SHBP Benefits and Retirement

State Health Benefit Plan

Retiree

To SHBP a retiree is a person who:

• Was enrolled in SHBP coverage as an ActiveMember immediately prior to theirretirement (no break in coverage).

• Receives a monthly annuity from a StateRetirement System at the time of theirretirement and is currently enrolled inSHBP coverage as a Retiree.

• Continuous coverage is defined as:

• Active Member status to Retireestatus

• State Extended Coverageparticipant to Retiree status

• COBRA participant to Retiree status

If as an Active Member covered by SHBP you withdraw all money from theretirement system prior to your retirement, you will not be able to continue SHBPcoverage as a Retiree.

• You will be eligible for: COBRA continuation coverage for up to a minimum of18 months as required by federal law.

• After COBRA coverage is exhausted, you may enroll in State ExtendedCoverage (SEC), if you are a:

• Former State employee with eight years of service; or

• Former teacher or public school employee with eight years of service in aState Retirement System and cannot retire due to age.

• Both COBRA and SEC premiums are the full costs of coverage or 100% of thecosts of coverage (unsubsidized), meaning SHBP makes no contribution tooffset the premium and therefore it is substantially higher.

Not Eligible for SHBP Coverage as a Retiree IF…

If you or your dependent(s) are Not Currently Covered by SHBP Prior to YourRetirement Date, neither of you will be able to enroll in SHBP Coverage.

• If you retire January 1, 2020 but are not currently enrolled in SHBP, youCANNOT be covered as a SHBP retiree (you must enroll during OpenEnrollment the year prior to your retirement). This is because SHBP coveragefor retirees must be continuous with no break in coverage from ActiveMember status to Retiree status and if you were not covered by SHBPimmediately prior to your retirement (with no break in coverage), you cannotbe covered by SHBP as an Annuitant.

Not Eligible for SHBP Coverage as a Retiree IF…

If the Dependent(s) is currentlycovered Dependent(s) immediatelyprior to retirement, the Dependent’scoverage will transition to retirementstatus on the same day that theRetirement coverage begins.

If the Dependent(s) is dropped fromcoverage, there will not be anopportunity to enroll them again,unless there is a Qualifying Event, orthe retiree returns to work with aSHBP Employing Entity in a benefits-eligible position.

Dependents Eligibility

If the employee is actively working, the responsibility of notifying SHBP ofretirement is the employers. Once the termination action for reason of retirementis entered into the PeopleSoft system, an electronic file is sent to SHBP notifyingthem of the change.

• Coverage the 1st of the following month after the retirement date• The premium the first month during retirement is covered by the employer. The

premium was deducted from the last month of employment with the employer.

• The coverage as an Active Member will terminate on the last date of the followingmonth after the employment is terminated.

• For example, if the employee terminates employment on September 30, 2019, thecoverage as an Active Member will end October 31, 2019 and the retiree coveragegenerally begins November 1, 2019.

Notifying SHBP of Retirement

If the State Retirement System HAS NOT reported the Retiree to SHBP as a NewRetiree:

• The Retiree will automatically become a Pending Retiree, which will allow him or her tocontinue coverage at the same rate the Retiree had as an Active Member for up to 6 months,without any interruption to his or her coverage.

• The Retiree will remain a Pending Retiree for up to 6 months at the Active Member Rate andsubmit premiums to SHBP via Direct Pay.

• The Retiree will transition to SHBP Retiree Coverage the 1st of the following month after theState Retirement System HAS Reported the employee to SHBP as a New Retiree.

• If the Retiree fails to pay the Direct Pay premiums to SHBP during the status as a PendingRetiree, the coverage will be terminated with no right to reinstatement unless the Retireereturns to a benefits-eligible position with an SHBP Employing Entity.

• The State Retirement System will not “catch-up” the Retiree on unpaid premiums to SHBP.

Notifying SHBP of Retirement

Welcome to Retirement

Upon Retirement or Pending Retirement, allSHBP Retirees will receive a Welcome Letternotifying them of important information.

• You May Receive a Bill from SHBP

• Pending Retiree Information

• Retirees and/or Covered Dependents Age 65or Older

• Returning to Work

• RE-Retirement (Returning to Retirement)

• Social Security Number or other TaxpayerIdentification Number

• Dependent Verification

• Questions or need help?

Retiree Coverage will be deducted from the retiree’s annuity (i.e., retirement check) if the monthlyannuity is sufficient to cover the SHBP monthly premium deduction and the premium amount doesnot exceed the maximum amount ($650.00) set yearly by SHBP which limits the amount SHBP willdeduct from a Retiree’s annuity.

Retiree Coverage WILL NOT be deducted from the retiree’s annuity and the retiree will be placedon Direct Pay if:

• If the premium is more than $650.00.• If the retirement check is not enough to cover the SHBP Monthly Premium Deduction.• If the employee submits their retirement paperwork late. If the employee retires after the ERS/TRS cutoff

for their retirement payroll, or after SHBP submits the premiums to ERS/TRS to be deducted from theretirement check.

• If an error occurs such as the Employer fails to timely and correctly term the coverage due to Retirement,The State Retirement System omits deducting the SHBP monthly premium from the retiree’s annuity, orSHBP omits providing the monthly premium to the State Retirement System for deduction from the annuity.

Failure to pay the invoice will result in termination of coverage with no right to reinstatementunless the retiree returns to work in a benefits-eligible position with an SHBP Employing Entity.

Paying the SHBP Premiums

Lapse Letters are mailed to the retiree by SHBP when there is a missed premiumdeduction for any reason, even if current premium deductions are being taken fromyour annuity.

• SHBP cannot waive the premiums (provide free coverage) and MUST collectany premiums that has been missed.

• The retiree will have 30 days to pay from the date of the lapse letter.

If the retiree believes the lapse letter is inaccurate and he/she has no missedpremiums: The Retiree MUST contact the State Retirement System to confirm thata deduction was actually taken from their annuity for the time period referenced inthe lapse letter. The retiree may also contact SHBP Member Services if the StateRetirement System confirms the missed premium was deducted.

Lapse Letters from SHBP

If the retiree receives a lapse letter from SHBP and:

• Throws it in the trash can.

• Ignores it, because they believe their premium(s) was deducted from theirannuity check.

The Retirees coverage will be permanently terminated with no right toreinstatement, unless the retiree returns to work in a benefits-eligible position withan SHBP Employing Entity.

Lapse Letters from SHBP

For Employee’s Planning to Retire:• Employees retiring on January 1, 2020 who are not currently enrolled in the SHBP or Flexible

Benefits Dental Plan cannot carry coverage as a SHBP/FLEX Retiree. Employees have to enrollduring the Open Enrollment the year prior to their retirement.

• Employees who make a change during Open Enrollment but retire before the change canbecome effective on January 1, 2020, will remain in their current elections/tier prior to OpenEnrollment, including Plan Option/Tier and covered dependents or waiver of coverage status.

• Employees planning to retire must update their email address in the SHBP Enrollment Portalfrom their work email address to a personal or other email address so they can receive SHBPemail notifications.

• Employees planning to retire must update their physical address and phone number so theycan receive SHBP notifications.

• Employees planning to retire should review the SHBP Retirement Presentation located athttps://shbp.Georgia.gov/.

• Employees planning to retire should attend a Pre-Retirement Meeting at the Employees’Retirement System of Georgia (ERS) or Teachers Retirement System of Georgia (TRS).

Retiree’s Responsibilities

For Employee’s Planning to Retire:• Employees planning to retire should review the SHBP

Retiree Decision Guide located athttps://shbp.Georgia.gov/

• Employees planning to retire should visit the SHBPwebsite prior to Retirement to determine whichsubsidy policy they are subject to, either theAnnuitant Basic Subsidy Policy or Annuitant Years ofService Subsidy Policy. The subsidy policy determinesthe costs of the Retiree’s premiums.

• Resources for Retiring Employees:• Retiree Option Change Period:

https://shbp.georgia.gov/retiree-option-change-period

• Retiree Rates (including Subsidy information):https://shbp.georgia.gov/retiree-rates

• Medicare Advantage: https://shbp.georgia.gov/medicare-advantage

Retiree’s Responsibilities

For Retiree’s at and after retirement:

• Pay SHBP Premiums Timely.

• Update all Contact Information with SHBP.

• Review all SHBP Mail and mail from SHBP partners such as ADP, ADP’s subcontractor WageWorks,Anthem, Kaiser Permanente, UnitedHealthcare, ERS and TRS.

• Read SHBP Resources for Retirees:

• Retiree Decision Guide: https://shbp.georgia.gov

• SHBP Plan Documents: https://shbp.georgia.gov/plan-documents-policies-forms-0

• Retiree Option Change Period: https://shbp.georgia.gov/retiree-option-change-period

• Retiree Rates (including Subsidy information): https://shbp.georgia.gov/retiree-rates

• Medicare Advantage: https://shbp.georgia.gov/medicare-advantage

• SHBP Enrollment Portal: www.mySHBPga.adp.com

• Mobile devices (phones, iPads, etc.) are not compatible with the SHBP Enrollment Portal.

Retiree’s Responsibilities

To continue to receive a State Subsidy toward the costof health premiums, Retirees (and theirSpouses/Dependents age 65 or older) must enroll inone of the SHBP Medicare Advantage Plan Options.

Retirees can Pay the Entire Health Coverage with NoState Subsidy.

• Retirees and or Spouse/Dependents age 65 or older mayremain enrolled in the non-Medicare Advantage PlanOptions available to Active Members, but they will pay theentire cost of coverage with no subsidy from the State whichis significantly higher.

Retired and Turning 65

Anthem BlueCross and BlueShield (Anthem)• MA PPO Standard

• MA PPO Premium

UnitedHealthcare • MA PPO Standard

• MA PPO Premium

SHBP Medicare Advantage Plan Options Include Everything Needed by a Retiree, and:• Replace traditional Medicare Part A (hospital) & B (medical)

• Include Part D Prescription Drug Coverage

• Are not supplemental plans

• Include benefits for services not covered by traditional Medicare (out-of-country emergency care)

2020 SHBP Retiree Medicare Advantage Options

Centers for Medicare and Medicaid Services (CMS), is the federal agency that sets the guidelines foreligible individuals to enroll in all Medicare Advantage Plans, including SHBP Medicare AdvantagePlan Options. If mail is returned from CMS, CMS will require SHBP to disenroll member from a SHBPMedicare Advantage Plan Option.

Social Security Administration (SSA) is the federal agency responsible for Medicare Enrollment.• If applicable, Retirees (and/or their Dependent(s)) must continue to pay the Medicare Part B premiums to

SSA. Failure to do so will result in SSA notifying CMS of a Retirees (and/or their Dependent(s)) failure to paythe Medicare Part B premiums. CMS will then require SHBP to disenroll the Retiree (and/or theirDependent(s)) from their SHBP Medicare Advantage Plan Option.

• Note: Medicare Part B premiums, if applicable, are in addition to and are not the same as the SHBPpremiums.

Retirees should apply for Medicare no less than 3 months in advance• Retirees should apply for Medicare Part B with SSA in advance of retirement to reduce the chance of not

having Part B on time.

Medicare Advantage Plan Option Important Facts

Do not enroll in a non-SHBP Medicare Advantage or PrescriptionDrug Plan (PDP).

• If a Retiree and/or Dependent enrolls in a non-SHBP MA or PDP, CMSwill terminate their enrollment in the SHBP MA Plan Option.

Do Not allow your Part B to terminate• If a Retiree and/or Dependent allows their Medicare Part B to

terminate, CMS will cancel their enrollment in the SHBP MA PlanOption.

If CMS Disenrolls a member from a SHBP Medicare AdvantagePlan Option, SHBP will automatically enroll the member and/ortheir dependents in the SHBP Anthem HRA Bronze (non-Medicare Advantage) Plan Option to ensure he/she does nothave a break in coverage.

• Retirees will receive NO state subsidy if enrolled in a non-MedicareAdvantage Plan Option.

Retiree No No’s

The Retiree must provide the Medicare Part B Information directly to SHBP andcannot be submitted to the medical administrator (i.e., Anthem or UnitedHealthcare), or the Retirement Systems (i.e., ERS or TRS).

Medicare Part B reminder letters are mailed by SHBP to active members andretirees at:

1. Age 64 years and 8 months old, and again

2. Age 64 years and 10 months old

The reminder letters give the active member and retirees information about:• What to do if you are retiring or have retired

• What to do if you continue to work past age 65

• Action required by the active member or retiree

Your Medicare Information And SHBP

If SHBP has received the Retiree/Dependent’s Medicare Part B information:• Member (and/or Dependent) will be enrolled in the lowest cost Medicare Advantage

Standard Plan Option the month that the Retiree or Dependent reaches age 65.

• If the Retiree wishes to enroll in another SHBP Plan Option, he/she will need to contact SHBPMember Services at 800-610-1863.

Medicare Advantage is also offered to all Retirees and/or their eligible Dependentsunder age 65 who have attained eligibility for Medicare due to a disability.

• Exception: If Medicare eligibility is due to End State Renal Disease (ESRD), members musthave completed the Coordination of Benefits period before CMS will approve enrollment in aSHBP Medicare Advantage Plan Option.

• SHBP does not automatically enroll Medicare-eligible members under the age of 65 intoMedicare Advantage plan options. Therefore, Medicare-eligible retirees must requestenrollment in a Medicare Advantage plan option by contacting SHBP Member Services at800-610-1863.

Your Medicare Information and SHBP

The information should be provided as it appears on theMember’s and/or Dependent’s Red, White and Blue MedicareCard.

There are two methods to provide Medicare information toSHBP.

1. Call SHBP Member Services at 1-800-610-1863, or2. Enter the information in the SHBP Enrollment Portal

Entering Medicare Part B information in the SHBP EnrollmentPortal: https://myshbpga.adp.com/shbp/

From the left navigation menu, after logging in:1. Select “My Information”2. Then Select “Medicare Management”3. Select the pencil next to Member/Dependent’s name to

enter Medicare Part B information

Medicare Information Needed to Enroll

Retirees may Change their Plan Options at the following times:1. Within 31 days of their retirement date.2. When Retiree or covered dependent(s) become eligible for Medicare (due to turning age 65 or

having End Stage Renal Disease.)3. If Retiree and spouse are covered by SHBP and have no other dependents and are both drawing

an annuity from a State Retirement System, the Retiree may:• Change from you + family coverage to each having “you only” coverage at any time (the

request for you and your spouse must be submitted at the same time), but• You will not be allowed to move from separate “you only” coverage back to you + family

coverage unless you have a Qualifying Event.4. During the annual Retiree Option Change Period (ROCP), which is held each Fall and

corresponds with the annual Open Enrollment (OE) period for Active Members.5. If the Retiree experiences a Qualifying Event.

Retirees May Decrease Tier (i.e., remove covered Dependents) at any time.• However, the Dependents will not be allowed to reenroll unless there is a Qualifying Event.

Retirees May Discontinue Coverage at Anytime.• However, the Retiree will not be able to regain coverage unless they return to work with an SHBP

Employing Entity in a benefits-eligible position.

Changing Plan Options when Retired

Benefits Eligibility:

If a retiree returns to work as a full-time employee in a SHBPbenefits eligible position with an SHBP Employing Entity,either immediately at retirement or at a later date, he/shemust enroll in coverage as an Active Member.

• Retirees who are returning to work are eligible for SHBP coverageas an Active Member if they work:• Minimum of 30 hours or more per week for State Employees• Minimum of 17.5 hours or more per week for Teachers• Minimum of 15 hours or more per week for Public School

employees (excluding Teachers)

New Hires:

Retirees who return to work in benefits-eligible positions areconsidered New Hires and are subject to the new hire rules.The retiree will need to elect coverage in the SHBP Enrollmentportal within 31 days of hire.

Returning to Active Employment

When a Retiree who was previously retired, returns to retirement status afteremployment, SHBP Must Be Notified by the RETIREE to reinstate their coverage as aRetiree.

Within 31 Days, the Retiree must notify SHBP of termination from employment bycontacting SHBP Member Services at 800-610-1863.

• SHBP will coordinate with the State Retirement system to resume deducting the SHBP monthlypremiums from the Retiree’s annuity.

Within 31 Days, the Retiree’s Employer Must Report the termination date to SHBP toprevent a gap in coverage between active employment and returning to retirement.

• If the employer fails to report the deductions timely, the member will have a lapse in coverage andwill be responsible for any premiums missed.

• A lapse in coverage may result in loss of eligibility for SHBP coverage with no right toreinstatement.

Returning To Retirement (Re-Retirement)

Anthem BlueCross Blue Shield (Anthem) – www.anthem.com/shbp

855-641-4862 Monday – Friday 8:00am to 8:00pm ET

United Healthcare – www.welcometouhc.com/shbp

888-364-6352 Monday – Friday 8:00am to 8:00pm ET

Kaiser Permanente (KP) – www.my.kp.org/shbp

855-512-5997 Monday – Friday 7:00am to 7:00pm ET

CVS Caremark – http://info.caremark.com/shbp

844-345-3241 24 hours a day/7 days a week

Employees’ Retirement System of Georgia - https://www.ers.ga.gov/

404/350-6300 Monday – Friday 8:00am to 4:30pm ET

SHBP Member Services – www.mySHBPga.adp.com

800-610-1863 Monday – Friday 8:30am to 5:00pm ET

GaBreeze – www.gabreeze.ga.gov

1-877-342-7339 Monday – Friday 8:00am to 5:00pm ET

Social Security Administration – www.ssa.gov

800-772-1213

Centers for Medicare & Medicaid Services (CMS)

800-633-4227 24 hours a day/7 days a week

www.medicare.gov

Contact Information for Retirees

Contact Information for DNR OHR Benefits

Office of Human Resources

Beth Findlay

(404) 656-2697

beth.findlay@dnr.ga.gov

Retirement and SHBP Benefits