OVERVIEW OF RETIREE
MEDICAL BENEFITS
Employee Services Agency
Employee Benefits Department
Fiscal Year 2017
July 1, 2016 to June 30, 2017
Agenda
Retiree benefits provided by the County
 How to qualify for retiree medical
 Cost of retiree medical
 Options for living out-of-state
 Medicare
 Exit Interview
 Retirement planning check list
 Questions

Retiree Medical Benefits Provided by the
County of Santa Clara
•
Medical premium payment equivalent to
100% of the Kaiser plan for the retiree
only. Exec Mgrs: 100% of lowest cost
plan.
•
Retiree pays the difference for a higher
cost plan.
•
Retiree pays the difference to provide
coverage for spouse or dependent.
What is not Provided by the County?
•
Dental or Vision Insurance
• Options for retirees
•
•
COBRA for a maximum of 36 months
Individual plan
• Retired Public Employees’ Association (800) 443-7732
• Liberty Dental
• Covered CA or another state’s health care
marketplace.
What is not Provided by the County?
•
Life Insurance and Long-Term Disability
•
Basic and Supplemental Life insurance policies can
be converted to a personal policy.
•
Retirees are provided with contact information
for conversion of life insurance plans at the time
of the Exit Interview with Employee Benefits.
•
Long-Term Disability insurance cannot be
continued after employment ends.
How Do Employees Qualify for Retiree
Medical Coverage?
•
Must be regular coded with continuous employment and
meet the following age and days of service requirement:
•
If hired prior to 8/12/96:
• 50 years of age and have 5 years of service (1305 days)
If hired between 8/12/96 and 06/18/06
•50 years of age and have 8 years of service (2088 days)
•
•
If hired on or after* 06/19/06:
•50 years of age and have 10 years of service (2610 days)
•
* Some union agreements require 15 years of service
(3915 days) – check your MOA to see if this applies to
your effective hire date.
How Do Employees Qualify for
Retiree Medical Coverage? Cont.
•
Must retire from CalPERS and the County
on the same date (move directly from
“employee” status into “retiree” status).
•
Enrollment in retiree medical coverage is
not automatic.
Schedule to attend an Exit Interview at
least 60 days before your retirement date.
•
Retirees’ Cost for Medical coverage
•
Sample of monthly retiree-only cost:
Plan
No
Medicare
Exec Mgrs
w/Medicare
All Others
w/Medicare
Health Net POS in California
$473.59
$398.56
$31.83
Health Net FlexNet Indemnity
$1,495.54
$525.19
$158.46
Health Net Nationwide PPO
$863.58
$543.39
$176.66
Valley Health Plan “Classic” *
$65.78
$321.80
$15.09
Valley Health Plan “Preferred”
$0.89
$274.25
$0.00
Kaiser Permanente HMO
$0.00
$0.00
$0.00
Rates shown are effective July 1, 2016 through June 30, 2017
* VHP “Classic” rates include a partial subsidy for FY17
Retirees’ Cost for Spouse Coverage
•
Sample of monthly cost for retiree + spouse:
(Medicare rates assume both retiree & spouse have Medicare)
Plan
No
Medicare
Exec Mgrs
w/Medicare
All Others
w/Medicare
Health Net POS in California
$999.55
$1,136.25
$769.52
Health Net FlexNet Indemnity
$2,913.75
$1,389.51
$1,022.78
Health Net Nationwide PPO
$1,618.01
$1,425.91
$1,059.18
Valley Health Plan “Classic” *
$948.68
$1,088.04
$781.33
Valley Health Plan “Preferred”
$707.66
$887.63
$613.38
Kaiser Permanente HMO
$705.85
$339.13
$339.13
Rates shown are effective July 1, 2016 through June 30, 2017
* VHP “Classic” rates include a partial subsidy for FY17
What are the Options for Coverage
Outside of California?
•
Retirees may choose to enroll in one of the
following out-of-area plans:
• Health Net
• Coverage available nationwide.
• PPO Plan
• Health Net FlexNet Indemnity Plan
• Point of Service plan not available nationwide.
What are the Options for Coverage
Outside of California?
•
Kaiser – Non Medicare Retirees
• Must be enrolled in Kaiser at the time of
his/her move. Can receive Emergency/Urgent
medical care.
• Retirees must travel to California for
coverage for routine care (subject to change).
•
Kaiser – Medicare Retirees
• No longer qualify for Kaiser coverage.
What are the Options for Coverage
Outside of California?
•
Valley Health Plan
• Available only in Santa Clara, San Mateo,
Alameda, Stanislaus, Merced, San Benito,
Monterey, Santa Cruz and San Francisco
counties.
•
No medical plan coverage is available
outside of the United States.
What is the Payment In Lieu Of
Medical Coverage?
•
•
•
Available to retirees permanently residing
outside of California and the U.S.
Must waive enrollment in a County sponsored
medical plan
Must provide proof of enrollment in any other
medical plan
What is the Payment In Lieu Of
Medical Coverage?
•
•
County pays retiree, on a quarterly basis, an
amount equal to the amount County
contributes for retiree medical coverage:
$705.86 per month for FY17
Amount is taxable - 1099 form sent to
participant after the end of the calendar year
Can Retirees Change Medical Plans
After Retirement?
..
• Yes, during the annual open enrollment period
• May 1st to May 31st
• Can change health plan
• Add or drop eligible dependents
• All changes go into effect on July 1st
Can Retirees Change Medical Plans
After Retirement?
..
• Yes, if you have a qualifying event, such as:
• Move away from the service area covered
by your current medical plan
• Marriage, divorce or add a child.
Any change must be made within 30 days of
the qualifying event.
Contact Employee Benefits to make a change.
Does Spouse and/or Dependent Medical
Coverage Continue After Retiree Death?
•
The County offers survivor coverage under the
following conditions:
•
•
•
The Spouse and/or dependent is covered on the
retiree's health plan at the time of death.
The spouse and/or dependent pays 100% of the
group premium in a timely and in a consistent
manner.
The County does not contribute towards
survivor coverage.
Medicare Overview
Medicare covers services (like lab tests,
surgeries, and doctor visits) and supplies
(like wheelchairs and walkers) considered
medically necessary to treat a disease or
condition.
 For
information about Medicare
◦ www.medicare.gov
◦ 1-800-MEDICARE
What Medicare Part A Covers
Hospital care
 Skilled nursing facility care
 Nursing home care (as long as custodial
care isn't the only care you need)
 Hospice
 Home health services

What Medicare Part B Covers
Medically necessary services: Services or supplies
that are needed to diagnose or treat your medical
condition and that meet accepted standards of
medical practice.
 Preventive services: Health care to prevent illness
(like the flu) or detect it at an early stage, when
treatment is most likely to work best.
 Part B covers things like:

◦
◦
◦
◦
◦
◦
Clinical research
Ambulance services
Durable medical equipment (DME)
Mental health
Getting a second opinion before surgery
Limited outpatient prescription drugs
Retirees over age 65
•
•
•
Retirees and/or their spouse eligible for Medicare
parts A & B must enroll!
Retirees and/or their spouse with Medicare A&B
are required to elect a County sponsored
Medicare coordinating Medical Plan within their
current plan.
Retirees or spouse must not enroll in the
Medicare Part D - Prescription Drug Program.
Retirees over age 65
•
Employee Benefits must receive a copy of the
Medicare B card.
•
•
•
If you or your spouse are already receiving Social Security
benefit payments, they will send you these cards
automatically
If you or your spouse are not receiving Social Security
benefit payments, you must enroll by your 65th birthday.
Notify Employee Benefits as soon as you enroll in Medicare.
How to enroll in Medicare A & B
Apply online at Social Security.
https://www.ssa.gov/medicare/apply.html
 Visit your local Social Security office.
 Call Social Security at 1-800-772-1213.

Medicare Part B Reimbursement

All retirees (except UAPD & Executive
Management) are eligible

Amount: the difference between what the
County pays for retiree-only coverage
and the cost for the retiree’s elected
Medicare health plan, up to the actual
cost to the retiree for their Medicare Part
B premium.

This is a negotiated benefit and subject to
change.
Medicare Part B Reimbursement

To be approved for the program retirees
must:
◦ Provide a copy of their Medicare Card
◦ Complete a Statement of Understanding
◦ Be enrolled in a Medicare coordinating health
plan or have waived medical coverage.
Medicare Part B Reimbursement

The County sends payment to enrolled
retirees on a quarterly basis (at the end of
the month following quarter’s end).
◦ Quarters are Jan - Mar, Apr - June, July - Sept &
Oct - Dec.

Participation begins on the month after
required documents are received.

Retirees who have waived medical coverage
will receive the full amount they pay for
Medicare Part B. Proof of payment amount
is required.
Exit Interview
Plan to attend an Exit Interview session:

Overview of retiree medical benefits

Completion of County forms

Completion of Medical Enrollment Forms

COBRA information
Retirement Planning Checklist
How do I contact the County
Employee Benefits Department?
Employee Benefits
70 West Hedding St., 8th Floor
San Jose, CA 95110
(408) 299-5880 or
(800) 541-7749 – toll free
[email protected]