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Your Benefit News for Retirees
There are no benefit changes for the Oxy Retiree Medical plan and a few enhancements to the Oxy Medicare Advantage PPO Plan for 2021. Please take this time to review your benefits.
An overview of benefit coverages for these plans is available on Page 3. For retiree contribution information refer to Page 4 and 5.
Oxy Medicare Advantage PPO Plan—Coverage is only available to covered retirees, spouses and dependents who are eligible and enrolled in Medicare Parts A and B. Keep an eye on your mail,
coming soon is information from Aetna about the Oxy Medicare Advantage PPO Plan for 2021. You may elect to opt out of the Oxy Medicare Advantage PPO
Plan between November 2 and
November 20 by calling OxyLink at 800-699-6903. However, remember if you opt out, you will lose your medical and prescription drug coverage through Oxy.
2021 Highlights
Oxy Retiree Medical Plan—
Coverage is available to covered retirees, spouses and dependents who are not currently eligible for Medicare, and are enrolled in the Oxy Retiree Medical Plan.
If you, your spouse and/or dependent(s) become eligible for Medicare due to disability or turn age 65 during the year, the individual becoming Medicare-eligible will be moved to the Oxy Medicare Advantage PPO Plan provided you are enrolled in Medicare Parts A and B and are approved by Medicare. You must contact OxyLink immediately to provide your Medicare ID number and effective date. If turning age 65, OxyLink will mail a packet of information about this plan approximately 60 days prior to the individual turning age 65.
No action required—You don’t need to do anything to retain your current retiree medical and/or dental coverage in 2021.
Western New York (WNY) Regional Medical Plans—
If you live in the WNY area and are not eligible for Medicare, we have included the BCBS of WNY and Independent Health medical benefit summaries in this packet. All BCBS of WNY rates will not increase for 2021, whereas certain Independent Health plans will see a slight increase.
Questions about your benefits—
Call OxyLink at 800-699-6903 (if outside the U.S. call 918 610-1990) or email oxylink@oxy.com.
IMPORTANT…
Not all benefits described in this newsletter apply to all participants.
Represented retirees should refer to their collective bargaining agreement for benefit eligibility.
Oxy Retiree Medical Plans
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Your Benefit News for Retirees2021 Medical plan benefits
For non-Medicare-eligible retirees
• Same comprehensive Retiree Medical Plan with Aetna and prescription drug coverage through Express Scripts.
• Continued access to current physicians and Aetna’s health care network.
• Teladoc, Aetna’s telemedicine services include not only general medicine phone visits or video doctor consult visits, but now also include: —Behavioral Health sessions:
• Therapist or Psychologist: $80 or less per session or
• Psychiatrist: $160 or less for evaluation, $90 or less for ongoing sessions
—Dermatology visits: $75 or less per visit
Note: Once your annual deductible is met, the cost of visits will reduce to your 20% coinsurance.
For Medicare-eligible retiree
• Continued access to current physicians and Aetna’s nationwide extended service area.
• Expanded Medicare Part D prescription drug benefits through Aetna.
• CVS Caremark Mail Service Pharmacy for at home prescription delivery (formerly called Aetna Mail Service Pharmacy).
• The option to use retail pharmacies rather than a mail order pharmacy to fill your maintenance prescriptions.
• No annual deductible. • Simple, convenient copays.
• Same cost share for in- and out-of-network providers. • Single ID card for both medical and prescription
drug coverage.
• Convenience of phone or video doctor’s
appointments through Aetna’s Teladoc telemedicine services.
• Programs and health advocates to help with chronic conditions.
• Access to the SilverSneakers® fitness plan, meal service
following in-patient hospital stays and covered transportation services—all at no cost.
• Important—Remember, you cannot separately be enrolled in another Medicare Advantage plan or Part D prescription drug plan if you are enrolled in the Oxy Medicare Advantage PPO Plan.
What is a Medicare Advantage plan?
A Medicare Advantage plan is another way to provide Medicare Part A (hospital insurance) and Medicare Part B (medical
insurance) benefits. In some cases, such as with the Oxy Medicare Advantage PPO Plan, a Medicare Advantage plan can also offer another way to provide Medicare Part D (prescription drug benefits). Medicare Advantage plans are offered through private insurance companies that have been approved by Medicare. These plans provide the same coverage as “traditional” Medicare and often offer additional services not covered by Medicare, like fitness programs and access to wellness care.
The following chart offers an overview of benefits under the 2021 Oxy Medicare Advantage PPO Plan and the Oxy Retiree Medical Plan. For additional plan benefit details, refer to the plan’s summary plan description found online at oxylink.oxy.com under Plan Documents & Information or you can call OxyLink to request a printed copy.
Oxy Retiree medical plans benefit overview
FEATURES
2021
Oxy Medicare Advantage PPO Plan for Medicare-eligible participants
2021
Oxy Retiree Medical Plan for non-Medicare participants
Plan Administrator Aetna Aetna
Annual Deductible NO YES
Annual Out-of-Pocket Maximum $2,000 $2,500
Healthy Home Visits YES NO
Teladoc YES YES
Prescription Drug Administrator Aetna Express Scripts
Preventive Services $0 $0
Doctor Office Visit $30 copay 20% after deductible
Specialist Office Visit $40 copay 20% after deductible Acupuncture Therapy
$40 copay for unlimited visits $25 copay for up to 12 visits/90 days if
chronic low back pain
20% after deductible, 26 visits per year
Hospitalization $120 copay 10% after deductible
Outpatient Surgery $100 copay 20% after deductible
Lab or X-ray $40 copay 20% after deductible
Ambulance $40 copay 20% after deductible
Urgent Care $50 copay 20% after deductible
Emergency Room $100 copay, waived if admitted 10% after deductible
Annual Eye Exam $0 $0
Home Health Care $0, unlimited visits 20% after deductible, 120 visits per year Hospice Care $0, unlimited visits 10% after deductible, unlimited visits Durable Medical Equipment or
Prosthetics 20% with no deductible 20% after deductible Hearing Aids $2,500 allowance every three years 20% after deductible, up to a
$2,500 allowance every three years
Diabetic Monitoring Supplies $0 20% after deductible
Transportation Services $0, 24 one-way trips up to
60 miles each per calendar year No coverage Meal Service after In-patient Stay $0, up to 14 meals No coverage
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Your Benefit News for Retirees2021 Medical plan contributions
Oxy has two retiree medical plans, the Oxy Retiree Medical Plan for non-Medicare-eligible participants and the Oxy Medicare Advantage PPO Plan for Medicare-eligible participants. Each plan has its own base rate. Your monthly contribution will continue to be based on a multiple of the base rate determined by the retiree’s age plus service
at retirement.
2021 Medical Plan Contribution Base Rate Medicare-eligible Retiree $75 Non-Medicare-eligible Retiree $202
If your coverage tier is not shown, call OxyLink at 800-699-6903 for your monthly contribution rate. To review all of the individual age plus service multiples, go to oxylink.oxy.com and select Information for Retirees.
Relax — We’ve done the math. See the chart below and the examples on Page 5.
2021 Monthly Retiree Medical Contributions
COVERAGE TIER Medicare- eligible Retiree Medicare- eligible Spouse Medicare- eligible Child(ren)1
Retiree Age + Service at Retirement 80+ (1X) 75-79 (2X) 70-74 (3X)2 65-69 (4X)2
Retiree Only Yes — — $75 $150 $150 $150
Retiree Only No — — $202 $404 $606 $808
Surviving Spouse Only — Yes — $75 $150 $150 $150
Surviving Spouse Only — No — $202 $404 $606 $808
Retiree + Spouse Yes Yes — $150 $300 $300 $300
Retiree + Spouse Yes No — $277 $554 $756 $958
Retiree + Spouse No Yes — $277 $554 $756 $958
Retiree + Spouse No No — $404 $808 $1,212 $1,616
Retiree + Family Yes Yes Yes $225 $450 $450 $450
Retiree + Family Yes Yes No $352 $704 $906 $1,108
Retiree + Family Yes No Yes $352 $704 $906 $1,108
Retiree + Family Yes No No $479 $958 $1,362 $1,766
Retiree + Family No Yes Yes $352 $704 $906 $1,108
Retiree + Family No Yes No $479 $958 $1,362 $1,766 Retiree + Family No No Yes $479 $958 $1,362 $1,766 Retiree + Family No No No $606 $1,212 $1,818 $2,424 1If retiree covers more than one child, retiree will pay the Medicare-eligible rate if at least one child is disabled. Otherwise retiree will be
charged the non-Medicare eligible rate.
Take a look at these examples
Frank
Frank is eligible for Medicare. He is single and covers no dependent children. His age plus service at retirement was 85 (1X base rate). As a result, his “Retiree Only” contribution for the Oxy Medicare Advantage PPO Plan for 2021 is $75 a month.Retiree Only coverage Eligible for Medicare
How it’s calculated Frank: $75 base x 1, for a total of $75
Andrea & Damon
Andrea is not eligible for Medicare but her husband, Damon, is eligible. This means they are considered a “split” family—one is Medicare-eligible andthe other is not. Their contributions are calculated with separate base rates. Andrea’s age plus service at retirement was 82 (1X base rate of $202). Since her husband, Damon, is Medicare-eligible, his base rate is $75. Andrea’s “Retiree + Spouse” contribution for 2021 will be $277 per month. Retiree + Spouse coverage
Split eligibility for Medicare
How it’s calculated Andrea: $202 base x 1= $202 + Damon: $75 base x 1 = $75, for a total of $277
Rey & Sofia
Rey and Sofia are both Medicare-eligible. Rey’s age plus service at retirement was 75 (2X base rate). His “Retiree + Spouse” coverage for 2021 will be $300 per month.
Retiree + Spouse Coverage Eligible for Medicare
How it’s calculated Rey: $75 base x 2 = $150 + Sofia: $75 base x 2 = $150, for a total of $300
Split Coverage
In cases where coverage is split between one non-Medicare-eligible participant and one Medicare-eligible participant, the participants will be in separate medical plans. The base rates will be different, and in some cases, the multiple may be different.
Questions and Answers
Do I have to pay for
Medicare Part D?
No. The cost of the Oxy expanded Medicare Part D is included in your Oxy monthly contribution rate, which is billed through PayFlex.I will turn 65 in May
2021. How do I enroll
in Medicare?
You should contact Medicare approximately three months prior to turning age 65. If you are eligible for Medicare and receiving Social Security (SS) benefits, you are automatically enrolled in Medicare Part A and B the first of the month that you turn age 65. If you are not receiving SS benefits, you must elect to enroll in Parts A & B. You do have the option to decline Part B, however, you may only want to do so, if you have other medical coverage through a spouse. To be eligible to participate in the Oxy Medicare Advantage PPO Plan you must be enrolled in Medicare Parts A and B.
2021 Dental contributions
2021 Monthly Retiree Dental Contributions
Coverage Level Monthly Amount
Retiree Only $45
Retiree + One $90
Family $136
Oxy will continue to offer retiree dental coverage through Aetna to eligible Oxy retirees. Dental contributions will decrease for 2021.
If you waived retiree dental coverage when first offered, you may not enroll in the Retiree Dental Plan unless you or your spouse (or a surviving spouse) currently has other dental insurance coverage (including COBRA continuation coverage) and you lose eligibility for that coverage. In that case, you may enroll in the Retiree Dental Plan within 31 days of the loss of coverage with proof of the loss.
The company expects and intends to continue its benefit plans but does not guarantee any specific level of benefits or the continuation of any benefit plan during any periods of active employment, inactive employment, disability or retirement. Benefits are provided solely at the company’s discretion and do not create a contract of employment. The company reserves the right to modify, suspend, change or terminate any of its plans at any time. This information is applicable to eligible non-represented employees. Applicability to represented employees is governed by local collective bargaining agreements. Subject to this and future agreements, the company reserves the right to change, amend or terminate any benefit plan at any time. The information provided in this document is not tax advice. While the information is believed to be accurate as of the print date, it is subject to change. Consult a qualified tax advisor for help in determining any tax benefit mentioned herein.
Dental discount program
The Vital Savings By Aetna Dental Discount Program is an optional discount program available through Aetna to Oxy retirees and their dependents who are eligible for retiree medical coverage. This discount program is not insurance and is in lieu of the Retiree Dental Plan. The program provides you access to a nationwide network of dentists who have agreed to provide a discount ranging from 15% to 50% on certain services. There is a small monthly fee of $4 to participate in the program ($7 per family). You must complete and submit an enrollment form to participate. You can find a form at oxylink.oxy.com
by selecting Plan Documents & Information, then Discount Programs.
Questions? Log into vitalsavingsbyaetna.com (select No when asked if you are an employer, administrator or trustee; select Yes when asked if you were referred to this site by your employer, administrator, school or trustee. Then, select I am sending my enrollment form or have enrolled directly with Aetna). If you prefer to enroll by phone, call 866-36-VITAL. The Employer Promotional Code is 882016-018.
Routine vision exams are covered at 100% under both the current Oxy Retiree Medical Plan and the new Oxy Medicare Advantage PPO Plan. If enrolled in an Aetna medical or dental plan, you are automatically eligible for Aetna’s vision and hearing discount programs. The programs are offered at no cost and can provide you and your enrolled dependents significant savings when you use participating providers.
These programs can provide substantial discounts on hearing exams, hearing aids, eyeglass frames, corrective lenses, contact lenses, non-prescription sunglasses, contact lens solutions and accessories. The vision programs also offer discounts on LASIK surgery, eye examinations and a mail-order contact lens program.
Want more information? Log into aetna.com and select Get Discounts under Health Programs or call Aetna customer service at 800-334-0299.
Vision and hearing
discount programs
Your Benefit News for Retirees
BeneBits
Update contact information.
Be sure your contact information and your emergency contact information is up to date:
Online: Log in to oxylink.oxy.com and select Employee Self Service, then Personal Details.
By phone: Contact OxyLink weekdays at (800) 699-6903 (918-610-1990 outside the U.S.), Monday through Friday, 8:00 a.m. to 4:30 p.m., CST. By email: oxylink@oxy.com
PayFlex for retiree medical
and dental billing.
PayFlex will continue to handle the retiree billing services for Oxy’s retiree medical and/or retiree dental plans. Visit payflex.com to view your balance, manage your profile and notifications. You may also set up Electronic Funds Transfer (EFT) by linking your bank account through
Account Settings to automatically pay your monthly premium and eliminate receiving a coupon book and monthly statements. If you have any questions, please contact PayFlex billing at 888-678-7835.
Check beneficiary designations.
It is important to check your beneficiary designations, as applicable, from time to time and update them, as needed. If you do not name a beneficiary, benefits will be payable in accordance to plan rules.
• Basic Life: To print a form, go to oxylink.oxy.com
and under Plan Information & Documents select Beneficiary Forms or call OxyLink at 800-699-6903 to request a form.
• Group Universal Life (GUL): Go to mybenefits.metlife. com or call MetLife customer service at 800-756-0124. • 401(k) and Retirement Plans: Go to oxy.voya.com
or call the Oxy Retirement Service Center at
844-699-4015.
Disabled dependents.
If you have an eligible disabled dependent currently covered under an Oxy retiree medical plan, and that dependent is Medicare-eligible or becomes
Medicare-eligible, contact OxyLink as soon as possible to provide the date your dependent became or will become eligible for Medicare. This will allow us to enroll your dependent in the new Oxy Medicare Advantage PPO Plan at a lower contribution rate.
Questions?
Oxy Medicare Advantage PPO Plan
For Medicare-eligible participants
Oxy Retiree Medical Plan
For non-Medicare participants
Oxy eligibility, status change events, updating personal information, and
all other questions.
Aetna Medicare Services oxy.aetnamedicare.com
866-539-6750
Monday through Friday 8:00 a.m. to 6:00 p.m.
(all time zones)
Aetna aetna.com 800-334-0299
Monday through Friday 8:00 a.m. to 6:00 p.m.
(Central time)
OxyLink oxylink.oxy.com
800-699-6903
Monday through Friday 8:00 a.m. to 4:30 p.m.
