Your Retirement Health Benefits NJPSA Presentation Retirement Health

Your Retirement Health Benefits NJPSA Presentation

Retirement Health Benefits Webinar �Eligibility �Enrollment �Coverage �Medicare �Payment of Coverage Costs

State Health Benefits Coverage at Retirement. Categories of Eligibility �Members already covered by SHBP through employer. Premium cost to member if not eligible for State or employer paid coverage. �Members with 25 years service credit in TPAF or on disability retirement (includes deferred with 25 years). State pays for health benefit cost. �Medicare eligible members retired from BOE, Voc. Tech. , Spec. Serv. Comm. , not participating in SHBP and not eligible above, must be in employer’s plan and enrolled Medicare A and B. You pay full cost.

ENROLLMENT �Offering Letter (about 3 months before retirement) �Eligibility of coverage � Coverage for you, your spouse/partner, and dependents � Children to age 26 and 31 (Chapter 375) � Disabled dependents (documentation required) �Cost to you � State paid � Partial Pay (Chapter 78) – % based on amount of pension � You pay in full

ENROLLMENT �Complete the application (print out from the Division of pension Website) �Retiree information. �Medicare (check off and submit documentation) �Plan Selection �Coverage Waiver �Dental – at additional cost �Dependents and documentation to be attached to the application

Health Plans �Medical Plan options (plan summaries on Division Web page) �Prescription plans (included with all plans) �Dental – Available at additional cost.

SHBP Medical Plans (Effective January 1, 2016) � Preferred Provider Organizations (PPO) (H)NJ Direct 10 (H)NJ Direct 1525 *Freedom 10 (H)NJ Direct 15 (H)NJ Direct 2030 *Freedom 1525 *Freedom 2030 (H) Administered by Horizon Blue Cross Blue Shield of New Jersey * Administered by Aetna � Health Maintenance Organizations (HMO) Aetna HMO Aetna 1525 Horizon HMO 1525 Aetna 2030 Horizon HMO 2030 � HD- High Deductible Health Plan (New in 2014) � AETNA VALUE HD 4000 � NJ DIRECT HD 4000 **Medicare Eligible Retirees Cannot enroll in plans listed in RED

Horizon NJ Direct Aetna Freedom (Effective January 1, 2016) Nationwide service areas �Primary care physician NOT required - No referrals �Certain services require pre-certification �In-network routine physical exams �Immunizations �Annual routine vision exam

Horizon NJ Direct 10/15 Aetna Freedom 10/15 (Effective January 1, 2016) Direct 10 Direct 15 In-Network Copayments $10 $15 Maximum Out-of Pocket In-Network $400 Individual $5, 317 Individual $1, 000 Family $10, 634 Family 20% R/C after 30% R/C after deductible ($100/$250) $2, 000 Individual $5, 000 Family Out-of-Network Coinsurance Maximum Out-of-Pocket Out-of-Network Maximum Covered Expenses Annual/Lifetime In-Network/Out-of-Network UNLIMITED Refer to Approved Medical Plan Design Chart for Other Local Education Retired Group Plans

Aetna HMO / Horizon HMO �Nationwide service areas � Primary care physician (PCP) required � Referrals required � Routine physical exams � Immunizations � Annual routine vision exam � All services, except emergencies, coordinated through PCP � Refer to Approved Medical Plan Design Chart for Other Local Education Retired Group Plans

Aetna HMO / Horizon HMO �No deductibles or claim forms to file � Copayments required for visits to PCP or a referred specialist � In network OOP Max $5, 317 Individual � $10, 634 Family � � No out-of-network benefits �Copayment $10 per visit �Emergency Room Copayment $35 �Unlimited Maximum Plan Covered Expenses Annual/Lifetime

Retiree Dental Plans Eligibility: ¨Retiree and survivors enrolled in SHBP medical plan. ¨Waiver eligible due to other coverage as dependent of spouse or domestic partner, or own employment ¨ Dependent eligibility same as medical plan eligibility

Retiree Dental Plans Enrollment: � One opportunity to enroll 30 -60 days of retirement �Waiver eligible must request coverage within 60 days of loss of coverage �COBRA coverage does not apply � Two Options – Dental Expense Plan (DEP) or Dental Plan Organization (DPO)

Retiree Dental Expense Plan Summary �Traditional indemnity fee for service plan �$50 person annual deductible/maximum $150 family �Deductible waived for preventive services �Benefit Tiers 1, 2, 3 for enrollees who have gone without group dental coverage �Reimburses for covered services at % of reasonable and customary charges

Retiree Dental Expense Plan Covered Services (In Network) � Preventive Care Tier 3 = 100% � Basic Restorative Care Tier 3 =70% � Major Restorative Care Tier 3 =50% � No orthodontic services � Maximum Annual Benefit $1500 person � Aetna Dental

Retiree Dental Plan Organization (DPO) � 5 Companies – each with a network of providers �Must use a network dentist in the DPO you select �Diagnostic and preventive services are covered in full �Eligible expenses require a co-payment (see handout) �Orthodontic services are NOT covered �May Change plans immediately if: �Your dentist drops out of Network and none available within 30 miles of your home �You move and your DPO cannot provide a dentist within 30 miles of your home

2016 Prescription Drug Coverage for Retirees Administered by Medco-Express Scrips Drug Aetna/Horizon HMO Pharmacy-30 day Generic Preferred Other Mail Order-90 day Generic Preferred Other Direct 10/15 $5 $13 $26 $8 $20 $42 $2 $19 $31 $3 $30 $52 Max Out-of-Pocket Copayment $1, 411 /person Annually

Miscellaneous Items �Medicare Coverage – age 65 �Multiple Coverage (in state plan prohibited) �Changing Plans �Survivor Enrollment

HEALTH CARE CONTRIBUTION Annual Earnings Year 1 Year 2 Year 3 Year 4 Contribution Toward Cost of Single Coverage* (Percentage of Premium) $95, 000 and Over 8. 75% 17. 50% 26. 25% 35. 00% Contribution Toward Cost of Member/Spouse* (Percentage of Premium) $100, 000 and Over 8. 75% 17. 50% 26. 25% 35. 00% Contribution Toward Cost of Family Coverage* (Percentage of Premium) $110, 000 and Over 8. 75% 17. 50% 26. 25% 35. 00% *No less than 1. 5% of salary for health care coverage SHBP Employers- Based on Medical and Prescription Cost Non-SHBP Employers- Based on Medical, Prescription, Dental, Vision Cost New Hire After Expiration of CNA- Contribution at Year 4 Level

Chapter 78, P. L. 2011 Cost Impact for Future Retirees Health Benefits With Less Than 20 Years of Service on 6/30/2011 Sections 125 Plans- Creation of Cafeteria Plans Employee Payments “Pre-tax” Permits Dependent Care Flexible Spending Accounts Employee Pension Contribution 6. 5% with additional one percent phased in over 7 years Payment for Waiver of Health Benefits- Shall not exceed 25% or $5, 000, whichever is less, of the amount saved by the employer. Waiver maximum applies to all new employees and to any existing employee who submits or renews a waiver on or after May 21, 2010. (Chapter 2, P. L. 2010)

Retirement Resources Retirement Living Information Center www. retirementliving. com § Retirement Communities § Places to Retire § Taxes by State § Newsletter § Retirement News § Resources § Senior Bookstore § Senior Online Publications § Marketplace § Products and Services § State Aging Agencies Division of Pensions www. state. nj. us/treasury/pensions Horizon http: //www. horizon-bcbsnj. com/shbp Aetna http: //www. aetna. com/statenj/ Aetna Dental http: //www. aetna. com/statenj Social Security www. socialsecurity. gov Medicare www. medicare. gov Medco www. medco. com IRS www. irs. gov

Robert Murphy Director Retirement Services 12 Centre Drive Monroe, NJ 08831 -1564 Phone: Fax: E-Mail: 609 -860 -1200 609 -860 -2999 rmurphy@njpsa. org