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HUMAN RESOURCES DEPARTMENTBenefi ts Division
Jina Edwards, Sr. Benefi ts Analyst703.746.3789 [email protected]
Tori Butler, Benefi ts Analyst703.746.3787 [email protected]
Shari Davidson, Benefi ts Manager703.746.3786 703.718.1133 (mobile)
301 King St., Room 2510Alexandria, VA 22314
Offi ce: 703.746.3777Fax: 703.519.3488
Email: [email protected]: alexandriava.gov/HR
10/24/2018
RETIREE OPEN ENROLLMENT GUIDEFOR MEDICARE-ELIGIBLE RETIREES AND SPOUSES 2019
Open Enrollment: November 6 – 30, 2018
alexandriava.gov/HR
RETIREE OPEN ENROLLMENT INFORMATION MEETINGWednesday, November 7
10 a.m. – NoonLee Center 1108 Jeff erson St.
This Retiree Open Enrollment Guide provides important information for City of Alexandria retirees and spouses.
Please maintain an accurate mailing address with the City of Alexandria. Retirees should contact the Human Resources Department's Benefi ts Division at 703.746.3777, or [email protected], to update an address or phone number.
Open enrollment is generally the only opportunity during the year you will have to change your medical plan elections.
Attend the informational session to ask questions, fi nd out more information about the 2019 changes, talk to the Benefi ts staff , Kaiser and UnitedHealthcare representatives and complete necessary forms.
Questions? Call 703.746.3777 or email [email protected] 7
ACTIONS REQUIRED:IF YOU... THEN YOU...
are currently in the Kaiser Plan or the UnitedHealthcare Plan and do not want to make a change
DO NOT HAVE TO DO ANYTHING.
want to change from one plan to the other or change from the Reimbursement Program to one of the plans
MUST complete the 2019 Retiree Medical Plan Change Form (included in this packet) and return to Human Resources, with the enclosed envelope, by Friday, November 30.
are currently in the Reimbursement Program and will continue in that program
are required once each year, at the end of your plan year, to provide documentation regarding the plan cost. The Reimbursement Statement (the blue form included in this packet) is provided to use for that purpose.
REMINDERS: • Only Medicare-eligible retirees/spouses may enroll in the City-sponsored Kaiser
Permanente Medicare and the UnitedHealthcare Medicare Advantage PPO Plans. Medicare-eligible retirees may not remain enrolled in the Kaiser or UnitedHealthcare “Employee Plans” after they become Medicare-eligible.
• If you previously opted out of the City-sponsored plans for the Retiree Health Insurance Reimbursement Program, you may re-enroll in either of the Medicare plans during this Open Enrollment period.
If you have questions or need additional information, we encourage you to attend the informational meeting with the Benefi ts staff , Kaiser and UnitedHealthcare representatives.
If you decide to change your insurance coverage, you must submit your election change form to Human Resources Department's Benefi ts Team (in person or postmarked) no later than November 30, 2018. Late submissions cannot be accepted.
Enrollment packages will be available at the informational meeting, or will be mailed upon request.
RETIREE OPEN ENROLLMENT INFORMATION MEETINGWednesday, November 7
10 a.m. – NoonLee Center 1108 Jeff erson St.
Please update your personal information or benefi ciary designation on the enclosed forms, if necessary.
6 2019 Medicare-Eligible Retiree Open Enrollment Guide
Uni
tedH
ealth
care
Kai
ser
Per
man
ente
In-N
etw
ork
Out
-of-
Net
wor
kP
lan
A w
ith P
art D
Den
tal
$15
cop
ay fo
r Med
icar
e-co
vere
d se
rvic
es
Dis
coun
t pla
n pr
ovid
ed b
y D
omin
ion
Den
tal:
$30
exa
m
copa
y, c
lean
ing
2x p
er y
ear &
25
%
disc
ount
with
par
ticip
atin
g de
ntis
ts
Hea
lth e
duca
tion
Rene
w P
rogr
am w
ith m
agaz
ine,
onl
ine
cour
ses,
art
icle
s,
vide
os, m
usic
str
eam
ing,
reci
pe li
brar
y an
d m
ore
Tota
l Hea
lth A
sses
smen
t, he
alth
ed
ucat
ion
clas
ses,
spe
cial
pr
ogra
ms
and
coac
hing
bot
h on
line
and
at m
edic
al c
ente
rs
Fitn
ess
prog
ram
Silv
erSn
eake
rs®
Fitn
ess:
sta
y ac
tive
with
a b
asic
gym
m
embe
rshi
p at
a p
artic
ipat
ing
loca
tion
at n
o ex
tra
cost
Dis
coun
ts o
n ac
upun
ctur
e,
chiro
prac
tic c
are,
mas
sage
ther
apy
and
"Cho
ose
Hea
lthy"
Pro
gram
Nur
seLi
neSp
eak
with
a re
gist
ered
nur
se (R
N) 2
4 ho
urs
a da
y, 7
day
s a
wee
k
Con
nect
with
a K
aise
r Per
man
ente
lic
ense
d ca
re p
rovi
der
day
or n
ight
for a
dvic
e, re
ferr
als,
pr
escr
iptio
ns, a
nd m
ore.
A
vaila
ble
24/7
at 1
.80
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7.79
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Virt
ual d
octo
r vis
its$
0 c
opay
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ak to
spe
cifi c
doc
tors
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ng c
ompu
ter o
r mob
ile d
evic
e
$0
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ay te
leph
one
ap
poin
tmen
ts w
ith y
our
doct
or, m
obile
dev
ice
or
com
pute
r with
a c
amer
a
Hou
seC
alls
Pro
gam
Ann
ual w
elln
ess
visi
t with
clin
icia
n in
you
r hom
e
*Ben
efi ts
are
com
bine
d in
and
out
-of-n
etw
ork.
Uni
tedH
ealth
care
U
HC
Ret
iree
.com
1
.877
.714
.017
8 (T
TY: 7
11)
Plan
s ar
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sure
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roug
h U
nite
dHea
lthca
re In
sura
nce
Com
pany
or o
ne o
f its
affi
liate
d co
mpa
nies
, a M
edic
are
Adv
anta
ge o
rgan
izat
ion
with
a M
edic
are
cont
ract
and
a
Med
icar
e-ap
prov
ed P
art D
spo
nsor
. Enr
ollm
ent i
n th
e pl
an d
epen
ds o
n th
e pl
an’s
con
trac
t ren
ewal
with
Med
icar
e. R
etire
e pl
an p
rosp
ects
mus
t mee
t the
elig
ibili
ty
requ
irem
ents
to e
nrol
l for
gro
up c
over
age.
Thi
s in
form
atio
n is
not
a c
ompl
ete
desc
riptio
n of
ben
efi ts
. Con
tact
the
plan
for m
ore
info
rmat
ion.
Lim
itatio
ns, c
opay
men
ts, a
nd
rest
rictio
ns m
ay a
pply
. Ben
efi ts
, pre
miu
m a
nd/o
r cop
aym
ents
/coi
nsur
ance
may
cha
nge
each
pla
n ye
ar.
Kai
ser
Per
man
ente
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p.or
g/m
edic
are 1
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)Ka
iser
Per
man
ente
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n w
ith a
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icar
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ntra
ct in
Virg
inia
and
an
Adv
anta
ge P
lan
in W
ashi
ngto
n, D
.C. a
nd M
aryl
and
begi
nnin
g on
Jan
uary
1, 2
019
. Enr
ollm
ent
in K
aise
r Per
man
ente
dep
ends
on
cont
act r
enew
al B
enefi
ts, f
orm
ular
y, p
harm
acy
netw
ork,
pro
vide
r net
wor
k, p
rem
ium
and
/or c
opay
men
ts/c
oins
uran
ce m
ay c
hang
e on
Ja
nuar
y 1
of e
ach
year
and
at o
ther
tim
es in
acc
ord
with
you
r gro
up’s
con
trac
t. Th
e be
nefi t
info
rmat
ion
prov
ided
is a
brie
f sum
mar
y, n
ot a
com
plet
e de
scrip
tion
of b
enefi
ts. F
or
mor
e in
form
atio
n, c
onta
ct th
e pl
an. L
imita
tions
, cop
aym
ents
, and
rest
rictio
ns m
ay a
pply
. Kai
ser P
erm
anen
te c
ompl
ies
with
app
licab
le F
eder
al c
ivil
right
s la
ws
and
does
not
di
scrim
inat
e on
the
basi
s of
race
, col
or, n
atio
nal o
rigin
, age
, dis
abili
ty, o
r sex
.
AD
DIT
ION
AL
INFO
RM
ATI
ON
Questions? Call 703.746.3777 or email [email protected] 3
As a City of Alexandria retiree, you and/or your Medicare-eligible dependents have an opportunity during this Open Enrollment Period to once again review the City-sponsored health insurance plan options and decide either to remain in your current plan or elect another plan option. This 2019 RETIREE OPEN ENROLLMENT GUIDE is designed to help you choose the plan that best meets your health needs and fi nancial resources. Please review it very carefully.
Open Enrollment begins on November 6 and ends on November 30, 2018. This is the time you may change your health insurance coverage for calendar year 2019.
CHANGES FROM 2018 UnitedHealthcare: There is a small rate reduction for the UnitedHealthcare Plan due to the removal of an Aff ordable Care Act fee for 2019.
A new benefi t is being added to help prevent malnourishment and reduce readmissions. The post-discharge Meal Delivery Program, Mom’s Meals, will provide up to 21 days of home-delivered meals to members immediately following a hospital discharge.
Kaiser: There is no rate change for Kaiser. The Kaiser plan is changing from a Medicare Cost Plan (integrated with Medicare) to a Medicare Advantage Plan (complete replacement for Medicare) for members in Washington, D.C. and Maryland in 2019. No action is required.
• Members in Virginia will transition in 2020.
• The plan design remains the same, but members must use Kaiser providers (i.e., can no longer use their Medicare card for services outside of Kaiser).
2019 Retiree Open Enrollment Guide for Medicare-Eligible Retirees and Spouses
2019 MONTHLY PREMIUM FOR THE MEDICARE-ELIGIBLE RETIREE PROGRAM
Plan 2019 Monthly
Premium 2018 Monthly
Premium Percent Increase
Kaiser Permanente Medicare Plan
$248.70 $248.70 0%
UnitedHealthcare Medicare Advantage PPO Plan
$399.94 $406.50 -2%
NOTE: Those who are eligible to receive the City’s monthly health insurance subsidy of up to $260 will be required to pay any additional premium in excess of the City provided subsidy. Participants in the UnitedHealthcare Medicare Advantage Plan would pay $139.94 per month in 2019 if you eligible for the full $260 per month subsidy.
4 2019 Medicare-Eligible Retiree Open Enrollment Guide
BEN
EFIT
S H
IGH
LIG
HTS
- C
ITY
OF
ALE
XA
ND
RIA
OV
ER 6
5 R
ETIR
EES
Eff e
ctiv
e Ja
nuar
y 1,
20
19 to
Dec
embe
r 31
, 20
19
This
is a
sho
rt d
escr
iptio
n of
pla
n be
nefi t
s. F
or c
ompl
ete
info
rmat
ion,
ple
ase
refe
r to
your
Sum
mar
y of
Ben
efi ts
or E
vide
nce
of
Cov
erag
e. L
imita
tions
, exc
lusi
ons
and
rest
rictio
ns m
ay a
pply
. Pla
n be
nefi t
s in
form
atio
n is
als
o av
aila
ble
at a
lexa
ndria
va.g
ov/H
R
unde
r Ret
irees
Cor
ner.
BEN
EFIT
S C
OV
ERED
BY
OR
IGIN
AL
MED
ICA
RE
AN
D Y
OU
R P
LAN
Uni
tedH
ealth
care
Kai
ser
Per
man
ente
In-N
etw
ork
Out
-of-
Net
wor
kP
lan
A w
ith P
art D
Ann
ual d
educ
tible
No
annu
al d
educ
tible
No
annu
al d
educ
tible
No
annu
al d
educ
tible
Doc
tor's
Offi
ce V
isit
Pre
vent
ive
Car
e$
0 c
opay
for M
edic
are-
cove
red
prev
entiv
e se
rvic
es$
0 c
opay
Prim
ary
Car
e$
15 c
opay
$15
cop
ay$
15 c
opay
Spe
cial
ist
$15
cop
ay$
15 c
opay
$15
cop
ay
Inpa
tient
hos
pita
l car
e, in
clud
ing
M
enta
l Hea
lth &
Sub
stan
ce A
buse
$10
0 c
opay
per
adm
issi
on$
100
cop
ay p
er a
dmis
sion
$10
0 p
er b
enefi
t pe
riod
Skill
ed n
ursi
ng fa
cilit
y (S
NF)
$0
cop
ay p
er d
ay u
p to
10
0 d
ays
$0
cop
ay p
er d
ay u
p to
10
0 d
ays
$0
cop
ay p
er d
ay u
p to
10
0 d
ays
Out
patie
nt s
urge
ry$
0 c
opay
$0
cop
ay$
0 c
opay
at S
urge
ry C
ente
r
Out
patie
nt re
habi
litat
ion
(phy
sica
l,
occu
patio
nal o
r spe
ech/
lang
uage
ther
apy)
$15
cop
ay$
15 c
opay
$15
cop
ay
Dia
gnos
tic ra
diol
ogy
serv
ices
(MR
Is, C
T sc
ans)
$0
cop
ay$
0 c
opay
$0
cop
ay
Lab
serv
ices
$0
cop
ay$
0 c
opay
$0
cop
ay
Out
patie
nt x
-ray
s$
0 c
opay
$0
cop
ay$
0 c
opay
Ther
apeu
tic ra
diol
ogy
serv
ices
(s
uch
as ra
diat
ion
trea
tmen
t for
can
cer)
$15
cop
ay$
15 c
opay
$15
cop
ay
Am
bula
nce
$0
cop
ay$
0 c
opay
$0
cop
ay
Emer
genc
y ca
re$
50
cop
ay (w
orld
wid
e)$
50
cop
ay
Urg
ently
nee
ded
serv
ices
$15
cop
ay (w
orld
wid
e)$
15 c
opay
(wor
ldw
ide)
$15
cop
ay (w
orld
wid
e)
Out
patie
ntM
enta
lHea
lthan
d$
$$
Questions? Call 703.746.3777 or email [email protected] 5
Out
patie
nt M
enta
l Hea
lth a
nd
Su
bsta
nce
Abu
se$
15 c
opay
$15
cop
ay$
15 c
opay
Chi
ropr
actic
$15
cop
ay$
15 c
opay
$15
cop
ay
Hom
e H
ealth
, Hos
pice
$0
cop
ay$
0 c
opay
$0
cop
ay
Dur
able
Med
ical
Equ
ipm
ent
$0
cop
ay$
0 c
opay
$0
cop
ay
Ann
ual o
ut-o
f-poc
ket m
axim
umC
ombi
ned
in-n
etw
ork
and
out-
of-n
etw
ork
max
imum
of $
3,40
0$
3,40
0
Pres
crip
tion
Dru
gsN
etw
ork
Phar
mac
yM
ail S
ervi
ce P
harm
acy
Kai
ser
Med
ical
Cen
ter
Pha
rmac
y:
$15
cop
ay fo
r gen
eric
or b
rand
dr
ugs
up to
60
day
s su
pply
Kai
ser
Mai
l Ord
er P
harm
acy:
$
10 c
opay
for g
ener
ic o
r bra
nd
drug
s up
to 9
0 d
ays
supp
ly
Affi
liat
ed N
etw
ork
Pha
rmac
y (G
iant
, Rite
Aid
, Saf
eway
, Tar
get,
Wal
mar
t): $
25 c
opay
for g
ener
ic o
r br
and
drug
s up
to 6
0 d
ays
supp
ly
Afte
r you
r tot
al o
ut-o
f-poc
ket
cost
s re
ach
$5
,100,
you
pay
$2
for g
ener
ic d
rugs
, $7.
50
for b
rand
na
me
drug
s an
d $
0 fo
r vac
cine
s
Tier
1: P
refe
rred
gen
eric
$10
cop
ay$
10 c
opay
Tier
2: P
refe
rred
bra
nd
(i
nclu
des
som
e ge
neric
s)$
25 c
opay
$10
cop
ay
Tier
3: N
on-p
refe
rred
dru
g
(incl
udes
som
e ge
neric
s)$
25 c
opay
$10
cop
ay
Tier
4: S
peci
alty
dru
gs$
25 c
opay
$10
cop
ay
Cov
erag
e ga
p st
age
– T
here
is n
o co
vera
ge g
apA
fter y
our t
otal
dru
g co
sts
reac
h $
3,85
0, th
e pl
an c
ontin
ues
to p
ay it
s sh
are
of th
e co
st o
f you
r dru
gs a
nd y
ou p
ay y
our s
hare
Cat
astr
ophi
c co
vera
ge s
tage
Afte
r you
r tot
al o
ut-o
f-poc
ket c
osts
reac
h $
5,10
0, y
ou p
ay th
egr
eate
r of $
3.40
cop
ay fo
r gen
eric
(inc
ludi
ng b
rand
dru
gstr
eate
d as
gen
eric
), $
8.5
0 c
opay
for a
ll dr
ugs,
or 5
% c
oins
uran
ce
AD
DIT
ION
AL
BEN
EFIT
S A
ND
PR
OG
RA
MS
NO
T C
OV
ERED
BY
OR
IGIN
AL
MED
ICA
RE
Rout
ine
phys
ical
exa
ms
$0
cop
ay; 1
per
pla
n ye
ar*
$0
cop
ay
Foot
car
e - r
outin
e$
15 c
opay
$15
cop
ay$
15 c
opay
(U
p to
6 v
isits
per
pla
n ye
ar)*
Hea
ring
- rou
tine
exam
$0
cop
ay; 1
exa
m e
very
12
mon
ths*
$15
cop
ay
Hea
ring
aids
Plan
pay
s up
to $
50
0 (e
very
3 y
ears
) *
$0
cop
ay; o
ne fo
r eac
h ea
r eve
ry
36 m
onth
s, li
mite
d to
$1,0
00
be
nefi t
max
imum
Excl
usio
ns f
or re
pair,
loss
, rou
tine
mai
nten
ance
app
ly
Vis
ion
- rou
tine
eye
exam
s$
15 c
opay
; 1 e
xam
eve
ry 1
2 m
onth
s*$
15 c
opay
; 25
% o
ff fr
ames
and
15
% o
ff co
ntac
t len
ses
