Understanding Your Benefits - Retirees Service Center

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Understanding Your Benefits - Retirees Service Center
Understanding
Your
Benefits
2012 Benefits Summary Information Booklet
for Retirees
Table of Contents
Important Benefit Plan Changes for 2012 3
Medicare Credible Coverage 4
HIPAA Compliance 4
COBRA 4
Pet Insurance 4
Find a Doctor 4
Medical Coverage Options 5
Dental 9
Vision 11
Life and Accidental Death & Dismemberment Insurance 12
Online Benefit Account Information 13
Qualifying Events for Changes 14
Traveling Abroad 15
Vendor Contacts
Back Cover
Benefits Staff
Back Cover
Related Links
Back Cover
NOTE THE SMALL (but important) PRINT: While we make every effort to present this information accurately, this document
is a summary overview. That means lots of details, explanations, and qualifiers are left out. It is intended only to provide general
guidance, and you should not rely upon it as a complete or binding explanation of Georgia State University’s benefit program. If
this summary information differs from the language or intent of the formal published descriptions and/or legal plan documents of
these benefit programs, that information prevails.
2
Benefit Plan Changes for 2012
* IMPORTANT *
Open Enrollment
October 24 – November 18
New Networks for Medical Plans with BlueCross
BlueShield of Georgia
BOR PPO and HSA (HDHP) PPO will no longer be
available.
The New Networks are as follows:
• BOR PPO becomes Blue Open Access POS
• HSA PPO (HDHP) becomes HSA Open Access POS
For both POS plans you will receive a new healthcare card
for you and any dependents to reflect this change. You do not
have to re-enroll for the 2012 plan year unless you wish to
change the level of coverage or medical plans. Please be sure to
check with your current doctor(s) to ensure membership in this
network. The monthly premium will increase by 5.2%.
For the HSA Open Access POS plan only the employer/
employee monthly premium contribution will change from
90/10 to 85/15.
What is Open Access POS Plan?
Blue Open Access POS is a point-of-service plan, which
means employees will have the flexibility to choose doctors
in or out of network. In-network will of course cost less than
out-of-network care. You and your dependents will also have
the added bonus of seeing these doctors without the need of a
referral. You will need to verify with your current healthcare
provider(s) that they are in this network or you will be subject
to the out-of-network benefits.
Medco
Change in prescription plan with Medco’s elimination of
quarterly out-of-pocket maximum and moving to an annual
out-of-pocket maximum as follows:
The following annual out-of-pocket maximum amounts (stop
loss) for members who obtain generic and preferred brandname prescription medications will apply:
Medco (cont.)
• Employee: $1,000
• Employee + Child: (Two (2) covered members): $2,000
• Employee + Spouse: (Two (2) covered members): $2,000
• Family: (Three (3) or more covered members): $3,000
Upon a member reaching the annual out-of-pocket maximum,
the prescription drug co-payments will be waived for any
additional generic and preferred brand-name medications for
the remainder of the calendar year.
BlueChoice Healthcare Plan (HMO) will not accept any new
enrollments. All current members will be allowed to continue in
the plan. The monthly premium will increase by 5.2%.
Kaiser Permanente Healthcare Plan (HMO) will not accept
any new enrollments. All current members will be allowed to
continue in the plan. (Senior Advantage Plan 65+ is still open
for new enrollment). The monthly premium will increase by
8.1%.
Consumer Choice Option
The Consumer Choice Option is eliminated for all medical
Healthcare Plans.
Board of Regents Dental
There is no rate increase for either the BOR Dental Plan or the
Georgia State University MetLife Dental Plan.
Plan Year 2011 “Reminders”
Tobacco Use Surcharge
There is no change to the $50 monthly premium surcharge for
the use of tobacco. A retiree must self identify.
Retirees who turn age 65 after 1/1/2011
Retirees and spouses reaching age 65 have the option to enroll
in Medicare B or pay the full cost of the USG system medical
insurance (employer and employee portion).
3
Important Notices
Coverage Expansion under the Affordable Care Act
Medicare Part D— Creditable Coverage (cont.)
Medicare Part D— Creditable Coverage
COBRA
Coverage of Young Adults under Age 26
Under the Affordable Care Act, you can now keep your young
adult(s), beginning at age 19, on your medical insurance
plan until they turn 26 years old. (See page 15 for dependent
coverage details).
Medicare eligible covered members must make a decision
to continue with their prescription drug coverage offered
through the healthcare plans of the Board of Regents or
whether to enroll in a Medicare Part D prescription drug plan.
If you participate in the Open Access POS healthcare plan,
the prescription drug coverage that you currently have with
the Board of Regents is deemed to be, on average, at least as
good as the standard Medicare Part D coverage. This is called
creditable coverage.
If you are in HSA Open Access POS, you may want to research
a Part D plan. You will find a helpful tool at www.cms.gov.
If you are a current Kaiser Permanente Senior Advantage
member, Kaiser Permanente will automatically serve as your
Medicare Part D provider.
The Consolidated Omnibus Budget Reconciliation Act
(COBRA) gives workers and their families who lose their
health benefits the right to choose to continue group health
benefits provided by their group health plan for limited periods
of time under certain circumstances such as voluntary or
involuntary job loss, reduction in the hours worked, transition
between jobs, death, divorce, and other life events. Qualified
individuals may be required to pay the entire premium for
coverage up to 102 percent of the cost to the plan.
NEW! - Pet Insurance with VPI
Accidents and illnesses happen to pets just as readily as they do in children. And though advances in veterinary
medicine help treat and cure many conditions, the costs of these treatments are increasing. What would you do if
your pet got sick or hurt today? Would you have enough in savings to cover the veterinary costs? VPI Pet Insurance can help
you pay for your pet’s veterinary expenses. VPI Pet Insurance is offering Georgia State University students, staff, and retirees
a 5% group discount on coverage per pet up to a discount of 15% for three eligible pets.
Pet insurance also provides a financial safety net for unexpected veterinary expenses. With pet insurance, you can focus on
giving your pet the best care possible, instead of focusing on the cost of treatment.
VPI has a variety of plans to choose from with coverage for preventive care, accidents, illnesses and diseases, including cancer.
Log on to the site to find out more information about coverage:
• www.petsvpi.com
• Under “Search for Your Company,” start typing in Georgia State University.
Once you see it in the box, click the “Search” button.
You can also call 877-PETS-VPI (877-738-7874). Simply mention that you are a
retiree of Georgia State University. You will be billed directly for this benefit.
4
Find a Doctor
Instructions on how to find a doctor for the:
■HMO
■Open Access POS and
■HSA Open Access POS Plans
1. Go to bcbsga.com/bor.
2. Click on “Find a Doctor.”
3. Click on “Georgia Providers for Individual Plans and Group Plans (through your
employer).”
4. On the Basic Information tab select “Doctor & Other Health Professionals.”
5. A search by Name, Specialty or Sub-Specialty is optional.
6. You will be prompted to enter the demographic information for your search.
7. Next click on the Insurance Plan Information tab.
8. Select the state in which you need service (you have the option of entering the
alpha prefix as well).
9. Select the type of healthcare/medical plan you are enrolled in.
10. Select the plan type.
11. Click the Additional Options tab to filter your search by gender, language,
etc...
12. Click the
button at the bottom of page.
5
Medical Open Access POS
Calendar year deductible
(Individual/family)
Out-of-pocket maximum
(Individual/family)
Office Visits and Services
Wellness: routine exams (physical, eye),
immunizations, well-child care, PSA and
mammograms
Illness or injury: physician office visits
X-ray, lab, and diagnotic tests; allergy testing;
outpatient surgery; urgent care services
Maternity care prenatal, delivery, and
postnatal
Emergency Room Services
Emergency room
In-Network
Out-of-Network
$300/$900
$400/$1,200
$1,000/$2,000
$2,000/$4,000
No office co-pay. Plan pays 100% of network
rate. Based upon national guidelines for age
and gender-appropriate services.
Not covered
$20 Co-pay per office visit
90% Of network rate; subject to deductible
60% Of network rate; subject to deductible/
balance billing
60% Of network rate; subject to deductible/
balance billing
90% of network rate after an initial visit
copayment of $20; not subject to deductible.
There will be no copayments charged for
subsequent visits
60% Of network rate; subject to deductible/
balance billing
90% Of network rate after a $75 co-pay;
copayment is reduced to $50 if referred by
24/7 nurseline; subject to deductible
90% Of network rate after a $75 co-pay;
copayment is reduced to $50 if referred by
24/7 nurseline; subject to deductible
Inpatient Services
Physician services, surgery, anesthesiology,
90% Of network rate; subject to deductible
60% Of network rate; subject to deductible
radiology, pathology, maternity/delivery
Note: some surgeons and/or hospital physicians, anesthesiologists, pathologists, and/or radiologists may not be a part of the participating
physician program/national participating provider network. If you incur services with these non-participating providers, you will be subject to
balance billing. See definition of balance billing below.
Pharmacy Benefit - Medco
30-Day supply for most prescriptions
• Generic
$10 Co-pay
• Preferred brand name
$30 Co-pay
• Non-preferred brand name
20% Co-pay (min. $40/Max. $100)
Not covered.
Up to a 90-day supply - Medco by mail
• Generic
$25 Co-pay
• Preferred brand name
$75 Co-pay
• Non-preferred brand name
20% Co-pay (min. $100/Max. $250)
Definitions
Deductible: Amount you pay out of pocket each calendar year prior to any benefits payable by the healthcare plan.
Co-payment: Amount you pay per office visit or prescription. UCR: Refers to the usual, customary and reasonable fee as set by
Blue Cross Blue Shield of Georgia (BCBSGA).
Balance billing is the amount charged over the usual, customary and reasonable (UCR) fee as set by BCBSGA. If you use the
participating provider program or national participating provider network you will minimize your out-of-pocket expenses. If you
access services outside the networks, you will be subject to balance billing.
For the BCBS wellness care guide, please click here or visit www.bcbsga.com/bor.
6
Medical HSA Open Access POS
In-Network
Out-of-Network
Calendar year deductible
$1,500/$3,000
(Individual/family)
Calendar year maximum out-of-pocket
$3,000/$6,000
$6,000/$12,000
(Stop loss) (individual/family)
The high deductible amount is significantly offset by your monthly premium savings. You must meet the family deductible before benefits
are payable for any family member.
Office Visits and Services
Wellness: routine exams (physical, eye),
immunizations, well-child care, PSA and
Plan pays 100%
Plan pays 70% subject to balance billing
mammograms
Physician office visits, laboratory fees,
maternity, outpatient surgery, inpatient
90% Of network rate; subject to deductible
70% Of network rate; subject to deductible
services
Outpatient hospital/ facility —
Anesthesiologist, pathologist, or radiologist
90% Of ucr charges; subject to deductible
70% Of network rate; subject to deductible
For services/consultations
Note: some surgeons and/or hospital physicians, anesthesiologists, pathologists, and/or radiologists may not be a part of the
Participating physician program/national participating provider network. If you incur services with these non-participating providers,
You will be subject to balance billing.
Emergency Room Services
Emergency room
90% Of network rate; subject to deductible/
70% Of network rate; subject to deductible/
balance billing
balance billing
Behavioral Health
Inpatient
90% Of network rate; subject to deductible;
Maximum benefit coverage of 60 days per person per plan year; 90 days lifetime
Outpatient
90% Of network rate; subject to deductible
Maximum benefit coverage of 20 visits per person per plan year.
Chiropractic Care
Limited to 20 visits — not subject to deductible
Pharmacy Benefit - Express Scripts
Open formulary
Subject to quantity limits and pre-authorization review. Other exclusions apply
Rx cost
Plan pays 90%
Plan pays 90%
Definitions
Deductible: Amount you pay out of pocket each calendar year prior to any benefits payable by the healthcare plan.
Balance billing: is the amount charged over the Usual, Customary and Reasonable (UCR) fee as set by BCBSGA.
For the BCBS wellness care guide, visit www.bcbsga.com/bor.
7
Medical -
Blue Choice and Kaiser Permanente HMO
Calendar year deductible and out-of-pocket
maximum
Office Visits and Services
Wellness routine exams, immunizations,
well-child care, PSA and mammograms
Illness or injury: physician office visits
X-ray, lab, and diagnotic tests; allergy testing;
outpatient surgery; urgent care services
Maternity care prenatal, delivery, and
postnatal
Emergency Room Services
Emergency room
(1) After hours/urgent care
(2) Ambulance
Inpatient Services
Physician services, surgery, anesthesiology,
radiology, pathology, maternity/delivery
Pharmacy Benefit - Medco
30-Day supply
Blue Choice HMO
(retiree must be under age 65)
Kaiser HMO
(contact Kaiser when Medicare
eligible)
None
None
No office co-pay
No office co-pay
$15 Co-pay per office visit
$15 Co-pay per office visit
100% Paid by insurance
100% Paid by insurance
100% Paid by ins. After $15 co-pay for
initial doctor visit
100% Paid by ins. After $15 co-pay for
initial prenatal, delivery and first
post-partum visit
$75 Co-pay per office visit
$30 co-pay
Paid at 100% when medically necessary
$75 Co-pay per office visit
$30 co-pay
$75 co-pay
100% paid by insurance;
$200 hospital co-pay
100% paid by insurance;
$200 hospital co-pay
$10 Co-pay for generic
$25 Co-pay for name brand
Definitions
Copayment:
8
Fixed amount you pay per office visit or prescription.
Kaiser pharmacy: mail order available
$10 Generic/$25 name brand
Network pharmacy:
$16 Generic/$31 name brand
Dental Board of Regents Indemnity
The Board of Regents Indemnity dental plan is administered through MetLife. There are many online services on their website,
www.metlife.com/mybenefits where you may elect to:
• View your personal coverage and claims information
• Sign up to receive e-mail alerts each time a dental claim is processed.
• Opt to turn off the delivery of paper Explanation of Benefits statements (EOB’s) and utilize
• View MyBenefits to access and print future EOB’s.
Registration is simple!
• Go to: www.metlife.com/mybenefits
• Enter “Georgia State University” as company name under Account Sign In
• Highlight BOR dental plan or the GSU dental plan, click submit
• Click Register Now
• Complete steps one through three
• Click Register
MetLife
Board of Regents Indemnity
Calendar year deductible: preventive
Calendar year deductible: basic/major
Annual plan maximum benefit per calendar year
Preventive services: two cleanings per year, oral exams,
x-rays (limit x-rays to ADA recommended timing).
Basic services: fillings, extractions, root canals, crowns,
bridge repair
Major services: crowns; inlays; dentures; bridges
Orthodontia Lifetime Maximum (6 month waiting period)
N/A
$50 Per member
$1200 Per member
Paid at 100% of network rate;
subject to deductible
Paid at 80% of network rate
Paid at 80% of network rate;
subject to deductible
$1000 per member at
Network Rate
NOTE: Balance billing is the amount charged by your dentist that is more than the plan’s allowed amount for that service.
Members who use non-network dental providers will be responsible for any balance billing charged by their dentist
Monthly Dental Premiums
Retiree Only
Retiree + Spouse
Retiree + Child
Family
$30.84
$61.66
$58.58
$98.66
9
Dental Georgia State University MetLife
The Preferred Dentist Program (PDP) dental plan is administered through MetLife. There are many online services on their
website, www.metlife.com/mybenefits where you may elect to:
• View your personal coverage and claims information
• Sign up to receive e-mail alerts each time a dental claim is processed.
• Opt to turn off the delivery of paper Explanation of Benefits statements (EOB’s) and utilize
• Access MyBenefits to access and print future EOB’s.
Registration is simple!
• Go to: www.metlife.com/mybenefits
• Enter “Georgia State University” as company name under Account Sign In
• Highlight BOR dental plan or the GSU dental plan, click submit
• Click Register Now
• Complete steps one through three
• Click Register
MetLife PDP
In-Network
Calendar year deductible: preventive
Calendar year deductible: basic/major
Annual plan maximum benefit per calendar year
Preventive services: two cleanings per year, oral
exams, x-rays
Basic services: fillings, extractions, root canals,
crowns, bridge repair
Major services: crowns; inlays; dentures; bridges
Orthodontia lifetime maximum (6 month waiting
period)
Out-of-Network
N/A
$50 Per member/$150 per family
$1200 Per member
Paid at 100% of PDP fee
Paid at 70% of PDP fee
Paid at 50% of PDP fee
$1000 Per child; paid at 50% of PDP fee
$100 Per member/$300 per family
$750 Per member/$300 per family
Paid at 100% of PDP fee/subject to
deductible
Paid at 70% of PDP fee/subject to
deductible
Paid at 50% of PDP fee/subject to
deductible
$750 Per child; paid at 50% of PDP fee
NOTE: Balance billing is the amount charged by your dentist that is more than the plan’s allowed amount for that service.
Members who use non-network dental providers will be responsible for any balance billing charged by their dentist. A PDP fee
refers to the fees that participating PDP dentists have agreed to accept as payment in full.
Monthly Dental Premiums
Retiree Only
Retiree + Spouse
Retiree + Child
Family
10
$25.47
$46.10
$58.28
$85.81
Vision UnitedHealthcare Vision
The vision plan is administered through UnitedHealthcare. Their network includes the following:
• All Georgia Optometry Locations
• All UnitedHealthcare Panel Doctors
• All UnitedHealthcare Retail Locations (Wal-Mart, For Eyes, Doctors Visionworks)
You can go online to print ID cards by visiting www.myuhcvision.com.
Benefits Frequency
Exam - Provided by a network optometrist or
ophthalmologist
Lenses and Lens Options
• Lined bifocal
• Ft35
• Lined trifocal
• Scratch coating
• Plastic bifocals
• Plastic trifocals
Frames
Option 1 - Materials Only
Option 2 - Exam and Materials
Lenses once every 12 months
Frames once every 12 months
Contacts once every 12 months
Exam once every 12 months
Lenses once every 12 months
Frames once every 12 months
Contacts once every 12 months
Not covered
100% covered after$10 co-pay
100% covered
Additional lens options may be available at a discount, please see the provider for
details.
Receive a $130 frame allowance applied toward the retail price of a frame at any
network provider. Your allowance applies to any frame on the market today. If the frame
costs less than the allowance, you have no additional out-of-pocket expense, other than
applicable co-pay. If the frame costs more than the allowance, you are only responsible
for the difference, plus any applicable co-pay.
Covered-in-Full Contact Lenses
Contacts (including disposables), the fitting/evaluation fees, and up to two follow-up
visits are covered in full. If covered disposable contact lenses are chosen, up to four
boxes are included when obtained from a network provider. (In lieu of eyeglasses,
contacts must be part of the UnitedHealthcare Vision covered selection.)
Non-Covered Contact Lenses
A $125 allowance is applied toward the fitting/evaluation fees and purchase of contact
lenses outside of UnitedHealthcare Vision covered-in-full contacts. The materials
co-pay does not apply.
Out-of-Network Benefits - Exam
Exam not covered
Exam: $40.00 (reimbursement amount)
Out-of-Network Benefits - Reimbursement Amount
Frames: $45.00
Single Vision: $40.00
Bifocal: $60.00
Trifocal: $80.00
Lenticular: $80.00
Contacts (in lieu of glasses): $125.00
Contacts - Medical: $210.00
Vision Premiums
Retiree Only
Retiree + Spouse
Retiree + Child
Family
Option 1
$5.52
$9.51
$9.05
$13.93
Option 2
$7.11
$12.82
$12.21
$17.83
11
Life Insurance Board of Regents Life Insurance
Basic Life and Accidental Death & Dismemberment (AD&D) Insurance - Employee Coverage Only
Basic life and AD&D insurance are provided to the employee at no cost. Coverage is provided at 100% through
Georgia State University:
• Basic Life /AD&D: $25,000 prior to age 70
Your AD&D insurance pays a benefit if you die or suffer certain permanent injuries due to a covered accident. This also includes a
Will Preparation Program. Your AD&D coverage ends at age 70.
Dependent Life Insurance - Spouse and Child(ren)
Dependents of retirees are eligible for life insurance, up to $5,000. Rates are based on the amount of coverage you elect.
Supplemental Life and AD&D - Employee
Rate per $1,000 of
Age
coverage
<25
$0.09
25 - 29
$0.10
30 - 34
$0.12
35 - 39
$0.13
40 - 44
$0.15
45 - 49
$0.20
50 - 54
$0.30
55 - 59
$0.54
60 - 64
$0.81
65 - 69
$1.58
70+
$2.60
Coverage When You Retire If You Retired After 1/1/88
Dependent Life
Coverage Amount
Rate per month
$5,000
$2.35
$3,500
$1.66
$2,000
$0.94
$1,000
$0.47
Update beneficiary information
anytime by logging on to ADP at
www.portal.adp.com.
Your $25,000 coverage for basic life and AD&D will continue at retirement at no cost to you. AD&D ends at age 70.
• If first enrolled in Supplemental Life on or after 11/1/80 - Reduces to 50% in effect immediately before retirement or $15,000,
whichever is less. This allows for $40,000 of maximum coverage (Basic plus Supplemental).
• If first enrolled in Supplemental Life on or after 1/1/88 - Coverage must be in effect for 10 years immediately prior to
retirement. If not, only Basic and Dependent coverage may be continued at retirement.
• If first enrolled in Supplemental Life prior to 11/1/80 (closed plan) - If you retired prior to age 67, coverage equals the amount
of Basic & Supplemental coverage in force immediately prior to retirement, with a maximum of $125,000. Coverage will
reduce at age 67 and 70. After age 70 supplemental life is reduced to $15,000 for a total of $40, 000 basic plus supplemental.
AD&D ends at age 70.
Go to http://www.usg.edu/hr/benefits_docs/life-ins.pdf to view complete Plan Booklet.
12
Online Access to
Benefit Account Information
Online Resource
ADP Portal Online Benefit Elections
(First time users please refer to the enclosed Employee Self Service
Registration Guide for instructions).
Instructions
1.
2.
3.
4.
5.
Go to: https://portal.adp.com/public/index.htm
Click on Benefits>My Benefits
Key in all demographics on dependents that will be covered
Choose desired medical, dental, and/or vision coverage
Life Insurance
a. Designate Beneficiaries for various life insurance coverage(s)
ADP Benefit Services Payment Setup
1. Go to https://www.benedirect.adp.com/ParticipantWeb/login.jsp
2. Click “Click To Register” under Participant Login
3. Enter required information to complete the registration process
Blue Choice HMO Member Access
1.
2.
3.
4.
•
•
•
•
•
•
Make premium payments
Change bank account information
Change your PCP on BlueChoice HMO without having to call
customer care
View and manage your benefits
Request a new member ID card
Review and print an explanation of benefits (EOB)
HSA Open Access POS Prescription Comparison Tool
Go to http://www.bcbsga.com/bor/
Select Member
Click on “Register Now”
Complete the required fields and your username and password
will be generated immediately
Note: Make sure you have your member ID card handy,
because you’ll need your HCID and Group ID numbers.
1. Login to Member Access at www.bcbsga.com/bor/ with existing
credentials (or create them, if you do not already have Member
Access credentials
2. From “Member Access Overview” page, choose the
“Prescriptions” tab
3. From “Prescriptions /overview” page, choose “Pharmacy
Member Services” (Note: Do NOT choose “NextRx On-line”)
4. From “Disclaimer Page,” hit ‘continue’
5. Choose “Price a Drug” (in the Quick Links box).
6. You should now be at the pricing tool.
13
Traveling Abroad
Traveling Abroad/Outside Service Areas
Open Access POS or HSA Open Access POS
To locate in-network providers out-of-country, go to www.bcbsga.com/bor and click on BlueCard WorldWide. This applies to
members traveling, or living abroad.
Open Access POS
All international providers are considered ‘in-network’ and claims are processed under the Georgia network. For members
working or traveling abroad, a network of hospitals and physicians is available to offer members services throughout the world.
At the physician and outpatient level, the member will need to pay for the services at the time they are performed. The member
will then submit an international claim form along with the original bill for the charges to the BlueCard Worldwide® Service
Center, where they will be translated and the currency converted to U.S dollars. The claim will then be processed through the Blue
Cross and Blue Shield system with payment issued to the member. (Please note: if you use an out-of-network hospital, you will
receive a lower level of coverage).
Blue Choice HMO
Only services for life-threatening injuries or illness will be covered. You will be required to pay the provider at the time medical
services are rendered. A paper claim can then be filed to receive reimbursement for services. You must attach an itemized bill
(translated to English) to your claim, and the billed amount must be converted to the equivalent U.S. currency rate.
Kaiser
As a Kaiser Permanente Member, you have 24-hour worldwide emergency coverage. When you travel outside the service area,
you are covered for any illness or injury requiring emergency care only; routine and preventive care is not covered outside the
service area.
14
Qualifying Events for Changes
Qualifying Events for Changes in Medical, Dental, and
Vision
A retiree will not be permitted to participate in the annual
change period unless he/she elected to take healthcare
coverage into retirement at the time of his/her separation from
employment with the University System of Georgia. During
open enrollment, an eligible retired employee may elect to: (1)
drop or discontinue healthcare coverage; (2) participate in a
different healthcare plan option; and/or (3) reduce his/her level
of coverage. During open enrollment, a retiree shall not be
permitted to add healthcare coverage, or increase the level of
coverage that he/she took into retirement, unless it is the result
of one of the following three qualifying events:
1. The addition of a dependent(s) because of marriage, birth,
adoption or a Qualified Medical Child Support Order
(QMSCO);
2. The loss of a dependent’s health benefit coverage through
a change in a spouse’s group coverage, through COBRA
coverage, through Medicare, or through Medicaid; and
3. A change in a spouse’s employment status that affects
coverage eligibility under a qualified health plan.
Documentation Required
If you have a qualifying event, documentation must be
submitted by fax or mail within 30 days of the event. You are
required to log into the ADP portal: www.portal.adp.com and
click on tabs: Benefits/My Benefits/Family Status Change.
c. The condition existed prior to age 26; and Proof of
incapacity is furnished within 30 days of the dependent
child’s 26th birthday
According to the new regulations, your dependent children
are eligible to remain under the Plan without residency and
financial support requirements. That means you can cover
dependent children up to age 26, who do not live with you, who
you do not claim on your tax return, and/or who is no longer a
full-time student.
If your dependent is disabled and over age 26, you must
provide:
• A copy of the front page of one of your last two year’s
filed federal tax return confirming that you claimed this
dependent. You may take out any financial information
• Proof of incapacity
Dependents turning Age 26:
Once your dependent turns age 26, they are no longer eligible
to remain covered under the University System of Georgia
Healthcare Plan. Your dependent’s coverage will end at the
end of the month when they turn 26. ADP will automatically
remove them from your plan and mail a COBRA packet to the
dependent(s) notifying them of their COBRA enrollment rights.
Dependents
Effective January 1, 2011, eligible dependents were defined as:
• Legal spouse (does not include common law spouse);
• Natural or adopted children ages up to age 26
• Children who have been placed for adoption in connection
with assumption by the person of a legal obligation for the
total or partial support of a child in anticipation of the legal
adoption of such child;
• Step-children ages up to age 26
• Children up to age 26 for whom the covered employee
is the permanent legal guardian if a court has named the
employee as the child’s permanent guardian.
• Unmarried, disabled children beyond age 26 if:
a. They are unable to support themselves; and
b. They depend on the employee for support; and
15
Vendor Contact Information
Benefits
Medical
• Open Access POS
• Blue Choice HMO
• HSA Open Access POS
Dental - BOR
Dental - GSU
Benedirect
Self-Service Portal
403(b), 457, ORP
403(b), 457, ORP
403(b), 457, ORP
Health Savings Account
Medical
Prescription Drug Open Access POS
Vision
Teachers Retirement System
Vendor
Phone Number
Webite
BlueCross BlueShield
1-800-424-8950
www.bcbsga.com/bor
MetLife
MetLife
ADP Services
GSU Help Desk
Fidelity
TIAA-CREF
Valic
U.S. Bank
Kaiser Permanente
1-866-832-5759
1-800-438-6388
1-800-770-7981
1-404-413-4357
1-800-343-0860
1-800-842-2003
1-770-395-4717
1-877-470-1771
1-404-261-2590
https://metlife.com/mybenefits
https://metlife.com/mybenefits
www.benedirect.adp.com
www.portal.adp.com
www.fidelity.com/atwork
www.tiaa-cref.org/georgiastate/
www.valic.com/usg
www.healthsavings.usbank.com
www.kp.org
Medco
1-877-300-5139
www.medco.com
UnitedHealthcare
Teachers Retirement System of Georgia
1-800-638-3120
1-404-352-6500
www.myuhcvision.com
www.trsga.com
GSU Benefits Staff
Staff
Robert Elmore
Corrin Sorteberg
Valerie Ross
Regina Barnett
Kizzy Williams
Phone
Email Address
404-413-3318
[email protected]
404-413-3314
404-413-3323
404-413-3334
404-413-3317
[email protected]
[email protected]
[email protected]
[email protected]
Other Important Links
State of Georgia website information regarding Agencies and Organizations
Board of Regents of the University System of Georgia
Employee Self-Service Portal (ESS) through ADP
Teachers Retirement System of Georgia (TRS)
Social Security Administration Online
Medicare
Internal Revenue Service
Title
Director, Payroll, Benefits,
HRIS
Benefits Manager
Benefits Specialist
Benefits Assistant
Benefits Assistant
www.georgia.gov
www.usg.edu
www.portal.adp.com
www.trsga.com
www.ssa.gov
www.medicare.gov
www.irs.gov
2012 Retiree Benefits Booklet
revised March 2012
One Park Place South, Suite 330
Mailing Address Benefits Georgia State University P.O. Box 3982 Atlanta GA 30302-3982
Phone (404) 413-3330 (404) 413-3335(fax) Email [email protected]

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