January 2015 This brochure provides general information about the post-retirement medical benefit subsidy plans available to retirees of the. Eligibility and enrollment for retiree medical are handled by the Marin County Employees Retirement Association (MCERA) in accordance with the rules established by the County. If you are not eligible for one of the Benefit Plans described in this brochure, you may retain the same level of coverage as a retiree that you had as an active employee. In this case, all medical premiums are the responsibility of the retiree and will not be reimbursed or subsidized by the County. Vision Care The State Association of County Retirement Systems (SACRS), of which MCERA is a member, sponsors a voluntary vision insurance plan for all retirees and beneficiaries through VSP Vision Care. The VSP Vision Care plan is separate from any plans that may be offered by your former employer. If you elect vision coverage through VSP as a retiree, you are responsible for all VSP Vision Care premiums as they are not covered by your employer-provided benefit subsidy plan. Plan enrollment and cancellation are administered by MCERA. All questions related to the VSP Vision Care plan should be directed to VSP or MCERA. VSP information is available on their website (vsp.com/ go/marincera) or by calling (800) 400-4569. Payment of Premiums Healthcare premiums will be deducted from your monthly retirement benefit payments, beginning with the first payment you receive after you retire. If you receive a subsidy from the County as outlined in the following Benefit Plans, this will appear on your monthly deposit confirmation as Employer Subsidy. Any amount you owe in addition to the subsidy will appear as Net Medical Care Cost. General Eligibility Rules As a retiree, you are eligible to enroll in the plan and level of coverage you have as an active employee. For example, if you (and your dependents) have the Kaiser Low plan as an active employee, you are eligible to continue the Kaiser Low coverage as a retiree. If you would like to change to a different medical plan before retirement, you must do so as an active employee during open enrollment. There is currently no open enrollment after retirement and if you drop a plan you cannot re-enroll. To be eligible for retiree health coverage under most Benefit Plans you must have: 5+ years of service, and Continuity of coverage (Benefit Plan 4 requires at least 5 years of continuous coverage in the same plan). To be eligible for retiree dental coverage under most Benefit Plans you must have: Dental coverage in place for 1+ year(s) prior to retirement (Benefit Plan 4 requires at least 5 years of continuous coverage).
2 Benefit Plans Benefit Plan 1 Eligibility: Became an MCERA member with County of Marin service prior to 10/1/87. Retiree premium: Medical and dental premiums paid by the County. Dependent premium: Paid by retiree. Medicare Part B premium: Basic Medicare premium for the retiree ($104.90 for 2015) is reimbursed by the County upon proof of enrollment. Reimbursement is paid monthly in your retirement check. The retiree is responsible for any difference over this amount. Note: Members eligible for Benefit Plan 1 may elect Benefit Plan 3 at retirement, which may be more beneficial if you have 30 years of service and are married/partnered. Benefit Plan 2 Eligibility: Became an MCERA member with County of Marin service between 10/1/87 to 9/30/93. Retiree premium: The County pays a maximum of $2,275 per year to subsidize a portion (or all) of the cost of the retiree s medical, dental and basic Medicare Part B premium. The retiree is responsible for any difference over this amount. There is no cash back if your annual subsidy is not used completely, nor can it be applied to the cost of dependent coverage. Dependent premium: Paid by retiree. Note: Members eligible for Benefit Plan 2 may elect Benefit Plan 3 at retirement, which may be more beneficial if you have over 5 years of service. Benefit Plan 3 Eligibility: Became an MCERA member with County of Marin service prior to 12/31/07. Retiree premium: The County uses a formula to calculate the maximum annual subsidy provided to cover a portion (or all) of the retiree s medical, dental and basic Medicare Part B premiums. Your maximum annual subsidy is determined by multiplying your years of service (up to a maximum of 20 years) by an allocation factor. The allocation factor is set annually by the Board of Supervisors. The 2015 allocation factor is $442.65 per year of service for a maximum annual amount of $8,853.00. The retiree is responsible for any difference over this amount. There is no cash back if your annual subsidy is not used completely, nor can it be applied to the cost of dependent coverage. Dependent premiums: If the retiree has less than 30 years of County service, the retiree is responsible for all dependent premiums. For those retirees with more than 30 years of County service, the retiree is eligible for a second subsidy equal to their own to cover their spouse s or partner s medical, dental and basic Medicare Part B premiums. Subsidy calculation samples: The tables on page 5 and 6 show examples of how the employer subsidy provided through Benefit Plan 3 may impact the retiree s cost for healthcare in the Kaiser Low and Anthem Blue Cross plans for calendar year 2015. Your employer-provided subsidy does not cover the VSP Vision Care plan described on page 1, so that premium is not included in the samples. Benefit Plan 4 Eligibility: Became an MCERA member with County of Marin service from 1/1/08 to the present. Must have 5 years of continuous coverage in the same medical plan. Retiree premium: The County uses a formula to calculate the maximum annual subsidy provided to cover a portion (or all) of the retiree s medical, dental and basic Medicare Part B premiums. Your maximum annual subsidy is determined by multiplying your years of service (up to a maximum of 20 years) by $150. Your maximum subsidy is $3,000 per year. The retiree is responsible for any difference over this amount. There is no cash back if your annual subsidy is not used completely, nor can it be applied to the cost of dependent coverage. Dependent premium: Paid by retiree. Subsidy calculation samples: The tables on page 7 and 8 show examples of how the employer subsidy provided through Benefit Plan 4 may impact the retiree s cost for healthcare in the Kaiser Low and Anthem Blue Cross plans for calendar year 2015. Your employer-provided subsidy does not cover the VSP Vision Care plan described on page 1, so that premium is not included in the samples.
3 Effective Date of Coverage The effective date of your retiree medical coverage is the first day of the month after you retire. COBRA COBRA is a right to extend your medical coverage beyond the termination date of your group coverage by paying separately. Your dependents may be eligible for COBRA when they are no longer eligible to participate in your healthcare plan. Your effective date of retirement may create a gap in your medical coverage. Because continuous health coverage is required for you to be eligible for retiree medical benefits, if your active employee coverage ends prior to the effective date of your retiree coverage you must apply for COBRA insurance to fill the gap. COBRA is handled through the Human Resources department. Coverage Areas and Relocation You must keep MCERA informed of your address. If you move outside of your primary healthcare provider s coverage area you may need to enroll in another healthcare plan. If you fail to notify MCERA of your new address, or falsify a claim, your healthcare coverage may be denied by the carrier. Coverage and premiums in non-california plans may be different, and coverage areas may be different for pre-age 65 and post-age 65 plans. We recommend checking with the plan provider before relocating to ensure that there will be no changes to your healthcare coverage. Life Insurance If you have 20 or more years of County service, and coverage was in force for five years prior to retirement, the County will pay the premiums for life insurance for you as follows: Basic life insurance ($10,000) plus supplemental life insurance with a declining face amount for eight years, or Double supplemental insurance with a declining face amount for eight years. MCERA staff can answer general questions related to life insurance. For more specific information please contact the. Medicare Eligibility and Enrollment Most MCERA members have contributed to Medicare and are eligible for Medicare at age 65. If you continue to work full-time beyond age 65, contact your employer s Human Resources office for information regarding Medicare. If you are not eligible for Medicare, please obtain a letter of non-eligibility from the Social Security Administration and submit it to the MCERA office. If you are eligible for Medicare and are retired, visit the Social Security office and apply for Medicare Parts A & B shortly before you turn 65. Send a copy of your Medicare enrollment card to MCERA, which gives us your eligibility date for the premium reimbursement. You will then need to change your healthcare plan to a Medicare supplement plan offered by your provider. Medicare will become your primary payor with Blue Cross or Kaiser becoming the secondary payor. Any amount left to pay after Medicare and what your Benefit Plan may cover is paid by you. When you apply for Parts A and B you will automatically receive Part D, the prescription drug program. You may only assign Medicare Part D benefits to one carrier at a time, so if you have dual coverage let MCERA know in advance. If you choose not to enroll in Medicare a surcharge will be applied in addition to your regular premium cost. This surcharge will not be subject to reimbursement by your employer nor will it be covered by your employerprovided benefit subsidy plan.
4 Health Coverage and Premiums Your Medicare coverage will combine with your current coverage (Kaiser or Blue Cross) for a single comprehensive health plan. You will retain your current benefits, but your health plan premiums will likely decrease. Please contact your health plan provider for more information specific to your individual situation. Medicare Premium Reimbursement The maximum monthly Medicare Part B premium reimbursement paid by the County for the 2015 calendar year is $104.90. While your actual Medicare Part B premium may be different, the County will only reimburse up to this amount. Medicare Resources To find out more about Medicare you can do any of the following: Visit Medicare s website (www.medicare.gov) to view or download the Medicare & You handbook (publication 10050). Call Social Security at 1-800-772-1213 for more information about Medicare eligibility and how to sign up. TTY users should call 1-800-325-0778. Visit www.medicare.gov, and select Find Out if You Are Eligible for Medicare and When You Can Enroll. Visit www.medicare.gov, and select Compare Health Plans and Medigap Policies in Your Area to learn more about Medicare Advantage or other Medicare health plans, as well as Medigap policies. Visit www.medicare.gov, and select Compare Medicare Prescription Drug Plans to learn more about Medicare drug plans and to compare plans. Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
5 Benefit Plan 3: Sample Subsidy Calculations for Under Age 65 Plans In Benefit Plan 3, your maximum annual subsidy is determined by multiplying your years of service (up to a maximum of 20 years) by an allocation factor. The allocation factor is set annually by the Board of Supervisors. The 2015 allocation factor is $442.65 per year of service, for a maximum annual amount of $8,853. If you have less than 30 years of service, the subsidy you receive under Benefit Plan 3 only covers your own premiums. If you have dependents on your healthcare plans you are responsible for those premiums. If you have 30 or more years of service you have a second subsidy, equal to your own, to cover all or a portion of your spouse s/partner s healthcare permiums. The second subsidy does not cover any other dependents you may have on your plans. Subsidy calculation for a member with 13.25 years of service Allocation factor $442.65 Years of service x 13.25 Maximum annual subsidy $5,865.11 Maximum monthly subsidy $488.76 Subsidy calculation for a member with 20 years of service (maximum) Allocation factor $442.65 Years of service x 20.00 Maximum annual subsidy $8,853.00 Maximum monthly subsidy $737.75 Kaiser Low Plan Kaiser Low premium $709.10 Total premiums due $762.50 Maximum employer subsidy - $488.76 What the retiree pays monthly $273.74 Kaiser Low Plan Kaiser Low premium $709.10 Total premiums due $762.50 Maximum employer subsidy - $737.75 What the retiree pays monthly $24.75 Anthem Blue Cross Plan Anthem Blue Cross premium $1,089.00 Total premiums due $1,142.40 Maximum employer subsidy - $488.76 What the retiree pays monthly $653.64 Anthem Blue Cross Plan Anthem Blue Cross premium $1,089.00 Total premiums due $1,142.40 Maximum employer subsidy - $737.75 What the retiree pays monthly $404.65
6 Benefit Plan 3: Sample Subsidy Calculations for Medicare Plans (Over Age 65) After age 65, Medicare reimbursement comes out of your subsidy first. You must pay your Medicare Part B premium directly to Medicare. Every month, you will be reimbursed up to the basic Medicare Part B premium ($104.90 for 2015) through your Benefit Plan 3 subsidy. The reimbursement comes out of your monthly allocation first, and the remainder is used toward payment of your premiums. Remaining subsidy after Medicare reimbursement with 13.25 years of service Maximum monthly subsidy $488.76 Basic Medicare Part B premium - $104.90 Remaining employer subsidy $383.86 Remaining subsidy after Medicare reimbursement with 20 years of service Maximum monthly subsidy $737.75 Basic Medicare Part B premium - $104.90 Remaining employer subsidy $632.85 Kaiser Low with Medicare Kaiser Sr Advantage premium $395.32 Total premiums due $448.72 Remaining employer subsidy - $383.86 What the retiree pays monthly $64.86 Kaiser Low with Medicare Kaiser Sr Advantage premium $395.32 Total premiums due $448.72 Remaining employer subsidy - $632.85 What the retiree pays monthly $0.00 Anthem Blue Cross with Medicare Anthem Blue Cross premium $537.05 Total premiums due $590.45 Remaining employer subsidy - $383.86 What the retiree pays monthly $206.59 Anthem Blue Cross with Medicare Anthem Blue Cross premium $537.05 Total premiums due $590.45 Remaining employer subsidy - $632.85 What the retiree pays monthly $0.00
7 Benefit Plan 4: Sample Subsidy Calculations for Under Age 65 Plans In Benefit Plan 4, your maximum annual subsidy is determined by multiplying your years of service (up to a maximum of 20 years) by $150. Your maximum subsidy is $3,000 per year. The subsidy you receive under Benefit Plan 4 only covers your own premiums. If you have dependents on your healthcare plans you are responsible for those premiums. Subsidy calculation for a member with 13.25 years of service Allocation per year of service $150.00 Years of service x 13.25 Maximum annual subsidy $1,987.50 Maximum monthly subsidy $165.62 Subsidy calculation for a member with 20 years of service (maximum) Allocation per year of service $150.00 Years of service x 20.00 Maximum annual subsidy $3,000.00 Maximum monthly subsidy $250.00 Kaiser Low Plan Kaiser Low premium $709.10 Total premiums due $762.50 Maximum employer subsidy - $165.62 What the retiree pays monthly $596.88 Kaiser Low Plan Kaiser Low premium $709.10 Total premiums due $762.50 Maximum employer subsidy - $250.00 What the retiree pays monthly $512.50 Anthem Blue Cross Plan Anthem Blue Cross premium $1,089.00 Total premiums due $1,142.40 Maximum employer subsidy - $165.62 What the retiree pays monthly $976.78 Anthem Blue Cross Plan Anthem Blue Cross premium $1,089.00 Total premiums due $1,142.40 Maximum employer subsidy - $250.00 What the retiree pays monthly $892.40
8 Benefit Plan 4: Sample Subsidy Calculations for Medicare Plans (Over Age 65) After age 65, Medicare reimbursement comes out of your subsidy first. You must pay your Medicare Part B premium directly to Medicare. Every month, you will be reimbursed up to the basic Medicare Part B premium ($104.90 for 2015) through your Benefit Plan 4 subsidy. The reimbursement comes out of your monthly allocation first, and the remainder is used toward payment of your premiums. Remaining subsidy after Medicare reimbursement with 13.25 years of service Maximum monthly subsidy $165.62 Basic Medicare Part B premium - $104.90 Remaining employer subsidy $60.72 Remaining subsidy after Medicare reimbursement with 20 years of service Maximum monthly subsidy $250.00 Basic Medicare Part B premium - $104.90 Remaining employer subsidy $145.10 Kaiser Low with Medicare Kaiser Sr Advantage premium $395.32 Total premiums due $448.72 Remaining employer subsidy - $60.72 What the retiree pays monthly $388.00 Kaiser Low with Medicare Kaiser Sr Advantage premium $395.32 Total premiums due $448.72 Remaining employer subsidy - $145.10 What the retiree pays monthly $303.62 Anthem Blue Cross with Medicare Anthem Blue Cross premium $537.05 Total premiums due $590.45 Remaining employer subsidy - $60.72 What the retiree pays monthly $529.73 Anthem Blue Cross with Medicare Anthem Blue Cross premium $537.05 Total premiums due $590.45 Remaining employer subsidy - $145.10 What the retiree pays monthly $445.35