City of Baltimore
City of Baltimore
2017 Retiree Benefits Booklet
Rajesh Gulhar, Chief, Employee Benefits Division
Mary H. Talley, Director & Chief Human Capital Officer
Note: This Comparison Is To Be Used As A Guide Only. Actual Benefits Will Be Governed by The Terms and Conditions of the Master Contract.
Revised 9/12/2016
Page 1
Table of Contents
Section
Section 1
Section 2 Section 3
Section 4 Section 5 Section 6
Contents
Cover Page Table of Contents Important Information Contacts Information About Your 2017 Benefits Alex Family Status Change Two Step Process Dependent Eligibility /Required Documentation
Medicare Information Medicare Sunset Letter Important Information About Medicare 2017 Retiree Premium Contributions 50% Retiree Contribution (15 or More Years of Service) 80% Retiree Contribution (10-14 Years of Service) 100% Retiree Contribution (5-9 Years of Service) Rx Premium Rx Premium Key Retiree without Medicare Benefits Retiree with Medicare Benefits Rx, Vision & Life Benefits Rx Copays Vision Benefits Basic Life Benefits Basic Life Beneficiary form Back Cover
Page
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 21 27 31 32 33 34 35 36
Revised 9/12/2016
Page 2
Section 1
Important Information
Revised 9/12/2016
Page 3
Retiree Contacts
Phone Numbers & Websites
Phone
Provider
Number
Insurance Companies
CareFirst PPN
1-800-535-2292
CareFirst Medicare Supplemental Beacon Health Options
Mental Health/Substance Abuse (CareFirst Non-Medicare Benefits Only)
Kaiser Permanente HMO
1-800-535-2292
1-866-468-5633 1-866-248-0715
Express Scripts Prescription Plan (Non-Medicare) Express Scripts Prescription Plan (Medicare) CareFirst Select Vision
1-800-354-8123 1-877-577-0459 1-800-535-2292
Securian Life (Life and AD&D)
1-888-658-0193
Retirement Agencies
Baltimore City Retirement System
1-877-273-7136
Fire & Police Retirement Maryland State Retirement (Pension Information)
1-888-410-1600 1-800-492-5909
Employee Benefits Division
Baltimore City Medicare Rx Plan (Medicare Part D)
410-396-1780
Employee Benefits Division (TTY)
TTY 711 (Maryland)
Website
baltimore express- express-
BaltimoreCity
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baltimorecity. baltimorecity.
Revised 9/12/2016
Page 4
Information About Your Benefits for 2017
Please read the information provided in this benefit book.
CareFirst Medicare Supplemental Plan
No coverage for Erectile Dysfunction Medication Dental Coverage
Effective January 1, 2017, the City's CareFirst Medicare Supplemental plan will no longer pay 100 % after Medicare. The City will reduce the Medicare eligible retiree's supplemental plan reimbursements paid by the plan from 100% to 80% of the Medicare allowed charges. The retiree must pay the remaining balance. Reminder: The City of Baltimore no longer covers erectile dysfunction medication for City of Baltimore Retirees and their dependents. This change was effective January 1, 2016.
Dental Benefits for all enrolled retirees is provided through their health plan. Reminder: Retirees enrolled in the CareFirst Medicare Supplemental Plan do not receive dental benefits.
Jelly Vision - Meet Alex
Dependent Eligibility
Summary Benefits and Coverage (SBC)
Prescription Coverage
The City of Baltimore will provide Jelly Vision to active employees and retirees without Medicare during Open Enrollment as well as Ongoing Enrollment starting October 21, 2016. Employees and retirees without Medicare will have an opportunity to interact online with Alex the virtual interactive benefits counselor. You can find Alex on the City's Health Benefits Enrollment System under the Main Menu. Alex will help you make smarter healthcare decisions that may save you time and money by answering a series of health related questions.
Administrative Information Dependent children are eligible for benefits until the end of the calendar year they reach age 26, regardless of student status.
The Patient Protection and Affordable Care Act (PPACA) require health plans and health insurance issuers to provide a Summary of Benefits and Coverage (SBC) to applicants and enrollees. The SBC is a concise document providing simple and consistent informat ion about health plan benefits and coverage. Its purpose is to help health plan consumers better understand the coverage they have and to help them make easy comparisons of different options when shopping for new coverage. The City of Baltimore will post this document on its enrollment website: baltimorecity. under its own drop down menu labeled Summary of Benefits and Coverage.
You and your dependents must be enrolled in a City of Baltimore medical plan in order to enroll in a prescription drug plan.
Duplicate Coverage Information
Medicare Secondary Payer (MSP)
Mandatory Reporting
If you and your spouse are City employees/retirees, you cannot enroll each other or the same eligible dependents on your City medical, dental, vision and prescription plans during any coverage period. You will be notified to adjust duplicate coverage, if applicable.
Under the Medicare Secondary Payer (MSP) Mandatory Reporting, federal law requires the mandatory collection and reporting of social security numbers for all covered participants including employees, retirees and their dependents through employer group health benefits. Noncompliance may result in the loss of coverage for participants with invalid or missing social security numbers.
Change of Address
You must notify your retirement agency, in writing, about your change of address the Employee Benefits Division cannot change your address.
Enrollment Website & Logon Information
baltimorecity. To log on to the website, you will need your social security number and your four -digit PIN number, which is provided on your worksheet.
New membership ID cards will only be issued for new enrollments and coverage level New Membership ID Cards changes.
Revised 9/12/2016
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Revised 9/12/2016
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