2016 ANNUAL ENROLLMENT GUIDE FOR TIRINTEEEL SRE4 2016 ANNUAL ENROLLMENT GUIDE FOR RETIREES Why IRMP May Cost More Intel’s Retiree Medical Plan continues to be an option to retirees

2016 ANNUAL ENROLLMENT GUIDE FOR RETIREES 1

2016 AnnuAl EnrollmEnt GuidE for intEl rEtirEEsIntel’s Annual Enrollment is October 26 through December 15, 2015*

Choose benefits to power your best life. Enroll at My Health Benefits website www.intel.com/go/myben or call (877) GoMyBen (466-9236). Benefit elections take effect January 1, 2016.

* See Page 4 for Medicare Open Enrollment Period Dates.

2 2016 ANNUAL ENROLLMENT GUIDE FOR RETIREES

Table of ConTenTsWhat’s Changing for 2016? ..................................................................................................................................................................................3

Sheltered Employee Retirement Medical Account (SERMA): Use Yours Wisely ......................................................................5

Intel Retiree Medical Plan (IRMP) Member Eligibility...............................................................................................................................7

All Plans ...........................................................................................................................................................................................................................7

IRMP Cigna Coinsurance .....................................................................................................................................................................................8

IRMP Cigna Indemnity With and Without Rx .......................................................................................................................................10

IRMP Vision Plan ..................................................................................................................................................................................................12

MetLife Dental .......................................................................................................................................................................................................14

Get the Help You Need Before You Enroll .................................................................................................................................................14

Make Your Annual Enrollment Decisions ...................................................................................................................................................15

new opTions To save!You may pay less for coverage that meets your personal needs through individual insurance plans outside Intel. See What’s Changing for 2016? and Aon Retiree Health Exchange: What to Expect for details.

The purpose of This GuideIt’s time for you and your family to review your healthcare plan

choices and make your Annual Enrollment decisions for 2016 to

help power your best life in retirement. In this guide, we share what’s

changing, what decisions you need to make, and provide plan

features and cost comparison charts to help you make informed

choices. If you want more, we outline the best venues for detailed

information and how you can get your questions answered.

Decision-support tools within the My Health Benefits website and

other resources will be available to you and your eligible dependents

starting on October 19, 2015. Take advantage of all the available

resources to help you prepare.

The Intel health benefits enrollment window for the Intel Retiree

Medical Plan (IRMP), VSP Vision, and MetLife Dental runs from

Oct. 26 through Nov. 13, 2015. For other healthcare enrollment

dates, please see page 4.


whaT’s ChanGinG for 2016? Intel retiree healthcare benefits are changing to offer more flexibility and choice. Here is a quick summary of changes:

• This year’s Annual Enrollment window is longer to give you time to examine all the choices available to you from Intel and through individual plans available in the marketplace to find an optimal plan for you and your family.

• Premiums for IRMP options increase 7% for 2016, so take full advantage of resources available to compare alternatives.

• The Aon Retiree Health Exchange is available to help all Intel retirees find the right healthcare options and perhaps save money with a plan comparable to the IRMP. Resources available at this one-stop shop are free for you and your family.

• A new Intel Catastrophic Rx Health Reimbursement Account (HRA) is available to Medicare retirees enrolled in Medicare Part D to provide more financial protection and extra peace of mind regarding prescription expenses. No enrollment or election is necessary for this benefit, but you do need to be enrolled in Medicare Part D.



Why IRMP May Cost More

Intel’s Retiree Medical Plan continues to be an option to retirees with a cost increase of 7% for 2016. The cost increase is attributed to the increasing cost of healthcare. It is compounded by the fact that few retirees are enrolling in our IRMP as more options become available in the marketplace.

Over the past few years, the health insurance marketplace has expanded. As a result, individual plans have become more widely available and affordable, and they offer an array of coverage opportunities, including medical, prescription drug, dental, and vision coverage. To help you assess the many choices available, Intel offers access to Aon Retiree Health Exchange with knowledgeable Benefits Advisors to help you understand all your options. This service is new to our Non-Medicare retirees. If you’re on Medicare, you’ve had this service for a few years.

The Aon Retiree Health Exchange: What to Expect

For the vast majority of Intel retirees, transitioning to a plan through Aon Retiree Health Exchange will mean more plan options to choose from with more affordable premiums. The Aon Retiree Health Exchange is one of the industry’s leading private exchanges of individual coverage options providing you tools, resources, and ongoing personalized support. Since the process for Non-Medicare and Medicare eligible individuals is slightly different, we have highlighted below the process depending upon your personal situation.

• Complete your Aon Retiree Exchange enrollment online at retiree.aon.com/intel, or

• For help with enrollment or to schedule an appointment, call Intel Health Benefits Center at (877) GoMyBen (466-9236)

– Say “Aon Retiree Health Exchange” – Select the “Set up new appointment”

option

how do i enroll in oTher healTh CoveraGe or sChedule an appoinTmenT

wiTh a benefiTs advisor?

• For help with Aon Retiree Exchange enrollment or to schedule an appointment, call Intel Health Benefits Center at (877) GoMyBen (466-9236)

– Say “Aon Retiree Health Exchange” – Select the “Set up new appointment”

option, or• Complete your enrollment online at

retiree.aon.com/intel

October 19 – December 11, 2015 when Can i Call To sChedule an appoinTmenT?

October 1 – December 3, 2015

November 1 – December 15, 2015 appoinTmenT/enrollmenT windowOctober 15 – December 7, 2015 (coincides with Medicare Open Enrollment dates)

January 1, 2016 effeCTive daTe of mediCal and/or presCripTion CoveraGe

January 1, 2016

• Your Aon Benefits Advisor will be able to explain the transition, how SERMA works, and what you need to do. While speaking with the Aon Benefits Advisor, if you have specific questions about plans available in your area, then the Aon Advisor will bring in a specially trained agent from eHealth, the leading individual insurance marketplace in the U.S., to assist and answer more detailed questions.

• When you are ready to enroll in a medical plan, you will need to enroll online through the eHealth website.

enrollmenT proCess

• Your Benefits Advisor will ask you questions to understand your needs and preferences to help you decide what plans meet your needs and budget based on the insurance options available in your area.

• Once you choose a plan, your Benefits Advisor will work with you to complete your application, either by telephone or online, and to fill out any forms that might be required.

whaT To do if you Choose a plan ThrouGh aon reTiree healTh exChanGe?You may need to adjust previous IRMP choices made for coverage effective January 1, 2016 by calling the Intel Health Benefits

Center at (877) GoMyBen (466-9236)—this could mean dropping your IRMP or adjusting SERMA, including “opting out.”

non-mediCare mediCarewhaT you Can expeCT:

https://retiree.aon.com/intel

https://retiree.aon.com/intel


Catastrophic Rx HRA – Capping Your Out-of-Pocket Costs Under Medicare Part D

Effective January 1, 2016, Medicare retirees who are enrolled in Medicare Part D for prescription coverage will not spend more than the Medicare Donut Hole (Coverage Gap) annual maximum ($4,700 in 2015). As you may know, Medicare Part D plans cover a broad range of medications at a cost share that changes as your prescription drug costs increase during the year. With Part D alone, you continue to pay 5% coinsurance for drugs, even after you reach the annual Donut Hole maximum. Intel’s new Catastrophic Rx HRA will reimburse you for that 5% coinsurance.

Medicare retirees do not need to enroll or elect this benefit during Annual Enrollment, but you do need to be enrolled in Medicare Part D (Medicare Open Enrollment Period is from October 15 – December 7, 2015).

To take advantage of this benefit, you simply need to call the Intel Health Benefit Center at (877) GoMyBen (466-9236) and select the “Your Spending Account” option to notify the team you have exceeded the Medicare Part D Donut Hole. Your Spending Account representative will walk you through what you need to do to submit claims for reimbursement.

MEDICARE PART D PLANSPrescription Drug CoverageAmounts noted are 2015 limits

DEDUCTIBLEFIRST $320

INITIAL COVERAGE LEVEL NEXT $2,640 ($2,960 TOTAL)

THE DONUT HOLEUP TO $4,700

CATASTROPHIC Rx HRA COVERAGE

100% paid by you (if applicable)

You pay copayment/coinsurance for each drug

You pay a percentage (65%)of the generic and (45%)

brand name drug cost

You pay a copayment (~5%) for each drug for the remainder of the year and get reimbursed

by Intel through the NEW Catastrophic Rx HRA

SERMA provides you with the ability to pay for the plan that best meets your needs. You have the ability to use SERMA in the following ways:

• To pay for all or part of your IRMP premium.

• To pay all or part of your premium from a plan selected through Aon Retiree Health Exchange.

• To reimburse yourself for the cost of non-Intel sponsored health insurance premiums identified at right.

Use SERMA for Other Healthcare Premiums

You may use your SERMA to reimburse yourself for premiums paid for you and your eligible dependents until you exhaust your account. Eligible reimbursements may include premium payments for:

• Individual health insurance

• Individual dental insurance

• Individual vision insurance

• Other employer retiree group plans

• COBRA

• Medicare

• Medigap

• TRICARE

• Long-term care

shelTered employee reTiremenT mediCal aCCounT (serma): use yours wisely

Retirees May “Opt Out” of SERMA for 2016

Non-Medicare retirees with access to SERMA will not qualify to receive federal premium tax credits. You may choose to “Opt Out” of SERMA for 2016 in order to qualify. When you “opt out,” your SERMA balance is frozen and you will not be able to use SERMA to pay for Intel or non-Intel sponsored healthcare premiums mentioned on page 5. Your “Opt Out” election will carry over from year to year unless you “Opt In” again during the next Annual Enrollment following the same process.

There are online tools that help you identify if your income levels are such to qualify for federal premium tax credits, and the Benefits Advisors at Aon Retiree Health Exchange can guide you through that process, if needed. If you want to learn more now, these sites are helpful: https://www.healthcare.gov/ and http://kff.org/health-reform/.

If you are considering using Federal premium tax credits to reduce the cost of health insurance purchased through an eligible exchange, you should seek advice from a tax advisor. If you decide that the federal premium tax credit is the best option, you will need to call the Intel Health Benefits Center at (877) GoMyBen (466-9236) and select the “Your Spending Account” option to “Opt Out” of access to your SERMA for 2016.

serma reimbursemenTsThe SERMA plan year runs from January 1 through December 31 of each year. You may submit premiums incurred during these dates as long as:

• You were eligible for a SERMA reimbursement on the date the coverage began.

• You file your claim after your coverage began.

• You file your claim before the run-out period ends on March 31 of the following year.

You’re allowed to submit claims for the prior year during the run-out period (January 1 to March 31), as long as the premiums occurred while you were eligible to utilize your SERMA. For example, you have until March 31, 2016 to submit a claim for June 2015 premiums. The run-out period provides you extra time to submit your claims. If you do not submit your claims with complete supporting documentation by March 31, your claim will be denied.

If you are enrolled in IRMP, you may also use your SERMA on other eligible healthcare premiums. For example, if you are on the IRMP plan and your spouse is enrolled in another retiree group health plan, you may use your SERMA toward both your IRMP premium and your spouse’s non-Intel retiree premium expense.

Checking Your SERMA

Call the Intel Health Benefits Center at (877) GoMyBen (466-9236) or go to the website at www.intel.com/go/myben and click on the My Health Benefits website link, log on to UPoint, and select the “Your Spending Account/SERMA” tile. If you are accessing the UPoint site for the first time, you will be asked to create a user ID and password to log on. Here, you can:

• View your SERMA balance

• Submit claims (you have the option to submit claims online, by fax or by mail)

• Check the status of your claims

• Learn more about eligible expenses

Using SERMA for IRMP

If you are enrolled in IRMP, you may use your SERMA to offset your monthly premium for medical and/or vision coverage until you exhaust your account. During Annual Enrollment, you may elect how much of your IRMP premium you would like paid from your SERMA each month; 25%, 50%, 75%, or 100%. Your IRMP premium payments will be paid directly from your SERMA; you do not need to submit a claim for reimbursement. The percentage you elect will apply to both you and enrolled dependent’s premiums. If you choose a SERMA contribution other than 100%, you are responsible for paying the remainder of the premium cost.



Make sure you and your family members are eligible for coverage.

• It is your responsibility to ensure that only your eligible depen-dents are enrolled in IRMP. If you are Medicare eligible and your eligible dependent is not, or vice-versa, the Medicare eligible person will be eligible to enroll in one of the IRMP Indemnity options, and the non-Medicare eligible person will be eligible to enroll in the CIGNA Coinsurance plan. For a complete descrip-tion of the dependent eligibility requirements, refer to the IRMP Summary Plan Description (SPD). For a copy of the SPD, contact the Intel Benefits Center at (877) 466-9236, or visit My Health Benefits at www.intel.com/go/myben, click on the My Health Benefits website link, log on to UPoint, and select the “Plan Information” tile. If you are accessing the UPoint site for the first time, you will be asked to create a user ID and password to log on.

• If you and your eligible dependents are newly enrolling in IRMP, you are required to provide proof of continuous health-care coverage for the previous 18 months. The proof must be received by the Intel Health Benefits Center within 30 days of your enrollment date.

• It is also your responsibility to update your dependent Social Security Number(s) or Taxpayer Identification Number(s) in My Health Benefits by December 31, 2015 in order to comply with reporting requirements under the Affordable Care Act (ACA) individual shared responsibility mandate. If we are missing your dependent Social Security Number(s), an alert will show at the top of My Health Benefits at www.intel.com/go/myben advising you to take necessary steps or to call the Intel Health Benefit Center at 877-GoMyBen (466-9236).

inTel reTiree mediCal plan (irmp) member eliGibiliTy

The medical plan options available under IRMP to eligible retirees and their eligible dependents are:

• Cigna Coinsurance Plan – available to Non-Medicare retirees. For more information go to page 8.

• Cigna Indemnity Plan with Rx – available to Medicare retirees. For more information, go to page 10.

• Cigna Indemnity Plan without Rx – available to Medicare retirees. For more information, go to page 10.

Additional plans:

• IRMP Vision Plan through VSP – available to all retirees. For more information, go to page 12.

• Dental Plan through MetLife – available to all retirees. For more information, go to page 14.

all plans


IRMP Cigna Coinsurance Plan Benefit Summary: Additional details available at www.intel.com/go/myben or in the IRMP Summary Plan Description (SPD); call Intel Benefits Center at 877-GoMyBen (466-9236) to request the IRMP SPD. Benefits In-Network Out-of-Network

Annual Deductible $600 Individual/$1,200 Family$600 Individual/$1,200 Family (separate from in-network deductible)

Out-of-Pocket Maximum $3,000 Individual/$6,000 Family $3,000 Individual/$6,000 Family

Major Medical Lifetime Maximum Unlimited Unlimited

Inpatient In-Network: Coinsurance applies after deductible is met

Out-of-Network: Coinsurance applies after deductible is met and is subject to reasonable and customary costs

Inpatient Hospital 20% coinsurance 40% coinsurance

Skilled Nursing Facility

20% coinsurance; limited to 100 days per calendar year 40% coinsurance

Home Health 20% coinsurance; $5,000 lifetime maximum

40% after deductible is met with a $5,000 lifetime maximum

Inpatient Mental Health (preauthorization required)

100% covered 40% coinsurance

Outpatient In-Network: Coinsurance applies after deductible is met


Physician Office Visit 20% coinsurance 40% coinsurance

Ambulatory Surgical Center 20% coinsurance 40% coinsurance

Outpatient Hospital 20% coinsurance 40% coinsurance

Occupational and Physical Therapy 20% coinsurance 40% coinsurance

Speech/Language Therapy 20% coinsurance 40% coinsurance

Ambulance 20% coinsurance 40% coinsurance

Emergency Room 20% coinsurance 40% coinsurance

Emergency Worldwide Coverage 20% coinsurance 40% coinsurance

Urgent Care 20% coinsurance 40% coinsurance

Urgent Care Worldwide Coverage 20% coinsurance 40% coinsurance

Prosthetic Devices 20% coinsurance 40% coinsurance

Mental Health & Substance Abuse 20% coinsurance 40% coinsurance

2016 Monthly PremiumYou Only, Spouse Only,* Child(ren) Only**

You + Spouse, You + Child(ren), Spouse + Child(ren) You + Spouse + Child(ren)

$1,017 $2,033 $3,050

irmp CiGna CoinsuranCe For Non-Medicare RetireesWhat you need to know before you enroll in this plan for 2016:

• Your premiums will increase by 7% for 2016.

• Certain compound medications are no longer covered; if this applies to you, Express Scripts will be in touch.

• New resources are available to help you through Aon Retiree Health Exchange. Benefits Advisors can help you navigate the many comparable plans available if you’d like to choose one of those options by December 15, 2015.

* For a complete description of the spouse and dependent eligibility requirements, refer to the IRMP Summary Plan Description (SPD).

** Same price for child or multiple children.

http://www.intel.com/go/myben


IRMP Cigna Coinsurance Plan Benefit Summary – Continued

Outpatient In-Network: Coinsurance applies after deductible is met


Diagnostic Tests/ Lab Services 20% coinsurance 40% coinsurance

Routine Outpatient X-Ray includes Radiation Therapy

20% coinsurance 40% coinsurance

Routine Physical Covered at 100% Covered at 100%

Additional Benefits In-Network: Coinsurance applies after deductible is met


Routine Chiropractic20% coinsurance; limited to 30 visits per year combined in- and out-of-network

40% coinsurance; limited to 30 visits per year combined in- and out-of-network

Routine Podiatry 20% coinsurance 40% coinsurance

Non-Emergency Transportation 20% coinsurance 40% coinsurance

Acupuncture 20% coinsurance; limited to 30 visits per year combined in- and out-of-network

40% coinsurance; limited to 30 visits per year combined in- and out-of-network

Preventive Dental Not covered Not covered

Vision Exam Not covered Not covered

Routine Hearing 20% coinsurance 40% coinsurance

Prescription Benefit (Certain compound medications are no longer covered; if this applies to you, Express Scripts will be in touch.)

Retail (34 day supply)

Mail/Walgreens/Costco (90 day supply)

Retail Penalty* (34 day supply)

Generic $10 $20 $20**

Preferred Brand20% coinsurance$25 minimum/ $60 maximum

20% coinsurance $62.50 minimum/ $150 maximum

50% coinsurance**$25 minimum

Non-Preferred Brand40% coinsurance $40 minimum/ $100 maximum

40% coinsurance $100 minimum/ $250 maximum

50% coinsurance** $40 minimum

Formulary (list of plan approved drugs) Please review at www.express-scripts.com/intel

* Penalty applies after the first two purchases of a maintenance (long-term) prescription at a retail pharmacy.** The out-of-pocket costs beyond the standard benefit will not apply toward deductible/out-of-pocket maximums.

http://www.express-scripts.com/intel


IRMP CIGNA Indemnity Plan with Rx AND without Rx Benefit Summary: Additional details available at www.intel.com/go/myben or in the IRMP Summary Plan Description (SPD); call Intel Health Benefits Center at 877-GoMyBen (466-9236) to request the IRMP SPD. Also refer to Medicare Part A & B (www.medicare.gov).Benefits Medicare** IRMP Cigna Indemnity Medicare-eligible

Annual Deductible Part B Deductible = $162 (See Inpatient Hospitalization section for Inpatient Deductible) $500 Individual/$1,000 Family

Out-of-Pocket Maximum Not applicable $2,000 Individual/$4,000 Family

Major Medical Lifetime Maximum (if applicable) Not applicable Unlimited

Inpatient Medicare** Coinsurance applies after deductible is met

Inpatient Hospital $1,132 deductible (Days 1–60); $283 (Days 61–90); $566 (Days 91–150)

20% of Medicare allowable after deductible is met

Skilled Nursing Facility

Pay for each benefit period, following at least a three day covered hospital stay. Days 1-20: $0 for each day; Days 21-100: $141.50 for each day. There is a limit of 100 days for each benefit period.

20% of Medicare allowable after $500 plan deductible; 100 days per calendar year

Home HealthCovered 100% by Medicare. There are no copayments for Medicare-covered home health visits.

Covered 100% by Medicare. There are no copayments for Medicare-covered home health visits.

Inpatient Mental Health 20% of Medicare approved 20% of Medicare allowable after deductible is met

Outpatient Medicare** Coinsurance applies after deductible is met

Physician Office Visit 20% of Medicare approved 20% of Medicare allowable

Mental Health and Substance Abuse 20% of Medicare approved 20% of Medicare allowable

Ambulatory Surgical Center 20% of Medicare approved 20% of Medicare allowable

Outpatient Hospital 20% of Medicare approved 20% of Medicare allowable

2016 Monthly Premium

With or Without Rx You Only, Spouse Only,* Child(ren) Only**

You + Spouse, You + Child(ren), Spouse + Child(ren) You + Spouse + Child(ren)

With Rx $584 $1,167 $1,750

Without Rx $188 $375 $562* For a complete description of the spouse and dependent eligibility requirements, refer to the IRMP Summary Plan Description (SPD).** Same price for child or multiple children.

irmp CiGna indemniTy wiTh and wiThouT rx For Medicare RetireesWhat you need to know before you enroll in this plan for 2016:

• Your premiums will increase by 7% for 2016.

• New resources are available to help you through Aon Retiree Health Exchange. Benefits Advisors can help you navigate the many comparable plans available if you’d like to choose one of those options by December 7, 2015.

• Retirees and dependents who are eligible for Medicare can enroll in the IRMP CIGNA Indemnity with Rx Plan or the IRMP CIGNA Indemnity without Rx Plan.

• If you choose the with Rx Plan, prescription drug coverage is included and you do not need to purchase a Medicare Part D plan to provide prescription drug benefits. Additionally, certain compound medications are no longer covered; if this applies to you, Express Scripts will be in touch.

• If you choose the without Rx Plan, this option does not cover prescription drugs. If you choose this plan, it is strongly recom-mended that you purchase a Medicare Part D program to obtain prescription drug benefits. Medicare Open Enrollment ends December 7, 2015.

• If you choose the without Rx Plan, you can get additional peace of mind through the Catastrophic Rx HRA. No enrollment or election is necessary for the Catastrophic Rx HRA benefit, but you do need to be enrolled in Medicare Part D for your pre-scription drug coverage.

• Both IRMP plans coordinate with Medicare, and that means they only provide a benefit for services not covered by Medicare.

http://www.intel.com/go/myben

http://www.medicare.gov


IRMP CIGNA Indemnity Plan with Rx AND without Rx Benefit Summary – ContinuedOutpatient – Continued Medicare** Coinsurance applies after deductible is met

Occupational and Physical Therapy 20% of Medicare approved 20% of Medicare allowable

Speech/Language Therapy 20% of Medicare approved 20% of Medicare allowable

Ambulance 20% of Medicare approved 20% of Medicare allowable

Emergency Room/Urgent Care 20% of Medicare approved 20% of Medicare allowable

Emergency/Urgent Care Worldwide Coverage Limited coverage outside U.S. 20% of Medicare allowable

DME/Supplies/Medical Rx Medicare** Coinsurance applies after deductible is met

Durable Medical Equipment 20% of Medicare approved 20% of Medicare allowable*

Prosthetic Devices 20% of Medicare approved 20% of Medicare allowable

Procedures Medicare** Coinsurance applies after deductible is met

Diagnostic Tests/Lab Services Generally 20% of Medicare approved ($0 for certain approved lab services) 20% of Medicare allowable

Routine Outpatient X-Ray includes Radiation Therapy 20% of Medicare approved 20% of Medicare allowable

Routine Physical Once during initial six months (MIPPE) 20% of Medicare allowable

Additional Benefits Medicare** Coinsurance applies after deductible is met

Chiropractic Not covered 20% of plan allowed; limited to 30 visits per calendar year

Routine Podiatry Not covered 20% of plan allowed

Non-Emergency Transportation Not covered 20% of plan allowed

Acupuncture Not covered 20% of plan allowed; limited to 30 visits per calendar year

Preventive Dental Not covered Not covered

Vision Exam Not covered Not covered

Eye Wear Not covered Not covered

Contact Lenses Not covered Not covered

Routine Hearing Not covered 20% coinsurance

Hearing Aid Allowance Not covered 20% coinsurance

* Note: Wigs and hair pieces covered up to $500 per calendar year.**2015 Medicare benefits provided. For 2016 benefits and complete details, visit www.medicare.gov, or call (800) 633-4227.Note: Part B premium is dependent on income. For complete details please refer to www.medicare.gov.

Prescription Benefit (The benefit below applies only to IRMP Cigna Indemnity with Rx Plan. Certain compound medications are no longer covered; if this applies to you, Express Scripts will be in touch.)

Retail (34 day supply)

Mail/Walgreens/Costco (90 day supply)

Retail Penalty* (34 day supply)

Generic $10 $20 $20**

Preferred Brand $20 $40 $40**

Non-Preferred Brand $30 $60 $60**

* Penalty applies after the first two purchases of a maintenance (long-term) prescription at a retail pharmacy.** The penalty out-of-pocket costs beyond the standard mail benefit will not apply towards deductible/out-of-pocket maximums.

Prescription Coverage Medicare IRMP Cigna Indemnity with Rx IRMP Cigna Indemnity without Rx

Medicare Prescriptions are not covered (available via Medicare Part D) See Prescription Benefit below Prescriptions are not covered

Out-of-Pocket Max (TrOOP) Prescriptions are not covered (available via Medicare Part D) None – See Prescription Benefit below Prescriptions are not covered

Formulary (list of plan approved drugs)

Prescriptions are not covered (available via Medicare Part D)

Please review at: www.express-scripts.com/intel Prescriptions are not covered

Pharmacy Network Prescriptions are not covered (available via Medicare Part D)

Please review at: www.express-scripts.com/intel Prescriptions are not covered






VSP Basic Vision PlanVSP Provider Network: VSP Choice

Benefit Description CopayYour Coverage with a VSP Provider

WellVision Exam*

• Focuses on your eyes and overall wellness• Every calendar year

$0

Retinal Screening

• Takes a picture of the back of your eyes and helps your VSP doctor find possible signs of eye disease

• Every calendar year$25

Prescription Glasses

Frame

• $130 allowance for a wide selection of frames• $150 allowance on featured frame brands1

• $70 allowance at Costco• 20% savings on the amount over your allowance• Every other calendar year

$25

Lenses• Single vision, lined bifocal, and lined trifocal lenses• Polycarbonate lenses for dependent children• Every calendar year

$25

Lens Enhancements

• Standard progressive lenses• Premium progressive lenses• Custom progressive lenses• Average savings of 20% – 25% on other lens enhancements

$55$95 - $105$150 - $175

Contacts (instead of glasses)

• $130 allowance for contacts; copay does not apply• Contact lens exam (fitting and evaluation)• Every calendar year

Up to $55

Primary Eye Care

• Treatment and diagnosis of eye conditions like pink eye, and vision loss; and monitoring of cataracts, glaucoma, and diabetic retinopathy. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details.

• As needed

$15

Exclusive Member Extras

Glasses and Sunglasses• Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers

for details.• 20% savings on additional glasses and sunglasses, including lens

enhancements, from any VSP doctor within 12 months of your last WellVision Exam.

Laser Vision Correction• Average 15% off the regular price or 5% off the promotional price;

discounts only available from contracted facilities.

your CoveraGe wiTh ouT-of-neTworK providers on The basiC plan• Exam: up to $40

• Frame: up to $70

• Single Vision Lenses: up to $30

• Lined Bifocal Lenses: up to $50

• Lined Trifocal Lenses: up to $70

• Progressive Lenses: up to $50

• Contacts: up to $130

1. Brands/Promotion subject to change.

* Allowances and out-of-network reimbursement apply to single purchase, no declining balance.


PlanYou Only, Spouse* Only, Child(ren)** Only

You + Spouse, You + Child(ren), Spouse + Child(ren)

You + Spouse + Child(ren)

VSP Basic Vision $6 $11 $14



irmp vision plan VSP provides you with a choice of afford-able vision plans—choose the plan that’s right for you. What you need to know before you enroll in this plan for 2016:

• There are two options for vision coverage—VSP Basic Vision Plan and VSP Vision Plus Plan.

• Retirees can enroll themselves or their dependents in the IRMP Vision Plan without purchasing IRMP medical coverage.

• New for 2016, anyone who enrolls in the VSP Vision Plus Plan receives the added benefit of laser vision correction (Lasik) coverage. The benefit is a $2,000 allowance per lifetime per covered member.

• To locate a VSP doctor prior to enroll-ment, go to www.vsp.com/advantage or call member services at (855) 663-2836.

http://vsp.com/specialoffers


VSP Vision Plus Plan VSP Provider Network: VSP Choice

Benefit Description CopayYour Coverage with a VSP Provider

WellVision Exam*

• Focuses on your eyes and overall wellness• Every calendar year

$0

Retinal Screening

• Takes a picture of the back of your eyes and helps your VSP doctor find possible signs of eye disease

• Every calendar year$25

Prescription Glasses

Frame

• $200 allowance for a wide selection of frames• $220 allowance on featured frame brands1

• $110 allowance at Costco• 20% savings on the amount over your allowance• Every calendar year

$10

Lenses• Single vision, lined bifocal, and lined trifocal lenses• Polycarbonate lenses for dependent children• Every calendar year

$10

Lens Enhancements

• Standard progressive lenses• Premium progressive lenses• Custom progressive lenses• Average savings of 20% – 25% on other lens enhancements

$55$95 - $105$150 - $175

Contacts (instead of glasses)

• $200 allowance for contacts; copay does not apply• Contact lens exam (fitting and evaluation)• Every calendar year

Up to $55

Primary Eye Care

• Treatment and diagnosis of eye conditions like pink eye, and vision loss; and monitoring of cataracts, glaucoma, and diabetic retinopathy. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details.

• As needed

$15

Exclusive Member Extras

Glasses and Sunglasses• Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers

for details.• 20% savings on additional glasses and sunglasses, including lens

enhancements, from any VSP doctor within 12 months of your last WellVision Exam.

Laser Vision Correction• Anyone who enrolls in the VSP Vision Plus Plan receives the added benefit

of laser vision correction (Lasik) coverage. The benefit is a $2,000 allowance per lifetime per covered member.

1. Brands/Promotion subject to change.

* Allowances and out-of-network reimbursement apply to single purchase, no declining balance.


PlanYou Only, Spouse* Only, Child(ren)** Only

You + Spouse, You + Child(ren), Spouse + Child(ren)

You + Spouse + Child(ren)

VSP Vision Plus $13 $24 $30



your CoveraGe wiTh ouT-of-neTworK providers on The plus plan• Exam: up to $40

• Frame: up to $110

• Single Vision Lenses: up to $30

• Lined Bifocal Lenses: up to $50

• Lined Trifocal Lenses: up to $70

• Progressive Lenses: up to $50

• Contacts: up to $200

http://vsp.com/specialoffers


Intel partners with MetLife to offer retirees a voluntary plan that offers access to comprehensive dental coverage. You may use SERMA to reimburse yourself for any eligible dental premiums. If you are currently enrolled, you will continue unless you advise otherwise; if you are not enrolled, MetLife will send you a letter offering enrollment options. For more information, call MetLife (866) 832-5756.Note: This voluntary dental plan is not an Intel-sponsored benefit and is not an ERISA welfare benefit plan.

Contact the Intel Health Benefits Center at (877) GoMyBen (466-9236) for answers to your questions about:

• Annual Enrollment

• IRMP medical, vision, and dental plans

• SERMA

• New Catastrophic Rx HRA

• New health plan options through Aon Retiree Health Exchange and to schedule an appointment with a Benefits Advisor

• Online resources available at www.intel.com/go/myben

Representatives are available Monday through Friday, 6 a.m. to 6 p.m. Pacific. When calling the Intel Health Benefits Center you will be asked to provide certain information while you navigate the Access Direct phone menu.

Attend Intel’s Annual Enrollment Virtual Roadshow for:

• In-depth materials including on-demand webinars from HR and our plan providers at www.intel.com/annualenrollment (simply select the Retiree option on the State map page)

• Additional information about how to work with Aon Retiree Health Exchange to enroll in the optimal plan for you

meTlife denTal

GeT The help you need before you enroll

more resourCes

Call (800) 468-3510 or visit Cigna online at www.mycigna.com. Open Enrollment (OE) ID: intelben2016OE Password: intelben2016

Call (800) 633-4227 or visit Medicare online at www.medicare.gov.

Call VSP at (855) 663-2836 or visit VSP online at www.vsp.com/advantage.

Call MetLife (866) 832-5756.

Call Express Scripts at (800) 899-2713 or visit Express Scripts online at www.express-scripts.com/intel.

Your Intel Benefits Center is typically your one-stop shop, but here are more resources if your questions are specific to a vendor or plan:

CIGNA PLANS

MEDICARE PART D

VISION COVERAGE

OPTIONAL DENTAL COVERAGE

PRESCRIPTION DRUG COVERAGE

Rx


If you make no changes, the coverage you have today will automatically continue in 2016.

If You’re Choosing Any of the IRMP Options

You can make elections at My Health Benefits online or by calling the Intel Health Benefits Center at (877) GoMyBen (466-9236). Here are the online steps to further guide you:

• Go to www.intel.com/go/myben and click on “My Health Benefits website” then log on by entering your User ID and password.

• If you are using the site for the first time, you will be asked to create a User ID and password to log on:

– To create your User ID, select “Create Your User ID” or “Are you a new user?” and follow the instructions.

– You will be asked to create a password and answer a series of security questions.

– Password is not required when calling or accessing your account by calling the Intel Health Benefits Center.

• Click the “Enroll” button, then click the medical plan or vision plan.

• Select the plan option you want to enroll in.

• Save your choices by selecting the “Complete Enrollment” button.

• Print a copy of your confirmed elections for your records. You can visit My Health Benefits at any time to view your elections. You may also make changes to your elections multiple times during Annual Enrollment.

maKe your annual enrollmenT deCisionsIf You’re Choosing Options through Aon Retiree Health Exchange

• Complete your enrollment online through eHealth; if you desire assistance, then the Aon Benefits Advisor and the eHealth specially trained agent can assist over the phone and help you navigate the website to complete your online enrollment.

• After calling the Intel Health Benefits Center at (877) GoMyBen (466-9236) and saying “Aon Retiree Health Exchange,” you have the option to “Reach your Benefits Advisor using their extension” (the extension will typically be given to you during your appointment) or obtain answers to any other questions.

Some changes are NOT available online

• You must call the Intel Health Benefits Center at (877) GoMyBen (466-9236) to complete your enrollment if:

– You have dependents with split eligibility (i.e., one who is Medicare eligible and one who is not Medicare eligible).

– You are enrolling in IRMP for the first time. – You have experienced a qualifying change-in-status event

(e.g., marriage). – You decide to enroll in a plan through Aon Retiree Health

Exchange after November 13 but before your applicable deadline (Non-Medicare = December 15, Medicare = December 7) and need to make changes or remove previous 2016 IRMP choices or adjust SERMA, including “opting out.”

benefiT eleCTions TaKe effeCT January 1, 2016The benefit elections you make during this Annual Enrollment period will become effective January 1, 2016. The next opportunity for you to make IRMP or SERMA changes will be during next year’s Annual Enrollment, or if you experience a qualifying change-in- status event during the year. You may be required to provide proof of 18 months of continuous health coverage.


This guide is intended to be a Summary of Material Modifications to your benefit plans. The information in this guide is a summary of your benefits and is not intended to take the place of or change official plan documents in any way. In the event of a discrepancy between the information in this guide and the 2016 Summary Plan Description (SPD) for the Intel Retiree Medical Plan (IRMP) and information about the Sheltered Employee Retirement Medical Account (SERMA), the SPD will prevail. For a copy of the current SPD, contact the Intel Health Benefits Center at (877) GoMyBen (466-9236) or online at www.intel.com/go/myben. The SPD will be available with 2016 updates in Q1 2016. Intel reserves the right to modify, change, or discontinue benefit plans at any time, at its sole discretion.

Copyright © 2015 Intel Corporation. All rights reserved. Intel and the Intel logo are trademarks of Intel Corporation in the U.S. and/or other countries.

0915/DR/HBD/PP/7.35K Printed in the USA. Please Recycle CPS# H000164469

Documents

2016 ANNUAL ENROLLMENT GUIDE FOR TIRINTEEEL SRE4 2016 ANNUAL ENROLLMENT GUIDE FOR RETIREES Why IRMP May Cost More Intel’s Retiree Medical Plan continues to be an option to retirees