 10 to 20 years of service Reciprocal time does not apply Unclassified and classified-unrepresented 5-year purchase does not apply Disability retirements not based on sliding scale

15 15 The sliding scale is available online and in the annual Open Enrollment Book

16 Retired on or after April 1, 2012 Not retired prior to April 1, 2012, required to make irrevocable health benefit election Option A & B Sliding scale based on 10 to 20 years of service Allowance can be applied to City-sponsored premiums directly from monthly pension payment Allowance can be applied to privately secured plan Reciprocal time does not apply Unclassified and classified-unrepresented 5-year purchase does not apply Disability retirements not based on sliding scale This election has already been made 16

17 Retired on or after April 1, 2012 Option C Defined contribution plan to be used for retiree and dependents HEALTH TRUST, not a monthly allowance May enroll in a City-sponsored plan or a privately secured plan All premiums can be reimbursed from the Health Trust, not SDCERS 17

18 Medicare Part B Reimbursements Options for Medicare Part B reimbursements vary depending on retirement date Retired prior to October 6, 1980 Eligible to be reimbursed for Medicare Part B up to maximum allowance of $ If your Part B is less than your maximum allowance, you may receive the difference by sending sufficient proof to SDCERS Retired between October 6, 1980 and March 31, 2012 Eligible to be reimbursed for 100% of Medicare Part B, in addition to receiving the monthly health allowance 18

19 Medicare Part B Reimbursements Retired on or After April 1, 2012 (Option A, B or C) You may use your monthly health allowance to be reimbursed for Medicare Part B Option C members submit reimbursement request to the Health Trust, not SDCERS Monthly reimbursement deadline is the 10 th of every month Reimbursement requests for expenses incurred more than 12 months prior to the request date will not be reimbursed by SDCERS 19

20 Privately Secured Reimbursements Reimbursed for individual premium up to maximum allowance Reimbursement deadline is the 10 th of every month Reimbursement requests for expenses incurred more than 12 months prior to the request date will not be reimbursed by SDCERS 20

21 COBRA Health Reimbursements New reimbursement process begins June 1, 2015 Collaboration between SDCERS and the City of San Diego One-time request for initial receipt of payment Payment to the Treasurer s Office is due the 10 th of every month for reimbursement on that month s pension payment Reimbursement requests for expenses incurred more than 12 months prior to the request date will not be reimbursed by SDCERS 21

22 Reimbursements Sufficient Proof of Payment 22

23 Reimbursements Insufficient Proof of Payment Front Only Documents that are not legible 23 Bank Statements with no name or account number or date of transaction

24 Health Reimbursements Sufficient Proof of Plan Premium Rate 24

25 Health Reimbursements Sufficient Proof of Coverage Letter from Health Care Provider 25

26 CareCounsel Healthcare assistance program Available to City of San Diego Retirees and their continuances at no cost Provides assistance with Understanding benefits Serving as a liaison Electing a primary care provider, specialist, or hospital Addressing network issues CareCounsel does not provide medical advice or treatment, but serves as an advocate to ensure your needs are met 26