FY 2018EARLY RETIREE GUIDE

TO THE OPEN ENROLLMENT PERIOD

Components of 2018 Open Enrollment Page

Opportunities Available to Retirees during Open Enrollment ................................................. 4Lists all changes to benefit programs that employees can make and describes how to make them

Open Enrollment Meeting Chart ................................................................................................ 6A chart that gives the date, time and location for all Open Enrollment meetings and the Wellness Fair

Information for Retirees Who Will Become 65 During This Plan Year ....................................... 8Guidance for retirees on the process for changing plans at 65

Reducing Your Medical Plan Cost ................................................................................................ 9A chart showing savings achievable and benefit differences when selecting lower cost options

Medical Benefit Comparison ...................................................................................................... 10 Charts providing detailed benefits data for all four plans

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OFFICE OF THE CITY MANAGER301 King Street, Suite 3500Alexandria, Virginia 22314

703.746.4300Fax: 703.838.6343

MARK B. JINKSCity Manager

Dear Retirees,

The Fiscal Year 2018 Open Enrollment period for the City’s non-Medicare eligible retirees’ benefit plans begins on Monday, May 1 and ends on Friday, May 19. Again this year, Human Resources (HRD) has incorporated the Annual Health Wellness & Benefits Fair within the Open Enrollment period (Tueday, May 16) to recognize the strong connection of Wellness to our benefit programs. In this guide, you will be provided information on the following components of Open Enrollment:

• Open Enrollment meeting schedule;• Retiree / City contribution chart; • Reducing medical plan cost; and• Medical benefit comparisons.

Unfortunately, insurance premiums are increasing 9.5% for Kaiser plans and 18.1% for United Healthcare plans, primarily due to unusually high claims in the past year. While outpatient costs rose only slightly, and prescription costs dropped, inpatient hospitalization use and costs increased substantially.

REMEMBER, BY MAY 19, RETIREES MUST:

• Retirees who wish to select a different medical plan must complete and submit the enclosed FY 2018 Early Retiree Medical Plan Change Form.

• Insurance Reimbursement Plan participants must submit the enclosed Insurance Reimbursement Plan Participant Documentation form for their upcoming plan year (may be submitted later if your Plan Year starts after July and you have not yet received the information).

I urge you to take the time to thoroughly review the Guide to FY 2018 Open Enrollment. The Guide should assist you in making well-informed benefit decisions for you and your family. For further information, you may also want to attend one of the 9 Open Enrollment meetings. As always, HRD’s Benefits Team is prepared to assist you in this process.

I hope to see you at the Health Wellness and Benefits Fair on Tuesday, May 16. On behalf of the senior leadership team, we wish you good health and happiness.

Sincerely,

Mark B. Jinks City Manager

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Opportunities Available To Retirees During Open Enrollment

The Open Enrollment period is from May 1, 2017 through May 19, 2017. During this period, retirees may make the following types of changes:

• Enroll in or cancel participation in any benefit plan• Change medical providers • Increase or decrease the level of coverage

Please note that new dependent enrollments during this period require documentation of eligibility.

Medical Plans

There are no benefit plan changes to the medical plans this enrollment period. Monthly rates are shown in the following table:

COVERAGE LEVEL

KAISER – DHMO KAISER – HMO

Retiree* City Total Retiree* City Total

Individual $302.46 $260 $562.46 $382.49 $260 $642.49

Retiree + 1 $815.93 $260 $1,075.93 $969.03 $260 $1,229.03

Family $1,427.37 $260 $1,687.37 $1,667.47 $260 $1,927.47

UNITED – CHOICE UNITED – CHOICE PLUS

Retiree* City Total Retiree* City Total

Individual $469.96 $260 $729.96 $606.78 $260 $866.78

Retiree + 1 $1,138.68 $260 $1,398.68 $1,398.75 $260 $1,658.75

Family $1,933.62 $260 $2,193.62 $2,340.36 $260 $2,600.36

*For retirees who are eligible for the $260 monthly City contribution, your monthly cost is the amount in the Retiree Column for your Coverage Level and Plan in the table above.

For retirees who are not eligible for the $260 monthly City contribution, your monthly cost is the amount in the Total Column for your Coverage Level and Plan in the table above.

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IF YOU PARTICIPATE IN A KAISER OR UNITED PLAN AND DO NOT WANT TO MAKE A CHANGE,YOU DO NOT NEED TO DO ANYTHING.

Retirees in the City of Alexandria Insurance Reimbursement Plan

Complete the Insurance Reimbursement Plan Participant Documentation form included in this package to satisfy the Annual Documentation Requirements for continued participation in the Plan.

Making Changes to Your Medical Plan Coverage

If you are considering making a change to your medical plan coverage and would like additional information about any of the plans, consider the following opportunities:

• Attend one of the nine employee/retiree meetings shown on page 6.• Contact one of the members of the Benefits Team identified below.

If you decide to make a change, you must complete the Medical Plan Change Form included in this package and return it to the address below so that it is received by May 19. For assistance in making changes, contact any member of the Benefits Team as follows:

Jina Edwards 703.746.3789 Sonja Jones 703.746.3787 Jim Davis 703.746.3786

COMPLETED FORMS FOR ALL CHANGES MUST BE RECEIVED IN HUMAN RESOURCES BY MAY 19.

City of Alexandria

Human Resources Department, Benefits Team301 King Street, Room 2500Alexandria, Virginia 22314

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Open Enrollment Meeting ChartTHE FY 2018 OPEN ENROLLMENT PERIOD WILL BE FROM MAY 1 – 19.

This is the one opportunity during the year to review and discuss plan benefits with representatives from the City-sponsored health and dental providers. The meeting dates, times and locations are listed below. Please plan to attend one of the sessions to help you make well-informed healthcare decisions for you and your family. At the 21st Annual Health, Wellness & Benefits Fair on Tuesday May 16, a representative from The Standard, the City’s life insurance and long-term disability carrier, will be available to answer your insurance and LTD questions.

DATE TIME LOCATION

Tuesday, May 2 1 – 4 p.m.Presentation: 1:30 p.m.

CITY HALL301 King St. – Conference Room 2000

Wednesday, May 3 9 – 11 a.m.Presentation: 9:30 a.m.

LEE CENTER 1108 Jefferson St. – Gold Room

Thursday, May 4 6 – 8 a.m.Presentation: 6:30 a.m.

SHERIFF’S OFFICE 2003 Mill Rd.

Friday, May 5 2 – 4 p.m.Presentation: 2:30 p.m.

BEATLEY CENTRAL LIBRARY 5005 Duke St. – Community Room

Monday, May 8 1 – 3 p.m.Presentation: 1:30 p.m.

PUBLIC SAFETY (POLICE)3600 Wheeler Ave. – Community Room

Tuesday, May 9 12:30 – 2 p.m.Presentation: 1 p.m.

COMMUNITY & HUMAN SERVICES2525 Mt. Vernon Ave. – Cyphers Conference Room

Wednesday, May 10 7 – 9 a.m.Presentation: 7:30 a.m.

PUBLIC SAFETY (FIRE)900 Second St. – 2nd Floor

Thursday, May 11 7 – 9 a.m.Presentation: 7:30 a.m.

TRANSPORTATION & ENVIRONMENTAL SCVS.2900-B Business Center Dr.

Tuesday, May 16 10 a.m. – 3 p.m.21ST ANNUAL HEALTH,

WELLNESS & BENEFITS FAIRHoliday Inn Suites Old Town – 625 First St.

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What if I am becoming Medicare eligible this year?

All Medicare-eligible City retirees (those 65 and older) are no longer permitted to remain in a City “employee plan” and MUST enroll in one of the following:• Kaiser Medicare Plus Plan• United Healthcare Medicare Advantage (PPO)• City of Alexandria Insurance Reimbursement Plan. You choose

coverage under any other health plan and expenses will be reimbursed by the City for up to $260 per month for either you or your spouse.

What do I have to do? Three months before your 65th birthday, apply for Medicare Parts A and B.

When you receive your Medicare card, contact the Benefits Office and they will provide you with the appropriate enrollment form. You will then complete the enrollment form and return it to the Benefits Office, along with a copy of your Medicare card. The Benefits Office will submit your enrollment package to the appropriate provider who will enroll you in their Plan.

What if my spouse is not Medicare eligible? Is he/she eligible to remain on the "employee plan?"

Yes. The non-Medicare spouse of a retiree currently insured in a City-sponsored plan may continue on the City-sponsored “employee plan."

What if my spouse is Medicare eligible and I am not?

The spouse is enrolled in the City's Medicare program and you would continue in the "employee plan."

The City pays for (or reimburses) up to $260 for either you or your spouse, but not both. If you and/or your spouse enroll in Kaiser or UHC Medicare plans, the City pays the monthly premium directly to the carrier for the oldest, eligible enrollee only. If you elected the UHC Medicare Advantage Plan, the City will debit your account $70/mo. to cover the difference between the $330 premium and the $260 maximum City reimbursement.

All premiums for the younger individual (whether Kaiser, UHC or another plan of your choice) are the responsibility of the retiree and must be paid to the City via electronic funds transfer. If both you and your spouse elect a plan other than the City-sponsored plans, Kaiser or UHC, your costs up to $260 will be reimbursed on a monthly basis.

Information for Retirees Who Will Become 65 During This Plan Year

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Reducing Your Medical Plan Cost

The table below shows the annual savings that can be achieved by changing from a provider's high cost plan to its low cost plan. The savings is calculated by comparing the total amount of your monthly contributions and the required deductible for each plan. The Comment column notes benefit differences between the plans.

Change to New Option

Kaiser – Annual Savings Comment

Individual Reitree + 1 Family

HMO DHMO $560 $1,037 $2,081 No benefit differences

UnitedHealthcare – Annual Savings

Individual Retiree + 1 Family

Choice Plus Choice $1,642 $3,121 $4,881 No out of network benefits

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Medical Benefit Comparison

Covered Benefits Kaiser DHMO

Kaiser Standard HMO

UnitedHealthcareChoice (EPO)

UnitedHealthcare Choice Plus (POS)

In-Network Out-of-Network

Annual Deductible per Plan Year $400 Individual$800 Family* None $400 Individual

$800 Family*$400 Individual

$800 Family*$800 Individual$1600 Family*

Out-of-Pocket Maximum $2200 Individual$6400 Family

$3500 Individual$9400 Family

$3175 Individual$6350 Family

$3175 Individual$6350 Family

$3175 Individual$9525 Family

Primary Care Office Visit for Illness and Injury

$15 Copay

$0 Copay for Children under age 5

$15 Copay

$0 Copay for Children under age 5

$15 Copay $15 Copay 80% Coinsurance

Specialist Office Visit for Illness $25 Copay $25 Copay $25 Copay $25 Copay 80% Coinsurance

X-ray, Lab, and Diagnostics (Outpatient) $0 Copay $0 Copay 100% 100% 80% Coinsurance

X-ray, Lab, and Major Diagnostics (CT, PET, MRI, MRA and Nuclear Medicine (Outpatient) $75 Copay $75 Copay $100 Copay per service $100 Copay per service 80% Coinsurance

Inpatient Hospitalization $500 Copay $500 Copay $500 Copay per admit $500 Copay per admit

$500 Copay 80% Coinsurance

Emergency Room Copay $150 Copay** $150 Copay** $150 Copay per visit** $150 Copay per visit**

$150 Copay per visit**

Urgent Care Center $25 Copay $25 Copay $25 Copay $25 Copay 80% Coinsurance

Mental Health and Substance Abuse Services- Inpatient/Intermediate $500 Copay $500 Copay $500 Copay per admit

$500 Copay per admit

$500 Copay per admit, 80%

Coinsurance

Mental Health and Substance Abuse Services- Outpatient $15 Copay Individual $7 Copay Group

$15 Copay Individual$7 Copay Group $15 Copay $15 Copay 80% Coinsurance

Pregnancy / Maternity Services – Prenatal Care Visits $15 Initial visit, then $0 copay

$15 Initial visit, then $0 copay

$15 Copay Initial visit, then $0 copay

$15 Copay Initial visit, then $0 copay 80% Coinsurance

PREVENTIVE CARE SERVICES

Well Child Care Covered in full Covered in full Covered in full Covered in full 80% Coinsurance

Adult Physical Exam Covered in full Covered in full Covered in full Covered in full 80% Coinsurance

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Covered Benefits Kaiser DHMO

Kaiser Standard HMO

UnitedHealthcareChoice (EPO)

UnitedHealthcare Choice Plus (POS)

In-Network Out-of-Network

Annual Deductible per Plan Year $400 Individual$800 Family* None $400 Individual

$800 Family*$400 Individual

$800 Family*$800 Individual$1600 Family*

Out-of-Pocket Maximum $2200 Individual$6400 Family

$3500 Individual$9400 Family

$3175 Individual$6350 Family

$3175 Individual$6350 Family

$3175 Individual$9525 Family

Primary Care Office Visit for Illness and Injury

$15 Copay

$0 Copay for Children under age 5

$15 Copay

$0 Copay for Children under age 5

$15 Copay $15 Copay 80% Coinsurance

Specialist Office Visit for Illness $25 Copay $25 Copay $25 Copay $25 Copay 80% Coinsurance

X-ray, Lab, and Diagnostics (Outpatient) $0 Copay $0 Copay 100% 100% 80% Coinsurance

X-ray, Lab, and Major Diagnostics (CT, PET, MRI, MRA and Nuclear Medicine (Outpatient) $75 Copay $75 Copay $100 Copay per service $100 Copay per service 80% Coinsurance

Inpatient Hospitalization $500 Copay $500 Copay $500 Copay per admit $500 Copay per admit

$500 Copay 80% Coinsurance

Emergency Room Copay $150 Copay** $150 Copay** $150 Copay per visit** $150 Copay per visit**

$150 Copay per visit**

Urgent Care Center $25 Copay $25 Copay $25 Copay $25 Copay 80% Coinsurance

Mental Health and Substance Abuse Services- Inpatient/Intermediate $500 Copay $500 Copay $500 Copay per admit

$500 Copay per admit

$500 Copay per admit, 80%

Coinsurance

Mental Health and Substance Abuse Services- Outpatient $15 Copay Individual $7 Copay Group

$15 Copay Individual$7 Copay Group $15 Copay $15 Copay 80% Coinsurance

Pregnancy / Maternity Services – Prenatal Care Visits $15 Initial visit, then $0 copay

$15 Initial visit, then $0 copay

$15 Copay Initial visit, then $0 copay

$15 Copay Initial visit, then $0 copay 80% Coinsurance

PREVENTIVE CARE SERVICES

Well Child Care Covered in full Covered in full Covered in full Covered in full 80% Coinsurance

Adult Physical Exam Covered in full Covered in full Covered in full Covered in full 80% Coinsurance

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Medical Benefit Comparison, Cont'd.

Covered Benefits Kaiser DHMO

Kaiser Standard HMO

UnitedHealthcareChoice (EPO)

UnitedHealthcare Choice Plus (POS)

In-Network Out-of-Network

Routine GYN Visit Covered in full Covered in full Covered in full Covered in full 80% Coinsurance

Routine Mammogram Covered in full Covered in full Covered in full Covered in full 80% Coinsurance

Cancer Screening (Pap Test, Prostate) Covered in full Covered in full Covered in full Covered in full 80% Coinsurance

PRESCRIPTION DRUG COVERAGE

Provided by CareFirst Caremark

Generic Brand (Lowest-Cost)$15 Medical Center,

$25 Participating Community Pharmacy

$15 Medical Center, $25 Participating

Community Pharmacy

$15 Copay $15 Copay 80% Coinsurance

Preferred Brand (Mid-Range Cost)

$30 Medical Center$40 Participating

Community Pharmacy

$30 Medical Center$40 Participating

Community Pharmacy

$30 Copay $30 Copay 80% Coinsurance

Non-Preferred Brand (Highest Cost)

$50 Medical Center$55 Participating

Community Pharmacy

$50 Medical Center$55 Participating

Community Pharmacy

$50 Copay $50 Copay 80% Coinsurance

Mail Order

Generic: $15Preferred: $30

Non-Preferred: $50

Generic: $15Preferred: $30

Non-Preferred: $50

Generic: $37.50Preferred: $75

Non-Preferred: $125

Generic: $37.50Preferred: $75

Non-Preferred: $125 Not Applicable

Retail 90-day Refill (CVS only) Not Applicable Not ApplicableGeneric: $37.50Preferred: $75

Non-Preferred: $125

Generic: $37.50Preferred: $75

Non-Preferred: $125Not Applicable

Rx Out-of-Pocket Maximum Not Applicable Not Applicable $3175 Individual$6350 Family

$3175 Individual$6350 Family

$3175 Individual$9525 Family

* Includes Employee + 1 **Waived if admitted

NOTE: Medical copays are after deductibles

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Covered Benefits Kaiser DHMO

Kaiser Standard HMO

UnitedHealthcareChoice (EPO)

UnitedHealthcare Choice Plus (POS)

In-Network Out-of-Network

Routine GYN Visit Covered in full Covered in full Covered in full Covered in full 80% Coinsurance

Routine Mammogram Covered in full Covered in full Covered in full Covered in full 80% Coinsurance

Cancer Screening (Pap Test, Prostate) Covered in full Covered in full Covered in full Covered in full 80% Coinsurance

PRESCRIPTION DRUG COVERAGE

Provided by CareFirst Caremark

Generic Brand (Lowest-Cost)$15 Medical Center,

$25 Participating Community Pharmacy

$15 Medical Center, $25 Participating

Community Pharmacy

$15 Copay $15 Copay 80% Coinsurance

Preferred Brand (Mid-Range Cost)

$30 Medical Center$40 Participating

Community Pharmacy

$30 Medical Center$40 Participating

Community Pharmacy

$30 Copay $30 Copay 80% Coinsurance

Non-Preferred Brand (Highest Cost)

$50 Medical Center$55 Participating

Community Pharmacy

$50 Medical Center$55 Participating

Community Pharmacy

$50 Copay $50 Copay 80% Coinsurance

Mail Order

Generic: $15Preferred: $30

Non-Preferred: $50

Generic: $15Preferred: $30

Non-Preferred: $50

Generic: $37.50Preferred: $75

Non-Preferred: $125

Generic: $37.50Preferred: $75

Non-Preferred: $125 Not Applicable

Retail 90-day Refill (CVS only) Not Applicable Not ApplicableGeneric: $37.50Preferred: $75

Non-Preferred: $125

Generic: $37.50Preferred: $75

Non-Preferred: $125Not Applicable

Rx Out-of-Pocket Maximum Not Applicable Not Applicable $3175 Individual$6350 Family

$3175 Individual$6350 Family

$3175 Individual$9525 Family

* Includes Employee + 1 **Waived if admitted

NOTE: Medical copays are after deductibles

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4/21/2017