State Retiree Health Benefits Program

Department of Human Resource Management

Office of Health Benefits

EligibilityMust be a retiring state employee receiving an immediate (not deferred) VRS annuity or periodic benefit from an ORP vendorMust have been eligible for state coverage as an active employee at the time of retirement (not Extended Coverage)Must enroll within 31 days of retirement date

Not EligibleCoverage is declined at retirement (except waiver)Enrollment is not completed within 31 days of retirementRetirement benefit is deferredCoverage is cancelled

Coverage Begins

The first day of the first full month of retirement

Eligible DependentsSame as active

employees, e.g.,Legal spouseUnmarried biological, legally adopted or step-childrenChildren in court-ordered sole permanent custody of retireeAdult children with a disability

Plan Choices

Non-Medicare PlansMedicare Plans

Current Non-Medicare Plans

COVA Care Basic or with optional benefits Out-of-Network (Medical & Behavioral Health) Expanded Dental Out-of-Network and Expanded Dental Vision, Hearing and Expanded Dental Out-of-Network, Vision, Hearing and Expanded

DentalCOVA HealthAware Basic or with optional benefits Expanded Dental and or Vision

Regional Plan – Kaiser Permanente (Northern Virginia, Fredericksburg, MD, DC)COVA High Deductible Health Plan (HDHP)TRICARE Supplement Plan for military retirees and their spouses/surviving spouses

Current Medicare PlansAdvantage 65Advantage 65 with Dental/VisionAdvantage 65-Medical OnlyAdvantage 65-Medical Only with Dental/Vision

Retiree Group MembersVRS Service RetireesVRS Disability RetireesORP RetireesLocal RetireesVSDP/LTD ParticipantsSurvivors Annuitant Non-Annuitant

Changes Allowed at Retirement

Enroll from active waive into single coverageDecrease membershipWaive to active/retiree coverage as dependent (and return in the future per plan provisions)Plan changeDecline/cancel coverage – no return to program

Not Allowed at Retirement

Increase in membership (unless there is a consistent, simultaneous qualifying mid-year event)

Allowable Changes After Retirement

Changes Consistent with Qualifying Mid-Year EventsMembership reduction (prospective)Cancellation (prospective)Open Enrollment (non-Medicare only)Medicare plan changes (prospective)

Required Change

To a Medicare-coordinating plan immediately upon Medicare eligibility

Medicare Eligibility

At age 65Prior to age 65

Original Medicare Plan

Medicare Part A – Hospital InsuranceMedicare Part B – Medical InsuranceMedicare Part D – Medicare Outpatient Prescription Drug Program

Premium Cost

Retiree pays the full cost of coverageHealth insurance credit if eligible

Premium PaymentVRS Deduction (post-tax) for VRS retirees with monthly benefit sufficient to cover premiumDirect Bill – all others Automatic Bank Draft

or on-line payments for Anthem plan participants

Non-Medicare Plan Premiums - 7/1/15—6/30/16

PLAN SingleTwo-

Person Family

COVA Care Basic $619 $1,148 $1,662

CC w/Out of Network $634 $1,168 $1,690

CC w/Expanded Dental $646 $1,199 $1,740

CC w/Vision/Hearing/Exp Dental $662 $1,226 $1,776

CC w/Out of Net/Exp Dental $661 $1,219 $1,768

CC w/Out of Net/Vision/Hearing/Exp Dental $677 $1,246 $1,804

Non-Medicare Plan Premiums - 7/1/15—6/30/16

PLAN SingleTwo-

Person FamilyCOVA HealthAware $566 $1,051 $1,517COVA HealthAware w/Exp Dental $592 $1,102 $1,594COVA HealthAware w/Exp Dental & Vision

$601 $1,117 $1,614

COVA HDHP $465 $864 $1,262COVA HDHP w/ Exp Dental $491 $915 $1,339Kaiser $573 $1,054 $1,536TRICARE $61 $120 $161

Medicare Plan Premiums - 2016

PLAN Single

Advantage 65 $293

Advantage 65 w/Dental & Vision $322

Advantage 65 – Medical Only $154

Advantage 65 – Medical Only w/Dental & Vision $183

How Does Advantage 65 Work – (2016)?

M edicare Pays (2015) Advantage 65 PaysHospital Inpatient (Part A) 60 days hospital after deductible Part A deductible except for f irst $100Skilled Nursing (Part A) Additional 30 days hospital (except coinsurance) Part A Coinsurance

60 hospital lifetime reserve days (exc. coinsurance)100% of allow able charge for eligible expenses for an 20 days at Medicare skilled nursing facility ("SNF") additional 365 days80 additional days at SNF (exc. coinsurance)

Physician and Other Services (Part B) Generally 80% of Medicare-Approved Amount Part B Coinsurance, but not Deductibleafter annual Deductible

Outpatient Prescription Drug (Part D) Basic or enhanced benefit, if enrolled Enhanced Part D plan (if M edical Only Plan selected, no outpatient prescription drug benefit*)

Dental Benefits $0 Optional BenefitRoutine Vision Benefits $0 Optional Benefit

Brief Summary of Advantage 65 Benefits

Advantage 65 Enhanced Medicare Part D Plan

FormularyDeductibleTiers and Coverage StagesNo “Doughnut Hole”Catastrophic benefitExcluded Drugs

Resources

DHRM Web Sitewww.dhrm.virginia.gov

Retiree Fact Sheets