ANNUAL ENROLLMENT 2020 PRE -65 RETIREES Guide
ANNUALENROLLMENTPRE-65 RETIREES2020guide
AnnualEnrollment isTable of ContentsWhat’s Changing for 2020?.1Annual Enrollment To Do List .2How to Make Your 2020 Benefit Elections.3NOVEMBER1 - 15, 20192020 Benefit Highlights.5NOVEMBER 2019This guide provides an overview of MarathonPetroleum’s benefits for pre-65 retirees in 2020 so youcan make informed decisions during this year’s AnnualEnrollment. The choices you make determine yourcoverage for the coming year, so think carefully andkeep this guide for reference throughout the year.Health Savings Account – 101.9Contacts.10Important Notices.11EnrollmentREMEMBER, THIS IS YOURONLY OPPORTUNITY TO MAKECHANGES TO YOUR 2020BENEFIT PLAN ELECTIONS,UNLESS YOU HAVE AQUALIFYING LIFE EVENT.If you have any dependent changes during theyear, such as marriage or divorce, you have upto 30 days after the date of the event (31 daysincluding the event). This could potentially havean effect on premiums, eligibility and offering ofbenefits through COBRA provisions.Note: Retiree members who obtain newly eligiblespouses or dependent children after theirretirement date will pay the full cost of the electedHealth Plan for those members.Annual Enrollment is November 1 - 15, 2019.Re-enrolling in coverage during this AnnualEnrollment is optional. However, it is important toreview your elections and who you are covering aseligible dependents. It is your responsibility to remove adependent who no longer meets eligibility requirements(e.g., divorced spouse).During Annual Enrollment you can: Change your Health Plan option for 2020. Add or remove dependents from coverage for 2020. Drop dental or vision coverage for 2020. (You will notbe able to re-enroll at a later date if you drop thiscoverage.)If you do not want to make any of these changes, yourcurrent elections will roll over to 2020, and you do notneed to take any action.The Company’s policies, plans, practices and procedures maybe amended, terminated or changed at any time at the solediscretion of the Company. If that should occur, the material inthis document will be superseded and the provisions of theofficial plan documents will be followed. If there arediscrepancies between this document and the official plandocuments, the official plan documents will always govern.WHAT’S CHANGING FOR 2020?The following changes will be effective January 1, 2020.Pre-65 Retiree MPC Health Plan ContributionsHealth Plan contributions will increase for the Classic Option and decrease for the Saver HSA Option.Classic Option2020Retiree OnlyRetiree SpouseRetiree ChildrenRetiree Family2019Saver HSA Option20202019 186 181 101 124 372 361 198 245 372 361 198 245 559 543 322 369Saver HSA Company ContributionFor the Saver HSA Option, there will be no Company contribution. Instead, retiree contribution ratesfor the Saver HSA Option will decrease.Pre-65 Retiree Kaiser Northern California and Southern California* ContributionsContributions for the Kaiser Northern California Health Plan will decrease and contributions for theKaiser Southern California Health Plan will increase. For more plan information, please call Kaiser at1-800-278-3296.NorthernRetiree OnlyRetiree SpouseRetiree ChildrenRetiree FamilySouthern2020201920202019 398.69 448.38 189.93 164.48 970.93 1,073.29 531.44 355.28 627.83 721.82 353.40 310.87 1,084.70 1,228.77 499.25 439.17*The Kaiser Health Plan is only available to members with a permanent residence within the Kaiser California service area(N. CA or S. CA).Pre-65 Retiree Dental*Retiree BillingDental contributions will decreasefor 2020.Beginning January 1, 2020, Benefitsolver willadminister the billing for retirees enrolled in any of thebenefit plans. Payment for coverage for the month ofDecember will be the last payment to PayFlex.PayFlex will not accept any payments made afterDecember 31, 2019. Use the directions on page 3 toset up payment to Benefitsolver for coveragebeginning January 1, 2020.2020Retiree OnlyRetiree SpouseRetiree ChildrenRetiree Family2019 21 23 42 46 46 50 75 79Pre-65 Retiree Vision*Vision contributions will remain the samefor 2020.*The Pre-65 Dental and Vision Plans are onlyavailable to retirees who enrolled upon retirement.Qualifying EventsBeginning January 1, 2020, for any qualifyingevent, you will have 30 days after the date of theevent to contact Benefitsolver to request achange (e.g., marriage, divorce, etc.) and providesupporting documentation of the event,otherwise the change will not be approved.MARATHON PETROLEUM PRE-65 2020 ANNUAL ENROLLMENT GUIDE 1
ANNUAL ENROLLMENT TO DO LISTRead this guide to find out what is changing for 2020.Review your current benefit elections by visiting Benefitsolver at www.BenefitsEnroll.com.–– IMPORTANT! Legacy MPC retirees will not be able to log in until November 1.Verify the dependents that you cover are eligible.Access detailed information about all of Marathon Petroleum’s benefit plans, includingSummary Plan Descriptions (SPDs) and Summaries of Benefits and Coverage (SBCs) atwww.myMPCbenefits.com under “Notices and Plan Documents.” If you prefer to receive aprinted copy of the SPDs or SBCs, we will provide one to you at no charge. Contact the BenefitsService Center at 1-888-421-2199, or email benefits@marathonpetroleum.com, to request a copy.Change your benefits with Benefitsolver by visiting www.BenefitsEnroll.com betweenNovember 1-15, 2019. If you don’t want to make any benefit changes for 2020, you do notneed to take any action.Contact Benefitsolver by calling 1-844-408-2575 between 7:30 a.m. and 6:30 p.m. CSTwith any questions.Important Reminders - Age 65Benefits for members that are turning 65 will end on the day before Medicare becomes effective (the1st of the month in which you turn 65). You do not need to take any action for the member that isunder age 65 and will be remaining in benefits. If the employee is becoming Medicare eligible, thespouse is eligible to remain on the Medical Plan but the Dental and Vision Plans will end.Members who are becoming eligible for Medicare due to disability, must enroll in Medicare Part A andPart B. Members may remain eligible for the Marathon Petroleum Health Plan, but Medicare coverage isprimary. For more information, please contact a Benefit Service Center counselor at 1-888-421-2199.MARATHON PETROLEUM PRE-65 2020 ANNUAL ENROLLMENT GUIDE 2HOW TO MAKE YOUR 2020 BENEFITELECTIONS WITH BENEFITSOLVERBenefitsolver will maintain your 2020 benefit elections. You can access your benefits, request changesdue to life qualifying events, and pay your monthly premiums at www.BenefitsEnroll.com. Follow theinstructions below for first time use. IMPORTANT! Legacy MPC retirees will not be able to log in untilNovember 1.➊ V isit Benefitsolver at www.BenefitsEnroll.com from anycomputer or smart device.➋ N ew users must registerand answer security questions.The Marathon PetroleumCompany key is MPC/Speedway.➌ O nce you log in, clickStart Here and follow theinstructions to make yourbenefit elections by November15, 2019.➍ U sing Previous and Next tonavigate, review your options asyou move through theenrollment process. Selectplan(s) and who you would liketo cover. Track your choicesand costs along the left side.MARATHON PETROLEUM PRE-65 2020 ANNUAL ENROLLMENT GUIDE 3
ake sure your personal➎ Minformation, elections, anddependents are accurate andApprove your enrollment.To finalize your enrollment,click I Agree.2020 BENEFIT HIGHLIGHTSMonthly contribution amounts for the Classic and Saver HSA Health Plan options shown below are forretirees with 100% of the Company subsidy. Your specific rates, based on your earned percentageof the Company subsidy, can be found by logging into Benefitsolver. You can find a complete list ofthe accrual rates on www.myMPCbenefits.com. your enrollment is➏ Whencomplete, you will receive aconfirmation number and youcan also Print BenefitSummary. Your To Do List willnotify you if you have anyadditional actions needed tocomplete your enrollment.➐ Y ou have year-round access toa benefits summary that showsyour personal selections. ClickBenefit Summary on thehomepage to review yourcurrent benefits at any time.For questions, technical assistance,or to enroll over the phone, pleasecontact Benefitsolver at 1-844-4082575.Monthly ContributionsClassic OptionSaver HSA OptionRetiree OnlyRetiree SpouseRetiree ChildrenFamily 186 101 372 198 372 198 559 322For the Saver HSA Option, there will be no Company contribution to a Health Savings Account (HSA).Instead, retiree contribution rates for the Saver HSA Option will decrease. Retirees with an HSA willkeep their accounts and remain eligible to contribute their own money.2020 Health Plan ComparisonsHealth Plan (includes Medical, Surgical, Mental Health and Substance Abuse)There are no changes to the deductible, out-of-pocket maximums, and copays or coinsurance of theHealth Plan for 2020.DeductibleClassic OptionIn-network benefitsSaver HSA OptionIn-network benefits 600 Individual 1,400 Retiree Only 1,200 Family 2,800 Retiree Dependents** 3,500 Individual 5,000 Individual 7,000 Family 10,000 FamilyYou pay 20% after deductibleYou pay 20% after deductibleOffice Visit 20 for primary care; 50 for specialist and urgent careYou pay 20% after deductiblePreventiveServicesPlan covers at 100% (no deductible)Plan covers at 100% (no deductible)ER Charge 200 charge, then deductibleplus 20% coinsuranceDeductible, then 200 charge,then 20% coinsuranceOut-of-pocket(OOP) Maximum*Coinsurance*Medical and prescription drug expenses will apply toward meeting the out-of-pocket maximum.**Retiree Dependents covers Retiree Spouse, Retiree Child(ren) and Retiree Family.MARATHON PETROLEUM PRE-65 2020 ANNUAL ENROLLMENT GUIDE 4MARATHON PETROLEUM PRE-65 2020 ANNUAL ENROLLMENT GUIDE 5
Prescription Drugs (Rx)Pre-65 Retiree Dental PlanMarathon Petroleum’s Health Plan includes prescription drug coverage, administered by ExpressScripts. There are no changes to the out-of-pocket maximum, deductibles, and copays orcoinsurance for the prescription drug plan for 2020.Marathon Petroleum’s Dental Plan is administered byDelta Dental. To find a Delta Dental PPO or Premier providerin your area, call Delta Dental at 1-800-524-0149 or go towww.deltadentaloh.com/findadentist. The largestdiscounts are available through a PPO provider. This Planis not open to new enrollment.All prescription and specialty drugs MUST be purchased through an Express Scripts participatingnetwork pharmacy or through the Express Scripts pharmacy; otherwise, there will be no coveragefrom the Plan. Certain specialty drugs must be filled through the Express Scripts specialty pharmacy,Accredo, after the first fill.Maintenance medications must be filled with 90-day supplies through a Walgreens pharmacy or theExpress Scripts mail order pharmacy. Otherwise, you will pay the full cost of the medication after thesecond fill.Classic OptionOut-of-pocket MaximumPrescription Annual DeductibleContribution amounts will decrease for 2020.Saver HSA OptionDelta DentalCombined with medicalRetiree SpouseRetiree ChildrenRetiree Family 21 42 46 75Pre-65 Retiree Dental Plan OverviewThere are no Plan changes for 2020. 10 after deductible 30 after deductible 60 after deductibleYou pay 20% after deductible**Annual Deductible: 50 per personCalendar Year Maximum: 1,000 per personMail Order or Smart90(90-day supply)* Generic Drugs** Preferred Brand Drugs(includes Specialty Drugs) Non-Preferred Brand DrugsRetireeOnlyCombined with medicalRetail Only 100 individual; 200 familyRetail (30-day supply)* Generic Drugs** Preferred Brand Drugs Non-Preferred Brand DrugsPre-65 Retiree Dental Plan Monthly ContributionsType of Service 25 75You pay 20% after deductible** 150* To encourage the use of Mail Order or Smart90-Walgreens, there will be no coverage for the third and subsequent fills of a“maintenance drug” purchased at other participating retail pharmacies. You will pay 100% of the cost of the medication.** Certain generic preventive drugs under the Saver HSA option are covered at 100%. A list of these drugs can be found atwww.myMPCbenefits.com.Service ExamplesCoverageExams (limited to two per year), x-rays100%*† (no deductible)Basic dental servicesFilling, extractions, root canals80%* (after deductible)Major dental servicesInlays, crowns, dentures50%* (after deductible)Orthodontia servicesNot coveredNot coveredPreventive and Diagnostic* When you receive services from a nonparticipating dentist, or a Delta Dental Premier provider, the percentages in this columnindicate the portion of Delta Dental’s PPO provider fee schedule that will be paid for those services. This amount may be lessthan what the dentist charges or Delta Dental approves and you are responsible for that difference.† 50 individual deductible does not apply to preventive services.The Dental Plan details and the claim form can be found atwww.myMPCbenefits.com/Forms/.MARATHON PETROLEUM PRE-65 2020 ANNUAL ENROLLMENT GUIDE 6MARATHON PETROLEUM PRE-65 2020 ANNUAL ENROLLMENT GUIDE 7
HEALTH SAVINGS ACCOUNT – 101Pre-65 Retiree Vision PlanThe Marathon Petroleum Vision Plan is administered byAnthem Blue View Vision. For a list of in-network providers,call Anthem at 1-855-698-5676 or visit www.Anthem.com.This Plan is not open to new enrollment.2020 Pre-65 Retiree Vision Plan Monthly ContributionsContribution amounts will remain the same for 2020.Vision PlanRetireeOnlyRetiree SpouseRetiree ChildrenRetiree Family 7 12 13 20Pre-65 Retiree Vision Plan OverviewKey FeaturesAn HSA is an individual account used inconjunction with an HSA-eligible health plan tocover out-of-pocket qualified medical expenseson a tax-advantaged basis. Your HSA belongsentirely to you and can be used to pay for bothcurrent and future qualified medical expensesfor you and your eligible dependents. You cancontribute to your account, withdrawcontributions to pay for current qualifiedmedical expenses, and potentially grow youraccount on a tax-free basis by investing. Administered by Fidelity.What type of expenses does an HSA cover?There are no Plan changes for 2020.Plan FeaturesIn-NetworkOut-of-NetworkFrequency of Service Exams Lenses/Contacts FramesOnce every calendar yearOnce every calendar yearOnce every other calendar yearOnce every calendar yearOnce every calendar yearOnce every other calendar yearExamsNo copayUp to a maximum allowance of 35Frames (every other year)No copay (Up to 130 retail)Up to a maximum allowance of 45Lenses Single Vision Bifocal Trifocal 10 copay 10 copay 10 copayUp to a maximum allowance of 25Up to a maximum allowance of 40Up to a maximum allowance of 55Up to a maximum allowance of 130Up to a maximum allowance of 105This benefit applies to one order ofcontact lenses per calendar yearThis benefit applies to one order of contactlenses per calendar yearContact Lenses (in lieuof prescription eyeglasslenses)What is an HSA?The Pre-65 Retiree Vision Plan details and the out-of-network claim form can be found at www.myMPCbenefits.com. Health plan deductibles and coinsurance Triple tax advantage account: thecontributions are tax-free, any investmentearnings are tax-free, and payments forqualified health care expenses are tax-free. Contributions can be made anytimethroughout the year. Your balance in the HSA rolls over from yearto year. You can choose investments for youraccount from a broad range of options,including a full range of Fidelity mutual funds,non-Fidelity funds and individual funds. Most medical care and servicesHSA Eligibility Rules Dental and vision care You must be enrolled in a high-deductiblehealth plan. Prescription drugs and insulin Medicare premiums (if age 65 or older)Refer to IRS Publications 969 and 502 atwww.irs.gov or consult a tax professional formore information on eligible expenses. You cannot be claimed as a dependent onsomeone else’s tax return. If you or your dependents are 65 and/orMedicare eligible, special rules apply.Please consult a tax professional. You cannot have any other medical coverage(such as through your spouse’s employer),unless it is also an HSA-qualified, highdeductible health plan under the IRS rules. If you are eligible for Veterans Benefits orTRICARE, special rules apply. Please consulta tax advisor. You cannot use HSA dollars for domesticpartners unless they are qualified taxdependents.MARATHON PETROLEUM PRE-65 2020 ANNUAL ENROLLMENT GUIDE 8MARATHON PETROLEUM PRE-65 2020 ANNUAL ENROLLMENT GUIDE 9
CONTACTSIMPORTANT NOTICESPlan o r com1-844-408-2575Service provider for benefitsenrollment, retiree billing and COBRA.7:30 a.m. to6:30 p.m. CSTMarathon Petroleum BenefitsService CenterEmail: benefits@marathonpetroleum.com1-888-421-2199Access to Plan documents, formsand updateswww.myMPCbenefits.com8:00 a.m. to5:00 p.m. ESTwww.anthem.comGroup #: 0033299931-855-698-56761-866-776-4793Mobile AppMyChoice MobilePLEASE NOTE:Review your benefits and planinformation, on the go.The following notices are current as ofSeptember 1, 2019.Health CareClassic and Saver HSA HealthPlan Options(pre-certification)Anthem BlueCross BlueShield Find Providers Claims and ID Cards Pre-CertificationAnthem AnywhereAccess your member ID, estimatecosts, find a doctor, and check thestatus of claims.www.express-scripts.comGroup #: www.BenefitsEnroll.com1-844-408-2575MyChoice Mobile7:30 a.m. to 6:30p.m. CSTReview your benefits and planinformation, on the go.Kaiser Permanente Health Plan www.kp.org1-800-278-3296Kaiser PermanenteFind doctors and locations,pay medical bills, schedule routineappointments and more.Pre-65 Retiree Dental PlanDelta DentalPre-65 Retiree Vision PlanAnthem Blue View VisionWomen’s Health and Cancer RightsAct of 1998 NoticePremium Assistance Under Medicaidand the Children’s Health InsuranceProgram (CHIP)www.deltadentaloh.com1-800-524-0149This notice is made solely to satisfy the Act’srequirements. The Health Plan has always coveredsuch procedures and in no way does this reflect achange in plan provisions.Delta Dental MobileAccess your ID card,find an in-network dentist, estimatecosts, and check the status ofclaims.www.anthem.com1-866-723-0515Special Enrollment NoticeAnthem AnywhereAccess your member ID and viewthe status of your claims.Special enrollment events allow you and your eligibledependents to enroll for health coverage outsideof the Annual Enrollment period under certaincircumstances if you lose eligibility for othercoverage, become eligible for state premiumassistance under Medicaid or the State Children’sHealth Insurance Program (S-CHIP), or acquirenewly eligible dependents. This is required under theHealth Insurance Portability and Accountability Act(HIPAA).Health Savings Account (HSA)FidelityTo request special enrollment or obtain moreinformation, contact Benefitsolver at 1-844-4082575.The Plan provides mastectomy coverage and alsoprovides for reconstructive surgery in a mannerdetermined in a consultation with the attendingphysician and the
Retiree Spouse 970.93 1,073.29 531.44 355.28 Retiree Children 627.83 721.82 353.40 310.87 Retiree Family 1,084.70 1
4 Auto-Enrollment: Algorithm 5 Auto-Enrollment: Rule 2 EBCI Tribal Option Detail 6 Auto-Enrollment Example Scenarios during Crossover 7 Individual Auto-Enrollment: with PCP in-network 8 Individual Auto-Enrollment: with PCP not in-network for any PHP 10 Mother, Son Auto-Enrolled: Enrolled in same PHP
Which Certificate Services role services should you recommend? A. Certificate Enrollment Web Service and Certificate Enrollment Policy Web Service B. Certificate Enrollment Policy Web Service and Certification Authority Web Enrollment C. Online Responder and Network Device Enrollment Service D. Online Responder and Certificate Enrollment Web .
Open Enrollment 2022 Dear George Washington University Community, Welcome to the 2022 Benefits Open Enrollment season! Open Enrollment . begins on Monday, October 11, 2021, and closes at 8 p.m. (ET) on Friday, October 29, 2021. Open Enrollment provides an annual opportunity to reflect upon yo
Health, Dental, and Vision Enrollment/Change Form - FINAL 12.20.2022 Page 1 of 6. Health, Dental, and Vision Enrollment/Change Form . Instructions: Form is only to be used for new employees or . qualifying event changes during the plan year (outside of annual Open Enrollment). For new hire enrollment,
EU Tracker Questions (GB) Total Well Total Badly DK NET Start of Fieldwork End of Fieldwork 2020 15/12/2020 16/12/2020 40 51 9-11 08/12/2020 09/12/2020 41 47 12-6 02/12/2020 03/12/2020 27 57 15-30 26/11/2020 27/11/2020 28 59 13-31 17/11/2020 18/11/2020 28 60 12-32 11/11/2020 12/11/2020 28 59 12-31 4/11/2020 05/11/2020 30 56 13-26 28/10/2020 29/10/2020 29 60 11-31
Enrollment” to resume the enrollment application and make the necessary changes. 6. The Provider Enrollment: Resume Enrollment page is displayed. Online Provider Enrollment User Manual, Chapter 1 13 Updated 07/19/2021 (pv11/02/2020) 7. Enter your assigned Tracking
enrollment to confirm that the provider name, routing number and account number on the document matches what was supplied in the enrollment. o Pre-note transaction: CAQH will, through its bank, conduct a pre-note transaction to confirm that the account included in the enrollment can receive funds. CAQH enrollment
Re-enrollments: The following steps will also apply when a resident must submit a re-enrollment application. The resident will receive a re-enrollment due letter six (6) months prior to the resident’s re-enrollment due date. This letter will contain the re-enrollment application tracking number (ATN) and provider ID
