Presentation on theme: "SJDC Health Benefit Overview Retiree Coverage – Group I March 7, 2012 Suzanne Franco Employee Benefits Specialist."— Presentation transcript:
SJDC Health Benefit Overview Retiree Coverage – Group I March 7, 2012 Suzanne Franco Employee Benefits Specialist
Blue Cross – Plan 4 Co-insurance 90/10 $100.00 Annual Deductible $300.00 Annual Out of Pocket Max $10.00 Office Visit co-pay $5.00/$8.00 Prescription
Delta Dental – Incentive Plan 70/80/90/100% Coverage $1000.00 Annual Maximum Additional $200.00 if DPO/PPO dental provider is used. NO implant coverage
Vision Service Plan – Plan B Lenses once per year Frames once every two years $10 Office Visit co-pay
Retiree Life Insurance Schedule GROUP TERM LIFE RETIRED MEMBERS LESS THAN AGE 60 Benefits $8,000 benefit RETIRED MEMBERS BETWEEN AGE 60-64 Benefits $6,000 benefit RETIRED MEMBERS BETWEEN AGE 65-69 Benefits $3,000 benefit RETIRED MEMBERS BETWEEN AGE 70-74 Benefits $2,000 benefit RETIRED MEMBERS AGE 75 OR OLDER Benefits $1,000 benefit
Prescription Reimbursement The District does not have the option to carry a $5/8 RX plan. Retirees will be reimbursed by our 3 rd party administrator the allowable amount that exceeds $5/$8 in pharmacy cost or $10/$18 mail order cost. Generic restriction does apply. Prescription receipts are mailed to Stanislaus Foundation for processing. Receipts can be submitted at any time. (ie: monthly, quarterly, annually, etc) Please allow 3-4 weeks for processing.
PRESCRIPTION REIMBURSEMENT In order to maintian the current level of benefits, the District has adopted a reimbursement plan through Stanislaus Foundation for Medical Care. When submitting your claims for reimbursement, please complete the following information to expedite your payment: Subscriber's (Retiree) Name:Subscriber's SSN: Patient's Name:Patient's Date of Birth: Pharmacy receipts must show:Please mail all claims to: Patient's Name # of Receipts Stanislaus Foundation for Medical Care Drug Name P. O. Box 576007 Prescription Number Modesto, CA 95357-6007 Co-Payment Amt Paid Tel: (209) 527-2430 San Joaquin Delta College District Contact: Suzanne Franco (209) 954-5016 firstname.lastname@example.org
You must enroll in Part A and Part B. CVT will enroll you in Part D A copy of your card must be provided to CVT and to the District.
Medicare Overview Medicare Part A – Hospital Use when hospitalized Medicare Part B – Medical Doctor’s appointments Medicare Part D – Prescription Coordinated with CVT coverage
Medicare Part A If you will receive a Social Security check you will automatically qualify for Part A. If you do not automatically qualify, you may qualify through your current spouse or previous spouse. Please check with the SSA for additional information. Ineligible Faculty members will receive information from STRS regarding automatic payment of Part A. You will need to enroll in the program offered by STRS.
Medicare Part B You must activate your Medicare Part B. Part B Premiums are reimbursed by the District once a quarter. Documentation of your premium is to be submitted to the District annually for covered individuals. Both retiree and spouse are eligible for the reimbursement. Checks are sent directly to our retiree only. The District cannot electronically transfer the reimbursement to your bank account. Medicare collects premiums in advance while the District reimburses in arrears. It is the retirees responsibility to notify the District of any rate changes.
Medicare Part B Reimbursement Schedule Checks are issued 30 days after the close of the Quarter. January – March April 30th April – June July 31st July – September October 30th October – DecemberJanuary 31st
Medicare Part D California’s Valued Trust will enroll you in Medicare Part D. Prescription plan name: SILVERSCRIPT Plan is coordinated with regular prescription plan. If you have a prescription that is not covered by SilverScript then CVT covers the prescription if previously allowed. Coordination is automatic. Some prescriptions may require pre-authorization or an override. CVT processes the override for our retired members. Separate cards will be issued for medical and prescription coverage.
Miscellaneous Questions I received an adjustment to my Part B Premium – how come? Those individuals with a higher gross adjusted income are being assessed higher Part B premiums. The District will honor the higher rates for reimbursement. Documentation will be required. What happens to my spouse’s coverage if I should pre-decease my spouse? Coverage is terminated at the end of the month in which our retiree deceases. Your spouse will be provided the option of continuing to purchase coverage. The plan will not be the same but is similar. The approximate cost for the medical, dental and vision coverage is $425/mo with Medicare Parts A and B activated. I’m over 65 but my spouse is not. What medical cards does my spouse use? Your spouse will continue to use the regular Blue Cross medical card. You will receive a separate medical and prescription card with your name on it. If your spouse will be 65 before you then your spouse will receive individual personalized cards. Now that I have Medicare, what do I give/tell my doctor? You will need to give the provider both your Medicare card and your Blue Cross card. Medicare will become your primary coverage and Blue Cross will be your secondary. Do I keep my dental and vision coverage now that I am eligible for Medicare? Yes. These coverage’s do not change.
Miscellaneous Questions I am under 65. Will my group number change on my Medical plan now that I have retired? Yes, you will receive new medical cards with a new group number. Please continue to use your regular card until you receive the new card. Can I use my coverage if I decide to reside outside of California or the United States? Blue Cross provides regular coverage for those residing within the United States. There will be minimal coverage for those residing internationally. If either circumstance applies, you will need to contact Blue Cross Blue Card for the proper billing procedures. If I marry after I retire, can I add my spouse and dependents? Yes. Documentation will be required. What happens when I reach my Medicare Part D “coverage gap”? CVT will pick up the cost of the prescriptions when you fall into the coverage gap between $2930 and $4700. You will not experience any interruption in coverage.
Important Contact Numbers California’s Valued Trust – Rep: Tracy P (800) 288-9870 Blue Cross Blue Card (800) 810-2583 Medicare (800) 633-4227 SilverScript Pre-authorization (800) 294-5979 Medicare and You – publication www.medicare.gov/publications