|
 |
 |
|
|
|
 |
 |
 |
|
 |
|
 |
|
 |
|
Mailing Address:
U.Va. Human Resources
914 Emmet Street
P.O. Box 400127
Charlottesville, VA
22904
Phone: (434) 924-4598
Email: hrdept@virginia.edu
|
|
|
|
|
| Benefits Summary Retired Employees |
Eligibility
Who Is Eligible
You may join the Retiree Health Benefits Program if:
- You are a retiring State employee eligible for a monthly annuity from VRS or a periodic benefit from the MCRP or FRP programs; and
- You were eligible for enrollment in the UVa Health Plan on your last day as an active state employee; and
- You are receiving (not deferring) your annuity immediately upon retirement; or
- You are approved for long-term disability through VSDP, the Medical Center Disability Program, or the Faculty Disability Program; and
- You submit an Enrollment/Waiver Form to the University Benefits Division within 31 days of your retirement date.
You may join the Retiree Health Benefits Program even if you were not enrolled in the UVa Health Plan as an active employee as long as you were eligible for enrollment in the health plan on your last day as an active state employee and were not terminated from the active employee health plan due to lack of payment. You must be eligible as stated above and submit an Enrollment/Waiver Form to the University Benefits Division within 31 days of your retirement date. If you have been approved for LTD through VSDP, you must have been enrolled in the UVa Health Plan as an active employee on the day prior to the start of your LTD.
Your eligible dependents who are enrolled on your UVa Health Plan policy on your last day as an active state employee may enroll with you in the Retiree Health Benefits Program.
The only exceptions which allow for enrollment after 31 days from your retirement date are:
- You are a State retiree who is enrolled as a dependent in your spouse’s active State employee health benefits membership. You may enroll in the retiree group within 31 days of the date the active employee ends State employment or retires. To maintain your eligibility for the retiree group, you must submit the waiver section of the Enrollment/Waiver form within 31 days of your retirement date.
- You are a Virginia Sickness and Disability Program participant in long-term disability (VSDP-LTD) and leaving LTD for service retirement. You may enroll in the Retiree Health Benefits Program, regardless of whether or not you have maintained health coverage in the State program while receiving LTD benefits, as long as there is no break in LTD benefits before retirement. You must enroll within 31 days of your retirement date.
Who Is Not Eligible
You will not be eligible for the Retiree Health Benefits Program at any time in the future if:
- You waive coverage when you retire;
- You fail to complete an Enrollment/Waiver Form within 31 days of retirement;
- You defer retirement when you leave state employment, except for certain involuntarily terminated employees with 20 years of creditable service; or
- You cancel coverage in the Retiree Health Benefits Program.
Deferring retirement means that you will receive your retirement annuity from the state at a later time, rather than directly after leaving State employment.
If you are not eligible for the Retiree Health Benefits Program, your spouse and/or dependents are also not eligible.
Enrollment
Enrollment in the Retiree Health Benefits Program is not automatic. You must take action by contacting the University Benefits Division at least three months before you retire. This allows plenty of time for the enrollment process and helps ensure that you have health insurance coverage beginning with the first day of your retirement.
If you decide to enroll, you may be eligible for the State Retiree Health Insurance Credit. This is a program that reimburses part of the premium for your State health benefits plan if you have 15 or more years of creditable service with a State agency.
If you decide not to enroll but are covered under another health insurance plan, you may be eligible for the Alternate Health Insurance Credit. This is a program that reimburses part of the premium for your health insurance if you have 15 or more years of creditable service with a State agency.
Enrollment in the Retiree Health Benefits Program is entirely your decision. If you do not enroll in State retiree coverage within 31 days of separation for retirement, you will never be able to enroll in the future.
Available Retiree Health Benefits Plans
Medicare-Supplement Plans
- Advantage 65
- Advantage 65 + Dental/Vision
- Advantage 65 - Medical Only
- Advantage 65 - Medical Only + Dental/Vision
Non-Medicare Eligible Plan
- UVa Health Plan - High Premium
- UVA Health Plan - Low Premium
Non-Medicare Eligible Retirees
This category applies if you and/or covered family members are not yet eligible for Medicare. Retirees or covered family members who are in their first 30 months of Medicare coverage due to End Stage Renal Disease (ESRD) are treated as if they are not yet eligible for Medicare since Medicare must be their secondary insurance for the first 30 months.
The insurance plan available for non-Medicare eligible retirees is the UVa Health Plan. Dental and/or vision options are available in addition to the basic health coverage with the UVa Health Plan. The Enrollment Form for Optional Dental and Vision Plans must be completed at your initial enrollment in the retiree group. These two options can also be added during the open enrollment period each year.
When you or an enrolled family member who was not Medicare eligible becomes eligible for Medicare, eligibility for enrollment in the UVa Health Plan ends. Make sure that person is enrolled in both Medicare Part A and Part B, terminates coverage in the UVa Health Plan, and enrolls in Advantage 65 or Advantage 65 – Medical Only (administered by Anthem). The Dental/Vision Plan is also available as an option with Advantage 65 and Advantage 65 – Medical Only. These changes do not occur automatically. You must take action by contacting the University Benefits Division at least two months before you or a family member becomes Medicare eligible. This allows plenty of time for the enrollment process and helps ensure that you or your family member has appropriate health insurance coverage beginning the first day of Medicare coverage. Applications must be received at the Benefits Division prior to the date of Medicare eligibility.
To cover both Medicare eligible and non-Medicare eligible family members, see information regarding coverage for a combination of non-Medicare eligible and Medicare eligible retirees.
Medicare Eligible Retirees
This category applies if you and covered family members are all eligible for Medicare.
Medicare benefits are an important part of your coverage. Make sure you are enrolled in Medicare Hospital Insurance (Part A) and Medical Insurance (Part B). You may apply by contacting any Social Security Administration office.
Medicare Part A helps pay for care in a hospital and skilled nursing facility, and for home health and hospice care. Medicare requires patients to pay a hospital benefit period deductible and coinsurance.
Medicare Part B covers 80% of Medicare approved participating physician charges and other health services, after you pay your calendar year deductible.
There are two supplemental plan choices for enrollment under the Retiree Health Benefits Program for retirees who are Medicare eligible: Advantage 65 and Advantage 65 – Medical Only. The Dental/Vision Plan is also available as an option with Advantage 65 and Advantage 65 – Medical Only. For those retirees who enroll in Advantage 65 or Advantage 65 – Medical Only, Medicare will be the primary payor and Advantage 65 or Advantage 65 – Medical Only will serve as a supplement to Medicare’s coverage. Descriptions of these plans follow.
Advantage 65 is a Medicare supplemental plan that pays secondary to Medicare and covers much of the cost of medical services for which Medicare does not pay 100%. Generally, with the exception of Out-of-Country Major Medical services specifically described in the Member Handbook, Advantage 65 will not pay for services that are denied by Medicare. Advantage 65 also includes an enhanced Medicare Part D benefit for outpatient prescription drug coverage.
Advantage 65 with Dental/Vision adds coverage for certain basic dental and routine vision services to the Advantage65 coverage described above. There is no coverage for prosthetic and complex restorative dental services.
Advantage 65 – Medical Only provides the same medical benefits as the Advantage 65 plan described above but does not include outpatient prescription drug coverage. (If this plan is elected, outpatient prescription drug coverage should be obtained through a non-state-sponsored Medicare Part D Plan or other creditable coverage such as Tricare, Veterans Benefits or coverage through a spouse’s active employment in order to avoid a higher Part D premium at a later date.)
Advantage 65 – Medical Only with Dental/Vision adds coverage for certain basic dental and routine vision services to the Advantage 65 – Medical Only coverage described above.
There is no coverage for prosthetic and complex restorative dental services.
To cover both Medicare eligible and non-Medicare eligible family members, see information regarding coverage for a combination of non-Medicare eligible and Medicare eligible retirees.
Combination of Non-Medicare Eligible and Medicare Eligible
This category applies if one or more covered family members are not eligible for Medicare, and one or more covered family members are eligible for Medicare.
The insurance plans available for Medicare eligible retirees are Advantage 65 and Advantage 65 – Medical Only. The Dental/Vision Plan is also available as an option with Advantage 65 and Advantage 65 – Medical Only. All non-Medicare eligible family members must enroll in the UVa Health Plan.
When you or your family member who was not Medicare eligible becomes eligible for Medicare, eligibility for enrollment in the UVa Health Plan ends. Make sure that person is enrolled in Medicare Part A and Part B, terminates coverage in the UVa Health Plan, and enrolls in Advantage 65 or Advantage 65 – Medical Only. The Dental/Vision Plan is also available as an option with Advantage 65 or Advantage 65 – Medical Only. These changes do not occur automatically. You must take action by contacting the University Benefits Division at least two months before you or a family member becomes Medicare eligible. This allows plenty of time for the enrollment process and helps ensure that you or your family member has appropriate health insurance coverage beginning the first day of Medicare coverage. Applications must be received at the Benefits Division prior to the date of Medicare eligibility. Those not yet eligible for Medicare are eligible for enrollment in the UVa Health Plan.
Payment of Retiree Health Insurance Premium
VRS Annuities
Retirees who receive a monthly annuity from VRS will have their health insurance premium deducted from their monthly annuity check if it is large enough to cover the premium. If the check is too small to pay the health premium, the retiree will be billed directly. Retirees will pay premiums by check each month or authorize a monthly bank draft from their checking or savings account to pay the premium if this option is available by the carrier.
Other Retirement Annuities
Retirees who receive a monthly annuity from an organization other than VRS will be billed directly. Retirees will pay premiums by check each month or authorize a monthly bank draft from their checking or savings account to pay the premium if this is available by the carrier.
Health Insurance Credit
The health insurance credit program is a benefit that was designed to assist retirees with the cost of their benefits.
Retirees with 15 or more years of creditable State service who enroll in the State Health Benefits Program are eligible for a health insurance credit of $4 per month for each year of creditable service. “Disability” retirees usually receive a health credit of $120 per month.
If you are receiving a monthly annuity from VRS and are enrolled in the State Retiree Health Benefits Program, the credit will be included in your monthly annuity check. If you are paying premiums directly to the plan and are enrolled in the State Retiree Health Benefits Program, the credit will be mailed to your home address the month after it is earned.
Retirees must be enrolled in an employer-sponsored health insurance plan, a personal health insurance plan or Medicare Part B to be eligible for the health insurance credit.
Alternate Health Insurance Credit Program
If you enroll in other health insurance instead of the State Retiree Health Benefits Program, you will be eligible for the Alternate Health Insurance Credit if you have at least 15 years of service credit with a State agency when you retire. The amount of the credit you receive is $4 per month for each year of creditable service. “Disability” retirees usually receive a health credit of $120 per month.
To receive the alternate health insurance credit, you must submit a Retiree Health Insurance Credit form (VRS-45) to VRS. If you are receiving a monthly annuity from VRS, the credit will be included in your monthly annuity check. Otherwise, your credit will be mailed to your home address the month after it is earned.
For more information on the Health Insurance Credit or the Alternate Health Insurance Credit, call VRS toll-free at (888) 827-3847.
Making Changes to Your Coverage
Retirees can reduce membership or cancel coverage prospectively (going forward) at any time, but retirees who cancel coverage may not re-enroll in the future. Changes are effective on the first day of the month following receipt of the form at the University Human Resources Benefits Division. If the dependent is being dropped because of eligibility loss, the change will be effective on the first day of the month following loss of eligibility.
Both Medicare and Non-Medicare Retirees may make membership level changes due to qualifying mid-year events.
Mid-year qualifying events are usually important events in your life that affect your health insurance needs. They include:
- Marriage
- Divorce
- Death of a spouse
- Birth, adoption, or placement for adoption of a child
- Death of a covered child
- Covered child exceeds plan’s age limit
- Covered child marries
- Gaining custody of an “other child
- Dependent losing eligibility for coverage
- Gain or loss of eligibility for Medicare or Medicaid
- Loss of eligibility for government sponsored plan
- Spouse or covered child begins or ends employment
- Spouse or covered child begins or ends leave without pay
- Annual enrollment allowed under another employer’s plan
To make a change in your health benefits plan membership, you must submit a completed enrollment form within 31 days of a mid-year qualifying event to the University Human Resources Benefits Division. Confirming documentation must accompany the enrollment form.
If approved, the change in your health benefits coverage will be effective on the first day of the month following receipt of the enrollment form with verifying documentation. If the change is being made because a dependent has lost eligibility, the change will be effective on the first day of the month following loss of eligibility.
Non-Medicare Retirees may also make membership changes for non-Medicare spouses or dependents at open enrollment. Medicare Retirees must experience a mid-year qualifying event to add dependents.
In the event of the retiree’s death, a retiree’s spouse who is covered by the plan at the time of the death can continue coverage for the rest of his life unless he remarries. See the section titled “Survivor Benefits” for details.
How To Obtain Assistance
Enrollment Forms and Questions
Address/Demographic Changes, Open Enrollment Changes, Mid-Year Qualifying Event Changes
Questions about Plan Benefits, Claims, or Claims Appeals
|
UVa Health Plan |
Southern Health Services
(888) 975-9557
Town Center One
1000 Research Park Blvd.
Charlottesville, VA 22911
http://www.southernhealth.com |
Anthem Blue Cross/Blue Shield Plans
(Advantage 65, Advantage 65 + Dental/Vision, Advantage 65 - Medical Only, Advantage 65 - Medical Only + Dental/Vision, Option I, Option II, Option II + Dental/Vision) – Secondary Medical Benefit (including mental health), Dental Benefit, Vision Benefit |
Anthem Blue Cross/Blue Shield
(804) 355-8506 in Richmond
(800) 552-2682 outside of Richmond
P.O. Box 27287
Richmond, VA 23261
http://www.anthem.com |
| Medco Health Solutions, Inc. (Advantage 65, Advantage 65 + Dental/Vision, Option I, Option II, Option II + Dental/Vision) – Prescription Drug Benefit |
Medco Health Solutions, Inc.
(800) 572-4098
www.medcohealth.com |
|
Medicare |
Local Social Security office or the Medicare Website or 1-800-Medicare
http://www.medicare.gov |
Questions about Premium Payments
|
Premiums paid directly to UVa Health Plan |
Southern Health Services
(888) 975-9557
Town Center One
1000 Research Park Blvd.
Charlottesville, VA 22911
http://www.southernhealth.com |
|
Premiums deducted from VRS check |
Virginia Retirement System (VRS)
(804) 649-8059 in Richmond
(888) 827-3847 outside Richmond
P.O. Box 2500
Richmond, VA 23218-2500
http://www.varetire.org/Members/Index.html |
|
Premiums paid directly to Anthem |
Anthem Blue Cross/Blue Shield
(804) 355-8506 in Richmond
(800) 552-2682 outside of Richmond
P.O. Box 27287
Richmond, VA 23261
http://www.anthem.com |
Questions about Health Insurance Credit
Survivor Benefits
Family members for whom survivor retirement benefits have been provided may enroll in the state Retiree Health Benefits Program upon the death of the retiree, regardless of whether they had coverage prior to the retiree’s death. These are considered to be annuitant survivors.
To continue or apply for coverage, the eligible family member must submit a Retiree Health Benefits Program Enrollment/Waiver Form within 31 days of the death of the retiree. If application is not made within that time limit, the right to enroll will be forfeited.
Non-annuitant survivors may continue coverage under the State Retiree Health Benefits Program if they enrolled at the time of the retiree’s death. To continue coverage, a Retiree Health Benefits Program Enrollment/Waiver Form must be submitted within 60 days of the death of the retiree. A spouse may continue coverage unless he/she becomes covered under another health plan, remarries or dies. Dependent children may be covered until the end of the calendar year in which they turn 23.
Appeals Process
The State Health Benefits Program has a specific appeals procedure for retirees in the self-funded plans administered by Anthem Blue/Cross Blue Shield (Advantage 65, Advantage 65 – Medical Only, Option I, Option II) to review the denial or payment of any claim. The retiree may request a review within 60 days of Anthem’s denial of your initial claim. If the retiree is not satisfied with the results of the review, he may pursue two levels of appeals with the Claims Administrator. A final appeal can be requested by writing to the Commonwealth of Virginia Department of Human Resources Management if the retiree is still not satisfied with Anthem’s decision. In situations requiring immediate medical care, Anthem provides a separate expedited emergency appeals process. Anthem will provide resolution within one business day of receipt of all information.
The UVa Health Plan has specific appeals procedures to review the denial or payment of any claim. The retiree may request two levels of appeals with the Claims Administrator, Southern Health Services, if he is dissatisfied with the denial of a medical claim or has a complaint of any kind. If the claim or complaint concerns mental health services, appeals are performed by United Behavioral Health (UBH). United Concordia performs the appeals for dental claims and PharmaCare performs the appeals for prescription drug coverage. If the retiree is not satisfied with the decision of the Claims Administrator when the complaint addresses medial decisions, he may pursue the decision further by submitting a request to the UVa Health Plan Ombudsman for an external review. In an emergency or in urgent circumstances, a retiree may request an expedited emergency appeals procedure which will provide resolution within one business day of receipt of a complaint concerning situations requiring immediate medical care.
Questions about the Claims Appeals Process for your self-funded plan
|
Plan |
Appeals Process |
Anthem Blue Cross/Blue Shield Plans
(Advantage 65, Advantage 65 + Dental/Vision, Advantage 65 – Medical Only, Advantage 65 – Medical Only + Dental/Vision, Option I, Option II, Option II + Dental/Vision) |
Review and Two Levels of Appeals through Anthem BC/BS:
(804) 355-8506 in Richmond
(800) 552-2682 outside of Richmond
http://www.anthem.com
Final Appeal:
The claim must be at least $300 to be eligible for this process. Within 60 days of the 2nd Level Appeals Decision, submit your final appeal in writing to: Dept. of Human Resource Management Office of State and Local Health Benefits 101 N. 14th Street, 13th Floor Richmond, Virginia 23219 |
|
UVa Health Plan |
Two Levels of Appeals through Southern Health Services:
(888) 975-9557
http://www.southernhealth.com
Final Appeal:
Appeals that address medical decisions may be pursued further. Within 30 days of receiving the 2nd Level Appeals decision, submit your final appeal in writing to:
UVa Health Plan Ombudsman
University of Virginia
Benefits Division
914 Emmet Street
P.O.Box 400127
Charlottesville, Virginia 22904-4127
(434) 924-4346
|
Monthly Premiums
Non-Medicare Eligible Plans through the University of Virginia Health Plan
Rates effective January 1, 2008
| |
Monthly Premium
High Premium/
Low Premium
|
Monthly Premium,
Dental Option |
Annual Payment,
Vision Option |
|
Single |
$367/$331 |
$25
|
$5 annual prepay |
|
Retiree + Child |
$722/$622 |
$40
|
$5 annual prepay |
|
Retiree + Spouse |
$746/$632 |
$57
|
$5 annual prepay |
|
Family |
$1161/$965 |
$109
|
$5 annual prepay |
Medicare-Supplement Plans through Anthem Blue Cross/Blue Shield
Rates effective January 1, 2008
| |
Monthly Premium Per Person |
|
Advantage 65 |
$277 |
|
Advantage 65 + Dental/Vision |
$308 |
|
Advantage 65 - Medical Only |
$126 |
|
Advantage 65 - Medical Only + Dental/Vision |
$157 |
Option I - Medicare Complementary |
$237 |
|
Option II - Medicare Supplemental |
$319 |
|
Option II + Dental/Vision |
$350 |
|
|
