SJDC Health Benefit SJDC Health Benefit OverviewOverviewRetiree Coverage – Group I

March 7, 2012 Suzanne Franco

Employee Benefits Specialist

Blue Cross – Plan 4Blue Cross – Plan 4

Co-insurance 90/10$100.00 Annual Deductible$300.00 Annual Out of Pocket Max

$10.00 Office Visit co-pay$5.00/$8.00 Prescription

Delta Dental – Incentive Delta Dental – Incentive PlanPlan

70/80/90/100% Coverage$1000.00 Annual MaximumAdditional $200.00 if DPO/PPO dental provider is used.

NO implant coverage

Vision Service Plan – Plan Vision Service Plan – Plan BB

Lenses once per yearFrames once every two years$10 Office Visit co-pay

Retiree Life Insurance Retiree Life Insurance ScheduleScheduleGROUP TERM LIFE

RETIRED MEMBERS LESS THAN AGE 60 Benefits$8,000 benefit

RETIRED MEMBERS BETWEEN AGE 60-64 Benefits

$6,000 benefit RETIRED MEMBERS BETWEEN AGE 65-69

Benefits$3,000 benefit

RETIRED MEMBERS BETWEEN AGE 70-74 Benefits

$2,000 benefit RETIRED MEMBERS AGE 75 OR OLDER Benefits

$1,000 benefit

Prescription Prescription ReimbursementReimbursementThe District does not have the option to

carry a $5/8 RX plan.Retirees will be reimbursed by our 3rd

party administrator the allowable amount that exceeds $5/$8 in pharmacy cost or $10/$18 mail order cost.

Generic restriction does apply.Prescription receipts are mailed to

Stanislaus Foundation for processing.Receipts can be submitted at any time.

(ie: monthly, quarterly, annually, etc)Please allow 3-4 weeks for processing.

PRESCRIPTION REIMBURSEMENT

In order to maintian the current level of benefits, the District has adopted a reimbursement plan through Stanislaus Foundation for Medical Care. When submitting your claims for reimbursement, please complete the following information to expedite your payment:

Subscriber's (Retiree) Name: Subscriber's SSN:

Patient's Name: Patient's Date of Birth:

Pharmacy receipts must show: Please mail all claims to:

• Patient's Name # of Receipts Stanislaus Foundation for Medical Care

• Drug Name P. O. Box 576007

• Prescription Number Modesto, CA 95357-6007

• Co-Payment Amt Paid Tel: (209) 527-2430

San Joaquin Delta College District Contact: Suzanne Franco • (209) 954-5016 • sfranco@deltacollege.edu

I’m 65!! I’m 65!! What happens What happens

now?now?

You must enroll in Part A and Part B.

CVT will enroll you in Part D

A copy of your card must be provided to CVT and to the District.

Medicare OverviewMedicare OverviewMedicare Part A – Hospital

Use when hospitalized

Medicare Part B – MedicalDoctor’s appointments

Medicare Part D – PrescriptionCoordinated with CVT coverage

Medicare Part AMedicare Part AIf you will receive a Social Security check

you will automatically qualify for Part A.If you do not automatically qualify, you

may qualify through your current spouse or previous spouse. Please check with the SSA for additional information.

Ineligible Faculty members will receive information from STRS regarding automatic payment of Part A. You will need to enroll in the program offered by STRS.

Medicare Part BMedicare Part BYou must activate your Medicare Part B. Part B Premiums are reimbursed by the

District once a quarter. Documentation of your premium is to be submitted to the District annually for covered individuals.

Both retiree and spouse are eligible for the reimbursement. Checks are sent directly to our retiree only.

The District cannot electronically transfer the reimbursement to your bank account.

Medicare collects premiums in advance while the District reimburses in arrears.

It is the retirees responsibility to notify the District of any rate changes.

Medicare Part B Medicare Part B Reimbursement Schedule

Checks are issued 30 days after the

close of the Quarter.

January – March April 30thApril – June July 31stJuly – September October

30thOctober – December January 31st

Medicare Part DMedicare Part DCalifornia’s Valued Trust will enroll you in

Medicare Part D. Prescription plan name: SILVERSCRIPTPlan is coordinated with regular

prescription plan. If you have a prescription that is not

covered by SilverScript then CVT covers the prescription if previously allowed.

Coordination is automatic.Some prescriptions may require pre-

authorization or an override. CVT processes the override for our retired members.

Separate cards will be issued for medical and prescription coverage.

Miscellaneous QuestionsMiscellaneous Questions I received an adjustment to my Part B Premium – how come?

Those individuals with a higher gross adjusted income are being assessed higher Part B premiums. The District will honor the higher rates for reimbursement. Documentation will be required.

What happens to my spouse’s coverage if I should pre-decease my spouse? Coverage is terminated at the end of the month in which our retiree deceases. Your spouse will be provided the option of continuing to purchase coverage. The plan will not be the same but is similar. The approximate cost for the medical, dental and vision coverage is $425/mo with Medicare Parts A and B activated.

I’m over 65 but my spouse is not. What medical cards does my spouse use? Your spouse will continue to use the regular Blue Cross medical card. You will receive a separate medical and prescription card with your name on it. If your spouse will be 65 before you then your spouse will receive individual personalized cards.

Now that I have Medicare, what do I give/tell my doctor? You will need to give the provider both your Medicare card and your Blue Cross card. Medicare will become your primary coverage and Blue Cross will be your secondary.

Do I keep my dental and vision coverage now that I am eligible for Medicare? Yes. These coverage’s do not change.

Miscellaneous QuestionsMiscellaneous Questions I am under 65. Will my group number change on my

Medical plan now that I have retired? Yes, you will receive new medical cards with a new group number. Please continue to use your regular card until you receive the new card.

Can I use my coverage if I decide to reside outside of California or the United States? Blue Cross provides regular coverage for those residing within the United States. There will be minimal coverage for those residing internationally. If either circumstance applies, you will need to contact Blue Cross Blue Card for the proper billing procedures.

If I marry after I retire, can I add my spouse and dependents?Yes. Documentation will be required.

What happens when I reach my Medicare Part D “coverage gap”?

CVT will pick up the cost of the prescriptions when you fall into the coverage gap between $2930 and $4700. You will not experience any interruption in coverage.

Important Contact Important Contact NumbersNumbersCalifornia’s Valued Trust – Rep:

Tracy P(800) 288-9870

Blue Cross Blue Card(800) 810-2583

Medicare(800) 633-4227

SilverScript Pre-authorization(800) 294-5979

Medicare and You – publicationwww.medicare.gov/publications