EMPLOYER GROUP HEALTH PLANS & RETIREE PLANS.

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Retiree Plans

♦ What is a Retiree Health Plan

♦ What do Retiree Health Plans cover and cost?

♦ What do I need to ask my benefits administrator about my Retiree Health Plan?

♦ State of California Retirement Benefits

Employer Group Health Plans (EGHP)

♦ What is an Employer or Union Group Health Plan (GHP)?

♦ Are there different types of Group Health Plans?

♦ What should I consider before dropping or changing my Group Health Plan?

♦ Should I sign up for Medicare Part A if I have an Employer or Union Group Health Plan?

♦I am no longer actively employed. When do I enroll in Medicare Parts B and D?

Federal Employees Health Benefits (FEHB)

♦ What is the Federal Employees Health Benefits (FEHB) Program?

♦ What Is FEHB Eligibility for Retirees and Survivor Annuitants?

♦ What Is FEHB Eligibility for Dependents?

♦ What Is FEHB Eligibility for Former Spouses?

♦ Do FEHB Plans and Medicare Cover the Same Types of Expenses?

♦ If I Have FEHB Coverage, Do I Need Medicare Coverage?

♦ Can I Change My Retiree FEHB Plan When I Become Eligible for Medicare?

♦ If I Want to Join a Medicare Advantage Plan, Should I Drop My FEHB Coverage?

♦ Do I Need Medigap Coverage if I have FEHB?

COBRA and CalCOBRA

♦ What is COBRA?

♦ What is CalCOBRA?

♦ What do COBRA and CalCOBRA cover?

♦ How long can I get COBRA and CalCOBRA?

♦ How much do COBRA and CalCOBRA cost?

♦ Medicare and COBRA

♦ What about COBRA, CalCOBRA, and Special Enrollment Periods (SEP) for Medicare Parts B and D?





Retiree Plans

What is a Retiree Health Plan?
A Retiree Health Plan is coverage offered by some employers and unions to their retired employees. An employer or union’s Retiree Health Plan is often different from the Group Health Plan they offer to active employees.



What do Retiree Health Plans cover and cost?
There are no set standards for Retiree Health Plans. The details of coverage and cost for each individual plan are determined by the employer or union and may be changed at any time. Many Retiree Plans notify members of changes in the fall around the Medicare Annual Election Period.



What do I need to ask my benefits administrator about my Retiree Health Plan?
Retirement is a big step, and it is important to have sufficient health coverage in place. Here are a few questions you may want to discuss with your employer or union benefits administrator about your Retiree Health Plan:

♦ Do I have a choice of Retiree Health Plan options?

♦ Does the Retiree Health Plan have a premium, deductible, or copayments? If so, how much are they?

♦ How will Medicare coordinate with my Retiree Health Plan benefits?

♦ Will the Retiree Health Plan have creditable prescription coverage that meets or exceeds the benefits of Medicare Part D?

♦ Are there additional services covered under the plan that are not covered by Medicare?

♦ Will I still have coverage when I travel or move?

♦ What will happen to my spouse’s coverage in the event I drop my coverage or pass away?

Call HICAP at 1-800-434-0222 to schedule a one-on-one appointment for more information.




State of California Retirement Benefits
If you retired or are retiring from employment with the State of California or a municipality and you receive health benefits through CalPERS, contact CalPERS at 1-888-225-7377 for more information about your options.

If you retired or are retiring from employment with the State of California Teachers system and you receive health benefits through CalSTRS, contact CalSTRS at 1-800-228-5453 for more information about your options.

NOTE: DO NOT enroll in a Medicare Part D prescription plan if you have CalPERS or CalSTRS. You will lose your health insurance coverage for life.





Employer Group Health Plans (EGHP)

What is an Employer or Union Group Health Plan (GHP)?
An Employer or Union Group Health Plan (GHP) is health coverage provided by an employer or union to its current, active employees or members, their spouses, and their eligible dependents.



Are there different types of Group Health Plans?
Group Health Plans are classified by size. Each type must follow different regulations that could affect your coverage depending on your circumstances.

Group Health Plans with fewer than 20 employees must follow different regulations than those for 20 up to 100 employees. Plans for 100 or more employees are known as Large Group Health Plans (LGHP) and have additional requirements they must follow in certain situations.

Contact HICAP at 1-800-434-0222 to schedule an appointment for more information.



What should I consider before dropping or changing my Group Health Plan?
It is extremely important that you talk with your employer, benefits administrator, or insurer before you make any changes to your Group Health Plan. If you drop your plan, you and your dependents may never be able to re-enroll.

If you are thinking about dropping your Group Health Plan and changing to a Medicare plan, here are a few questions to consider before making a change:

♦ Does your current plan have creditable prescription drug coverage that meets or exceeds that of Medicare Part D?

♦ Will you reach the Part D “donut hole” or gap in coverage if you change plans?

♦ What are the premiums, deductibles, and co-payments for each plan?

♦ Which plan provides the most comprehensive coverage?

♦ Does your current plan provide coverage for dental, hearing, and vision care that Medicare plans may not?

♦ Which plan has the largest selection of doctors and hospitals?

♦ If you change plans, will you need to change doctors?

♦ Will you still have coverage if you move or travel to another area?

♦ If you drop the Group Plan, can your spouse or eligible dependent still be covered?

Contact HICAP at 1-800-434-0222 to schedule a one-on-one appointment about your options.



Should I sign up for Medicare Part A if I have an Employer or Union Group Health Plan?
If you are entitled to Part A without a premium, it is beneficial to enroll even if you have an Employer or Union Group Health Plan. Contact Social Security at 1-800-772-1213 or www.ssa.gov for more information.



I am no longer actively employed. When do I enroll in Medicare Parts B and D?
If you or your spouse delayed Medicare Part B enrollment due to group health coverage based on active employment, you have an 8 month Special Enrollment Period (SEP) to sign up for Part B without a penalty when the employment ends.

If you or your spouse delayed Part D enrollment because your Group Health Plan has creditable prescription drug coverage (coverage considered at least equivalent to Medicare Part D benefits), you will have a limited, 63 day Special Enrollment Period (SEP) to join a Medicare drug plan without penalty when the employment ends.

Contact HICAP at 1-800-434-0222 to schedule a one-on-one appointment about your options.




Federal Employees Health Benefits (FEHB)

What is the Federal Employees Health Benefits (FEHB) Program?

The Federal Employees Health Benefits (FEHB) Program is a group health insurance program for Federal civilian employees, retirees, and their eligible family members.

The Federal Employees Health Benefits (FEHB) Program provides a wide selection of coverage options including:

♦ Fee for Service (FFS) plans

♦ Preferred Provider Organizations (PPO)

♦ Health Maintenance Organizations (HMO)

♦ High Deductible Plans that offer catastrophic risk protection

to compare the costs, benefits, and features of different FEHB plans.
And always review your yearly “Open Season” packet to evaluate options.




What Is FEHB Eligibility for Retirees and Survivor Annuitants?
Federal retirees and their surviving spouses may be eligible for FEHB health coverage at the same cost as current employees. In order to carry your FEHB coverage into retirement, you must have been continuously enrolled (or covered as a family member) in any FEHB plan(s) for the 5 years of service immediately before the date of your annuity starts, or for the full period(s) of service since your first opportunity to enroll (if less than 5 years). Federal retirees and their dependents have the option of NOT participating in Medicare.

for more information at the U.S. Office of Personnel Management website.

And always review your yearly “Open Season” packet to evaluate options. Consult with your local NARFE chapter (National Active and Retired Federal Employees Association) for more information.




What Is FEHB Eligibility for Dependents?
Dependent family members eligible for FEHB coverage are a Federal employee’s spouse (including a valid common law marriage) and unmarried dependent children under age 22, including legally adopted children and recognized natural (born out of wedlock) children who meet certain dependency requirements. Stepchildren and foster children are included if they live with the Federal employee in a regular parent-child relationship. An unmarried dependent child age 22 or over who is incapable of self-support because of a mental or physical disability that existed before age 22 is also an eligible family member.

for more information at the U.S. Office of Personnel Management website.




What Is FEHB Eligibility for Former Spouses?
Under the Civil Service Retirement Spouse Equity Act of 1984, certain former spouses of Federal employees, former employees, and annuitants may qualify to enroll in a health benefits plan under the FEHB Program.

for more information at the U.S. Office of Personnel Management website.




Do FEHB Plans and Medicare Cover the Same Types of Expenses?
Plans under the FEHB Program generally help pay for the same types of expenses as Medicare. There are some services that FEHB may cover that Medicare does not, such as emergency care outside the United States and dental and vision services. Likewise, Medicare provides some coverage for orthopedic and prosthetic devices, durable medical equipment (DME), home health care, limited chiropractic services, skilled nursing care, and some medical supplies, which certain FEHB plans may not cover or only partially cover. Check your specific plan’s evidence of coverage booklet for more details.



If I Have FEHB Coverage, Do I Need Medicare Coverage?
If you are entitled to Part A without a premium, it is beneficial to enroll even if you are still working. Medicare Part A may help cover some your FEHB plan’s deductibles, coinsurance, and costs that exceed the plan’s allowable charges.

You don’t have to take Part B coverage if you don’t want it, and your FEHB plan can’t require you to take it. There are some advantages to enrolling in Part B, however, such as:

♦ If you have Medicare Parts A and B, you have the option of enrolling in a Medicare Advantage Plan.

♦ Medicare and your FEHB plan may coordinate to reduce your out-of-pocket costs.

♦ Your FEHB plan may waive its copayments, coinsurance, and deductibles for Part B services.

♦ Some services covered under Part B might not be covered or only partially covered by your FEHB plan.

Note: If you decide not to enroll in Part B, and later you change your mind, you may be subject to Medicare’s Late Enrollment Penalty, and cannot enroll until the General Enrollment Period (January-March), with an effective date of July 1.



Can I Change My Retiree FEHB Plan When I Become Eligible for Medicare?
You may change your retiree FEHB plan to any available plan or option beginning 30 days before you become eligible for Medicare. Once Medicare becomes the primary payer, you may find that a lower cost FEHB plan is adequate for your needs, especially if you are currently enrolled in a plan’s high option. Some plans may waive deductibles, coinsurance, and copayments when Medicare is your primary insurer, as well.



If I Want to Join a Medicare Advantage Plan, Should I Drop My FEHB Coverage?
If you enroll in a Medicare Advantage plan, you may not need retiree FEHB coverage because the Medicare Advantage plan will provide you with many of the same benefits. You should review the Medicare Advantage Plan benefits carefully before making a decision to suspend or cancel FEHB coverage. You should contact your retirement system to discuss benefit suspension and re-enrollment.



Do I Need Medigap Coverage if I have FEHB?
You do not need to purchase a Medigap policy since FEHB and Medicare will coordinate benefits to provide comprehensive coverage for a wide range of medical expenses.




COBRA and CalCOBRA

What is COBRA?
COBRA is a Federal law that allows you to temporarily continue your group health benefits when your coverage would otherwise end. Circumstances such as job loss, reduced hours, divorce, or death of the actively employed spouse may qualify a person for COBRA. COBRA laws only apply to employers with at least 20 employees.



What is CalCOBRA?
CalCOBRA is a state law that allows you to temporarily continue your group health benefits through a company with 2 to 19 employees when your coverage would otherwise end. Circumstances such as job loss, reduced hours, divorce, or death of the actively employed spouse may qualify a person for CalCOBRA.



What do COBRA and CalCOBRA cover?
COBRA coverage will generally be the same as your group health coverage. If the employer changes the group health benefits, your COBRA or CalCOBRA benefits will also change.



How long can I get COBRA and CalCOBRA?
The maximum length of coverage for COBRA and CalCOBRA can vary greatly depending on your specific circumstances. In most instances, you may be covered by COBRA and CalCOBRA from 18 to 36 months. For more information, call HICAP at 1-800-434-0222 for a one-on-one appointment.

for more information from the California Department of Insurance



How much do COBRA and CalCOBRA cost?
Employers often contribute to the costs of group healthcare coverage. With COBRA and CalCOBRA, however, you must pay the full cost of the premium plus an additional administration fee. For COBRA, your premium is 102 percent of the employer’s full premium. Your premium for CalCOBRA can range from 110 to 213 percent of the employer’s full premium depending on how the group rate is calculated. If the employer’s premium changes, your COBRA or CalCOBRA premium will change as well.



Medicare and COBRA
If you become eligible for Medicare while you are already on COBRA or CalCOBRA, the COBRA or CalCOBRA coverage will end. If your spouse is also on COBRA or CalCOBRA, however, they may qualify for continuing coverage.

If you already have Medicare, you cannot become eligible for CalCOBRA coverage.

If you have Medicare and then become eligible for COBRA coverage, however, you have two options:

♦ Pay for both Medicare and COBRA coverage

♦ Decline COBRA and have Medicare only

Call HICAP at 1-800-434-0222 to schedule a one-on-one appointment to discuss your specific circumstances and options.




What about COBRA, CalCOBRA, and Special Enrollment Periods (SEP) for Medicare Parts B and D?

If you or your spouse delayed Part B enrollment due to group health coverage based on active employment, you have an 8 month Special Enrollment Period (SEP) to sign up for Part B without a penalty when the employment ends. If you elect COBRA and wait until your COBRA eligibility ends before enrolling in Medicare Part B, you may be required to pay the late enrollment penalty and the effective date of your benefits may be delayed. In addition, you may not be able to enroll in Medicare Part B until the General Election Period.

If your COBRA plan has creditable prescription drug coverage (coverage considered at least equivalent to Medicare Part D benefits), you will have a limited Special Enrollment Period (SEP) to join a Medicare drug plan without penalty when the COBRA coverage ends.

for more information on Enrollment Periods/Guaranteed Rights

Call HICAP at 1-800-434-0222 to schedule a one-on-one appointment to discuss your specific circumstances and options.

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