PEBB Retiree Options

PEBB Retiree OptionsSara Whitley and Ellen WolfhagenOctober 2021

Agenda PEBB non-Medicare and Medicare Plans &2022 Plan premiums UHC MA-PD/UMP Benefit Comparisons Enrollment Resources2

Non-Medicare Retirees & the PEBB PortfolioPEBB non-Medicare PlansKaiser NW ClassicKaiser NW CDHPKaiser WA ClassicKaiser WA ValueKaiser WA SoundChoiceKaiser WA CDHPUMP ClassicUMP PlusUMP Select PEBB non-Medicareretirees can enroll in anynon-Medicare planoffering. Retirees can move intothe PEBB Medicare plansupon receiving Medicareeligibility. The plan options andrates for Medicare/nonMedicare split accountsare uniqueUMP CDHP3

Non-Medicare Retirees & Split AccountsSplit Account Enrollment Split Account is defined asnon-Medicare and Medicaremembers enrolled underone Subscriber account. For Example:– Subscriber Medicareeligible– Spouse non-MedicareeligibleWhen the Medicare member selects:The non-Medicare Member can select:Kaiser NW Senior AdvantageKaiser NW ClassicKaiser WA ClassicKaiser WA Medicare Advantage & OriginalMedicareKaiser WA ValueKaiser WA SoundChoiceUMP ClassicUMP Classic MedicareUMP PlusUMP SelectUnitedHeathcare (MA-PD) PEBB CompleteUnitedHealthcare (MA-PD) PEBB BalanceUMP ClassicPremera Medicare Supplement PlansUMP Classic4

2022 PEBB non-Medicare Retiree Rates PEBB non-Medicareretirees pay the full valueof the plan premium, theemployer portion of thepremium no longerapplies. Plan offerings include allnon-Medicare plans. Retirees can move intothe PEBB Medicare poolupon receiving Medicareeligibility.Single SubscriberPremiumKaiser NW Classic 768Kaiser NW CDHP 644Kaiser WA Classic 813Kaiser WA Value 722Kaiser WA SoundChoice 659Kaiser WA CDHP 641UMP Classic 719UMP Plus 687UMP Select 648UMP CDHP 6395

Medicare & the PEBB PortfolioCoordination of Benefits(COB) with OriginalMedicare(UMP Classic Medicare)Medicare Part A (Hospital) Medicare Part B (OP/Prof)Original Medicare Health planscoordinate thepayment of medicalclaims with OriginalMedicareMedical Claims Medicare Primary UMP SecondaryPharmacy Claims UMP Only payerMedicare AdvantageMedicare Advantageplus Part D(Kaiser WA and KaiserNW MA)(UHC MA-PD plans) Covers all OriginalMedicare MedicarePart D drug coverage Plans receive riskadjusted revenue additional revenuefor Part D benefit Part D revenueintended to coverapproximately 75%of Part D drug costs Employer groupplans allow forcustomization ofbenefit/formulary Covers all OriginalMedicare Plans receive riskadjusted Federalsubsidy dollars fromCMS to administerthe medical benefitof the plans Popular option forretirees seekingadditional benefitsnot covered byOriginal Medicare Offer Creditable DrugCoverage, HCAreceives RDS**Retiree Drug Subsidy (RDS)6Medicare Supplement(Premera Plans F & G) Supplemental(Medigap) plans forMedicare eligibleenrollees (retired ordisabled) Plans help cover outof-pocket costs forOriginal Medicare Do not include drugcoverage

PEBB Medicare PortfolioUMP ClassicMedicareMedicareExplicitSubsidyKaiser WA &Kaiser NW MAUHC MA-PDMedicareSupplementPlansPremera Plan F andPlan G 183 or 50% of premium, whichever is lessMedicalCOB with OriginalMedicarePharmacyCreditable DrugCoverageMedicare Part C(Part A Part B, Managed Care)Creditable DrugCoverage7Part D drugcoverageHelp to coverout-of-pocketcosts of OriginalMedicareNo drugcoverage

Retiree Premium CalculationTotalPlan BidRateMedicareExplicitSubsidy2022 Medicare Explicit Subsidy is set at 183 or 50% of the premium, whichever is less.8RetireePremium

2022 PEBB Medicare Retiree RatesSingle SubscriberPremium*Medicare ExplicitSubsidyComposite RateKaiser NW Senior Advantage 172.79 167.79 340.58Kaiser WA Medicare Advantage & Original Medicare 175.69 170.70 346.39UMP Classic Medicare 364.87 183.00 547.87UnitedHealthcare (MA-PD) PEBB Complete 148.68 143.68 292.36UnitedHealthcare (MA-PD) PEBB Balance 125.99 120.99 246.98Premera Medicare Supplement Plan F Retired 116.11 111.12 227.23Premera Medicare Supplement Plan F Disabled 199.77 183.00 382.77Premera Medicare Supplement Plan G Retired 99.35 94.35 193.70Premera Medicare Supplement Plan G Disabled 165.39 160.40 325.792022 Medicare Explicit Subsidy is set at 183 or 50% of the premium, whichever is less.9

Medicare Bid Rate DevelopmentIllustrative ExampleTotal Bid Rate 600*Risk Adjusted CMS Revenue to administer Medicare Parts A and B10

Simplified Comparison Chart11

UMP v. UHC MAPD – Medical BenefitsUMP ClassicMedical DeductibleMax Medical Benefit Out-of-PocketIn-Patient ServicesOut-Patient ServicesOut-Patient Mental Health CarePrimary Care Office VisitSpecialty CareUrgent CareER CopayChiropractic CareAcupunctureMassage TherapyUHC PEBB CompleteCore Medical Benefits 250 0 2,500 500 200/day (up to 600 per 0admission)15% 015% 015% 015% 015% 15 75 15% 65Supplemental Benefits 15, 24 visits 0, 20 combined visits 15, 24 visits 15, 24 visits 0, 30 visitsUHC PEBB Balance 0 2,000 500/admission 15 primary care/ 30 specialist 15 group/ 30 individual 15 30 15 65 15, 20 combined visits 15, 30 visitsRoutine Vision Exams and Hardware 0 annual exam; 30 copay forcontact lens fittinghardware up to 150 every 2 years 0 annual exam, hardware up to 300 every 24 monthsRoutine Hearing Exams and Hearing Aids 0 annual exam,hardware one per ear every 5 years 0 annual exam,hardware up to 2500 from United Hearing every 5 yearsGym MembershipNot coveredRenew Active, 012

UMP v. UHC MAPD – Pharmacy BenefitUMP Classic 100 ( only on Tier 2 and specialtydrugs) excludes insulinRX Out-of-Pocket Limit 2,000Retail Pharmacy (30 day supply)Value Tier5% up to 10Tier 1 (primarily low-cost generic)10% up to 2530% up to 75 (includes specialtyTier 2 (preferred brand-name and high-cost generic)drugs)Tier 3 (non-preferred)N/ATier 4 (mostly specialty/limited to 30 day supplyN/AMail Order (Based on 90 day supply)Value Tier5% up to 30Tier 1 (primarily low-cost generic)10% up to S7530% up to 225 (includes specialtyTier 2 (preferred brand-name and high-cost generic)drugs)Tier 3 (non-preferred)N/ATier 4 (mostly specialty/limited to 30 day supplyN/ARx Deductible13UHC PEBB CompleteUHC PEBB Balance 100 (Tiers 2, 3 and 4) 2,000N/A10% up to 25 (Preferred insulin, 10 max)30% up to 4750%50% up to 100N/A10% up to 7530% up to 14150%50% up to 100

Questions about United?1-855-873-3268 ProviderPharmacySpecific drugsBenefits14

Enrollment Process Form C must be used to designate a MedicareAdvantage (or) MAPD plan Form C must be signed Signature date determines Effective Date Can only be enrolled in 1 Part D plan at a time15

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Enrollment Questions HCA Customer Service –1-800-200-1004 HCA Website:www.hca.wa.gov/employee-retiree-benefits17

Switching Plans Can switch INTO or OUT of any Medicare planduring Open Enrollment If on Plan F or Plan G and an individualstandalone Part D plan, must disenroll fromdrug coverage before new plan effective18

Dental Plan Options Delta Dental– DeltaCare (a closed network)– Uniform Dental Plan [UDP] Willamette Dental Group (a closed network)19

SHIBA Statewide Health Insurance Benefits Advisorso 1-800-562-6900o Insurance.wa.gov Part of the OIC Not related to PEBB Volunteer advisors around the state20

Questions?Ellen WolfhagenEmployee and Retiree Benefits DivisionEllen.Wolfhagen@hca.wa.govSara WhitleyFinancial Services DivisionSara.Whitley@hca.wa.gov21

Kaiser WA SoundChoice Kaiser WA CDHP UMP Classic UMP Plus UMP Select UMP CDHP. Non-Medicare Retirees & Split Accounts. 4 Split Account is defined as non-Medicare and Medicare members enrolled under one Subscriber account. For Example: . Sara.Whitley@hca.