2 0 2 1 - Welcome to Human Resources | Human …

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CITY OF

BALTIMORE

DEPARTMENT OF

HUMAN RESOURCES

TABLE OF CONTENTS

SECTION TOPIC

Section 1 New and Important Information

Retiree Contacts Phone Numbers & Websites

Information About Your Benefits for 2021

Administrative Information

Enrollment Process

Section 2

Qualifying Life Events and Status Changes

Documentation for Newly Added Dependents & Family Status Changes

Medicare Information

Important Medicare Information

Notice of Creditable Coverage

Medicare Beneficiary Identifier (MBI/HIC)

Section 3 Retiree Contribution Schedule

Graduated Retiree Contribution Schedule

Graduated Retiree Contribution Schedule FAQs

2021 Retiree Medical Plan Rate Chart Monthly Deduction Retiree Contribution for Retirees 15+ Years 2021 Retiree Medical Plan Rate Chart Monthly Deduction Retiree Contribution for Retirees 10-14 Years 2021 Retiree Medical Plan Rate Chart Monthly Deduction Retiree Contribution for Retirees 5-9 Years

Retiree Prescription Drug Coverage Premium

Section 4 Medical Plan Comparison Chart (Non-Medicare)

Comparing Medical Plan Benefits

Retiree Benefit Plan Without Medicare

Dependent Benefit Plan Without Medicare of a Retiree With Medicare

PAGE 1 2 3 4 5 7 9 10 11 15 18 19 20 21 22 23 24 25 26 27 27 33

Table of Contents I

TABLE OF CONTENTS (continued)

Section 5 Medical Plan Comparison Chart (Medicare)

36

Comparing Medical Plans

37

Retiree Benefit Plans With Medicare

37

Section 6 Rx, Dental, Vision & Life Insurance

40

Rx Copays CareFirst: High Option

41

Rx Copays CareFirst: Standard Option

42

Rx Copays Aetna & Kaiser: MAPD

43

National Vision Administrators (NVA)

44

United Concordia: Dental HMO

45

United Concordia: Dental PPO

47

Retiree Life Insurance Information

48

Table of Contents II

SECTION 1 NEW AND IMPORTANT INFORMATION

Page 1

RETIREE CONTACTS PHONE NUMBERS & WEBSITES

Insurance Companies

Provider

Phone Number Website

BlueChoice Advantage (PPO) (Non-Medicare Retirees)

(800) 535-2292

Aetna Medicare Advantage Plan (PPO) with Extended Service Area (ESA) Including Prescription Drug Benefits

(855) 335-1407 TTY 711



Aetna Open Choice (PPO)

(Non-Medicare Beneficiary &

(877) 440-4711

Dependents)

Kaiser Permanente (HMO)

(Non-Medicare Retirees)

(866) 248-0715

Kaiser MAPD (Medicare Retirees)

CareFirst Caremark/CVS (Non-Medicare Retirees)

(800) 241-3371

National Vision Administrators (NVA) (800) 672-7723 e-

MetLife

(866) 492-6983 mybenefits

United Concordia Dental

(866) 851-7568

baltimore

Retirement Agencies

Provider

Phone Number Website

Baltimore City Employee Retirement System (ERS)

(877) 273-7136

Fire & Police Retirement System (F&P) Maryland State Retirement System

(888) 410-1600 (800) 492-5909

sra.state.md.us/

Office of Employee Benefits

Provider 7 E. Redwood Street, 20th Floor

Phone Number (410) 396-5830

Website

Baltimore, MD 21202

(410) 396-5216 ogin

Medicare/CMS/ SSA

Provider

Phone Number Website

Medicare Service Center

(800) MEDICARE ((800) 633-4227)

TTY (877) 486-2048

Local

Centers for Medicare & Medicaid Services (CMS)

(410) 786-3000 TTY Toll-Free (866) 226-1819



TTY Local (410) 786-0727

Social Security Administration

(800) 772-1213



TTY (800) 325-0778

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