PEIA Benefits in Retirement Plan Year 2023

PEIA Benefits in Retirement Plan Year 2023

Retirement Paperwork Basics You need to complete both retiree health and life insurance enrollment forms to keep your benefits Do this 60-90 days in advance of your retirement Coverage as an active employee will terminate You’ll be re-enrolled as a retiree You’ll receive a retirement confirmation letter after PEIA has processed your paperwork Still have open enrollment rights and will receive a Shopper’s Guide each year 2

Non-Medicare Benefits 3 May choose PEIA PPB Plans A or B or Health Plan HMO or POS PEIA PPB plan specifics: Plan A : deductible 525 single/ 1,050 family; oop 1,500/ 3,000 Plan B: 925 single/ 1,850 family; oop 3,000/ 6,000 PPB Plan coverage is the same as active employees Networks become more important as retirees travel more and are more likely to move outside WV

Networks 4 PEIA’s Network consists of: All WV providers who provide services or supplies to PEIA members Providers outside WV who participate in UnitedHealthcare’s Choice Plus network Network listings are available from UMR or at www.umr.com If you live in WV or a bordering county In-network out-of-state care (beyond bordering counties) must be preauthorized to assure highest benefit level Out-of-state, out-of-network care IS NOT covered Out-of-state, in-network care not preauthorized by UMR is paid at the lower benefit level (varies based on what plan you’re in) the deductible and out-of-pocket maximum are doubled

More on the Network If you LIVE more than one county out of state, be sure to change your address 5 You don’t need prior approval for out-of-state care when you use in-network providers Out-of-state care will be paid at the highest out-of-state benefit level – 70/30 for Plan A or 65/35 for Plan B If you are TRAVELING outside WV Medical emergency covered at in-network out-of-state level Other care - call UMR to protect your benefits at highest out-of-state benefit level

Let’s Look at Medicare 6 Must take Medicare Parts A and B upon retirement – but NOT Part D!!! Most Medicare-eligible retirees are in Humana’s Medicare Advantage Plan for medical and prescription benefits New Medicare members don’t move immediately to Humana Retirees who turn 65 and employees aged 65 and older who retire during the plan year Join the Special Medicare Plan until the next Medicare plan year Can move immediately to Humana – call PEIA for a Humana Transfer form Medicare retirees’ benefits follow Medicare’s Plan Year January – December Special Medicare Plan benefits and premiums mirror Humana Plan 1 (except Rx)

Paying for Benefits 7 Retirees are eligible for the tobacco-free discount: 25 per month single 50 per month family Retirees pay premiums for health and life insurance. May use sick/annual leave if hired before 7/1/2001 Must pay for life insurance, including Basic, if taken

Using Accrued Leave/Teaching Service 8 Accrued leave or teaching service credit pays the premium for the health care plan the policyholder is enrolled in PEIA PPB Plan A or B, Special Medicare Plan, HMO, Humana Must go immediately from active employment into retirement and use the benefit immediately Not available to those hired on and after July 1, 2001 (leave) or July 1, 2009 (teaching service) Premium increases do not affect the exchange rate

Calculating Your Benefit Sick/Annual Leave If your PEIA coverage has been in effect continuously since: Before July 1, 1988: 2 days 100% premium for 1 month single coverage 3 days 100% premium for 1 month family coverage After July 1, 1988, but before July 1, 2001: 2 days 50% premium 1 month single coverage 3 days 50% premium for 1 month family coverage 9

Calculating Your Benefit 10 Teaching Service Full-time faculty member employed on an annual contract basis for a period other than 12 months, may extend employer-paid insurance coverage based on years of teaching service. The benefit is calculated as follows: 3 1/3 years of teaching service 1 year of single coverage 5 years of teaching service 1 year of family coverage This benefit is not available to faculty hired on or after July 1, 2009.

Non-Medicare Premiums 1. 2. 3. Out-ofPocket Maximum Monthly Premium Annual Deductible Out-ofPocket Maximum Monthly Premium Annual Deductible Out-ofPocket Maximum Monthly Premium Annual Deductible Out-ofPocket Maximum Non-Medicare Retired Policyholder with Medicare Dependents(PlanA)1 Annual Deductible Non-Medicare Retired Policyholder withnon-Medicare Dependents(PlanB) Monthly Premium Non-Medicare Retired Policyholder withnon-Medicare Dependents(PlanA) Out-ofPocket Maximum Non-Medicare Retired Policyholder Only(PlanB) Annual Deductible Non-Medicare Retired Policyholder Only(PlanA) Monthly Premium PPB 11 Unsubsidized Premium3 1,160 525 1,500 1,064 925 3,000 2,760 1,050 3,000 2,531 1,850 6,000 1,934 675 2,700 5-9 years 929 525 1,500 853 925 3,000 2,209 1,050 3,000 2,027 1,850 6,000 1,548 675 2,700 10-14 years 716 525 1,500 658 925 3,000 1,665 1,050 3,000 1,527 1,850 6,000 1,153 675 2,700 15-19 years 501 525 1,500 461 925 3,000 1,124 1,050 3,000 1,032 1,850 6,000 760 675 2,700 20-24 years 375 525 1,500 345 925 3,000 799 1,050 3,000 734 1,850 6,000 526 675 2,700 25 years2 291 525 1,500 267 925 3,000 582 1,050 3,000 534 1,850 6,000 367 675 2,700 This rate assumes one person on Medicare. If you have more than one, subtract 22 for each additional Medicare Member. These rates are also provided to all non-Medicare retirees who retired prior to July 1, 1997, to non-Medicare surviving dependents enrolled before July 1, 2015, and to some non-Medicare disability retirees. Surviving dependents enrolled in the PEIA plan on or after July 1, 2015, pay premiums based on the years of service earned by the deceased policyholder. Surviving dependents enrolled before July 1, 2015, are grandfathered under the previous benefit and continue to pay premiums based on 25 or more years of service. This premium rate is provided to all employees hired on or after July 1, 2010, even if they retire as a result of a disability. It also applies to those who retire with fewer than 5 years of service. This rate represents the full premium with no subsidy from active employers or employees. Two classes of employees hired on or after July 1, 2010, will not be required to pay the unsubsidized rate: a) Active employees who were originally hired before July 1, 2010, with continuous coverage prior to July 1, 2010, and who have a break in service not greater than two years after July 1, 2010; and b) retired employees who retired before July 1, 2010, come back to active service after July 1, 2010, and then go back into retirement. In those cases, the original hire date will apply. Please note that there are no Plan B premiums for Non-Medicare retiree with Medicare dependents because this coverage is not available Health Plan HMO and PPO Premiums can be found in the current Shopper’s Guide.

12 Medicare Rates Medicare Policyholder Only Medicare Policyholder with Non-Medicare Dependents Medicare Policyholder with Medicare Dependents 2 1 Unsubsidized Premium (Hired on or after July 1, 2010) 4 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 or more years³ 1. 2. 3. 4. Humana/ PEIA PLAN 1 Humana/ PEIA PLAN 2 Humana/ PEIA PLAN 1 Humana/ PEIA PLAN 1 Humana/ PEIA PLAN 2 281 182 1,390 561 363 196 162 128 99 127 105 83 64 1,205 929 652 474 422 341 263 197 273 221 170 128 81 52 359 144 93 This rate assumes one person on Medicare. If you have more than one, subtract 22 for each additional Medicare Member. This rate assumes two people on Medicare. If you have more than two, subtract 22 for each additional Medicare Member These rates are also provided to all Medicare retirees who retired prior to July 1, 1997, to all Medicare surviving dependents prior to July 1, 2015, and to some Medicare disability retirees. Surviving dependents enrolling in the PEIA plan on or after July 1, 2015, pay premiums based on the years of service earned by the deceased policyholder. Surviving dependents enrolled before July 1, 2015, are grandfathered under the previous benefit and continue to pay premiums based on 25 or more years of service. This premium rate applies to all employees hired on and after July 1, 2010, even if they retire as a result of a disability. It also applies to those who retired with fewer than 5 years of service. This rate represents the full premium with no subsidy from active employers or employees. Two classes of employees hired on and after July 1, 2010, will not be required to pay the unsubsidized rate: 1) active employees who were originally hired before July 1, 2010, and who have a break in service of fewer than two years after July 1, 2010; and 2) retired employees who retired before July 1, 2010, come back to active service after July 1, 2010, and then go back into retirement. In those two cases, the original hire date will apply.

13 Survivor Benefits If the policyholder dies, the spouse and children covered at the time of death can continue health coverage as surviving dependents. If the surviving spouse remarries, coverage under the survivor benefit terminates Surviving dependent children subject to the same eligibility rules as any other dependent children in the plan. If the survivor is an active or retired public employee, he/she can enroll as the policyholder Survivors are not eligible for life insurance

14 Surviving Dependents (cont’d) Paying for Benefits: Surviving dependents pay premiums based on the years of service earned by the deceased policyholder. Survivor CANNOT use the policyholder’s sick/annual leave benefit.

15 Premium and Benefit Assistance Program is available to retirees whose income is at or below 250% of federal poverty level Must provide documentation of income to qualify. Premium Assistance pays part or all of the premium, depending on income and years of service Medicare eligibles with 15 or more years of service may also qualify for Benefit Assistance. Non-Medicare retirees receive ONLY premium assistance, no benefit assistance. Reduces out-of-pocket costs for medical and prescriptions Typically helps retirees who have been retired for a while

16 Basic Life Insurance Life Insurance provided by MetLife Coverage on policyholder is decreasing term coverage with no cash value Basic life coverage: 10,000 paid by employer while active drops to 5,000 at retirement drops to 2,500 at age 67 Retiree pays premium for basic life insurance Retired Employee's Basic Life Monthly Premium Under age 67 -- 5,000 Age 67 and over -- 2,500 Keep your beneficiary up to date 11.14 5.56

17 Additional Life Insurance Coverage up to 150,000 for retirees Submit a statement of health and be approved by life insurer Be sure you do your life insurance paperwork when you retire Optional life insurance is decreasing term coverage Must have had that level or more as an active employee OR Optional life may be continued at retirement, but not added later Premiums go up and coverage goes down as you age Premiums are printed in the Shopper’s Guide each year

18 Retiree Dependent Life Premiums Dependent life insurance is available for retirees. Dependent eligibility is the same as for health coverage. For coverage in retirement: Must have had desired level or more as an active employee OR Submit a statement of health with information about each dependent to be covered and be approved by the life insurer Retiree Dependent Life Insurance Monthly Rates Plan 1 ( 5,000 Spouse/ 2,000 child) Plan 2 ( 10,000 Spouse/ 4,000 child) 8.42 16.80 Plan 3 ( 15,000 Spouse/ 7,500 child) 25.28 Plan 4 ( 20,000 Spouse/ 10,000 child) Plan 5 ( 40,000 Spouse/ 15,000 child) 33.70 67.40

Who to Call UMR – (888) 440-7342 (non-Medicare retirees and SMP) questions about Medicare Retiree benefits FBMC Benefit Management (FBMC) – (855) 569-3262 eligibility and life insurance enrollment Humana – (800) 783-4599 questions about prescription claims PEIA – (888) 680-7342 or visit our website at www.wvpeia.com questions about PPB Plan medical claims/benefits, requests for out-of-state services, pre-certification, case management, and medical ID cards Express Scripts – 855-224-6247 (non-Medicare retirees and SMP) 19 Dental, vision and hearing aid benefits for retirees MetLife – 888-466-8640 Questions about life insurance and beneficiaries