State Retiree Health Benefits Program

1. State Retiree Health Benefits Program Department of Human Resource Management Office of Health Benefits

2. 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

3. 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

4. Coverage Begins • The first day of the first full month of retirement

5. 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

6. Plan Choices • Non-Medicare Plans • Medicare Plans

7. 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

8. Current Medicare Plans • Advantage 65 • Advantage 65 with Dental/Vision • Advantage 65-Medical Only • Advantage 65-Medical Only with Dental/Vision

9. Retiree Group Members • VRS Service Retirees • VRS Disability Retirees • ORP Retirees • Local Retirees • VSDP/LTD Participants • Survivors • Annuitant • Non-Annuitant

10. 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

11. Not Allowed at Retirement • Increase in membership (unless there is a consistent, simultaneous qualifying mid-year event)

12. 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)

13. Required Change • To a Medicare-coordinating plan immediately upon Medicare eligibility

14. Medicare Eligibility • At age 65 • Prior to age 65

15. Original Medicare Plan • Medicare Part A – Hospital Insurance • Medicare Part B – Medical Insurance • Medicare Part D – Medicare Outpatient Prescription Drug Program

16. Premium Cost • Retiree pays the full cost of coverage • Health insurance credit if eligible

17. 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

18. Non-Medicare Plan Premiums - 7/1/11—6/30/12

19. Medicare Plan Premiums - 2012

20. How Does Advantage 65 Work – (2012)?

21. Advantage 65 Enhanced Medicare Part D Plan • Formulary • Deductible • Tiers and Coverage Stages • No “Doughnut Hole” • Catastrophic benefit • Excluded Drugs

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