State Retiree Health Benefits Program

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State Retiree Health Benefits Program

• Department of Human Resource Management
• Office of Health Benefits

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Eligibility

• Must be a retiring state employee receiving an
  immediate (not deferred) VRS annuity or periodic
  benefit from an ORP vendor
• Must 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

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Not Eligible

• Coverage is declined at retirement (except
  waiver)
• Enrollment is not completed within 31 days of
  retirement
• Retirement benefit is deferred
• Coverage is cancelled

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Coverage Begins

• The first day of the first full month of
  retirement

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Eligible Dependents

• Same as active employees, e.g.,
• Legal spouse
• Unmarried biological, legally adopted or
  step-children
• Children in court-ordered sole permanent custody
  of retiree
• Adult children with a disability

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Plan Choices

• Non-Medicare Plans
• Medicare Plans

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Current Non-Medicare Plans

• COVA Care/Connect
• COVA Care/Connect 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
  Dental
• 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

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Current Medicare Plans

• Advantage 65
• Advantage 65 with Dental/Vision
• Advantage 65-Medical Only
• Advantage 65-Medical Only with Dental/Vision

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Retiree Group Members

• VRS Service Retirees
• VRS Disability Retirees
• ORP Retirees
• Local Retirees
• VSDP/LTD Participants
• Survivors
• Annuitant
• Non-Annuitant

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Changes Allowed at Retirement

• Enroll from active waive into single coverage
• Decrease membership
• Waive to active/retiree coverage as dependent
  (and return in the future per plan provisions)
• Plan change
• Decline/cancel coverage no return to program

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Not Allowed at Retirement

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

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Allowable Changes After Retirement

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

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Required Change

• To a Medicare-coordinating plan immediately upon
  Medicare eligibility

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Medicare Eligibility

• At age 65
• Prior to age 65

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Original Medicare Plan

• Medicare Part A Hospital Insurance
• Medicare Part B Medical Insurance
• Medicare Part D Medicare Outpatient
  Prescription Drug Program

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Premium Cost

• Retiree pays the full cost of coverage
• Health insurance credit if eligible

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Premium Payment

• VRS Deduction (post-tax) for VRS retirees with
  monthly benefit sufficient to cover premium
• Direct Bill all others
• Automatic Bank Draft or on-line payments for
  Anthem plan participants

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Non-Medicare Plan Premiums - 7/1/116/30/12
PLAN Single Two-Person Family
COVA Care Basic 500 925 1,352
CC w/Out of Network 512 941 1,374
CC w/Expanded Dental 515 955 1,396
CC w/Vision/Hearing/Exp Dental 526 974 1,422
CC w/Out of Net/Exp Dental 527 970 1,417
CC w/Out of Net/Vision/Hearing/Exp Dental 537 989 1,442
COVA HDHP 401 743 1,086
Kaiser 539 993 1,448
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Medicare Plan Premiums - 2012
PLAN Single
Advantage 65 220
Advantage 65 w/Dental Vision 253
Advantage 65 Medical Only 137
Advantage 65 Medical Only w/Dental Vision 170
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How Does Advantage 65 Work (2012)?
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Advantage 65 Enhanced Medicare Part D Plan

• Formulary
• Deductible
• Tiers and Coverage Stages
• No Doughnut Hole
• Catastrophic benefit
• Excluded Drugs

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Resources

• DHRM Web Site
• www.dhrm.virginia.
• gov
• Retiree Fact Sheets