Transcript State Retiree Health Benefits Program

State Retiree Health Benefits
Program
Department of Human Resource
Management
Office of Health Benefits
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
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
Coverage Begins
The first day of
the first full
month of
retirement
Eligible Dependents
Same as active
employees, e.g.,
Legal spouse
Unmarried biological,
legally adopted or stepchildren
Children in courtordered sole permanent
custody of retiree
Adult children with a
disability
Plan Choices
Non-Medicare
Plans
Medicare 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 Dental
COVA 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 Plans
Advantage 65
Advantage 65 with Dental/Vision
Advantage 65-Medical Only
Advantage 65-Medical Only with
Dental/Vision
Retiree Group Members
VRS Service Retirees
VRS Disability Retirees
ORP Retirees
Local Retirees
VSDP/LTD Participants
Survivors


Annuitant
Non-Annuitant
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
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 Events
Membership reduction
(prospective)
Cancellation (prospective)
Open Enrollment (nonMedicare only)
Medicare plan changes
(prospective)
Required Change
To a Medicarecoordinating plan
immediately upon
Medicare eligibility
Medicare Eligibility
At age 65
Prior to age 65
Original Medicare Plan
Medicare Part A – Hospital Insurance
Medicare Part B – Medical Insurance
Medicare Part D – Medicare Outpatient
Prescription Drug Program
Premium Cost
Retiree pays
the full cost of
coverage
Health
insurance credit
if eligible
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
Non-Medicare Plan Premiums 7/1/14—6/30/15
PLAN
Single
TwoPerson Family
COVA Care Basic
$604
$1,119
$1,620
CC w/Out of Network
$618
$1,138
$1,646
CC w/Expanded Dental
$629
$1,167
$1,693
CC w/Vision/Hearing/Exp Dental
$644
$1,192
$1,727
CC w/Out of Net/Exp Dental
$643
$1,186
$1,719
CC w/Out of Net/Vision/Hearing/Exp
Dental
$658
$1,211
$1,753
Non-Medicare Plan Premiums 7/1/14—6/30/15
PLAN
Single
TwoPerson Family
COVA HealthAware
$555
$1,029
$1,486
COVA HealthAware w/Exp Dental
$580
$1,077
$1,559
COVA HealthAware w/Exp Dental &
Vision
$588
$1,091
$1,578
COVA HDHP
$456
$847
$1,237
COVA HDHP w/ Exp Dental
$481
$895
$1,310
Kaiser
$549
$1,010
$1,475
TRICARE
$61
$120
$161
Medicare Plan Premiums - 2015
PLAN
Single
Advantage 65
$273
Advantage 65 w/Dental & Vision
$307
Advantage 65 – Medical Only
$145
Advantage 65 – Medical Only w/Dental &
Vision
$179
How Does Advantage 65
Work – (2015)?
Brief Summary of Advantage 65 Benefits
M edicare Pays (2015)
Advantage 65 Pays
Hospital Inpatient (Part A)
60 days hospital after deductible
Part A deductible except for first $100
Skilled 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 days
80 additional days at SNF (exc. coinsurance)
Physician and Other Services (Part B) Generally 80% of Medicare-Approved Amount
Part B Coinsurance, but not Deductible
after 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 Benefit
Routine Vision Benefits
$0
Optional Benefit
Advantage 65 Enhanced
Medicare Part D Plan
Formulary
Deductible
Tiers and Coverage
Stages
No “Doughnut Hole”
Catastrophic benefit
Excluded Drugs
Resources
DHRM Web Site
www.dhrm.virginia.gov

Retiree Fact Sheets