group medicare enrollment manual group medicare enrollment …

Baltimore County Public Schools

GROUP MEDICARE ENROLLMENT MANUAL

www.laborfirst.com

Ver: 09-20

Community College of Baltimore County Retirees and Dependents age

65+ or eligible for Medicare B


www.laborfirst.com

Ver: 09-21

Baltimore County Public Schools


www.laborfirst.com Ver: 09-21

Table of Contents

Enrollment and Eligibility Guidelines Pages 4-6

Labor First Plan Selection Guide Page 7

Medical Options Pages 8-9

Prescription Options Page 10

Kaiser Medicare Advantage Plan Pages 11-12

Frequently Asked Questions Pages 13-18

Dental Insurance Options Page 20

Vision Insurance Page 21

Life Insurance Page 22

Cancer, Catastrophic & Other Insurances Page 23

Important Contacts Page 24

“Very, very pleased with the service from Labor First, always thinking out of the box…”

- Baltimore County Retiree

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Group Medicare Enrollment Manual:

Table of Contents Enrollment and Eligibility Guidelines Page 4 – 5

Labor First Plan Selection Guide Page 6

Default Cigna Medicare Advantage Option Page 7

Alternative Medicare Advantage Options Page 8

Kaiser Medicare Advantage Plan Page 9

Alternative Medical Options Page 10

Alternative Prescription Options Page 11

Frequently Asked Questions Page 12 - 17

Important Contacts Page 18

"Very, very pleased with the service from Labor First, always thinking out of the box…”

- Baltimore County Retiree

Group Medicare Enrollment Manual:

Eligibility Retirees who, immediately following active employment, begin to receive a monthly pension, are eligible to enroll themselves and their eligible dependents in medical/prescription, dental and vision plans. Life insurance plans may be continued if enrolled in while employed. Retirees who do not qualify for a pension or who have elected to defer pension benefits are ineligible to participate in benefits.

Dependent Eligibility Spouse a person to whom you are legally married by ceremony.Dependent child who is: Your or your spouse’s biological, adopted, or legal dependents (including grandchildren for whom you have legal custody) Acceptable dependent verification includes a marriage certificate, birth certificate, signed federal tax return, court orders, and adoption papers.

Rehired RetireeRetirees who are re-employed are only eligible to enroll in the retiree benefit program offered. They may not enroll in benefits as a new employee. Prior to accepting any employment (with BCPS or elsewhere), retirees should contact their pension plan to determine what effect, if any, employment will have on the amount of their pension. • Maryland State Retirement Pension System (MSRPS) retirees who are rehired into non-MSRPS eligible positions may be eligible to participate in the ERS pension plan • MSRPS retirees rehired into MSRPS eligible positions are subject to an earnings limitation cap. Please direct questions to MSRPS.

• ERS retirees rehired into ERS eligible positions are only able to be hired as a temporary employee one time only for a maximum of 6 months, regardless of the number of hours worked. There is one exception. Retirees with a service retirement may work as a school bus driver without an earnings restriction. • If a person is receiving a pension from MSRPS, they cannot participate in MSRPS while employed with BCPS

Domestic PartnerAs of July 1, 2019, BCPS has eliminated eligibility for new enrollment of domestic partners on the benefit plans. However, retirees who had a domestic partner enrolled prior to July 1, 2019 will have their eligibility grandfathered. Retirees covering a domestic partner who have previously declared their domestic partner as a tax-dependent will be required to recertify and provide supporting documentation.

Surviving Spouse/Children Upon a retiree’s death, if the spouse and dependent children have been covered under a BCPS health care plan, they will have the option to continue coverage. The Board of Education will contribute to the cost of the health care based on the retiree’s years of service for a

2022 Open Enrollment Information Benefits changes must be completed between October 15, 2021 and November 14, 2021. Changes will be effective January 1, 2022.

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Eligibility − In order to maintain your health insurance

benefits as a retiree of Baltimore County, you must have 10 or more creditable years of County service prior to retirement and must be receiving a pension amount that covers the retiree’s share of the health plan premium deductions. (Retirees that retired prior to 7/1/2006 must have 5 or more creditable years of County service prior to retirement)

− Employees with 30 or more years of service, not contributing to the Baltimore County Employees’ Retirement System, may participate in County group insurance plans or partnerships with no County contribution when they retire. This means that County employees in this category are eligible to remit 100% of the premium for plans that they or their dependents are eligible for.

Dependent Eligibility − Spouse (opposite and same sex marriage

must be legally recognized)

− Widow/Widower (must have a pension sufficient to cover the plan premium)

− Dependent child who is: • The retiree or spouse’s child by birth or legal

adoption recognized under Maryland Law that is currently enrolled in Medicare.

Eligible dependents are required to have legal standing and/or legally sufficient documentation for residency in the United States while included on the County health plans.

Medicare Retiree Eligibility (Due to Age or Disability) Baltimore County requires that as soon as a retiree or spouse of a retiree is eligible for Medicare due to age or disability, that they accept Medicare as their primary health insurance. It is very important to obtain both Part A (Hospital) and Part B (Medical) of Medicare. Typically, Medicare becomes effective the first day of the month in which you reach age 65 or otherwise become eligible due to disability. For additional information regarding Medicare, please contact Social Security Administration. Once enrolled in Medicare, you or your spouse, will be eligible to enroll in a Medicare Advantage, Medicare Supplemental and/ or Part D Prescription plans offered through Labor First. Please notify Labor First at (410) 431-2226 as soon as you are enrolled in Medicare to discuss your Medical and Prescription plan options. Dental and Vision enrollments will still be administered by Baltimore County Government.

period of one year after the retiree’s death. After one year, coverage may continue at the full cost. A surviving spouse may not add dependents.

Medicare Retiree Eligibility (Due to Age or Disability) Baltimore County Public Schools requires that as soon as a retiree or spouse of a retiree is eligible for Medicare due to age or disability, that they accept Medicare as their primary health insurance. It is very important to obtain both Part A (Hospital) and Part B (Medical) of Medicare. Typically, Medicare becomes effective the first day of the month in which you reach age 65 or otherwise become eligible due to disability. For additional information regarding Medicare, please contact Social Security Administration. Once enrolled in Medicare, you or your spouse, will be eligible to enroll in a Medicare Advantage, Medicare Supplemental and/ or Part D Prescription plans offered through Labor First. Please notify Labor First at (443) 290-3114 (TTY 711) or Toll Free (833) 550-1676 (TTY 711) as soon as you are enrolled in Medicare to discuss your Medical and Prescription plan options. Dental, Vision and Life enrollments will still be administered by Baltimore County Public Schools.

What If My Spouse or I are Not Eligible for Medicare? You may not be eligible for Medicare if you did not work the number of quarters required by the Social Security Administration. If you do not qualify on your own, you may qualify for spousal coverage. You will need to contact your local Social Security office to determine whether you can enroll in Medicare. Those few retirees not eligible for Medicare, either on their own or

through a spouse, should contact the Benefits Office upon reaching their 65th birthday to discuss their options. What if I Become Eligible for Medicare, but My Spouse is Not Yet Eligible? You will be enrolled in a Medicare Advantage, Medicare Supplemental plan and/or Prescription plan and your spouse can continue in a non-Medicare plan until they are eligible for Medicare (same applies if spouse is eligible before retiree). You will pay a rate by enrollee for coverage in each of the plans. Changes During the Year It is your responsibility to notify Labor First for the changes below: • Address Change • Change in Medicare Eligibility Status• Marriage, Divorce or Legal Separation

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What If My Spouse or I are Not Eligible for Medicare? You may not be eligible for Medicare if you did not work the number of quarters required by the Social Security Administration. If you do not qualify on your own, you may qualify for spousal coverage. You will need to contact your local Social Security office to determine whether you can enroll in Medicare. Those few retirees not eligible for Medicare, either on their own or through a spouse, should contact the Insurance Division upon reaching their 65th birthday to discuss their options.

What if I Become Eligible for Medicare, but My Spouse is Not Yet Eligible? You will be enrolled in a Medicare Advantage, Medicare Supplemental plan and/or Prescription plan and your spouse can continue in a non-Medicare plan until they are eligible for Medicare (same applies if spouse is eligible before retiree). You will pay a rate by enrollee for coverage in each of the plans.

Changes During the Year It is your responsibility to notify Labor First for the changes below:

− Address Change − Change in Medicare Eligibility Status − Marriage, Divorce or Legal Separation

Changes During Open Enrollment Examples of changes you may need to make during Open Enrollment include:

− Selecting an insurance plan − Adding or removing a dependent if you did not

do so within the first 31 days of the qualifying event

− Change the medical, dental or other plans you currently have

About Labor First Labor First is a Retiree Benefits Administrator and Advocacy Company, that specializes in retiree healthcare. Labor First is not an insurance carrier. We fully understand that the challenges most retirees face in relation to health plans are unique to each individual which is why Medicare health benefit administration and advocacy is all that we do.

Our team employs a dedicated support strategy that is aimed at creating an atmosphere where retirees feel confident they are receiving the best service available. Our dedicated Member Advocates are here to not only assist members with enrollment, but to provide ongoing retiree support to Baltimore County Retirees throughout their enrollment in any of our plans.

“I feel lucky that I can afford my medication and have the LF Options.”

- BCFPE (Health) Retiree

“I feel lucky that I can afford my medication and have the LF Options.” - BCFPE (Health) Retiree

Changes During Open Enrollment Examples of changes you may need to make during Open Enrollment include:• Selecting a plan other than the auto-

enrollment plan indicated• Adding or removing a dependent if you

did not do so within the first 31 days of the qualifying event

• Change the medical, dental or other plans you currently have

About Labor FirstLabor First is a Retiree Benefits Administrator and Advocacy Company, that specializes in retiree healthcare. Labor First is not an insurance carrier. We fully understand that the challenges most retirees face in relation to health plans are unique to each individual which is why Medicare health benefit administration and advocacy is all that we do. Our team employs a dedicated support strategy that is aimed at creating an atmosphere where retirees feel confident they are receiving the best service available. Our dedicated Retiree Advocates are here to not only assist members with enrollment, but to provide ongoing retiree support to Baltimore County Retirees throughout their enrollment in any of our plans.

6

If you chose an alternative to the Cigna True Choice Medicare PPO – High Option (Plan 1A), please call Labor First to change your enrollment at: (443) 290-3114 (TTY 711) if you would like to make a change to your Medical

or Prescription benefits before November 14th.

LABOR FIRST PLAN SELECTION GUIDEPlease follow the guide below for the 2022 options:

OR

OR

OPTION 2

OPTION 3

Plan 1AOPTION 1 Stay in the new Cigna True Choice Medicare PPO that you are automatically

being enrolled into. The medical option can be viewed in the highlighted column on Pages 8-9. The prescription option can be viewed in the highlighted column on Page 10. To stay in this plan, you DO NOT need to do anything.

Choose your medical plan option. These plans can be viewed on pages 8-9. 1. Cigna True Choice Medicare PPO (Medicare Advantage)2. Cigna Surround Medicare Supplement 3. United American Medicare Supplement

AND / OR

Choose your Prescription plan option. These plans can be viewed on page 10.A. Cigna High RxB. Cigna Mid RxC. Cigna Low RxD. AARP SaverE. AARP Walgreens

Choose the Kaiser Medicare Advantage with Prescription Drug HMO plan. This plan design can be viewed on pages 11-12.

7

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8

The medical FAQ sections can be located on pages 14-15.

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9

The medical FAQ sections can be located on pages 14-15.

of 21

CHOOSE YOUR RX PLAN (PLANS A-E)

Cigna RX HIGH Plan A

(Auto Enrolled)

Cigna RX MID

Plan B

Cigna RX LOW

Plan C

AARP Saver

Plan D

AARP Walgreens

Plan E

Benefit Retiree Pays Retiree Pays Retiree Pays Retiree Pays Retiree Pays

Rx Deductible $0 $250 $250 $445 Tier 1-2: $0 Tier 3-5: $445

30 Day Retail

Pref Generics N/A N/A N/A $1 $0

Generics $6 $10 $6 $7 $6

Brand 20% 25% 25% $33 $40

Non-Preferred Brand 20% 30% 25% 40% 40%

Specialty 20% ($150 max) 20% ($150 max) $150 25% 25%

90 Day Retail / MO

Pref Generics N/A N/A N/A $3 $0

Generics $18 $25 $15 $21 $18

Brand $40 25% 25% $99 $120

Non-Preferred Brand $40 30% 25% 40% 40%

Specialty 20% ($375 max) 20% ($375 max) $375 N/A N/A

Features

Donut Hole Full Coverage Full Coverage Full Coverage CMS Minimum CMS Minimum

ED Drugs Included Included Included Not Included Not Included

$0 Preventive Drugs Included Included Not Included Not Included Not Included

Medical Compatibility Plan 1, 2, & 3 Plan 1, 2, & 3 Plan 1, 2, & 3 Plan 2 & 3 Plan 2 & 3

*Plan D & E shows the 2021 deductible and copay structure.The 2022 plan information will be released on Oct 15th. Please contact Labor First if you are interested in these particular plans.

10

CHOOSE YOUR RX PLAN (PLANS A-E)Option 2, continued

The prescription FAQ section can be located on page 16.

of 21

Kaiser Permanente Medicare Advantage Plan w/ Rx – HMO Option

Medicare Advantage – Kaiser

Benefit Retiree Pays Deductible $0 Annual Out-of-Pocket Max $3,400 Lifetime Coverage Max Unlimited Other Professional/Outpatient Services Office Visit $15 Advanced Imagine (CT,MRI,PET) $0 Laboratory Test & X-Rays $0 Physical/Speech/Occupational Therapy $15 Radiation Therapy/Chemotherapy/Renal Dialysis $15 Outpatient Surgery $15 Allergy Testing/Covered Injections $15 Acupuncture $15 Preventive/Well Care (Routine) Adult Physical, Immunizations, and Diagnostic Tests $0 GYN (PAP) Services $0 Prostate Screening (PSA Test) after age 50 $0 Mammogram Screening after age 40 $0 Emergency Care Urgent Care $50 Accidental Injury/First Aid/Medical Emergency/Life Threating Emergency $50

Ambulance (Ground) $0 Prosthetic Devices and Orthopedic Braces Purchase, Repair or Replacement $0 Durable Medical Equipment $0 Medical Supplies $0 Hearing Aids $0 (Per 36 months)

OPTION 3

Page 11 of 18


Medicare Advantage – Kaiser Plan

Benefit Retiree Pays Deductible $0 Lifetime Coverage Max Unlimited Inpatient Hospital / Facility Services $100 per benefit period Emergency Care $50 Office Visit $0 Outpatient Hospital Facility Services $15 Outpatient / Inpatient Services $0 - $100 Skilled Nursing $0: Days 1-100 Annual Out-of-Pocket Max $3,400

Ancillary Benefits Coverage

Hearing Benefits $0 copay fitting. $0 copay hearing aids (any type). $1000 max per ear per device every 3 years

Vision Benefits $100 allowance per calendar year (Kaiser facilities) Fitness Benefit Included Post Hospital Meal Delivery Not available Clinical Care Program Included

Prescription Drug Benefits Deductible $0 Mail Order from Kaiser Permanente Mail Order Pharmacy

$10 Generic or Brand Up to 90 days supply

Kaiser Permanente Medical Center Pharmacy


Affiliated Network Pharmacy Giant, Rite Aid, Safeway, Target & Walmart


OPTION 3

www.laborfirst.com 11

Option 3

The Kaiser FAQ section can be located on page 17.

12

of 21

Home Health Care Facility $0 Inpatient Hospital/Facility Services Room & Board (Includes ICU/CCU/Other Special Care Units and Ancillary Services) $100

Extended Care Facility/Skilled Nursing Care Days 1-100 $0 Inpatient Professional/Practitioner Services Physical Surgical Services $0 Anesthesia, Assistant Surgeon $0 Consultation & Physician Visits $0 Radiation Therapy/Chemotherapy/Renal Dialysis $0 Mental Health Inpatient Hospital/Facility and Profession Services $100 (per benefit period) Outpatient Facility and Professional Services $15 Other Services Outpatient Private Duty Nursing Special Limitations Apply Cardiac Rehabilitation $15 Hospice Care $0

Routine Dental $30 for Preventative Care

Routine Vision $15 Routine Eye Exam

Prescription

Kaiser Permanente Medical Center

Community Retail Pharmacy Mail Order

Generic (Tier 1) $15 $25 $10 Preferred Brand (Tier 2) $15 $25 $10

Non-Preferred Brand (Tier 3) $15 $25 $10

Page 12 of 21

Home Health Care Facility $0 Inpatient Hospital/Facility Services Room & Board (Includes ICU/CCU/Other Special Care Units and Ancillary Services) $100

Extended Care Facility/Skilled Nursing Care Days 1-100 $0 Inpatient Professional/Practitioner Services Physical Surgical Services $0 Anesthesia, Assistant Surgeon $0 Consultation & Physician Visits $0 Radiation Therapy/Chemotherapy/Renal Dialysis $0 Mental Health Inpatient Hospital/Facility and Profession Services $100 (per benefit period) Outpatient Facility and Professional Services $15 Other Services Outpatient Private Duty Nursing Special Limitations Apply Cardiac Rehabilitation $15 Hospice Care $0

Routine Dental $30 for Preventative Care

Routine Vision $15 Routine Eye Exam

Prescription

Kaiser Permanente Medical Center

Community Retail Pharmacy Mail Order

Generic (Tier 1) $15 $25 $10 Preferred Brand (Tier 2) $15 $25 $10

Non-Preferred Brand (Tier 3) $15 $25 $10

Page 11 of 18


Medicare Advantage – Kaiser Plan

Benefit Retiree Pays Deductible $0 Lifetime Coverage Max Unlimited Inpatient Hospital / Facility Services $100 per benefit period Emergency Care $50 Office Visit $0 Outpatient Hospital Facility Services $15 Outpatient / Inpatient Services $0 - $100 Skilled Nursing $0: Days 1-100 Annual Out-of-Pocket Max $3,400

Ancillary Benefits Coverage

Hearing Benefits $0 copay fitting. $0 copay hearing aids (any type). $1000 max per ear per device every 3 years

Vision Benefits $100 allowance per calendar year (Kaiser facilities) Fitness Benefit Included Post Hospital Meal Delivery Not available Clinical Care Program Included

Prescription Drug Benefits Deductible $0 Mail Order from Kaiser Permanente Mail Order Pharmacy


Kaiser Permanente Medical Center Pharmacy


Affiliated Network Pharmacy Giant, Rite Aid, Safeway, Target & Walmart


OPTION 3 Option 3, continued

The Kaiser FAQ section can be located on page 17.

General Questions

1. Who is Labor First? Labor First is a Retiree Benefits Administrator and Advocacy Company that specializes in retiree healthcare. Our dedicated Retiree Advocates are here to not only assist members with enrollment, but to provide ongoing retiree support to Baltimore County Public School Retirees throughout their enrollment and coverage in any of our plans.

2. When will I receive my card/ Welcome Kit? Cards and Welcome Kits should be received mid-late December. Members and covered Spouses/Medicare Eligible Dependents will each receive separate welcome kits and ID cards. UA Medicare supplement packets, AARP® MedicareRx packets and Cigna Rx packets are mailed separately and at different times.

3. What will be my premium charge? Please see the included rate sheets for your premium amount and subsidy level.

4. What prescription option should I choose if I plan to enroll into either the Cigna Medicare Supplement Plan or the UA Medicare Supplement Plan? You can choose from any of the five (5) prescription plans.

5. If I choose to remain in the Cigna True Choice Medicare PPO plan, can my spouse choose a different option, and vice versa? No, both you and your spouse must take the same plan.

6. If I am happy with the plan I will be automatically enrolled into, do I have to do anything to enroll? No, if you are happy with being enrolled into the Cigna True Choice Medicare PPO – High Option, you do not have to do anything. You will automatically be enrolled.

7. If I chose to enroll into another plan, do I have to do anything? If you chose to enroll into another option offered please call Labor First at (443) 290-3114 (TTY 711) or (833) 550-1676 (TTY 711). Some plans require an application. This can be mailed, emailed, or faxed to you.

8. How much will this plan cost me? Please reference the enclosed rate sheet for your 2022 plan cost.

9. What do I do if I lose my ID Card? Please call Labor First at (443) 290-3114 (TTY 711) or (833) 550-1676 (TTY 711) and we will obtain a new one on your behalf, mail you a temporary card, and call your pharmacy and/or providers if needed.

10. When can I call Labor First? Labor First is open Monday – Friday 9:00 AM – 5:00 PM EST beginning now and continuing through your enrollment into the plan.

11. What items can Labor First assist me with? Labor First can assist with a variety of things from medical and prescription billing questions, assisting with enrollment, eligibility verification from providers, medical and prescription prior authorizations, medication look up, provider and RX network questions, Medicare / SSA assistance and much more.

FREQUENTLY ASKED QUESTIONS:

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12. How do I know what plan is best for me? Based on the information provided by Cigna and the County, members were automatically enrolled into the most cost-effective plan that best aligns their current plan. However, we understand that everyone’s medical needs may differ. The factors that the Retiree Advocates will take into consideration are; your financial status, existing health, how often you visit your providers and your current list of medications to help you make an unbiased decision.

13. What should I be prepared with when I call Labor First? We recommend you have a list of your medications, dosage, frequency, list of your providers, retirement date and years of service.

14. Can I enroll in a medical plan with Labor First but not a prescription drug plan or vice versa? No, all retirees must enroll in both Medical and Prescription.

15. What is the difference between Medicare Advantage and Medicare Supplemental coverage? For both Medicare Supplemental and Medicare Advantage you are required to be enrolled in both Medicare Part A and Medicare Part B and continue paying your Part B premium. A Medicare Supplemental plan supplements Original Medicare. Original Medicare pays 80% of cost as primary coverage and the Medicare Supplemental plan pays for the balance minus the copay or coinsurance as secondary coverage. Medicare Supplemental coverage cannot contain Rx coverage and does not cover additional benefits such as: vision, fitness, meal delivery services after inpatient hospital care, 24/7 nurse line, at

home wellness visits and more. In comparison, Medicare Advantage plans take the place of Original Medicare as the primary and only payer aside from any copay or coinsurance left over. These plans can include Rx coverage, and additional riders for vision, fitness, meal delivery services after inpatient hospital care, 24/7 nurse line, at home wellness visits and more. The MAPD plans offered in this guide are not like the MAPD plan you have heard about on TV. The Cigna True Choice Medicare PPO plan does not require referrals and you can continue to see any provider that accepts Medicare and is willing to bill Cigna; however, the Kaiser remains a more traditional HMO set up in that it does require referrals and uses a network of providers.

Cigna True Choice Medicare PPO Plan Questions (Plan 1)1. Does this plan require referrals?

No, this plan does not require referrals.

2. Does this plan require pre-certifications? Some services may require pre-certification.

3. Does this plan have a network? Yes, but you can go to any provider, hospital, or facility that accepts Medicare and is willing to bill Cigna. This plans in and out of network benefits are the same.

4. Can I go to my current providers? Yes, you can see any provider that accepts Medicare and is willing to bill Cigna.

5. Do I still use my Medicare Card? No. Put your Medicare card in a safe place in case you need it at a later date. You will use only your newly combined Cigna ID Card for medical and prescription.

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6. What if my Provider says they do not accept this plan? If your provider accepts Medicare, they will be paid the same by the plan whether they are considered in or out of network. Please call Labor First at (443) 290-3114 (TTY 711) or (833) 550-1676 (TTY 711) to assist. We can reach out to your provider to explain.

7. Are my medications covered? Most likely yes, the formulary is a comprehensive formulary just as before. You will receive an abridged formulary with your Welcome Kit and cards. Please call Labor First at (443) 290-3114 (TTY 711) or (833) 550-1676 (TTY 711) if you need you do not see your drug listed or need help looking up your drugs.

8. Can I go to the same Retail Pharmacy? Most likely, yes. There should be little to no pharmacy disruption. Cigna has over 65,000 pharmacies in network. You do NOT need new prescriptions for retail pharmacy refills.

9. Is there a Home Delivery Pharmacy? Yes, Cigna offers a home delivery pharmacy through Express Scripts.

10. Is there a discount at the Home Delivery Pharmacy? Yes, for generic medications there is a 90-day discount. This discount is also available at the retail pharmacy.

11. Will my prescriptions transfer from the old plan? If you use the retail pharmacy or Express Scripts Home Delivery Pharmacy and have refills remaining, you do NOT need to obtain new prescriptions.

12. Can I still go to the VA for my medications? Yes. If you obtain some medications from the VA, you may continue to do so.

13. Do I need Prior Authorizations for certain prescription medicines? Some drugs may require a PA. Please contact Labor First at (443) 290-3114 (TTY 711) or (833) 550-1676 (TTY 711) if you have questions or need assistance with prior authorizations as well as any other requirements such as step therapy, quantity limit, or formulary exceptions.

Medicare Supplement Plan Questions for Cigna Surround and United American (UA) (Plans 2 & 3)1. Do these plans require referrals?

No, neither Cigna Surround nor UA require referrals.

2. Do these plans require pre-certifications? No, neither Cigna Surround nor UA require pre-certifications.

3. Do these plans have a network? No, both of these plans allow you to go to any provider, hospital, or facility that accepts Medicare.

4. Can I go to my current providers? Yes, both Cigna Surround and UA allow you to see any provider that accepts Medicare.

5. Do I still need my Medicare Card? Yes, Medicare will continue to be your primary insurance. You will need to show your provider your Medicare card and either your Cigna Surround or your UA ID card at the hospital and doctor’s visits. The claim will automatically be processed by Medicare and then Cigna or UA. You will receive an Explanation of Benefits (EOB) from both.

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Prescription Drug Plan Questions for Cigna and AARP (Plans A, B, C, D, & E)1. Are my drugs covered?

If you are interested in enrolling into one of the Cigna Rx plans, your medications are most likely covered. If you are interested in one of the AARP plans offered, the formularies are more limited. It’s possible a medication that you are taking is not covered but an alternative may be available. Please have your current list of medications available and contact one of our Retiree Advocates. We can review your information and provide prescription plan options that best meet your needs and budget.

2. Can I go to the same Pharmacy? If you are interested in enrolling into one of the Cigna Rx plans, you can most likely visit any pharmacy and there should be little to no pharmacy disruption. If you plan to enroll into one of the AARP plan options, we recommend visiting a preferred pharmacy as there are higher copays for out of network pharmacies. You do NOT need new prescriptions for retail pharmacy fills. However, you will see the most cost savings using the preferred retail pharmacies for the prescription plan that you choose.

3. Is there a Mail Order Pharmacy? Yes, but you will need new prescriptions if you prefer to use the mail order service. Cigna uses Express Scripts for their home delivery services and AARP uses Optum Rx for their mail order.

4. Can I still go to the VA for my drugs? Yes. If you obtain some drugs from the VA, you may continue to do so.

5. Does this plan have donut hole coverage? The Cigna High, Medium and Low plans all have donut hole coverage. This means you will continue to pay your same cost share throughout the donut hole. The AARP plans do NOT have donut hole coverage. This means during this phase you will be responsible for 25% of the cost for brand name drugs and 37% for generic drugs.

6. Do I need prior authorizations for certain prescription medicines? Some drugs may require a PA. Please contact Labor First at (443) 290-3114 (TTY 711) or (833) 550-1676 (TTY 711) if you have questions or need assistance with prior authorizations as well as any other requirements such as step therapy, quanity limit, or formulary exceptions.

7. What Medications classes fall under the $0 preventive drugs? Diabetic medications and supplies, Asthma, Blood Pressure, Blood Thinners, Cholesterol, and Osteoporosis are the classes covered under the $0 preventive drug listing. Not all medications under these classes are covered at $0. Please contact Labor First to determine if your medications fall under this list. Medications on this list are NOT subject to the $250 deductible on the Cigna Mid Rx plan.

8. What are the important differences between the Cigna Rx plans and the AARP Rx plans? The Cigna High and Cigna Medium plans have the most comprehensive drug list, also known as the formulary, and the three Cigna plans have full donut hole coverage. The AARP plans are generally recommended to retirees with little to no medications as the formulary is very limited, there is a limited pharmacy network, and CMS standard coverage for the donut hole.

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Kaiser Medicare Advantage with Prescription Drug Plan Questions (Option 3)1. Does this plan require referrals?

Yes, some services require referrals from your primary care provider for specialist visits and hospital-based care. Other services like primary care, OB/GYN, behavioral health, or out-of-area dialysis do not require a referral. If you have specific questions about what requires a referral, you may call Member Services at (888) 777-5536.

2. Does this plan require pre-certifications? Some services may require pre-certification.

3. Does this plan have a network? Yes, you must use a doctor, hospital or facility within the Kaiser Permanente Medicare Advantage network. The network contains over 4,000 physicians and specialty providers and can be found at www.kp.org under “Doctors and Locations” or www.kp.org/directory

4. Can I go to my current providers? You can see any provider that accepts Medicare and is within the Kaiser Permanente Medicare Advantage network. You can find the details at kp.org/directory.

5. Do I still use my Medicare Card? No. Put your Medicare card in a safe place in case you need it at a later date. You will use only your Kaiser ID Card for Medical and Drug.

6. What if my Provider says they do not accept this plan? If your provider accepts Medicare and is in the Kaiser network, you should be able to be seen there. Please call Kaiser Permanente Member Services to assist at (888) 777-5536.

7. Are my drugs covered? Most likely yes, the formulary is a comprehensive formulary just as before. Please call Kaiser at (888) 777-5536 if you need assistance looking up your drugs or visit www.kp.org/seniorrx.

8. Can I go to the same Network Pharmacy? Most likely, yes if your pharmacy is within the Kaiser Permanente network. The pharmacy directory can be accessed at www.kp.org/directory. It provides a list of our plan’s network pharmacies. We call the pharmacies on this list our “network pharmacies” because we have contracted with them to provide prescription drugs to plan members. You may also visit any Kaiser Permanente Pharmacy. You do NOT need new prescriptions for retail pharmacy refills.

9. Is there a Home Delivery Pharmacy? Yes, Kaiser Permanente offers home delivery or mail order prescriptions. Mail order prescriptions can be mailed to you at no additional cost. Just call 1-800-700-1479 (TTY 711) to get most prescription refills mailed to you. Or register for an account at www.kp.org. Then place your order online and choose the mail option. You may pay lesser cost shares by using the Kaiser Permanente Mail Order Pharmacy and should receive them within 3-5 days. Please consult your Evidence of Coverage for more details.

10. Is there a discount at the Home Delivery Pharmacy? Yes, there is a 90-day discount at the Kaiser Home Delivery Pharmacy.

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11. Will my prescriptions transfer from the old plan? If you use the retail pharmacy or Kaiser Home Delivery Pharmacy and have refills remaining, you do NOT need to obtain new scripts. To transfer your prescription to a Kaiser Permanente pharmacy, visit www.kp.org/newmember and click “transition prescriptions” or call 1-800-700-1479 (TTY 711). You will need to provide your Kaiser Permanente medical record number, the name and telephone number of your current pharmacy, the name, strength, and directions for use of the prescribed medication, the prescription number of the prescribed medication, the name and phone number of the physician who prescribed the medication.

12. Can I still go to the VA for my drugs? Yes. If you obtain some drugs from the VA, you may continue to do so.

13. Do I need Prior Authorizations for certain prescription medicines? Some drugs may require a prior authorization. Please contact Kaiser at (888) 777-5536 if you have questions or need assistance with Prior Authorizations as well as any other requirements such as Step Therapy, Quantity Limit, or Formulary Exceptions.

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BCPS Ancillary Retiree Benefits

These Benefits are administered by BCPS and not Labor First

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Dental Insurance Options

Plan Name CareFirst Regional Dental PPO CareFirst Regional Dental

Traditional

Cigna Dental Care Access

DHMO

Group Number 7J91 7J91 10013509

Network Nationwide Nationwide Nationwide

Plan Features In-Network Out-of-Network In-Network Out-of-Network In-Network

Only

Calendar Year Deductible

Individual: $10 Family: $20



None

Maximum Benefit Per Calendar Year

$1,000 Per Person $750 Per Person Unlimited

Member Pays Member Pays Member Pays Member Pays Member Pays

Preventive & Diagnostic Services

No Charge 20%** No Charge No Charge** No Charge

Basic Services 20% (AD) 40% (AD)** 20% (AD) 20% (AD)** $0—$220 Copay

Major Services Surgical 20% (AD) 40% (AD)** 20% (AD) 20% (AD)** $15—$335 Copay

Major Services Restorative

20% (AD) 40% (AD)** 20% (AD) 20% (AD)** $15—$335 Copay

Dentures & Bridges 50% (AD) 70% (AD)** 50% (AD) 50% (AD)** $15—$335 Copay

Orthodontia Lifetime Maximum Benefit

$1,500 Per Person $1,000*** Per Person 24 Months $1,000 Per Person

Orthodontia 50%* 50%* 50%* 50%* See Fee Schedule

This chart is intended for comparison purposes only. If there are any discrepancies, the summary plan document will govern (AD) After Deductible *Orthodontia is only available to dependent children up to age 19 if you select one of the CareFirst plans. **CareFirst payments for Out-of-Network services are based on the Allowable Benefit. Non-participating providers may balance bill for the difference ***See full fee-schedule for exact costs

Prevention First! Make sure you take advantage of your preventive dental visits. Preventive care services are not subject to any deductible and all three plans cover 100% of the cost when you visit an in-network provider.

Need to Locate a Participating Provider? CareFirst Visit www.Carefirst.com. Click on “Find a Doctor” and then “Continue as guest”. Select “Dental” and then either “Preferred Dental PPO” or “Traditional Dental”.

• Providers in the Traditional Dental network who do not also participate in the Preferred Dental PPO network, will accept the insurance for members enrolled in the Regional Dental PPO and the coerage will be paid at the out-of-network level. The Traditional provider however, may not balance bill.

Cigna Visit www.Cigna.com/dental. Click on “Find a Dentist” and then “For plans offered through work or school”. Enter your zip code and select “Cigna Dental Care HMO”.

This insurance is not administered by Labor First.

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Vision Insurance

This chart is intended for comparison purposes only. If there are any discrepancies, the summary plan document will govern *Preapproval required **You are responsible for all charges and services received out-of-network and must file a claim for reimbursement within 12 months of the date of service

Plan Features CareFirst Davis Vision

In-Network Out-of-Network**

Eye Exams (Once Every 12 Months) $20 Copay Covered up to $35

Spectacle Lenses (Once Every 24 Months)

Single Vision $20 Copay Covered up to $25

Lined Bifocal $20 Copay Covered up to $40

Lined Trifocal $20 Copay Covered up to $55

Lenticular $20 Copay Covered up to $80

Frames (Once Every 24 Months)

Tower Collection No Charge Covered up to $35

Non-Tower Frames Covered up to $130 Covered up to $35

Contact Lenses (Once Every 24 Months)

Elective (in Lieu of Lenses and Frames) Covered up to $130 Covered up to $130

Medically Necessary* $20 Copay Covered up to $210

Lens Options (add to spectacle lens prices)

Transition Lenses $65 Copay

Photochromic Lenses $30 Copay

Scratch-Resistant Coating $25 Copay

Anti-Reflective Coating (AR) $35 Copay

Ultraviolet Coating $12 Copay

Premium Progressive Lenses $90 Copay

Example Cost for Glasses (Lenses & Frames) with Davis Vision Provider • Tower collection frames with bifocal lenses, including

scratch-resistant coating = $40

• Non-tower frames (retail $185) with single vision premium progressive lenses = $165

• Non-tower frames (retail $230) with single vision transi-tion lenses = $185

Additional Information • Benefits are based on your last date of service. For exam-

ple, if you have your eye exam and purchase glasses on March 1, 2020, you will not be eligible for another eye exam until March 2, 2021 even though the plan year re-news January 1, 2021. you would not be eligible for glasses until March 2, 2022

Discounted Rates on Special Services Need to Locate a Participating Provider? Changes in your Prescription?

In addition to your standard eye glass coverage, you will also have access to various discounts including up to 35% off the usual and customary charge for Laser Vision correction when using a Davis Vi-sion Laser provider

The Davis Vision network now includes many national and retail stores including Wal-Mart, Target Optical, Sears Optical, Pearle Vision, and Doctor’s Visionworks.

Remember, if you choose an eye care profes-sional that is not part of the Davis Vision net-work, you will be expected to pay the entire cost for services up front. You may then seek reimbursement up to the allowed amounts by filing a claim form with CareFirst Davis Vision

If your lens prescription changes before you are eligible for new lenses and that prescription meets one of the following criteria, lenses and frames will be re-placed as a 12 month frequency:

• Differs from the original by at least 0.50 diopter sphere

• Axis changes by 15 degrees or more

• Change in prism diopter 0.5 in at least one eye


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Life Insurance



Enrollment A personalized life insurance election form will be provided to you by the Office of Benefits, Leaves, and Retirement. Continuation is optional. If you do no elect to continue this benefit at the time of retirement, you will forefeet your eligibility indefinitely. The election form must be completed and returned within thirty days of the effect date of your retirement.

Benefit Amount & Reduction Schedule Retirees may not elect to continue more than $50,000 in coverage. This includes $15,000 of Basic Term Life Insurance and up to $35,000 in Sup-plemental Life Insurance.

Reduction Schedule Supplemental Life Insurance coverage immediately reduces by 10% on the date of retirement. Therefore, the maximum amount of total Life Insurance on the date of retirement is $46,500. Following retirement, the Supplemental Life Insurance will be reduced by the same dollar amount on each of the following four anniversaries of your retirement date. The cost of Life Insurance is paid entirely by the retiree. Premiums are deducted from your pension check. Coverage terminated for non-payment of premium cannot be reinstated. See example below:

Date

Supplemental Coverage

Basic Coverage Total Coverage

Active June 1, 2021 $65,000 $15,000 $80,000

Retired July 1, 2021 $31,500 $15,000 $46,500*

1st Year July 1, 2022 $28,000 $15,000 $43,000

2nd Year July 1, 2023 $24,500 $15,000 $39,500

3rd Year July 1, 2024 $21,000 $15,000 $36,000

4th Year July 1, 2025 $17,500 $15,000 $32,500

Cost of Coverage Employees who retire at age 65 who elect to continue the Basic Term Life and the maximum amount of Supplemental Life Insurance will pay $58.61 per month for $46,5000 in total benefit.

Monthly Cost for Basic Term Life Insurance

Retired Prior to 1/1/2005 $9.15 (for $7,380 of coverage)

Retired After 1/1/2005 $18.60 (for $15,000 of coverage)

Monthly Rate per $1,000 of Supplemental Life Insurance

Age 50-54 55-59 60-64 65-69* 70+

Rate .23 .43 .66 1.27 2.06

Ages 25-49 contact the Office of Benefits, Leaves, and Retirement for rates

Don’t Forget to Designate a Beneficiary! Choosing who will receive your Life Insurance benefit is an important decision. Please make sure your beneficiary is up to date.

Cancelling Life Insurance Retirees may cancel their Basic Term Life and/or Supplemental Life Insurance Coverage at any time. Coverage which has been cancelled cannot be reinstated.


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18

Cancer, Catastrophic, and Other Insurances



• Axis changes by 15 degrees or more

• Change in prism diopter 0.5 in at least one eye

Cancer Insurance Retirees who were enrolled in cancer insurance at the time of retirement could elect to continue to pay the premoums to keep the coverage. Pre-miums are deducted from pension checks in combination with the cost of health insurance. Thus, a retiree with cancer insurance will see a deduc-tion from the pension check that combines the cost of both programs. Retirees wishing to cancel this insurance must notify the Office of Benefits, Leaves, and Retirement for BCPS in writing. Coverage that is canceled cannot be reinstated. This policy is through Washington National Insurance Co. (Conseco) (877) 372-5916.

Catastrophic Insurance The insurance coverage has been billed by CareFirst BlueCross BlueShield for many years. Any billing or coverage questions should be addressed to CareFirst directly (410) 581-3404.

Accidental Death & Dismemberment (AD&D) Insurance Retirees who were enrolled in AD&D at the time of retirement are able to continue the policy by contacting Prudential at (800) 778-3827 and con-verting the policy into an individual policy. Preiums will be paid directly to Prudential. Conversion must happen within thirty days immediately following retirement.

Plans Available Through MRSPA Retiree dental, vision, and long-term care insurance plans are available to purchase through the Maryland Retired School Personnel Association. Contact the MRSPA directly at (410) 551-1517 or online at www.mrspa.org for more details about eligibility guidelines and costs for these plans.


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IMPORTANT CONTACTS

CONTACT: REGARDING:

Labor First, LLC 1000 Midlantic Drive, Suite 100 Mount Laurel, NJ 08054 Phone: (443) 290-3114 (TTY 711) or (833) 550-1676 (TTY 711) Email: [email protected] Internet: www.laborfirst.com

Medical and Prescription billing questionsAssist with enrollmentEligibility verification from providersMedical and Prescription prior authorizationsDrug and copay look upProvider and pharmacy network questionsMedicare/SSA assistance and many more.

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Who is eligible for County health plan coverage?Life status changes–i.e. marriage, divorce, birth, adoption, death of dependents, loss of dependent statusChanges to life insurance beneficiariesAssistance with benefits elections when retiringDental and Vision Enrollments

Social Security Administration (SSA) Phone: 800-772-1213

Change of addressGeneral Medicare Part A or B eligibility or premiums

Medicare Help Line Phone: 1-800-MEDICARE (633-4227)

www.medicare.gov

Baltimore County Public Schools- Office of Benefits and Retirement

Address: 6901 N. Charles Street, Towson, MD 21204

Phone: 443-809-8949

Fax: 410-887-8950

Email: [email protected]

Internet: hr.bcps.org/departments/human_resources_operations/benefits__leaves__and_retirement/benefits/retiree_benefits

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Questions about your pension benefitsQuestions about who you designated as your retirement beneficiary Requests for retirement conferencesChanges to your address or other retirement information on fileLife status changes - i.e. marriage, divorce, or death of spouse/dependent or other retirement beneficiary

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Request new ID cardOrdering Medicare publicationsGeneral Medicare information

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