RETIREE HEALTH COVERAGE WORKSHOP

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April 20, 2015

City of San Diego Retirees

RETIREE HEALTH

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Fact:

The world of health coverage is ever-changing

No one has all the answers!

Goal:

Direct you to the proper resources so you can do

your homework and feel confident

Team Effort:

Your health coverage is administered by the City

and processed by SDCERS, in partnership with

healthcare providers

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Meet the Team

 Me’ya Alomar – SDCERS

 Rosa Ceja-Manzo – SDCERS

 Joy Delos Reyes – SDCERS

 Sarah Levy - SDCERS

 Angelica Aguilar - SDCERS

 Cathleen Bryant – Health Net

 Kimberly Shields – Health Net

 Charlotte Souza – Kaiser Permanente

 Nancy Voltero – Kaiser Permanente

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Today’s Agenda



2015 Open Enrollment



Health insurance coverage



Insurance allowances and tiers



Reimbursement process



Health Net overview



Kaiser overview



Covered California and the new marketplace



Medicare overview



City of San Diego presentation



Questions at the end

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SDCERS Health Overview

Me’ya Alomar

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Open Enrollment runs June 1 through June 30

Help Day is June 17

 Balboa Park Club Ballroom

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

Key points for Open Enrollment

– No change in providers

 Health Net

 Kaiser

 Some rates will go up – New enrollment

– Submit changes

– No changes – nothing to do! – All forms due by June 30



Changes outside of Open Enrollment

– Qualifying events – Disenrollments – Additions

(8)



Dental and vision coverage

– Switching dental plans can only be done during Open Enrollment

– Limitations on changes outside of Open Enrollment



_{Moving out of state?}

– Contact healthcare provider and SDCERS 6 to 8 weeks prior to moving

– Options with City-sponsored

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COBRA

(Consolidated Omnibus Budget Reconciliation Act)

– When you retire or terminate, you enroll in COBRA through the City of San Diego’s Risk Management department, not SDCERS

– You and your dependents may continue COBRA for 36 months (COBRA and Cal-COBRA)

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Insurance Allowances



Insurance allowances can only be used to cover

health insurance premiums for the retiree



Health insurance allowances vary by retirement date

– Retired prior to October 6, 1980

– Retired between October 6, 1980 and June 30, 2009 – Retired between July 1, 2009 and March 31, 2012 – Retired on or after April 1, 2012



For City-sponsored plans, allowance is applied

directly to monthly pension payment



If premium cost is greater than allowance, difference

is deducted from monthly pension payment

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Retired Prior to October 6, 1980

 $1,200 annual allowance ($100 per month maximum)

 Allowance can be applied to City-sponsored premiums

 Allowance can be applied to privately secured plan

 For privately secured plans, allowance can be used to reimburse multiple health insurance expenses, such as:

 Monthly premiums

 Medicare Part B and Part D

 Doctor co-payments

 Prescription drugs

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Retired between

October 6, 1980 and June 30, 2009



One allowance



_{No sliding scale based on years of service}



Allowance can be applied to City-sponsored

premiums directly from monthly pension payment



Allowance can be applied to privately secured

plan

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13

SDMC Section 24.1202(b)(2): “After Fiscal Year 2003, the maximum

payment or reimbursement level for Health Eligible Retirees will be

adjusted annually based upon the projected increase for National Health Expenditures by the Centers for Medicare and Medicaid Services, Office of the Actuary, for the full-year period ending January 1 before each plan

year. No adjustment may exceed 10 percent for any plan year.”  Code states the annual increase can be up to 10 percent, not that

it will be 10 percent each year

 “Projected increase” has averaged between 5 percent and 7 percent

 Last year the increase was 6 percent

 Since that amount is less than last year’s rate increase by Kaiser and Health Net, members pay that difference out of pocket

Why doesn’t the “10 percent escalator”

cover my health care increase?

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Retired between 2009 and 2012

 Multiple tiers based on retirement date and representation

 Allowance can be applied to City-sponsored premiums directly from monthly pension payment

 Allowance can be applied to privately secured plan

 Sliding scale based on 10 to 20 years of service – Reciprocal time does not apply

– Unclassified and classified-unrepresented 5-year purchase does not apply

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The sliding scale is available online and in the annual Open Enrollment Book

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Retired on or after April 1, 2012

 Not retired prior to April 1, 2012, required to make irrevocable health benefit election

 Option A & B

– Sliding scale based on 10 to 20 years of service

– Allowance can be applied to City-sponsored premiums directly

from monthly pension payment

– Allowance can be applied to privately secured plan – Reciprocal time does not apply

– Unclassified and classified-unrepresented 5-year purchase does

not apply

– Disability retirements not based on sliding scale

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Retired on or after April 1, 2012



_{Option C}

– Defined contribution plan to be used for retiree and dependents

– HEALTH TRUST, not a monthly allowance

– May enroll in a City-sponsored plan or a privately secured plan

– All premiums can be reimbursed from the Health Trust, not SDCERS

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Medicare Part B Reimbursements

Options for Medicare Part B reimbursements vary

depending on retirement date

 Retired prior to October 6, 1980

– Eligible to be reimbursed for Medicare Part B up to maximum allowance of $100.00

– If your Part B is less than your maximum allowance, you may receive the difference by sending sufficient proof to SDCERS

 Retired between October 6, 1980 and March 31, 2012

– Eligible to be reimbursed for 100% of Medicare Part B, in addition to receiving the monthly health allowance

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Medicare Part B Reimbursements

 Retired on or After April 1, 2012 (Option A, B or C)

– You may use your monthly health allowance to be reimbursed

for Medicare Part B

– Option C members submit reimbursement request to the

Health Trust, not SDCERS

 Monthly reimbursement deadline is the 10th_{of every}

month

 Reimbursement requests for expenses incurred more than 12 months prior to the request date will not be reimbursed by SDCERS

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Privately Secured Reimbursements



Reimbursed for individual premium up to

maximum allowance



Reimbursement deadline is the 10

th

of every

month



_{Reimbursement requests for expenses incurred}

more than 12 months prior to the request date

will not be reimbursed by SDCERS

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COBRA Health Reimbursements



_{New reimbursement process begins June 1,}

2015

 Collaboration between SDCERS and the City of San Diego

 One-time request for initial receipt of payment

 Payment to the Treasurer’s Office is due the 10th_{of every} month for reimbursement on that month’s pension payment

 Reimbursement requests for expenses incurred more than 12 months prior to the request date will not be reimbursed by

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Reimbursements

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Reimbursements

Insufficient Proof of Payment

Front Only Bank Statements with no name or account number or date of transaction Documents that are not legible

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Health Reimbursements

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Health Reimbursements

Sufficient Proof of Coverage

Letter

from Health

Care Provider

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CareCounsel

 Healthcare assistance program

 Available to City of San Diego Retirees and their continuances at no cost

 Provides assistance with

– Understanding benefits – Serving as a liaison

– Electing a primary care provider, specialist, or hospital – Addressing network issues

 CareCounsel does not provide medical advice or

treatment, but serves as an advocate to ensure your needs are met