RETIREE BENEFITS EMBRACE BENEFITS - West Virginia
2021RETIREEBENEFITSGUIDEEMBRACEYOURBENEFITS
Table ofContentsTable of Contents2Key Things to Know3How to Enroll4Eligibility and Payments5Dental6Vision9Hearing11Group Legal Insurance13Changing Your Coverage15Notices17Benefits Directory182020 Benefit Fair Conference Calls ScheduleTOC2Back
Key Things to KnowWelcome to your Retiree Mountaineer Flexible Benefits Plan. FBMC Benefits Management, Inc. (FBMC)administers this plan for PEIA. This guide will provide you with information about the benefits available toyou and your dependents, as well as information on how to enroll.Important Dates to RememberYour Open Enrollment dates are:April 2, 2020 - May 15, 2020.Your Period of Coverage dates are:July 1, 2020 - June 30, 2021.Get ready for benefitsopen enrollment! Here’swhat’s changing for yourupcoming MountaineerFlexible Benefits PlanOpen Enrollment: Hearing rates are slightly increasing.See Page 11 for hearing rate changes. Your dental rates are slightly decreasing.See Page 6 for dental changes.Please note the following: This is a changes-only enrollment. If you do notmake changes during open enrollment, yourbenefits will roll over and you will continue to beliable for all premiums due. To make changes,please submit a new enrollment form. If you are a currently enrolled retiree and youdo not want to change your benefits for thenew plan year, you do not have to complete anenrollment form. Retirees who would like to add or changebenefits during open enrollment must completean enrollment form in its entirety and return it toFBMC by mail. Newly-eligible retirees will have the monthof and two months following from the date oftheir retirement to return the enrollment form.Benefits do not automatically roll over from activeemployment into retirement. Please keep this benefits guide for referenceduring the plan year.3
How to EnrollIf you wish to keep your current benefits you donot need to complete a Retiree Enrollment Form.Retirees wishing to elect or change coveragemust complete the enrollment form.Enrollment Form Section 1Be sure to follow the instructions in this section.Vision CareYou may choose either the Full Service Plan or theExam Plus Plan, but not both. Check the type ofcoverage you are choosing. If you select 'Retiree& Family' coverage, you must complete thedependent information in Section 4.Hearing Benefit:Enrollment Form Section 2Complete all of your personal information.If you are selecting ‘Retiree & Children,’ ‘Retiree &Spouse’ or ‘Retiree & Family’ coverage, you mustcomplete the dependent information in Section 4.Enrollment Form Section 3Group Legal Plan:Mark each benefit and tier level you are selecting.Remember to complete all requested informationfor your benefits.Enrollment Form Section 4If you selected dependent coverage (child,spouse, family) for dental, vision, legal and/orhearing benefits, you must complete this section.This includes the dependents’ names, relationshipto you, birth dates and Social Security numbers.Send FBMC the white copy of the form and keepthe yellow copy for your records.You must complete the dependent information inSection 4.Please send the white copyof the form to:FBMC Benefits Management, Inc.Retiree Direct BillPO Box 10789Tallahassee, Florida 32302-2789If your retirement date is after July 1, 2020, yourenrollment form must be submitted within themonth of retirement and two months followingyour retirement date. Your coverage will beeffective the first day of the month following yourretirement and you will be billed accordingly.Dental Care:You may select one of the four Delta Dental plans,including: Routine Plan, Assistance Plan, BasicPlan or Enhanced Plan.Check the type of coverage you are choosing.If you are selecting ‘Retiree & Children,’ ‘Retiree &Spouse,’ or ‘Retiree & Family’ coverage, you mustcomplete the dependent information in Section 4.4Until your CPRB deductions or ACH(electronic) payments begin, payment bypersonal check or money order is required.You will receive an enrollment summaryreport upon enrolling, which will includewhere to submit your monthly premiumuntil CPRB or ACH deductions begin.
Eligibility and PaymentsWho is Eligible?An eligible retiree is a retired employee (or his/hersurviving spouse) of the State of West Virginia, aCounty Board of Education, or a non-state agencywho currently receives income from the WVConsolidated Public Retirement Board (CPRB) or aTIAA-CREF retirement plan.Note for New Retirees: Benefits do notautomatically roll over from active employmentinto retirement.How to Enroll During the Plan YearIf you wish to enroll in vision, dental, legal orhearing coverage, you will need to complete,sign and return the enclosed Retiree EnrollmentForm within the month of and two monthsfollowing your retirement. Your coverage will beeffective the first day of the month following yourretirement and you will be billed accordingly. Ifyou do not enroll during this time, you mustwait until the next open enrollment periodto participate.For more information, please contact theFBMC Service Center at 1-844-55-WVA4U(1-844-559-8248).Making Payments Any State of West Virginia Retiree whoreceives income from the Consolidated PublicRetirement Board can choose to have theirpremium payments deducted from their CPRBretirement check by electing this option onthe Retiree Enrollment Form, unless costs aregreater than the total amount of your check. Inthis instance, payment must be made directlyto FBMC as directed on the monthly enrollmentsummary report you will receive. Please makecheck payable to FBMC and submit yourmonthly premium to: FBMC Retiree Direct BillPO Box 10789Tallahassee, FL 32302-2789Until annuity deductions begin, payment bypersonal check or money order is required. Fullpremium payment(s) must be paid by the duedate specified. You will receive an enrollmentsummary report upon enrolling, which willinclude where to submit your premium untilCPRB deductions begin. T IAA-CREF Retirees - Payment by personalcheck or money order must be sent to FBMConce you receive your enrollment summaryreport. Payments must be made by the duedate specified.Retiree and BillingIf you are electing CPRB pension deductions,please be advised of the following: Confirm that you are currently receiving apension check. Allow time to process your pensiondeductions as this may take 30 – 90 daysto begin deducting. Review your pension statement or bankaccount each month to ensure that deductionshave been taken. Be prepared to send payment by check ormoney order if your premium has not beendeducted.5
DentalYou may choose from the followingdental plans: Routine Plan Assistance Plan Basic Plan Enhanced PlanWith Delta Dental, you have complete freedomof choice in selecting a dentist. You can choosea dentist from the Delta Dental Premier or DeltaDental PPOSM networks, or a dentist who doesnot participate in either network. Your choice ofdentist can determine your cost savings.Save on out-of-pocket costsPPO dentists have agreed to reduced fees thatare often lower than Premier fees. This helps youcover more services under your annual maximum.As with your Premier network dentist’s plan, youwon’t get charged more than your expected shareof the bill when you visit a PPO dentist. You won’thave to submit any claim paperwork when youvisit a Delta Dental dentist.6How can I tell if my dentist is Premieror PPO?Your dentist might already be a PPO dentist. Tofind out, enter your dentist’s name in the Find aDentist search at deltadentalins.com. You canalso call your dental office to confirm.Ask whether your dentist is a “contracted DeltaDental PPO dentist.”Online ServicesGet information about your plan anytime,anywhere by signing up for an Online Servicesaccount. Available once your coverage kicks in,this free service lets you find a network dentist,view or print your ID card and more. The onetime registration process takes only a minute.Receive an email when a new dental benefitsstatement is available. Save time, reduce clutterand preserve environmental resources. To enroll,log in to Online Services and update your settingsat deltadentalins.com.
DentalMONTHLY Dental RatesRoutineRetiree Only 10.95Retiree Children 21.95Retiree Spouse 24.49Retiree Family 35.55AssistanceRetiree Only 11.83Retiree Children 23.72Retiree Spouse 26.46Retiree Family 38.41Further InformationEligible retirees may cover your eligible dependentchildren to age 26, and spouses.See the chart on page 8 for a partial list ofcovered services. Call Delta Dental for moreinformation concerning your benefits, to view a list ofexclusions or to request a claim form.Submit Claim Forms to:Delta Dental of West Virginia Plan #01058PO Box 2105Mechanicsburg, PA 17055-2105Customer Service: 1-800-932-0783TTY/TDD: 1-888-373-3582How to Print your ID cardBasicRetiree Only 16.92Retiree Children 33.89Retiree Spouse 37.77Retiree Family 54.77EnhancedRetiree Only 28.15Retiree Children 56.29Retiree Spouse 65.37Retiree Family 93.37There are no ID cards distributed with theseplans. Go to deltadentalins.com. Log in to Online Services with your usernameand password. (If you don’t already have ausername or password, click “Register Today”link to complete the quickregistration process.) Once you’ve logged in, click the “Eligibility &Benefits” tab. Select “Print ID card” on the left-hand sideof the page. (If you do not see this option, insome instances you may also need to click onthe “Eligibility & Benefits” link on the left-handside of the page before you have the option toselect “Print an ID card.”) Click “Print.”Note: The card is not required to obtain services.7
Partial List of Covered ServicesDentalCall Delta Dental for more information concerning your benefits, to request a list of exclusions or torequest a claim form. This is not a full list of the terms and conditions applicable to the benefits outlinedbelow.Deductible (Per Person Per Plan Year) Maximum total family deductiblePlan Year Max (Per Person) Delta Dental network dentist Non-participating dentistOther Maximums Ortho Lifetime Max (Paid over two plan years) TMJ DisorderBENEFITDiagnostic/Preventive Services*** Visits/Exams (twice in a plan year) Routine cleaning (twice in a plan year) Fluoride treatments (to age 19, twice in aplan year) Bitewing X-rays (twice in a plan year) Space maintainers (to age 14) Sealants (to age 14, once in any 36-month periodon unfilled permanent first and second molars)Basic Restorative** Amalgam (“silver”) and composite (“white”) onanterior teeth and the facial surface of bicuspidsOral Surgery Extractions Oral surgery procedures (Medical is primary forimpactions) General anesthesia and IV sedation arebenefitted with all covered oral surgeryprocedures and with select endodontic andperiodontic surgeries.Endodontics Pulpal therapy Root canal therapyPeriodontics*** Treatment for gums and supporting structuresMajor Restorative** Inlays, onlays, crowns (crowns for natural teeth,not implants)Prosthodontic** Bridges, Full and partial dentures, Dentureadjustments/reliningOrthodontia** For eligible dependent children to age 26,employees and EDPLANNo deductibleYou pay 25applies to allservices)† 75You pay 25(applies to allservices)† 75You pay 50(diagnostic,preventive &ortho are exempt) 150 500 500 750 500 750 500 1,250 1,000N/AN/AN/AN/AN/AN/A 1,000 500Plan paysPlan paysPlan paysPlan 0%*N/A25%*80%*80%*N/A25%*80%*80%*N/ANOT COVEREDNOT COVERED50%*N/ANOT COVEREDNOT COVERED50%*N/ANOT COVEREDNOT COVERED50%*N/ANOT COVEREDNOT COVERED50%*† Deductible waived for diagnostic/preventive procedures at Delta Dental PPO Provider. Deductible applies to all services rendered by Delta Dental Premier and non-participating dentists.* Percentage is based on Delta Dental’s applicable Maximum Plan Allowance or the dentist’s fee, whichever is less (the Allowed Amount). The Delta Dental payment under the program, plusthe patient payment, equals the Allowed Amount, which is accepted by Delta Dental participating dentists as full payment. Participating dentists are paid directly by Delta Dental, and byagreement cannot bill you more than the applicable Copayment, deductible or charges where maximums have been exceeded for covered services. By selecting a participating dentist,you always limit your out-of-pocket costs. For services performed by non-participating dentists, Delta Dental sends the benefit payment directly to you. You are responsible for paying thenon-participating dentist’s total fee, which may include amounts in addition to your share of Delta Dental’s Allowed Amount. Out-of-pocket costs may also include applicable Copayments,deductibles, charges where maximums have been exceeded, and services not covered by the Group Dental Service Contract. Maximum Plan Allowance is an amount, determined by DeltaDental, from claim charges submitted on a regional basis for a given service by dentists of similar training within the same geographical area. These charges are blended by Delta Dentalwith dentist fee information from a number of other sources, using various factors, subject to regulatory limitations and adjustment for extraordinary circumstances, such as extreme difficultyor unusual circumstances.** Basic Restorative have a 30-day exclusion. Major Restorative, Prosthodontics, and Orthodontics require six month plan participation.*** Enhanced benefits for pregnancy, which include an additional oral evaluation and a choice of an additional periodontal scaling, root planing or prophylaris, or additional periodontalmaintenance procedure are covered.8
VisionMONTHLY Vision RatesPrint a personalized Vision ID cardEXAM PLUS PLANRetiree Only 1.33Retiree Family 3.03FULL SERVICE PLANRetiree Only 7.74Retiree Family 19.69You may choose from the followingvision plans: Exam Plus Vision Plan Full Service Vision PlanMetLife Vision Plan continues to be your vision provider.You may choose to cover your family by selecting the“Employee & Family” rates. You may cover your spouseand any children, stepchildren or foster children upto age 26.Value-Added BenefitDiabetic Eyecare Program – Provides additional coveragethrough medical diagnosis and procedure codes specificallytargeted toward members with Type 1 diabetes.How To Use These PlansTo obtain vision care benefits, call a MetLife Vision memberdoctor, identify yourself as a MetLife Vision patient andmake an appointment. The doctor’s office will verifythe patient’s eligibility and plan coverage and obtainauthorization from MetLife Vision. There are no ID cardsdistributed with these plans.The doctor will explain any additional charges.After you pay your Copayment, the doctor will take care ofall the paperwork.If you prefer, you can visit a non-member doctor andpay the doctor’s normal charges. Save your itemizedreceipt and mail it, along with the MetLife Vision MemberReimbursement Form, within six months of service date to:MetLife Vision ClaimsPO Box 385018Birmingham, AL 35238-5018A Vision ID card is not required to obtain services.Note: you will not be able to obtain an ID card untilyou are enrolled in the MetLife Vision Plan.1. Click on Get My Vision ID card (located on rightside of the landing page)2. Select the state where you reside3. The vision identification card will be displayed4. Using the printer icon located on top right ofpage – print your cardMyBenefits – MetLife’s Self-Service WebsiteLogging on to the MyBenefits:1. Go to the MyBenefits website atmybenefits.metlife.com/westvirginia2. Complete the Account sign-in process by entering yourusername and password or3. If you are a first-time user, click on the “Register Now”button Provide your first name, last name, date of birth, SocialSecurity number and email address Create your own username and password Select three security questions and provide youranswers, in the event you forget your username orpassword in the future4. Read and agree to the MyBenefits website’s terms of use5. You will see a “Thank You” page and a registrationconfirmation email will be sent to the email address youprovided while registeringFind a participating eye care professional1. Click on the Find a Vision Provider near you link at:mybenefits.metlife.com/westvirginia2. Enter your ZIP code or address3. Add additional information to refine your search for avision provider4. Select your plan: Exam Plus Vision or Full ServiceVision PlanYou can also call MetLife Vision at 1-855-MET-SEE9(1-855-638-7339) for access to the 24/7 Interactive VoiceResponse system.Claim forms with the correct address can be downloadedfrom mybenefits.metlife.com/westvirginia.For more information, contact MetLife Vision’s CustomerService Line at 1-855-638-7339 (855-MET-SEE9).9
VisionThis is not a full list of the terms and conditions applicable to the benefits outlined below. Please contact 1-855-MET-SEE9(1-855-638-7339) or review the certificate of coverage for more information.EXAM PLUS VISION PLANFULL SERVICE VISION PLANMETLIFE MEMBERDOCTORNON-MEMBERDOCTORMETLIFE MEMBERDOCTORNON-MEMBERDOCTOR 10Once per yearNot coveredCovered up to 35allowanceOnce per yearNot covered 20Once per year 20Covered up to 35allowanceOnce per year 0Vision Examination(every plan year)tCovered in full aftercopay 35Covered in full aftercopay 35Lenses (every plan year)*** Single Vision Lenses** Bifocal Lenses - (includingprogressive lenses)** Trifocal Lenses Lenticular Lenses**20% Savings atprivate practicelocations only(Does NOT apply toWalmart/Sam's Club)Covered in fullCovered in fullCovered up to 25Covered up to 40Covered in fullCovered in fullCovered up to 55Covered up to 80Covered in full*Covered up to 45Covered in full*** 150 AllowanceServices are coveredin full once every planyear, after a maximum 60.00 copayment****Exam & 210Exam & 105 020% - Savings onadditional pairs ofprescription glasses,non-prescriptionsunglasses and lensenhancements froma MetLife visionmember doctor.- Single vision 25allowance- Lined bifocal 40allowance- Lined trifocal 55allowance- Lenticular 80allowanceCopayments† Exam Copay Exam Frequency Prescription GlassesFrames(every other plan year) (Up to 150allowance)Sam's Club/Walmart 85.00 allowanceContact Lenses**(in place of lenses & frames) Necessary1 Elective Fitting and evaluationPrescriptionGlasses DiscountPrescription Contact Lenses Discount20% Savings atprivate practicelocations only(Does NOT apply toWalmart/Sam's Club)15% Savings at privatepractice locationsis for Fitting andEvaluation only.Necessary andElective for contactlenses are notcovered.20% - Savings onadditional pairs ofprescription glasses,non-prescriptionsunglasses and lensenhancements froma MetLife visionmember doctor.15% Savings is for thefitting and evaluationonly at privatepractice locations only(Does NOT apply toWalmart/Sam's Club)15%Laser Vision Care ProgramNot coveredNot coveredNot coveredNoneNot coveredNoneStandard or premiumApplied to thefit covered in full withallowance for contacta copay not to exceedlenses 6015%NoneAverage 15% off the regular price or 5% off a promotional offer for laser surgery, including LASIK, CustomLASIK and PRK surgeries. This offer is only available at MetLife participating locations.1 These are patients who cannot have their vision corrected with standard glasses/lenses. They HAVE to have contact lenses which makes them necessary.† Copayments apply in-network (MetLife Vision Member Doctor) at the time of service.* Within Plan Limitations. If you select a frame that costs more than your plan allowance, there will be an additional charge you will pay out of pocket. When you visit a MetLife Visionmember doctor, ask him/her which frames are covered in full. The allowance is very competitive and ensures a good choice with little or no out-of-pocket cost.There will be an extra cost if you select materials or services that are elective or cosmetic in nature, such as tints and scratch coatings.** Exam and contact lenses are also covered once every plan year, if necessary, provided you have not received spectacle lenses in the same plan year. You may receive eyeglassframes every other plan year. You may receive either spectacle lenses or contact lenses in the plan year, but not both.*** There is a single materials Copayment of 20 on lenses and frames or medically necessary contact lenses.****15% discount applies to Member Doctor’s usual and customary professional fees for contact lens evaluation and fitting.10
HearingMONTHLY Hearing RatesWith EPIC, you'll have accesss to:YOUR MONTHLY HEARING RATESRetiree Only 2.02Retiree Children 2.97Retiree Spouse 4.01Retiree Family 4.94Why have a Hearing Plan?Hearing is one of the five natural senses that allowus to enjoy life and the world around us. Music,radio, television, movies and theater all becomeless accessible and enjoyable without the benefitof hearing. And the loss of sounds, like sirens andalarms, can actually endanger your life.Hearing is a valued life asset that can beprotected and treated through a programfor hearing healthcare. With EPIC HearingHealthcare (EPIC), you’ll get the options, care andconvenience to help make it easier to hear thesounds you’ve been missing. Name-brand and private-labeled hearing aidsat significant savings. Choose from hundredsof name-brand and private-labeled hearing aidsfrom major manufacturers including Beltone ,Oticon, Phonak, ReSound, Signia, Starkey ,Unitron and Widex and more at savings of upto 80 percent off industry prices. More than 5,000 credentialed hearingprovider locations. Access the largestnationwide network of credentialed hearingprofessionals that provide hearing tests,hearing aid evaluations and follow-up support. Convenient ordering. Order hearing aids inperson through an EPIC provider or have themdelivered right to your home in 5-10 businessdays. Personal support, every step of the way. You’llreceive access to professional, nationwidesupport, online tutorials, hearing health tipsand more. *Plus, your hearing aid order willinclude extra batteries, a 3-year extendedwarranty and a trial period so you can stayconnected and get the most out of yourhearing aids.11
HearingHow the EPIC Plan Works1. Call 1-866-956-5400, 8 a.m. – 8 p.m. CT,Monday – Friday. Contact a hearing counselorto register. You’ll discuss product and serviceoptions and locate a hearing provider nearestyou.2. Get your hearing tested. Visit a hearingprovider near you for a hearing test andhearing aid evaluation. OrSubmit a recent hearing test online atEPICHearing.com.3. Receive your custom-programmed hearingaids. You’ll receive your hearing aids in personthrough your hearing provider, including followup support, or through home delivery within5-10 business days.When to Call EPICIf you or a family member experience any of thefollowing, you may have a hearing problem thatcould be helped by a hearing health professional: Difficulty understanding voices and words(especially those of women and children). Occasional ringing in one or both ears. Itching in the ear canals. Difficulty understanding in noisy situations Turning up the television volume to understandthe dialogue.In addition, some more serious symptoms meritimmediate attention by a physician: A sudden hearing loss.Spinning and dizziness with vomiting.Persistent ringing in one ear.Blood or fluid draining from one or both ears.Persistent pain in one or both ears.Underwritten by Fidelity Security Life Insurance Company, KansasCity, MO Policy Form #M-9091, Policy Number HC-111.*These are discounted items and are not insured benefits.FEATUREExamination Adults ChildrenHearing Aid Device Adults ChildrenBENEFITFREQUENCY 70 70Adults: Once every 2 yearsChildren: Once every year 500 per ear device benefit 500 per ear device benefitAdults: Once every 5 yearsChildren: Once every 2 yearsFor more information on EPIC or your hearing aid benefit, call 1-866-956-5400, 8 a.m. – 8 p.m.CT, Monday – Friday, or visit EPICHearing.com12Fully Insured Exclusions: No benefits will be paid for services or materials: provided free of charge in the absence of insurance;payable under any Workers’ Compensation law or similar statutory authority; payable under any governmental plan or programwhether Federal, state or subdivisions thereof, except for medical assistance benefits under Title XIX of the Social Security Act(Medicaid); for the medical and/or surgical treatment of the internal or external structures of the ear(s); provided by a Hearing AidDispenser; required by an employer as a condition of employment; not prescribed by a Physician or Audiologist; for Hearing Aidbatteries, cleaning supplies or accessories; for ear protection devices or plugs; for Assistive Listening Devices; or for replacementdue to loss, theft of or damage to the Hearing Aid.Termination of Coverage: The Insured’s insurance will cease on the date the Policy ends; the end of the last period for whichany required premium has been made; or the date the Insured is no longer eligible for insurance.
Group Legal InsuranceThe Freedom and Control toEmbrace Life’s OpportunitiesWe want you to embrace life’s opportunitieswith fewer worries. That’s why we’re excited toprovide you with legal insurance from ARAG . It’saffordable legal counsel for everyday life matters– like a dispute with a contractor, buying or sellinga home or the need for estate planning. The planprovides you with peace of mind knowing thatattorney fees for most covered legal matters are100% paid in full when you work with a NetworkAttorney. That means you’ll avoid paying high-costattorney fees, which currently average 368an hour*.Resolve Your Legal Issues with aNetwork Attorney by Your SideWhen a life event turns into a legal issue, ARAGwill be there for you, backed by a nationwidenetwork of more than 13,000 credentialedattorneys. They can review or prepare documents,make follow-up calls or write letters on yourbehalf, provide legal advice and consultation,and represent you in court. Rely on legal helpand protection with a wide range of coveredservices. For additional details regardingyour plan’s specifically-covered services, visitARAGLegalCenter.com and enter Access Code18387ret to learn more about what these plansoffer, research specific legal topics and more.MONTHLY Group Legal RatesYOUR MONTHLY GROUP LEGAL RATESUltimate Advisor (Retiree Family) 11.50Ultimate Advisor PlusTM(Retiree Family) 16.50Call for Questions or Legal AssistanceYou can also get assistance from trustedprofessionals and an award-winning CustomerCare Center, with dedicated representatives whowill help you navigate your legal issues.Call 800- 247-4184 to speak with an ARAGCustomer Care Specialist.Visit ARAGlegal.com/myinfoand enter Access Code 18387ret tolearn more about your legal benefit!See the plan options on thefollowing page.* Average attorney rates in the United States of 368 per hourfor attorneys with 11-15 years of experience, Survey of Law FirmEconomics, The National Law Journal and ALM Legal Intelligence,November 2019.Pre-existing and Personal Legal MattersFor any legal matters not covered and notexcluded, you may be eligible to receive aminimum 25% reduced fee off a NetworkAttorney’s normal hourly rate.13
Group Legal Insurance14
Changing Your CoverageIt is important that you carefully consider yourbenefit elections during your initial enrollment asa retiree or during any annual open enrollment.Coverage you select will remain in effect the entireplan year, except under limited circumstances asdescribed below.Changes to CoverageOnce you elect coverage, you may only changeyour coverage mid-plan-year due to marriage,divorce, birth or death. You may increase ordecrease coverage only for the individual(s)involved. You may also decrease or cancelcoverage if your spouse or a dependentbecomes ineligible for coverage under yourplan, or becomes eligible for coverage underanother employer’s plan, a state CHIP program orMedicare/Medicaid.Coverage you cancel cannot be reinstated untilthe next annual open enrollment period.How do I make a change?Contact FBMC Service Center at1-844-55-WVA4U (1-844-559-8248) with yourchange information. Any changes to your retireebenefits will require your written authorization.Premium changes will be promptly initiated afteryour request has been received and will becomeeffective the first of the following month afterreceipt of all processable data. Changes will notbe made retroactively. However, if you are havingpremium payments deducted from your retirementcheck, any required refunds will be completed assoon as verification is received that your deductionhas changed. Refunds are processed one timeeach month and are mailed no later than the 15thof the following month.Please send your written requests for changes to:FBMC Benefits Management, Inc.Attn: Retiree Direct BillPO Box 10789Tallahassee, Florida 32302-2789What are the Plan’s Rules forGoverning Changes in Status?1. Loss of Dependent Eligibility – If a changein your marital status involves a decrease orcessation of your spouse’s or dependent’seligibility for coverage due to your divorce orannulment from your spouse, your spouse’sor dependent’s death or a dependent ceasingto satisfy eligibility requirements, then youmay decrease or cancel coverage only for theindividual involved. You cannot decrease orcancel any other individual’s coverage underthese circumstances.2. Gain of Coverage Eligibility Under AnotherEmployer’s Plan – If you, your spouse or yourdependent gains eligibility for coverage underanother employer’s plan as a result of a changein marital or employment status, then you maycease or decrease that individual’s coverage.Changing Your Benefits DuringThe Plan YearYou will have the month of and two monthsfollowing a qualifying event to submit an electionform and supporting documentation to FBMC.Upon the approv
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
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 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
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
Retiree Health Plan Marathon Petroleum Company LP (Company) sponsors and maintains the Marathon Petroleum Retiree Health Plan (the "Plan" or "Retiree Health Plan"). This document amends and restates the Plan effective as of January 1, 2022. This document serves both as the plan document and the Summary Plan Description (SPD) for the Plan.
Abrasive Jet machining can be employed for machining super alloys and refractory from materials. This process is based on surface erosion process. The process parameters that control metal removal rate are air quality and pressure, Abrasive grain size, nozzle material, nozzle diameter, stand of distance between nozzle tip and work surface. INTRODUCTION: Abrasives are costly but the abrasive .
