Retirees Age 65 and Older

Retirees Age 65 and Older

Retirees Age 65 and Older

As a retiree of ORNL, turning age 65 is a major milestone: important changes occur in your benefits. At age 65, you become eligible for Medicare and your coverage under the ORNL UnitedHealthcare, MetLife and Delta Dental plans ends.

ORNL provides health care benefits to eligible retirees, spouses, and surviving spouses who are age 65 and older. ORNL has chosen Via Benefits to assist retirees with selecting individual health coverage in the Medicare market. As professionals in the health care insurance market (including coverage that works with Medicare), Via Benefits’ licensed benefit advisors will help you evaluate options and enroll in individual coverage that fits your budget and your unique medical, dental, and vision needs.

When you enroll in a Medicare Supplement plan through Via Benefits, ORNL will provide enhanced Medicare Part D prescription drug coverage, the ORNL Rx plan, so you will not experience a gap in drug coverage. That is part of standard Medicare Part D plans and is known as the donut hole. If you are eligible, ORNL will share in the cost of the plan by paying a portion of the ORNL Rx premium. Your share of the ORNL Rx premium is deducted from your pension check.

In addition, if eligible, ORNL will assist with the cost of health care coverage. When you enroll in a Medicare Supplement plan through Via Benefits and in the ORNL Rx plan, ORNL will provide benefit dollars through a Health Reimbursement Arrangement (HRA) that can be used to reimburse health care expenses including insurance premiums and other eligible out-of-pocket health care expenses.

ORNL Medicare Supplement Program

ORNL Medicare Supplement Program

Eligibility

As a retiree, when you reach age 65, your coverage under the UnitedHealthcare medical and MetLife or Delta Dental plans ends, and you are eligible to enroll in a Medicare Supplement plan and dental and vision coverage through Via Benefits. If you have a Health Savings Account (HSA), it will remain in effect for you to use for your eligible medical expenses.

Your spouse and dependents can be covered under the ORNL plans ONLY if you, the retiree, are enrolled in either a UnitedHealthcare medical plan or a Medicare Supplement plan through Via Benefits with prescription drug coverage through the ORNL Rx Plan.

Your younger spouse and dependents may continue coverage under the MetLife or Delta Dental plans until your spouse reaches age 65. Your younger spouse and eligible dependents may continue coverage under the UnitedHealthcare medical plan as long as you, the retiree, enroll in a Medicare Supplement plan through Via Benefits with prescription drug coverage through the ORNL Rx Plan. When your spouse reaches age 65, UnitedHealthcare medical and MetLife or Delta dental coverage ends and your spouse may enroll in a Medicare Supplement plan and dental and vision coverage through Via Benefits. Any eligible dependents may continue coverage through COBRA.

Retiree coverage at age 65

Enroll in Medicare Part A and Part B during your Initial Enrollment Period.
You will receive information from Via Benefits and ORNL Benefits approximately 3 months before you reach age 65 to begin the enrollment process and establish your HRA.
Enroll in a Medicare Supplement plan through Via Benefits and establish your HRA. You may also enroll in a dental and/or vision plan through Via Benefits.
Complete and return the ORNL enrollment form, along with a copy of your Medicare Part A and Part B card to enroll in the ORNL Rx plan.
Your Medicare supplement plan and Rx drug plan will be effective the first of the month you reach age 65.

Spouse coverage at age 65

Enroll in Medicare Part A and Part B during the Initial Enrollment Period.
If retiree is under age 65, your spouse will remain on the UnitedHealthcare plan. Medicare Part A and Part B will become the primary payer and UnitedHealthcare will be secondary.
When the retiree reaches age 65, an over age 65 spouse will also be eligible to enroll in a Medicare Supplement plan through Via Benefits with prescription drug coverage through the ORNL Rx plan.
Your spouse will receive information from Via Benefits and ORNL Benefits to begin the enrollment process.
Once your spouse completes the enrollment process for medical and Rx, benefit dollars will be added to your HRA account for your spouse.

Note for retirees and spouses: If your birthday is on the first of a month, you actually become eligible for Medicare the first of the month prior. For example: for March 1 birthday, you are Medicare eligible on February 1 and lose coverage under the ORNL sponsored-group health plan at the end of January. Otherwise, you are eligible for Medicare on the first day of the month of your 65th birthday.

Health Care Options

Learn how these parts combine to provide you with coverage.

Because you will be choosing coverage that coordinates with Medicare, it’s good to become familiar with what Medicare offers. To decide how to best supplement Medicare, you should take into consideration your budget and the extent of coverage you feel comfortable with. The cost of the supplement or supplements you choose is one of the expenses you may submit to your HRA for reimbursement.

¹The Medicare information provided is intended as a general summary. For more information, please call 1-800-MEDICARE, visit www.Medicare.gov , or refer to the “Medicare and You” book provided to you each year.

Original Medicare consists of Part A and Part B. As a retiree, when you reach age 65 and qualify for Medicare, you automatically receive Part A and become eligible for Part B.

Part A

Provides you with inpatient care and covers inpatient hospital stays, home health care, stays in skilled nursing facilities, and hospice care. Provided at no cost.

Part B

Provides you with outpatient care, and covers physician fees and other medical services not requiring hospitalization. To enroll, contact your Social Security office and keep your Medicare A&B card when it arrives in the mail. You pay a monthly premium.

The ORNL Rx plan, provided by Express Scripts, is included when you enroll in a medical plan with Via Benefits. ORNL Rx coverage is an enhanced Medicare Part D plan which exceeds the level of coverage provided by a standard Medicare Part D prescription drug plan or a Medicare Advantage prescription drug (MAPD) plan.

WHAT YOU CHOOSE

Original Medicare pays for many, but not all, health care services and supplies. A Medicare Supplement Insurance policy can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.

Medigap

Medigap plans are “standardized” policies identified in most states by letters A-N. All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs. Different insurance companies may charge different premiums for the same exact policy. As you shop for a policy, be sure you’re comparing the same policy (e.g., compare Plan A from one company with Plan A from another company). Medigap SELECT policies, if available in your area, require you to use a network of hospitals, doctors, and other health care providers to get full coverage.

Medicare Advantage (Part C)

Medicare Advantage plans often include a drug plan with limited coverage and, because of Centers for Medicare & Medicaid Service rules, very few plans are available that coordinate with the ORNL Prescription drug coverage. In addition, some physicians do not accept these plans. Generally speaking, they are only available to ORNL retirees who live in a rural area. Via Benefits will help determine if a Medicare Advantage plan is available for you.

Dental or Vision coverage

Via Benefits offers separate dental and vision plans. The plans are not sponsored or supplemented by ORNL and enrollment is optional.

HOW TO DECIDE

You may combine the supplemental plans above to create a package of plans that covers all of your needs. Choosing the best combination requires some education and some comparison of plan features and costs. Via Benefits benefit advisors have the experience and knowledge to help. They can determine which plans are available to you and help you choose the best options.

How Health Reimbursement Arrangements Work

An HRA is an employer- provided health plan in which a single account is established for the retiree and spouse.

When you enroll in individual medical coverage through Via Benefits, with the ORNL Rx plan, an HRA account will be established and benefit dollars will be allocated to the account.
Your funds will be prorated based on the month you enroll.
You can use the funds in your account to be reimbursed for premiums and/or your share of eligible health care expenses during the year. You decide how to use the benefit dollars in your HRA account.
If you have an eligible spouse, you and your spouse will have a joint HRA account, and both you and your spouse may claim eligible expenses from the total amount in the account.
Each year, an annual allocation will be made to the account in January. You will also be able to roll over unused benefit dollars from year to year, allowing you to accumulate dollars for future use.

Premiums for Medicare Part B and ORNL Rx Plan
Premiums for Medigap coverage
Dental and vision premiums
Dental and vision expenses not covered by insurance
Out-of-pocket expenses such as deductibles, medical co-pays and your share of coinsurance
For a complete list of HRA-eligible expenses, go to irs.gov or call the IRS at 800-829-3676 and request Publication 502—Medical and Dental Expenses

Once the eligible retiree/surviving spouse or spouse enrolls in individual medical coverage through Via Benefits with the ORNL Rx plan, monies will be allocated for each eligible retiree/surviving spouse or spouse. ORNL will allocate each account with benefit dollars. At the beginning of each subsequent year, ORNL will allocate additional benefit dollars to each HRA.

Note: To qualify for your HRA, ORNL requires that you enroll in a medical plan through Via Benefits with prescription drug coverage through ORNL. If you change plans in future years, you must use Via Benefits to find and enroll in a new medical plan or you will lose your HRA eligibility.

Frequently Asked Questions

When you retire at age 65 or older, you are required to enroll in Medicare Part A and Part B and you will become eligible for the Medicare Supplement plan with ORNL Rx coverage and the HRA.

If you are not yet age 65 and retire, you will be eligible to participate in your existing coverage. Once you reach age 65 you will no longer be eligible for such coverage. You are required to enroll in Medicare Part A & Part B and you will become eligible for the Medicare Supplement plan with ORNL Rx coverage and the HRA.

An HRA is employer-sponsored health coverage, in which a single account is established for the eligible retiree and spouse.
The account is credited with benefit dollars that can be used to pay eligible health care expenses such as premiums for plans that work with Medicare. Unused benefit dollars may be rolled over to the next year.

ORNL will continue to evaluate the marketplace to set the allocation amount. The amount placed in the HRA could increase or decrease in the future, and if it does, you will be informed of any changes in a timely manner.

No. The benefit dollars placed in your HRA will not have cash value to you but will be available to reimburse you for eligible medical expenses, including, for example, individual insurance premiums and eligible out-of-pocket medical expenses.

If you and your spouse are both over age 65 and enrolled in a medical plan through Extend Health with ORNL Rx coverage, the surviving spouse becomes the account holder, and his or her contributions will continue if he or she remains in the plan. When there is no surviving spouse, the estate has 6 months to submit claims for expenses incurred prior to the date of death.

A sample list of eligible expenses is included with this mailing. To view a printable SAMPLE list of the health care expenses that are eligible for reimbursement, visit your Via Benefits online account.

A reimbursement request can be denied for a number of reasons, including an incorrect or incomplete document or an ineligible expense. If a reimbursement you submit is denied, you can learn why in your Explanation of Payment, your online account, or by calling Via Benefits to speak to a representative.

Former employees have qualification requirements to access reimbursement funds. Your Benefit Advisor discussed your specific qualification rules during your enrollment call. Should you want to make changes to your current coverage, we encourage you to contact Via Benefits for assistance to make sure that you understand all the implications of making the change. Call Via Benefits for assistance in understanding your qualification requirements.

Once your request is approved, you should receive your reimbursement within 14 days. If you have elected direct deposit, your reimbursement should be issued within 3 days of the request approval. For quicker access to your reimbursement, sign up for direct deposit online, or use the enclosed direct deposit election form.

Each time Via Benefits processes a request for reimbursement, you will be sent an EOP. This statement includes a summary of your paid reimbursements, available balance, and the amounts you have been reimbursed. A check will be included with the EOP for those without direct deposit. The EOP will list the reason for denial when a reimbursement request is denied.

If you have not received or are unable to locate an EOP, contact Via Benefits. Use the phone number listed in your Welcome Letter.

Automatic Premium Reimbursement allows you to obtain reimbursement without submitting a monthly reimbursement request form. You may activate this feature, if it is available for the plans that you selected, in your online account or through Via Benefits Customer Service. Once you have elected to receive Automatic Reimbursement, you do not have to submit requests for these expenses in order to be reimbursed.

To verify whether or not you chose Automatic Reimbursement, please refer to the Selection Confirmation letter you received from Via Benefits shortly after your enrollment call. You can also check by using your online account or call Via Benefits to speak to a representative.

Automatic Premium Reimbursement is not intended to be the fastest way to be reimbursed. It is intended to remove the burden of submitting monthly premium reimbursement requests.

The majority of automatic reimbursements will arrive in the second month following the start of your plan. The first reimbursement will usually include the first 2 months of premium payments. Timing depends on your specific insurance carrier/health care provider, when your premium payment was received, and when your policy was issued.

Once Automatic Reimbursement begins, it will usually arrive about the same time each month. This may vary depending on when your premium payments to your carrier are made and the timing of the files being sent to Via Benefits.

An Authorization to Release Protected Information (ARPI) form allows you to designate someone of your choice to see your allocation and funding balance, submit reimbursement requests, and check on the status. This permits the person you designated to speak on your behalf without your presence on the telephone.

To print a copy of the ARPI from your online account, go to the Funds & Reimbursements section and select the File Reimbursements Requests link. Next, select the Resource Center tab where you will find the list of available forms including the ARPI form to download and print. You can also call Via Benefits, and they will send you a copy of the form. Once completed, send it to Via Benefits using the contact information on the form. You may cancel this authorization at any time by calling Via Benefits.

If you have questions that are not answered in this guide or online, or if you simply prefer to speak to someone, Via Benefits’ trained representatives are always happy to hear from you.

Via Benefits’ Customer Service Representatives are available Monday through Friday, from 8 a.m. until 9 p.m. ET. Call using the toll-free phone number printed in your Welcome Letter.

To direct your call accurately, the Via Benefits telephone system may ask you to select from a menu of options. If you are calling about the status of an Automatic Reimbursement payment, select option two. If you are calling with questions about your funding account or requests, select option three.

To verify your identity, you may be asked a few questions before you are connected to a representative. Please be prepared to provide your zip code and the last four digits of your Social Security number.