PERS Health Insurance Program Fall Plan Change Meetings
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1 PERS Health Insurance Program 2015 Fall Plan Change Meetings
2 Agenda What is the PERS Health Insurance Program (PHIP)? Health Plans (Medicare / Non-Medicare) Providence Health Plans Kaiser Permanente PacificSource Moda Health & Delta Dental Plan of Oregon Question & Answer Intermission (5 minutes) Medicare Basics Medicare Enrollment PHIP Enrollment Question & Answer
3 What is the PERS Health Insurance Program (PHIP)? PHIP is a group insurance plan specifically designed for retired Oregon public employees and their eligible family members. Currently offering: Health insurance Medicare health plans Non-Medicare health plans Dental insurance
4 Health Plans Offered by PHIP Medicare and Non-Medicare options: When selecting a PHIP health plan, your primary residence (not mailing address) must be within the United States and the health plan s service area.
5 Dental Plans Offered by PHIP PHIP offers two dental plans: You are eligible to enroll in PHIP dental only if you also are enrolled in PHIP medical If anyone in your family wants dental coverage, the whole family must have dental coverage You can enroll in either dental plan regardless of your medical plan selection Must live in the Kaiser Permanente service area to enroll in the Kaiser dental program
6 Who is eligible for PHIP? A PERS retiree, who is receiving a PERS retirement allowance or benefit, or who received an optional lump sum payment. The spouse of an eligible PERS retiree. A dependent child who is less than 26 years of age and meets the following definitions: A natural child A legally adopted child or a child placed in the home pending adoption A step-child who resides in the household of an eligible retiree A grandchild Whose parent resides in the retired member s household and was covered under the retired member s health plan at the time of birth.
7 Who is eligible for PHIP? An overage dependent (26 or older) who is unable to achieve self-support through work due to a developmental disability as verified by a physician. A dependent domestic partner who meets the following definitions: Has a relationship and resides with the PERS retiree for a minimum of 12 months; The PERS retiree is providing more than 50% of the financial support; Listed as a dependent on most recent federal tax return; Must provide an Affidavit of Domestic Partnership. An eligible surviving spouse or dependent of an eligible PERS retiree
8 Value to Retirees Enhanced Medicare Part D and non-medicare Prescription Drug Plan: No deductible No coverage gap (Donut Hole) Annual out of pocket cost will not exceed $4,850
9 Value to Retirees Prescription Drug Comparison PHIP Prescription Drug Plan 2016 (Medicare Part D) You pay 40% not to exceed $150 per prescription; No coverage gap Calendar Year Deductible Initial Coverage Coverage Gap (Donut Hole) Medicare Part D Basic 2016 You pay first $360 You and the Plan pay up to a combined total of $3,310 You pay 58% of generic medications You pay 45% of all other medications Up to $4,850 After $4,850 you pay $0 Catastrophic Coverage Generics - $2.95 or 5% whichever is greater All other medications - $7.40 or 5% whichever is greater
10 Value to Retirees PERS Premium Subsidies: (Available to eligible Tier 1 and 2 PERS retirees enrolled in a PHIP sponsored health plan) Retirement Health Insurance Account (RHIA) Medicare retirees only Subsidy $60 a month Retiree Health Insurance Premium Account (RHIPA) State of Oregon non-medicare retirees only Subsidy varies based on state service time Retiree and spouse enroll separately if both are eligible for a subsidy
11 Value to Retirees Annual plan change available (Guaranteed regardless of health status) October 1 st through November 15 th Different than Medicare Annual Enrollment Period (AEP) Changes effective January 1 st To make plan changes, submit two forms Disenrollment form for current plan Enrollment Request form for new plan Not a time to Add dental benefit Add dependents Special Election for non-medicare plans: Due to significant changes to our Select Value plan, members will be allowed to move to the Core Value plan during the 2015 Plan Change only.
12 Value to Retirees Member Resources Quarterly Healthwise Newsletter PHIP Website pershealth.com Quarterly PERS Health Fairs Dedicated Customer Service
13 After Enrollment Changing Plans Permanently moving outside of your plans service area Switch to a PHIP plan within a new service area Temporarily living outside your service area (over 60 days) Review your health plan s travel benefits Snowbird Option
14 After Enrollment Making Monthly Premium Payments Pension Deduction Electronic Funds Transfer (EFT) from checking or savings Surviving Spouse or Dependent Benefits As a surviving spouse or dependent of a PERS retiree Continue PHIP if already enrolled Not yet enrolled in PHIP 90 day enrollment opportunity from death of PERS retiree
15 2016 PHIP Program Updates Pharmacy benefits are now administered by respective carrier Affects Providence and PacificSource members Updated Enrollment Request Form No mandated benefit changes due to health reform in 2016
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