Retiree Benefits Book 2020 - Human Resources
City of BaltimoreRetiree Benefits Book2020Open EnrollmentNovember 1 - November 15See Inside for “WHAT’S NEW in 2020”New Dental Plan for Non-Medicare retireesNew Life Insurance VendorNew Enrollment ProcessSee page 5 for more information
Table of ContentsSectionSection 1Section 2Section 3Section 4Section 5Section 6 ContentsPageCover PageTable of ContentsNew and Important InformationImportant ContactsWhat’s New for your 2020 Benefits?Alex, our Virtual Benefits AdvisorNew Enrollment Process for RetireesQualifying Life Events/ Family Status ChangeDependent Eligibility /Required Medicare InformationImportant Information About MedicareKaiser Permanente your Medicare Advantage PlanMedicare MBI# replace the Medicare HIC#CMS allows removal of Part D drugs from FormularyRetiree Contribution ScheduleGraduated Retiree Contribution Schedule2020 Retiree Premium Contributions Monthly50% Retiree Contribution (15 or More Years of Service)80% Retiree Contribution (10-14 Years of Service)100% Retiree Contribution (5-9 Years of Service)Prescription Drug Plan Monthly PremiumHow To Determine Your Monthly Prescription Drug CostNon-Medicare Retirees - Medical Plan Comparison ChartRetiree Without Medicare Benefit Comparison ChartMedicare Retirees – Medical Plan Comparison ChartRetiree With Medicare Benefit Comparison ChartDental, Rx, Vision & Life BenefitsNew Dental HMO and PPO PlansPrescription Drug Plan CopaysVision Plan and BenefitsBasic Life BenefitsBasic Life Beneficiary FormBack CoverPage 2
Section 1New and Important InformationPage 3
Retiree ContactsPhone Numbers & WebsitesProviderPhone NumberWebsiteInsurance CompaniesBlueChoice Advantage PPO(Non-Medicare Retirees)CareFirst Medicare SupplementalKaiser Permanente HMOCareFirst Caremark/CVS (Non-Medicare)Silver Script Medicare Prescription PlanNational Vision Administrators (NVA)MetLifeTASC FSAUnited Concordia dia.com/cityofbaltimoreRetirement AgenciesBaltimore City Retirement System (ERS)Fire & Police Retirement (FPR)Maryland State Retirement(Pension us/Employee Benefits DivisionBaltimore City Medicare Rx Plan(Medicare Part D)Employee Benefits DivisionEmployee Benefits Division (TTY)410-396-5830TTY 711 ent Upload to Employee forms/m1wapno1gsphmm/410-396-1780Employee Benefits Division7E. Redwood Street, 20th FLBaltimore, MD 21202Phone: 410-396-5830Fax: 410-396-5216http://my.adp.comMedicare/CMS/ SSAMedicare Service CenterCenters for Medicare & MedicaidServices (CMS)Social Security Administration1-800-MEDICARE (800-633-4227)TTY: 877-486-2048Local: 410-786-3000TTY Toll-Free: 1.866-226-1819TTY Local: 410-786-07271-800-772-1213TTY .cms.gov/https://www.ssa.gov/Page 4
Information About Your Benefits for 2020Please read the information provided in this benefit book. What’s New for2020New Dental Benefits for non-Medicare retirees enrolled in Bluechoice PPO is providedthrough the United Concordia DHMO plan. Dental Benefits for Non-Medicare retireesthat live outside of MD and PA is provided thorough the Low Option United ConcordiaPPO plan.See Dental schedules on pages 42-44Visit www.unitedconcordia.com/cityofbaltimore to find a dentist in your area The City of Baltimore moved to a new enrollment platform called ADP BenefitsMarketplace (BenMark) effective May 6, 2019. Retirees and beneficiaries will nothave direct online access to the BenMark System. See page 7-8 for moreinformation. MetLife will be the New Life Insurance vendor effective 1/1/2020. See pages 49-50 for more information.Retirees may upload their information directly to Employee Benefits.Document UploadUploading Your Enrollment forms, and Dependent Documents has been made easy.You now have the option to “Upload Required Documents” directly to the Office of EmployeeBenefits by using the following link and follow all the necessary gsphmm/. See page 8 for more informationSee Page 8 for more information.Reminder: The City of Baltimore’s Diabetic Services, Supplies and Medication is covered underthe Medical Plans and the Prescription Drug plans.Contact your plan directly for information.Diabetic SuppliesCareFirstMedicareSupplementalPlanDental CoverageMedical Plans Cover -Diabetic test supplies and servicesPrescription Drugs Plan Cover - Diabetic Medication and Diabetic Insulin/medical suppliesused to inject insulin.Reminder: Effective January 1, 2017, the City’s CareFirst Medicare Supplemental plan pays80% of the 20 % balance due after Medicare. The City will no longer pay 100 % after Medicare.The retiree must pay the remaining balance.The New Dental Vendor is United Concordia, under the DHMO plan, you must select a dentist orone will be automatically assigned to you.Visit www.unitedconcordia.com/cityofbaltimore to find a dentist in your areaRetirees enrolled in Kaiser Medicare Advantage Plan have dental coverage. Please contact Kaiser formore information.Reminder: Retirees enrolled in the CareFirst Medicare Supplemental Plan are not eligiblefor dental benefits.Page 5
Kaiser now offers a Medicare Advantage (MA) Plan as opposed to the KaiserMedicare Cost (MC) Plan.Once enrolled in the Kaiser Medicare Advantage plan you will no longer be able to useKaiser Permanente your red, white and blue Medicare card to seek services from Medicare providersoutside of Kaiser Permanente for non-emergency care. With Kaiser PermanenteMedicare AdvantageMedicare Advantage, you will need to always use Kaiser Permanente providers, orproviders that they send you to, for the bill to be covered.Dependent EligibilitySummary Benefitsand Coverage(SBC)Prescription CoverageDuplicateCoverageInformationMedicare SecondaryPayer (MSP)Mandatory ReportingChange of AddressEnrollment InformationNew Membership ID CardsRetirees enrolled in Kaiser Medicare Advantage Plan have dental coverage. Pleasecontact Kaiser for more informationAdministrative InformationDependent children are eligible for benefits until the end of the calendar yearthey reach age 26, regardless of student status.The Patient Protection and Affordable Care Act (PPACA) require health plans and healthinsurance issuers to provide a Summary of Benefits and Coverage (SBC) to applicants andenrollees. The SBC is a concise document providing simple and consistent informat ion abouthealth plan benefits and coverage. Its purpose is to help health plan consumers betterunderstand the coverage they have and to help them make easy comparisons of differentoptions when shopping for new coverage. The City of Baltimore will post this document on theCity of Baltimore’s r-divisions/benefitsYou and your dependents must be enrolled in a City of Baltimore medical plan in order to enrollin a prescription drug plan.If you and your spouse are City employees/retirees, you cannot enroll each other or thesame eligible dependents on your City medical, dental, vision and prescription plans duringany coverage period. You will be notified to adjust duplicate coverage, if applicable.Under the Medicare Secondary Payer (MSP) Mandatory Reporting, federal law requires themandatory collection and reporting of social security numbers for all covered participantsincluding employees, retirees and their dependents through employer group health benefits.Noncompliance may result in the loss of coverage for participants with invalid or missingsocial security numbers.You must notify your retirement agency, in writing, about your change of address the EmployeeBenefits Division cannot change your address.SEE PAGE #7-8 FOR NEW RETIREE ENROLLMENT INFORMATION!New membership ID cards will only be issued for new plans, new enrollmentsand coverage level changes.Review Your Options with Alex!Alex walks you through the process of picking your best benefits and provides easy tounderstand explanations for any questions you might have along the way. Prepare to make thebest benefits decision with ALEX athttps://www.myalex.com/cityofbaltimore/2020Page 6
NEW Enrollment ProcessThe City of Baltimore moved to a new ADP platform called ADP Benefits Marketplace(BenMark) effective May 6, 2019. Retirees/beneficiaries will not have direct access to theBenMark System. As an alternative, retirees/beneficiaries will be required to make healthbenefit elections and changes by using a Baltimore City Retiree Health Benefits EnrollmentForm. Open EnrollmentDuring the City of Baltimore’s Annual Open Enrollment period held from November 1,2019 through November 15, 2019, retirees will receive a retiree 2020 Open Enrollment Packet thatincludes; a personalized 2020 Retiree Benefits Summary of their current health benefit elections atthe 2020 costs, Retiree Open Enrollment Health Benefits Enrollment Form, 2020 Retiree BenefitsBooklet and Open Enrollment Benefit Fair Flyer.During Open Enrollment, if the retiree wants to: Remain Enrolled in their Current Health Benefit Elections at the 2020 Costs: No action isrequired. The retiree’s current health benefit elections with the 2020 costs as stated on their 2020Retiree Benefit Summary will remain and be effective January 1, 2020. Make Health Benefit Enrollment Election and/or Dependent Enrollment Changes: If theretiree would like to make benefit and/or dependent election changes to their medical, prescriptiondrug or vision benefits, if eligible, effective January 1, 2020, they must complete the 2020 RetireeOpen Enrollment Health Benefits Enrollment Form included in the Open Enrollment packet.The signed and completed form along with required documentation if required, must be mailed toDHR-Office of Employee Benefits, 7 E. Redwood Street, 20th Floor, Baltimore, MD 21202 byNovember 15, 2019. An Employee Benefits Specialist will process the open enrollment electionsaccordingly effective January 1, 2020. NOTE: If the retiree is not making any benefit and/or dependent election changes, there isno need to complete or return the 2020 Open Enrollment Health Benefits Enrollment Formto DHR-Office of Employee Benefits. KEEP THIS FOR YOUR RECORDS! New Retiree Enrollment-As a new retiree/beneficiary, the retiree will have 60 days, from their date of retirement to enrollin health benefits. Retirees are entitled to enroll in retiree health benefits through the City ofBaltimore using their Personalized Retiree Health Benefits Enrollment Form that will be enclosed intheir new retiree packet.The retiree’s enrollment deadline will be printed at the top right-hand corner of their personalizedenrollment form. Once completed the retiree must mail the completed form and requireddocumentation, if applicable, to DHR – Office of Employee Benefits, 7 E. Redwood Street, 20th Floor,Baltimore, MD 21202 before the enrollment deadline.Page 7
If the new retiree does not enroll in health benefits by completing the Personalized Retiree HealthBenefits Enrollment Form during the 60-day enrollment period, their Medical, Prescription Drug,Dental and Vision benefits, if eligible, will default to “No Coverage” at the end of the enrollmentperiod. Qualified Life Changes If a retiree experiences a qualified life event, they must request a Baltimore City Retiree HealthBenefits Enrollment Form from the Office of Employee Benefits. The retiree must complete therequested Baltimore City Retiree Health Benefits Enrollment Form, attach the supporting and requireddocumentation if applicable, then return all documents to Office of Employee Benefits within 60days of the qualified life event. If the Enrollment Form along with the required documentation to theoffice of Employee Benefits is not completed and returned within 60 days of the event date, the retireemust wait until the next annual open enrollment period to make the benefit changes.If you have any questions or to request a Retiree Health Benefits Enrollment Form, please contactthe Office of Employee Benefits between 8:30 AM and 4:30 PM at 410-396-5830 and select option 2(City Retirees) or 3 (BCPSS Retirees) and then option 1 to speak to an Employee Benefits Specialist.Page 8
IRS regulations for cafeteria plans strictly govern when andhow benefits election changes can be made.Generally, you can only change your health coverage duringthe Open Enrollment period each year. Thecoverage you elect during Open Enrollment will be effectiveJanuary 1 through December 31. However, you may makecertain changes to your coverage outside of the annual OpenEnrollment period if you have a qualifying change in status.Examples include the following: Birth or adoption/placement for adoption of a child; Death of a dependent; Marriage or divorce; Loss of other coverage, such as if coverage under yourspouse’s employment ends or your child is no longer eligiblefor coverage; Gaining eligibility for Medicare (for retirees); or Changes in your other coverage (such as through a spouse’s employer), which has a different plan year.You have 60 days from the date of the qualifying change in status to update your health benefits enrollment bycompleting the Retiree Benefits Enrollment form.You must submit any supporting documentation to change your coverage to the Office of Employee Benefitswithin 60 days. Any changes submitted later than 60 days after the qualifying change in status will not beaccepted, and you will have to wait until the next Open Enrollment period to make a change.If you are removing an ineligible dependent past 60 days, contact the Employee Benefits Division immediatelyat 410-396-5830.Page 9
Enrolling Eligible DependentsYou must submit documentation for each dependent you wish to enroll for coverage verifying he/shemeets the eligibility requirements of the Program. If you do not provide all required documentation bythe deadline, his/her coverage may be terminated. You will be required to wait until the next annualopen enrollment period to enroll new dependents or make any changes to your enrollment.You now have the option to “Upload Required Documents” directly to the Office of EmployeeBenefits (OEB). Please use the following link and follow all the necessary gsphmm/. If you have any question on the submitteddocuments, please contact the OEB office at 410-396-5830.The following chart lists eligible dependents and the document. Photocopies are acceptable providedany seal or official certification can be seen clearly.Relationship EligibilityDocumentation for Newly Added Dependents& Family Status ChangesEligible DependentRelationships ToEmployee/RetireeLegal SpouseChildren Birth Adoption Stepchild PermanentGuardianship Grandchild Medical ChildSupport Order Disabled Child(At Age 26 as ofDecember 31) DependentEligibilityCriteriaLegally married as recognizedby the laws of the State ofMaryland or in a jurisdictionwhere such marriage is legalUnder age 26 as of December31Required to reside in yourhomeMay be married or unmarriedProvide 100% economicsupportCovered until the end of theyear they reach age 26Over age 26 and incapable ofself-support due to mental orphysical incapacity incurredprior to age 26DocumentationFor Verification of Relationship(Provide Copy Of)Official Court-Certified State Marriage Certificate (must be certified anddated by the appropriate state or County official, such as the Clerk ofCourt): From the court in the County or City in which the marriage tookplace; or From the Maryland Division of Vital Records; or From the Department of Health and Mental Hygiene (DHMH)website www.dhmh.maryland.gov (click Online Services) orwww.vitalchek.com Birth: Official Sate Birth Certificate with name of employee/retiree aschild’s parent Adoption: Official Court Documents & Official State Birth Certificate Stepchild: Official Court-Certified State Marriage Certificate & OfficialState Birth Certificate with name of spouse of employee/retiree aschild’s parent Permanent Guardianship: Official Court Documents signed by a judge& Official State Birth Certificate Grandchild: Official State Birth Certificate of your child and grandchildshowing line of relationship, recent Income Tax Return claiminggrandchild and the “Certification of Economic Support ForGrandchildren Form” (Posted on website under FORMS LIBRARY) Medical Child Support Order: Official Medical Child Support Orderrequiring employee/retiree to provide health coverage signed by thechild support officer or judge Disabled Child: Original Disability Questionnaire Form (Posted onwebsite under FORMS LIBRARY)Termination of Covered Dependents Due To A Family Status ChangeTermination of Dependents Due To Family Status ChangeCopy of Required DocumentationDeath of Spouse or ChildDivorceGain Other Coverage (Employee, Retiree, Spouse or Child)Marriage of Dependent ChildDeath CertificateDivorce DecreeLetter from Employer or Medical PlanOfficial State Marriage CertificateEnrollment Due To A Family Status ChangeEnrollment Due To Family Status ChangeCopy of Required DocumentationLoss of Coverage (Employee, Retiree, Spouse or Child)Letter from Employer or Medical PlanPage 10
Section 2Medicare InformationPage 11
IMPORTANT MEDICARE INFORMATIONThe City of Baltimore requires all its members including retirees, beneficiaries, spouses and childrencovered under a Baltimore City retiree medical plan to enroll in Medicare Part B through Social SecurityAdministration at the time you become eligible for Medicare Part A. Once enrolled in Medicare Part B, youmust remain enrolled in order to continue receiving the maximum possible benefits.As a Baltimore City or Baltimore City Public School System (BCPSS) retiree, you and your covered dependentsmust enroll in BOTH MEDICARE PART A (HOSPITAL INSURANCE) & PART B (MEDICAL INSURANCE) as soon asyou or your dependents are eligible.Who is eligible for Medicare? People age 65 or olderSome people with disabilities under age 65 as determined by Social Security Administration (SSA)People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney ---------------------------------------------When and how do I enroll in Medicare Part A & Part B?Attaining Age 65If you are not already getting Social Security retirement benefit checks, you should visit your local Social Securityoffice or call Social Security Administration (SSA) at 1-800-772-1213 to enroll in Medicare Part A & Part B whenyou become age 65 during your Initial Enrollment Period. Your Initial Enrollment Period begins three monthsbefore the month you turn 65 and ends three months after you turn 65. If you wait until the month you turn 65,your Medicare Part B start date will be delayed.Disability Under Age 65If you are already getting Social Security retirement checks due to a disability determined by SSA, you will beautomatically enrolled in Medicare Parts A and B and a Medicare card will be mailed to you on the 25th monthafter your disability benefits began. When you receive your Medicare card, the Social Security Administrationwill give you the option of turning down your enrollment in Part B. Do not turn down your Medicare Part B.BALTIMORE CITY REQUIRES THAT YOU ENROLL IN BOTH MEDICARE PART A & PART B IN ORDER TO RECEIVETHE MAXIMUM POSSIBLE BENEFITS.Important Note: If you (or your spouse/child) do not enroll in Medicare Part B when you are first eligible, youwill not
Retiree Benefits Book See Inside for “WHAT’S NEW in 2020” . retiree would like to make benefit and/or dependent election changes to their medical, prescription drug or vision benefits, if eligible, effec
If you are selecting 'Retiree & Children,' 'Retiree & Spouse' or 'Retiree & Family' coverage, you must complete the dependent information in Section 4. Group Legal Plan: You must complete the dependent information in Section 4. Please send the white copy of the form to: FBMC Benefits Management, Inc. Retiree Direct Bill PO Box 10789
Retiree Benefits Change Form Author: Office of Human Resources Subject: Retirees from the University of Missouri should use this Retiree Benefits Change Form to make changes to their benefits Keywords: university, missouri, um, enrollment, retiree, benefit, change, form Created Date: 10/1/2020 1:49:14 PM
When Jenny turns 65, she retires with IU Retiree Status. Both elect IU Retiree coverage: ‒ Jenny—IU Anthem Blue Retiree Plan (for 65 ) ‒ Dan—IU Anthem U65 PPO HDHP (for under 65) When Dan turns 65, he can switch to the IU Blue Retiree plan—the same plan as Jenny. Scenario #1 . Jenny & Dan. Dan - Age 63 (Spouse) Jenny .
Retiree Medical Plan (also referred to as the "Retiree Medical Plan" or "Plan"), which is a Component Plan of the Huntington Ingalls Industries, Inc. Retiree Welfare Benefits Plan (the "Welfare Benefits Plan"). If you have questions that are not answered in this SPD, contact
1 RN Retiree Guide 1/2018. Retiree Benefits . Which Plans Continue During My Retirement? One of the factors to consider when you are thinking about retirement is post-retirement benefits. Here is an overview of your benefits and which coverages can continue into retirement. Medical . Your Montefiore medical benefits stop when you retire.
Retiree contributions will decrease for Retiree Only and increase for all other tiers in the Kaiser Northern California Health Plan option. Retiree contributions for Retiree Family coverage will increase and all other tiers will decrease in the Kaiser Southern California option. For more plan information, please call Kaiser at 1-800-278-3296.
Wells Fargo & Company Retiree Plan. Please take the time to read this supplementary information to the Wells Fargo & Company Retiree Plan (Retiree Plan) describing how testing and evaluation for COVID-19 is covered effective January 1, 2021, and keep a copy of it with your
27 Science Zoology Dr. O. P. Sharma Amrita Mallick Full Time 18/2009 11.06.2009 Evaluation of Genotxic Effects & Changes in Protein Profile in Muscle Tissue of Freshwater Fish Channa Punctatus Exposed to Herbicides Page 3 of 10. Sl. No. Faculty Department Name of the supervisor Name of the Ph.D. Scholar with Aadhar Number/Photo ID Mode of Ph.D. (Full Time/Part-Time) Registration Number Date of .
