2023 Benefits Enrollment Guide For Retirees And Disabled Participants
2023 BenefitsEnrollment Guidefor Retirees andDisabled ParticipantsBenefits effective January 1, 2023
2023 Retirees Benefits Annual Enrollment GuideThis guide contains the University enrollment materials and application for the benefits available to you as aneligible University retiree or participant on disability status. You have different medical plan options to choosefrom for 2023 depending on whether you are under age 65, age 65 or over, or a participant on disability status.CERTIFICATE OF COVERAGEIf you are age 65 or over: Upon enrollment, a Certificate of Coverage will be mailed to your home by your medicalplan along with more detailed information about your medical benefits.If there are any differences between this guide and the Certificate of Coverage, the Certificate will govern.SUMMARY OF BENEFITSIf you are under age 65: The Medical Summary of Benefits and Dental Summary of Benefits that describe yourmedical or dental coverage are available online at z.umn.edu/medicalbenefits and z.umn.edu/dentalbenefits. If yourequire a print copy, call Total Rewards at 612-624-8647 or 800-756-2363.If there are any differences between this guide and the Summary of Benefits, the Summary will govern.Find More Retiree Benefits Information OnlineThe University’s Office of Human Resources website has a special section just for retirees. There you will find: Important documents you may need Details on continuing your U of M medical, dental, and group life insurance coverage in retirement Wellbeing programs for retirees Dental programs for retirees Travel and emergency assistance Contact information for your medical plan vendor And much moreVisit OHR’s Benefits for Retirees web pages at https://z.umn.edu/retireebenefits or, from the OHR home page, click onBenefits, then Benefits for Retirees.OHR Contact CenterTelephone: 612-624-8647 Toll Free: 1-800-756-2363Benefits Enrollment for 20232hr.umn.edu/benefits
Table of ContentsEnrollment Guidelines & Instructions.Page 4Basic Medicare Information.Page 5Questions to Aid in Choosing a Medicare-Enrolled Medical Plan.Page 6Medicare-Enrolled Health Plans. Page 7Non-Medicare Eligible Health Plans. Page 18Dental Plans. Page 19Important Notice from UPlan Medical Program.Page 22Application for Coverage.Page 25Benefits Enrollment for 20233
Enrollment Guidelines & InstructionsYou have 30 days after you retire to decide about continuing coverage. If you do not continue coverage, you and yourdependents will not be able to re-enroll in the University’s medical or dental plans in the future.CHOOSE THE RIGHT PLAN FOR YOUR AGE GROUPIf you and your spouse are both under the age of 65, you must enroll in the same plan with Medica. If you and yourspouse are over the age of 65, you must enroll with the same carrier, however one of you may enroll in Plan 1 and theother in Plan 2.If you are in different age groups—one is under 65 and one is 65 or over—you must select plans appropriate for your agegroup. The under age 65 participant may continue to be enrolled in the active employee medical plan; the 65-or-overparticipant must select a Medicare Eligible Medical plan. In all cases, the retiree must continue coverage for the spouseto be eligible for a University retiree plan.HOW TO ENROLLIf you do not want to make any changes to your benefits during Open Enrollment, you do not need to do anythingat this time.If you are already enrolled in retiree benefits and want to make a change to your benefits, you must complete and returnthe Continuation of Coverage form at the back of this book. The form must be received by the Office of HumanResources no later than 4:30 p.m. on November 30, 2022. In addition to the form, if you will be changing from onemedical plan for Medicare enrollees to another, you must contact your current medical carrier to cancel coverage.Contact information for medical plan carriers can be found in the directory on page 7.Non-Medicare Enrollees: If this is your initial retirement from the University, we recommend returning Continuation ofCoverage form to Total Rewards about two months before your retirement date, but we must receive it no later than30 days after your last day of work. You do not need any other forms to continue dental insurance or medical plans ifyou are not a Medicare participant.Medicare Enrollees: The retiree medical carrier will mail an enrollment kit to you, including an enrollment formrequired by Medicare. With BCBS, you will receive an additional enrollment form for the Group Medicare Blue Rxpharmacy plan. With Medica and HealthPartners, they will make three attempts to contact you via phone to enroll youand if that is unsuccessful they will mail the enrollment form. HealthPartners also has the option to enroll electronically.You will need to return the form to the carrier by December 31, 2022, to become effective January 1, 2023. Fornew retirees, you need to send it to the carrier by the last day of the month before your effective date.Supplemental plans cannot backdate coverage.Once the carrier receives enrollment forms, you will receive a confirmation letter, ID card, and other member materials.MEMBER ID CARDSGenerally, the plans send new member ID cards if you have made a plan change. Some of the carriers send new cardseach year.Benefits Enrollment for 20234
Basic Medicare InformationWho is generally eligible for Medicare? People over age 65. Disabled people or those with end-stage renal disease, no matter their age.Does the University contribute towards the cost of Medicare? No.What are the different parts of Medicare? A: Hospital coverage. Covers hospitalization, skilled nursing facility, home health care, & hospice care. There is nomonthly premium as long as you or your spouse have paid into the Medicare tax for at least 10 years. B: Basic medical coverage. Covers doctor visits, labs, x-rays, outpatient surgery, ambulance, medical supplies andequipment, etc. If you are receiving Social Security payments, they will withhold the Medicare Part B monthlypremium from your monthly payments, and if you are not, they will bill you quarterly. Monthly premiums are basedon your household income. D: Prescription drug coverage. Covers prescription drugs and can also provide additional coverage through theMedicare Coverage Gap/Donut Hole. Part D coverage is included in all our 65 plans.When should I enroll in Medicare? If you are working and covered under your employer’s group health plan, you may defer enrolling in Medicare untilyou stop working in your benefits-eligible position. If you retired before turning 65, you should enroll in Medicare so it is active as of the first of the month in whichyou will turn 65. Generally, you can apply about three months before your 65th birthday.How much time should I allow to enroll in Medicare? It is recommended to enroll in Medicare within two to three months of your upcoming retirement date or themonth in which you will turn 65.If I’m enrolled in an HSA, can that affect my Medicare? In some circumstances, there can be tax consequences related to Medicare Part A coverage and HSAcontributions. If you or your spouse are enrolled in an HSA and will have Medicare Part A coverage in the next fewyears, contact Medicare to understand how it impacts you.For more information on Medicare: Visit: www.medicare.gov Call: 1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048Benefits Enrollment for 20235
Questions to Aid in Choosing a Medicare-Enrolled Medical PlancWhat is the monthly premium? Compare rates on pages 8–9.c Are my current healthcare providers covered under the plan? Consider checking the provider finder on each plan’s website. Contact a plan using the information on page 7.c If I am taking any medications, are they covered under the plan, and what is the out-of-pocket cost (copay orc m I planning on moving outside of the local service area (Minnesota, western Wisconsin, eastern Dakotas) forAmore than six consecutive months?coinsurance)? See pages 14–15 to compare prescription drug coverage across plans. Contact the plan to understand any impact from moving outside the local service area permanently. Contactinformation is on page 7.cWhat is the coverage for hearing aids? Compare costs on pages 12–13.cIs there a deductible? Compare maximums on pages 16–17.cIs there coverage if I travel internationally? Compare coverage on pages 16–17.cI s my health club covered under the plan? Check Wellness Benefits on pages 14–15 and use the contactinformation on page 7 for more information.cWhat if one of these plans is not right for me? If you would like more information about what plans are offered in the marketplace, Senior LinkAge Line is anonprofit dedicated to serving Minnesota Seniors and they are able to assist in your search.» Call Senior LinkAge Line: 800-333-2433» Visit Senior LinkAge Line online: www.seniorlinkageline.comBenefits Enrollment for 20236
Medicare-Enrolled Health Plans DirectoryBlue Cross Blue Shield of MinnesotaU of M Retiree PlanU of M Plan 1Toll Free: 1-800-262-0819TTY: Call the National Relay Center at 711 and ask for 1-888-878-0137Group Medicare Supplement Plan with High Deductible Coverage with Group MedicareBlue Rx (PDP)U of M Plan 2Toll Free: 1-800-531-6686 for Current Members1-888-870-6297 for Prospective MembersTTY: Call the National Relay Center at 711 and ask for ription Drug Coverage for U of M Plan 1 and Plan 2Group MedicareBlue Rx (PDP)Telephone: 1-877-838-3827TTY: 711www.yourmedicaresolutions.comHealthPartners Journey and HealthPartners Retiree National ChoiceU of M Plans 1 & 2Telephone: 952-883-7428Toll Free: 1-866-993-7428TTY: Call the National Relay Center at 711 and ask for 1-866-993-7428www.healthpartners.com/uofmMedica Group PlanU of M Plans 1 & 2Telephone: 1-855-844-6395Toll Free: 1-855-844-6395TTY: Call the National Relay Center at 711 and ask for UCare Medicare GroupU of M Plans 1 & 2Telephone: 612-676-6900TTY: 612-676-6810Groupsales@ucare.orgToll Free: 1-877-598-6574TTY: 1-800-688-2534Benefits Enrollment for 20237
Medicare-Enrolled Health PlansPremium per monthper personType of PolicyBlue Cross Blue Shield ofMinnesotaU of M Plan 1Blue Cross Blue Shieldof MinnesotaU of M Plan 2HealthPartnersJourney & RetireeNational ChoiceU of M Plan 1HealthPartners Journey& Retiree NationalChoiceU of M Plan 2 392.10Pre MACRA* 176.10Post MACRA* 158.60 296.80 167.50Coordinates with Medicare andMedicare PrescriptionDrug PlanMedicare Supplement Planwith Medicare PrescriptionDrug PlanHow Plan Workswith Medicare andMedicare AssignmentU of M Retiree Plan pays afterapplying U of MRetiree Plan inpatientdeductible and coinsurance.You pay Medicare Part Bannual deductibles.Network Providers(Medicare Assignment)You are encouraged to useBCBS network providers,but you do not assign yourMedicare benefits to BlueCross. You are allowed to useyour Medicare benefitsoutside of the BCBS network. Journey: Medicare Advantage Plan RNC: Coordinates with Medicare and includesMedicare Prescription Drug PlanType of Policy is determined by county of residenceMedicare pays first. You pay Journey: HealthPartners administers benefitsPart A and B deductibles and/and claims payment for all plan coveredor coinsurance until you meetmedical services and Part D.your deductible of 2,490(2022); then plan pays 100%. RNC: For medical services, HealthPartners coordinateswith Medicare. For Part D drug coverage, HealthPartnersDeductible may changeadministers benefits and claims payment.in 2023*You can use anyMedicare-contractedprovider nationwide.You can see any provider that accepts Medicareand your insurance.Outpatient HospitalOutpatient SurgeryLab/X-Ray, CT scan,MRI, other outpatientdiagnostic tests100% afterMedicare Part Bannual deductible 226100% after deductibleis satisfiedEmergency ServicesAmbulance100%100% after 75 copayLab services 100%All other services 15 copayLab services 100%All other services 30 copay100% after 50 copay100% after 100 copay100%80%*MACRA: If enrolled in Medicare Part A prior to 1/1/2020, Plan pays 100% of annual Medicare Part B deductible; Medicare eligible 1/1/2020 orafter Retiree pays 100% of annual Part B deductible ( 226). This impacts Blue Cross Blue Shield Plan 2.Benefits Enrollment for 20238
Medicare-Enrolled Health PlansPremium per monthper personType of PolicyHow Plan Workswith Medicare andMedicare AssignmentNetwork Providers(Medicare Assignment)MedicaU of M Plan 1MedicaU of M Plan 2UCareU of M Plan 1UCareU of M Plan 2 359.00 189.00 315.00 167.00Medicare Cost Plan with Medicare Prescription Drug Coverageor Medicare Advantage PPO plan with Medicare PrescriptionDrug CoverageCost: Medicare pays primary for Part A inpatient hospital, skillednursing facility, and home health care expenses. Medica paysMedicare Part B provider expenses.Medicare Advantage: Medica pays primary for Part Ahospitalization and Part B provider expenses.Cost Plan: You are encouraged to use Medica network providers,but you do not assign your Medicare benefits to Medica. You areallowed to use your Medicare benefits outside of theMedica network.Medicare Advantage Plan: You can see any provider that acceptsMedicare and your insurance.Medicare Advantage Plan including PrescriptionDrug CoverageUCare administers benefits and claims payment ofMedicare Parts A and B, as well as additional benefitsincluded in plan, such as Prescription Drug coverage(Part D) and preventive care. Bills for health careservices are sent directly to UCare by providers(not to Medicare) and are processed in UCareClaims department.Travel anywhere within the U.S. and pay onlyyour in-network copay on routine care,including clinic and specialist visits, physicaltherapy and counseling services.You also have access to out-of-state providers withan expanded MultiPlan national network. At theseproviders, your plan works the same as in network.You may see any provider that accepts Medicare.UCare will also cover 80% of many other servicesthroughout the U.S.Outpatient Hospital100% after 50 copay100% after 100 copay100%100% after 100 copayLab services 100%All other services 20 copayLab services 100%All other services 30 copayPrimary or Specialtyoffice - 100%OP Hospital / Surg. Ctr. 25 copayPrimary or Specialty office100%OP Hospital / Surg. Ctr. 25 copayEmergency Services100% after 50 copay100% after 75 copay100% after 50 copay100% after 75 copayAmbulance100% after 50 copay100% after 65 copay100%100% after 100 copayOutpatient SurgeryLab/X-Ray, CT scan,MRI, other outpatientdiagnostic testsBenefits Enrollment for 20239
Medicare-Enrolled Health PlansBlue Cross Blue Shieldof MinnesotaU of M Plan 1Blue Cross Blue Shieldof MinnesotaU of M Plan 2HealthPartnersU of M Plan 1HealthPartnersU of M Plan 2100% after Medicare Part Bannual deductible 226100% after deductibleis satisfied100% after 15 copay100% after 30 copayHospitalPlan pays 80% of first 3,000of total allowed amountfollowing 200 annual inpatientdeductible; then 100% throughend of calendar year.Out-of-pocket expense limitedto 800 per year, including 200 deductible100% after deductibleis satisfied.No limit on number of dayscovered by plan100%100% after 200 copayper visitSkilled NursingPlan pays 80% of first 3,000of total allowed amountfollowing 200 annual inpatientdeductible; then 100% throughend of calendar year. Outof-pocket expense limited to 800 per year, including 200deductible. No 3-day hospitalstay requirement100% for up to100 days per benefit periodafter deductible is satisfied.3-day hospital stay required.Urgent Care VisitInpatientMental HealthChemicalDependencyPlan pays 80% of first 3,000of total allowed amountfollowing 200 annual inpatientdeductible; then 100% throughend of calendar year.Out-of-pocket expense limitedto 800 per year, including 200 deductible100% after deductible issatisfied up to 190 days ofinpatient psychiatric hospitalcare in a lifetime.This limitation does notapply to inpatient psychiatricservices furnished in ageneral hospital 100% for up to100 days per benefit period. RNC: 3-day hospital stay required.100%100% after 200 copayper visit100% after deductibleis satisfiedOutpatient MedicalPreventive100%100% for Medicare coveredpreventive services only100%100%PhysicianOffice Visit100% after Medicare Part Bannual deductible 226100% after deductible issatisfied100% after 15 copayPrimary Care 100% after 20 copay / Specialist100% after 30 copayBenefits Enrollment for 202310
Medicare-Enrolled Health PlansUrgent Care VisitMedicaU of M Plan 1MedicaU of M Plan 2UCareU of M Plan 1UCareU of M Plan 2100% after 20 copay100% after 30 copay100% after 20 copay100% after 35 copay100% after 100 copay100% after 200 copay100%100% after 200 copay100% coverage after 3-dayhospitalization for up 20days. Days 21-100 100copay per day.100% coverage after 3-dayhospitalization for up 20days. Days 21-100 150copay per day.InpatientHospitalSkilled NursingMental Health100% after 100 copay100% coverage for up to 100 days per benefit period;no 3-day hospital stay requirement100% after 200 copay100%100% after 200 copayChemicalDependencyOutpatient MedicalPreventive100%100%100%100%PhysicianOffice VisitPrimary Care 100%Specialist 100% after 20 copayPrimary Care 100%Specialist 100% after 30 copayPrimary Care 100%Specialist 100% after 15 copayPrimary Care 100%Specialist 100% after 30 copayBenefits Enrollment for 202311
Medicare-Enrolled Health PlansMedications Deliveredin Physician OfficeSetting and Paid underMedicare Part BRoutine Eye andHearing ExamsBlue Cross Blue Shieldof MinnesotaU of M Plan 1Blue Cross Blue Shieldof MinnesotaU of M Plan 2HealthPartnersU of M Plan 1HealthPartnersU of M Plan 2100% after MedicarePart B annual deductible 226100% after deductibleis satisfied80%80%100%No coverage100%100%100% after 15 individual/ 7.50 group100% after 20 individual/ 10 group100% after 15 copay100% after 20 copayOutpatientMental HealthOutpatient ChemicalDependency100%Chiropractic CarePodiatryPhysical andOccupational Therapy100% after MedicarePart B annual deductible 226100% after deductibleis satisfied100% after 15 copay100% after 20 copay100%100%Speech andLanguage TherapyHome Health CareMedical EquipmentDME ProstheticsHearing Aids100% after MedicarePart B annual deductible 226100% after deductibleis satisfied90%80%80% for hearing aidsevery 3 yearsNo coverage.Discounts available. 99/ 199/ 499 copay perhearing aid for up to two peryear through TruHearing 499/ 699/ 999 copay perhearing aid for up to two peryear through TruHearingBenefits Enrollment for 202312
Medicare-Enrolled Health PlansMedications Delivered inPhysician Office Settingand Paid Under MedicarePart BRoutine Eye andHearing ExamsMedicaU of M Plan 1MedicaU of M Plan 2UCareU of M Plan 1UCareU of M Plan 280% coverage80% coverage80% coverage80% coverage100%100%100%100%100% after 20 copay100% after 30 copay100% after 15 copay100% after 30 copay100% after 15 copay100% after 20 copay100%100%100% after 20 copay100% after 30 copay100% after 15 copay100% after 30 copay100%100%100%100%90% coverage80% coverage80% DME/100% Prosthetics80% DME/100% ProstheticsNo coverage Coverage for up to twoTruHearing branded aidsper year 499/ 799 copay forAdvanced or Premium Aids Coverage for up to twoTruHearing branded aidsper year 599/ 899 copay forAdvanced or Premium AidsOutpatient Mental HealthOutpatient ChemicalDependencyChiropractic CarePodiatryPhysical andOccupational TherapySpeech andLanguage TherapyHome Health CareMedical EquipmentDME ProstheticsHearing Aids 500 allowance per yearBenefits Enrollment for 202313
Medicare-Enrolled Health PlansBlue Cross Blue Shieldof Minnesota U of M Plan 1Blue Cross Blue Shieldof Minnesota U of M Plan 2HealthPartnersU of M Plan 1HealthPartnersU of M Plan 2Generic Drugs — Retail 10 copayPreferred generic - 5 copayGeneric - 10 copay 10 copayPreferred generic 10 copayGeneric - 20 copayFormulary Brand Drugs— Retail 30 copay80% coverage 30 copay 35 copayNon-preferredFormulary Brand — Retail 50 copay55% coverage 30 copay 70 copaySpecialty Drugs 50 copay67% coverage 50 copay75% coverage75% coverageNo coverageCovered at generic andbrand copays shownaboveCovered at generic andbrand copays shownabove3-month supply for 2 copaysthrough mail order or if usingPreferred Extended Network(PXT) within Group MedicareBlue Rx pharmacy network3-month supply for 2 copays orcoinsurance through mail orderor if using Preferred ExtendedNetwork (PXT) within GroupMedicareBlue Rx pharmacynetwork3-month supply for2 copays throughpreferred mail orderpharmacy3-month supply for2 copays throughpreferred mail orderpharmacy100% coverage after:Benefits in the Medicare 10 generic copayCoverage Gap (between 30 preferred brand copay 4,660 total prescription 50 non-preferred brand copaycosts and 7,400 total 50 specialty copayout-of-pocket expenses)100% coverage after 5 copayfor preferred generic drugsand 10 copay for generic,Participants will pay no morethan 25% of the plan’s costfor all other generic and branddrugs, on non-preferred drugsand specialty drugs.100% coverage after: 10 generic copay 30 brand copay 50 specialty copay100% coverage after: 10 preferred genericcopay 20 generic copay 75% coverage forbrand or specialtyThe above copays or 5%(whichever is less)Member cost will be thegreater of 5% of drug cost(not to exceed copaysabove) or 4.15 copay forgeneric drugs and 10.35copay for all othercovered drugsPrescription DrugsSupplemental DrugsMail OrderCatastrophic Level(after 7,400 in totalout-of-pocket expenses)Member cost will be the greater of 5% of drug cost or 4.15copay for generic drugs (including brand drugs treated asgeneric) and 10.35 copay for all other covered drugsWellness BenefitsFitness ClubMembershipNurselineDentalVisionOther Wellness BenefitsSilver Sneakers Fitness Program24-hour Nurse Line24-hour Nurse LineN/AN/A Stop Smoking support Wellness Discount Marketplace: blue365deals.com/bcbsmnBenefits Enrollment for 202314Silver Sneakers Fitness ProgramFree access to registered nurses 24/7 throughthe CareLineSM nurse lineN/AUp to 35% discount off eyewear Free, unlimited number of Virtuwell visitswhere available. Healthy discounts on eating services, deliveryservices, fitness equipment, and much more
Medicare-Enrolled Health PlansMedicaU of M Plan 1MedicaU of M Plan 2UCareU of M Plan 1UCareU of M Plan 2Generic Drugs — RetailPreferred generic - 5/10CopayNon-preferred generic 25/30 CopayPreferred generic - 5/10CopayNon-preferred generic 15/20 Copay 10 copay 10 copayFormulary Brand Drugs— Retail 25/30 copay 25/30 copay 30 copay 30 copayNon-preferredFormulary — Retail 55/60 copay 65/70 copay 50 copay 60 copay 100/ 110 copay72% coverage 50 copay75% coverageNot coveredNot coveredCovered at generic andbrand copays shown aboveNot coveredPrescription DrugsSpecialty DrugsSupplemental DrugsMail OrderBenefits in theMedicare CoverageGap (between 4,660total prescription costsand 7,400 totalout-of-pocket expenses)Catastrophic Level(after 7,400 in totalout-of-pocket expenses)90-day supply for 2 copays on 90-day supply for 2 copays ontier 1-4 medicationstier 1-4 medications100% coverage after 5/10or 25/30 generic or brandcopay, 55/60 non-preferredformulary and 100/110specialty90-day supply for 2 copays through mail order orPreferred Pharmacy network (retail)100% coverage after 5/10or 15/20 copay for genericmedications. 75% coveragefor brand name medications.50% reimbursement from branddrug manufacturer at pharmacycounts toward the 7,400OOP expenses.100% coverage after 10generic copay, 30 preferredbrand copay, 50 nonpreferred drug or specialtydrug copay (counts towardthe OOP max)Member cost will be thegreater of 5% of drug cost or 4.15 copay for generic drugsand 10.35 copay for brand/formulary drugs100% coverage after 10Member cost will be thegeneric copay,greater of 5% of drug cost 30 preferred brand copay, or 4.15 copay for generic 50 non-preferred drug or drugs and 10.35 copay forspecialty drug copaybrand/formulary drugs100% coverage after 10 generic copay. 75%coverage for brand andspecialty drugsWellness BenefitsFitness ClubMembershipOne Pass Fitness ProgramOne Pass Fitness Program - over 20,000 clubs nationwideUCare Health Club Savings Program - 30 per monthPersonal Health Advocate can help navigate the healthcaresystem as well as provide access to registered nurses forguidance and support 24 hours a day/7 days a weekHealth Connections — 24-Hour Nurse LineCommunity Education Class reimbursement — threeclasses per year, My Health Decisions Online ToolDental 500 dental reimbursement allowanceN/AVisionN/A 200 Annual Eyewear allowance Hearing Aid Discount program A survey for senior members that is reviewed by nurses inMedica’s Care Management area to assess additional needs Medication Therapy Management (MTM) program providesinformation and resources to improve medication useand patient care 75 every six months for over-the-counter items Quit Smoking, plus Disease and Case Management Programs Falls Prevention Program Mammogram Incentive ProgramsNurselineOther Wellness BenefitsBenefits Enrollment for 202315
Medicare-Enrolled Health PlansBlue Cross Blue Shieldof MinnesotaU of M Plan 1Blue Cross Blue Shieldof MinnesotaU of M Plan 2HealthPartnersU of M Plan 1HealthPartnersU of M Plan 2Travel and Out-of-Area BenefitsDomesticTravel BenefitsNo limitations Broad-based travel benefits available for up to 9consecutive months.No limitations Assist America support available if more than100 miles from home.See below for description of services. Emergency and urgently needed care are coveredworldwide at 80%.InternationalTravel BenefitsOption to Live Outsideof Service Area Assist America: 24/7 nationwide and worldwide supportto talk to experienced clinicians who can help determineyour need for medical care, or coordinate post-stabilizationtransportation to the nearest facility or your homefor traveling members more than 100 miles away fromtheir residence.80% coverageEmergency care coveredat 80%YesYesYesYes 1,033 that includes 800 plus 226 MedicarePart B deductible.This is a high-deductibleplan. You must first pay forMedicare-covered costsup to your plan deductible 2,490 (subject to changein 2023) before the planbegins to pay 100% forapproved services andsupplies. 3,000 nnual Out-of-Pocket(Pharmacy copays donot apply)LifetimeBenefits Enrollment for 202316
Medicare-Enrolled Health PlansMedicaU of M Plan 1MedicaU of M Plan 2UCareU of M Plan 1UCareU of M Plan 2Travel and Out-of-Area Benefits Members can be gone up to six consecutive months—noneed to call UCare Emergency benefits applyDomesticTravel BenefitsYou can see any provider that accepts Medicare and yourinsurance while out of the Medica service area. MultiPlan providers will cover benefits the same as innetwork providers. If not a MultiPlan provider, other out-ofnetwork office visits will be covered with in-network copay. Must see provider that accepts Medicare 80% for non-emergency services—limited to 100,000per yearInternationalTravel BenefitsOption to Live Outsideof Service AreaCoverage for emergencies onlyCoverage for emergencies onlyYesYesNoNo 2,000 3,250 2,800 nnual Out-of-Pocket(Pharmacy copays donot apply)LifetimeBenefits Enrollment for 202317
Non-Medicare-Enrolled Health PlansPlans available are the same as active employee plans. See z.umn.edu/medicalplans for plan details.Statements will be mailed to you directly from your medical plan administrator.Spouse and/or dependent children are only eligible for benefits if retiree is on University retiree benefits or passed away while onUniversity retiree benefits.WELLBEING PROGRAMEmployees and/or spouses who are under age 65 and covered by the Non-Medicare-Enrolled medical plan mayparticipate in the Wellbeing Program to earn the lower Wellbeing rate shown in the table below. Those who do notparticipate or do not earn the required points will pay the standard rate.Visit z.umn.edu/ohrwellbeing to learn more, and begin participating.2023 Monthly RatesRetiree or Disability Status Only / Spouse Under Age 65 Only / One Dependent Child OnlyPlanWellbeing RateStandard RateMedica Elect/Essential: Twin Cities and Duluth Base PlanMedica Choice Regional: Greater Minnesota Base Plan 803.87 845.54Medica ACO Plan: Crookston area, Duluth area and parts ofnortheastern Minnesota, Rochester area, Twin Cities metro area 760.24 801.91Medica Choice National 997.29 1,038.96Medica HSA 727.16 768.83Retiree or Disabled Status and Children / Spouse Under Age 65 and Children / Two or MoreDependent Children OnlyPlanWellbeing RateStandard RateMedica Elect/Essential: Twin Cities and Duluth Base PlanMedica Choice Regional: Greater Minnesota Base Plan 1,423.13 1,464.80Medica ACO Plan: Crookston area, Duluth area and parts ofnortheastern Minnesota, Rochester area, Twin Cities metro area 1,344.54 1,386.21Medica Choice National 1,756.32 1,797.99Medica HSA 1,273.95 1,315.62Retiree or Disability Status and Spouse With or Without ChildrenWellbeing RateStandard RateMedica Elect/Essential: Twin Cities and Duluth Base PlanMedica Choice Regional: Greater Minnesota Base PlanPlan 2,130.02 2,192.52M
Benefits, then Benefits for Retirees. Find More Retiree Benefits Information Online OHR Contact Center Telephone: 612-624-8647 Toll Free: 1-800-756-2363 hr.umn.edu/benefits. Benefits Enrollment for 2023 3 Table of Contents
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Each year, Annual Enrollment is your chance to choose your ParTNers for Health plan benefits or make changes that will be effective the following Jan. 1 through Dec. 31. Your Annual Enrollment period for 2023 benefits is Oct. 1-28, 2022. This newsletter gives you important information about your 2023 benefits choices.
Each year, Annual Enrollment is your chance to choose your ParTNers for Health plan benefits or make changes that will be effective the following Jan. 1 through Dec. 31. Your annual enrollment period for 2023 benefits is Oct. 1-14, 2022. This newsletter gives you important information about your 2023 benefits choices.
