2016 Healthcare Enrollment Guide for New Intel Retirees · MetLife Dental ... You have the option...

2016 HEALTHCARE ENROLLMENT GUIDE FOR NEW INTEL RETIREES 1

2016 HealtHcare enrollment Guide for new intel retireesChoose benefits to power your best life.

Enroll at My Health Benefits website www.intel.com/go/myben or call (877) GoMyBen (466-9236). Healthcare benefit elections are for 2016.

2 2016 HEALTHCARE ENROLLMENT GUIDE FOR NEW INTEL RETIREES

The PurPose of This GuideCongratulations on your retirement from Intel. Since you are no longer

an active employee, it’s time for you and your family to review the

available retiree health plan choices and make your healthcare

decisions for 2016 to help power your best life in retirement.

In this guide, we share what decisions you need to make and provide

plan features and cost comparison charts to help you make informed choices. If you want more, we

outline the best venues for detailed information and how you can get your questions answered.

Decision-support tools within the My Health Benefits website and other resources are available to

you and your eligible dependents. Take advantage of all the available resources to help you prepare.

oPTions To save!You may pay less for coverage that meets your personal needs through individual insurance plans outside Intel. See Aon Retiree Health Exchange: What to Expect for details.

Table of ConTenTsWhat Will I Receive, When Will I Receive It, and What Action Do I Need to Take? ...............................................................3

What’s Available in 2016? .....................................................................................................................................................................................4

Sheltered Employee Retirement Medical Account (SERMA) Eligibility .........................................................................................6

Intel Retiree Medical Plan (IRMP) Eligibility ..................................................................................................................................................7

SERMA: Use Yours Wisely ......................................................................................................................................................................................7

All Plans ...........................................................................................................................................................................................................................9

IRMP Cigna Coinsurance ..................................................................................................................................................................................10

IRMP Cigna Indemnity With and Without Rx .......................................................................................................................................12

A Note on How the Cigna Indemnity Plans Work ..............................................................................................................................14

IRMP Vision Plan ..................................................................................................................................................................................................16

MetLife Dental .......................................................................................................................................................................................................18

Get the Help You Need Before You Enroll .................................................................................................................................................18

Make Your Enrollment Decisions ....................................................................................................................................................................19


WhaT Will i reCeive, When Will i reCeive iT, and WhaT aCTion do i need To Take? Your active employee healthcare coverage is good until the end of the month after your official last day of work. For example, if the last day you work is Nov. 6, your active coverage ends Nov. 30.

Approximately two weeks AFTER your retirement, you will receive two packets from Aon Hewitt:

Packet 1: Understanding COBRA

• Upon retirement, you become a qualified beneficiary and have the right to elect COBRA to continue your healthcare coverage if you were covered under one of the Intel medical/dental/vision options, the Health Flexible Spending Account (“Health FSA”), or the Limited Use Health Flexible Spending Account (“Limited Use Health FSA”) the day before your retirement.

• If you are covered under the Health FSA or Limited Use Health FSA only as a result of carry-over funds from the previous plan year, you do not have a COBRA election right.

• You also become a qualified beneficiary and have the right to elect COBRA to continue your healthcare coverage for the Employee Assistance Program (EAP), the Executive Health Program, and the Health for Life Center (Arizona, New Mexico, and Oregon residents only).

• If you choose to enroll in COBRA, you must enroll within 60 days from the date your active healthcare coverage ends.

• Coverage under COBRA is retroactive to your initial COBRA eligibility date to ensure no lapse in coverage.

• About 30 days prior to your COBRA coverage ending, it is your responsibility to notify Aon Hewitt so you can obtain an updated Retiree Health Enrollment Guide and trigger the 30 day window to enroll in IRMP or another health plan.

For complete information on COBRA, please review Chapter 11 in the Pay, Stock and Benefits Handbook available on the My Health Benefits website at www.intel.com/go/myben or by calling (877) GoMyBen (466-9236).

Packet 2: Plan information on the Intel Retiree Medical Plan (IRMP) and Sheltered Employee Retirement Medical Account (SERMA)

• You may enroll in IRMP within 30 days from a qualified change of status event (for example, your retirement date or the date your COBRA coverage ends). You are encouraged to explore all your health plan options. You may pay less for coverage that meets your personal needs through individual insurance plans outside Intel. See Aon Retiree Health Exchange: What to Expect in this guide for details.

• If you meet the SERMA eligibility rules, a SERMA will be established for you 30-45 days after retirement. SERMA may be used toward IRMP premiums or non-Intel sponsored health insurance premiums as identified below.

You have the option to elect COBRA and delay enrollment in IRMP or non-Intel sponsored health insurance until COBRA coverage ends. However, please note that early termination of COBRA coverage prior to the end of your COBRA coverage period, generally 18 months, is not considered a special enrollment event that would allow you to enroll in Marketplace coverage or another group health plan. For example, if you choose not to pay COBRA premiums although your COBRA coverage period is not exhausted, you will not qualify for special enrollment in a Marketplace and will have to wait for the next Marketplace open enrollment.

Note that if you are retiring from Intel and have a SERMA balance, you may be eligible for Health Insurance Marketplace coverage, but are not eligible for a Marketplace subsidy.

For additional details regarding IRMP and SERMA, see the Intel Retiree Medical Plan and Sheltered Employee Retirement Medical Account Summary Plan Description on the My Health Benefits website at www.intel.com/go/myben or by calling (877) GoMyBen (466-9236).

WhaT’s available in 2016? Intel retiree healthcare benefits for 2016 offer more flexibility and choice than ever before.

• Premiums for Intel Retiree Medical Plan (IRMP) may be high, so take full advantage of the resources available to compare alternatives.

• The Aon Retiree Health Exchange* is available to help all Intel retirees find the right healthcare options and perhaps save money with a plan comparable to the IRMP. Resources available at this one-stop shop are free for you and your family.

• An Intel Catastrophic Rx Health Reimbursement Account (HRA) is available to post-65 retirees enrolled in a Medicare Part D Plan to provide more financial protection and extra peace of mind regarding prescription expenses. No enrollment or election is necessary for this benefit, but you do need to be enrolled in a Medicare Part D Plan.

* Aon Retiree Health Exchange is a service offered through Aon Corporation, and is not an Intel sponsored program.

Why IRMP May Cost More

IRMP continues to be an option to retirees. The cost can be attributed to the increased cost in healthcare and is also com-pounded by the fact that few retirees are enrolling in IRMP as more options become available in the Marketplace.

Over the past few years, the health insurance marketplace has expanded. As a result, individual plans have become more widely available and affordable, and they offer an array of coverage op-portunities, including medical, prescription drug, dental, and vision coverage. To help you assess the many choices available, Intel offers access to Aon Retiree Health Exchange with knowledgeable Benefits Advisors to help you understand all your options.



• Call Aon Retiree Health Exchange at 1 (877) 458-9659

• Select the “For Appointments” option

• Call Aon Retiree Health Exchange at 1 (877) 458-9659

• Select the “For Appointments” option

Your Aon Retiree Health Exchange Benefits Advisor will assist with questions related to the overall transition, SERMA, and enrollment deadlines. The Aon Advisor can also help you prepare to shop and enroll by:

• Sharing that your current group coverage most mirrors a Gold metallic plan level

• Reminding you to review plan design elements such as copays, deductibles, and networks before making an enrollment decision

• Highlighting decision support tools available on the eHealth website

If you request to speak with a licensed agent, then the Aon Benefits Advisor can bring on a representative from eHealth to assist.

When you are ready to enroll in a medical plan, you will need to enroll online through the eHealth website.

Your Aon Retiree Health Exchange Benefits Advisor will educate you on the basics of Medicare, if necessary, along with the different types of plans you will be choosing from.

Your Benefits Advisor will also ask you various questions about your needs and preferences to better understand what types of plans work best for you.

Once you decide on the right plans for you, your Benefits Advisor will walk you through the enrollment process, and assist with completing your application.

A non-Medicare retiree can expect to receive confirmations from eHealth as their application status progresses. The Carrier will also send a confirmation of enrollment once the enrollment is complete.

A Medicare retiree can expect to receive a letter from the Carrier, typically within 10 days of application, called their “Evidence of Coverage.” The retiree can use this as proof of coverage for medical or prescriptions (depending on the plan) prior to their ID card arriving. Shortly afterward (1-2 weeks), the retiree can expect to receive ID cards and a Welcome packet from the Carrier. The Welcome packet contains detailed information about the plan, such as explanation of benefits and drug formularies.

non-MediCare MediCareWhaT You Can exPeCT:

The Aon Retiree Health Exchange: What to Expect

For the vast majority of Intel retirees, transitioning to a health plan through Aon Retiree Health Exchange will mean more plan options to choose from with more affordable premiums. The Aon Retiree Health Exchange is one of the industry’s leading private exchanges of in-dividual coverage options providing you tools, resources, and ongoing personalized support. Since the process for non-Medicare eligible and Medicare eligible individuals is slightly different, we have highlighted below the process depending upon your personal situation.

hoW do i sChedule an aPPoinTMenT WiTh an aon reTiree healTh exChanGe benefiTs advisor

enrollMenT ConfirMaTion

enrollMenT ProCess


shelTered eMPloYee reTireMenT MediCal aCCounT (serMa) eliGibiliTY• If you were hired before Jan. 1, 2014, a SERMA will be established upon your retirement if you are a U.S. employee at the time you

retire and meet any of the retirement eligibility rules.

• If you were hired, rehired, transferred to the U.S. (with no prior U.S. service), or transferred to Intel from a non-participating Intel subsidiary (i.e., McAfee or Wind River) on or after Jan. 1 2014, you are not eligible for SERMA.

• For SERMA Bridge of Service rules go to Intel Pay, Stock and Benefits Handbook, Chapter 10, Life Events and Impact to Intel Benefit and Program.

• For complete information on SERMA, please review the Intel Retiree Medical Plan and Sheltered Employee Retiree Medical Account Summary Plan Description on the My Health Benefits website at www.intel.com/go/myben or by calling (877) GoMyBen (466-9236).

Catastrophic Rx HRA – Capping Your Out-of-Pocket costs under Medicare Part D

Retirees who are enrolled in a Medicare Part D Plan for prescription coverage will not spend more than the Medicare Donut Hole (Coverage Gap) total annual out-of-pocket maximum ($4,850 in 2016). As you may know, Medicare Part D plans cover a broad range of medications at a cost share that changes as your prescrip-tion drug costs increase during the year. With Part D alone, you continue to pay 5% coinsurance for drugs, even after you reach the annual Donut Hole maximum. Intel’s new Catastrophic Rx HRA will reimburse you for that 5% coinsurance.

Retirees do not need to enroll or elect this benefit, but you do need to be enrolled in a Medicare Part D Plan.

To take advantage of this benefit, you simply need to call the Intel Health Benefit Center at (877) GoMyBen (466-9236) and select the “Your Spending Account” option to notify the team you have exceeded the Medicare Part D Donut Hole. Your Spending Account representative will walk you through what you need to do to submit claims for reimbursement.

MEDICARE PART D PLANSPrescription Drug CoverageAmounts noted are 2015 limits

DEDUCTIBLEFIRST $360

INITIAL COVERAGE LEVEL NEXT $2,950 ($3,310 TOTAL)

THE DONUT HOLEUP TO $4,850

CATASTROPHIC Rx HRA COVERAGE

100% paid by you (if applicable)

You pay copayment/coinsurance for each drug

You pay a percentage (65%)of the generic and (45%)

brand name drug cost

You pay a copayment (~5%) for each drug for the remainder of the year and get reimbursed

by Intel through the NEW Catastrophic Rx HRA


inTel reTiree MediCal Plan (irMP) eliGibiliTYMake Sure Your Family Members Are Eligible for Coverage

• It is your responsibility to ensure that only your eligible depen-dents are enrolled in IRMP medical or vision plan options.

• If you are Medicare eligible and your eligible dependent is not, or vice-versa, the Medicare eligible person will be eligible to enroll in one of the IRMP Indemnity options, and the non-Medicare eligible person will be eligible to enroll in the Cigna Coinsurance plan. For a complete description of the dependent eligibility requirements, refer to the IRMP Summary Plan Description (SPD). For a copy of the SPD, contact the Intel Benefits Center at (877) 466-9236, or visit My Health Benefits at www.intel.com/go/myben, click on the My Health Benefits website link, login to UPoint, and select the “Plan Information” tile. If you are accessing the UPoint site for the first time, you will be asked to create a user ID and password to login.

• If you and your eligible dependents are newly enrolling in IRMP, you are required to provide proof of continuous health-care coverage for the previous 18 months. The proof must be received by the Intel Health Benefits Center within 30 days of your enrollment date.

• It is also your responsibility to update your dependent Social Security Number(s) or Taxpayer Identification Number(s) in My Health Benefits in order to comply with reporting require-ments under the Affordable Care Act’s (ACA) individual shared responsibility mandate. If we are missing your dependent Social Security Number(s), an alert will show at the top of My Health Benefits at www.intel.com/go/myben advising you to take necessary steps or to call the Intel Health Benefit Center at (877) GoMyBen (466-9236).

serMa: use Yours WiselYSERMA provides you with the ability to pay for the healthcare plan that best meets your needs. Depending on your SERMA balance, you may use SERMA in the following ways:

• To pay for all or part of your IRMP premium

• To pay all or part of your Aon Retiree Health Exchange plan premium

• To reimburse yourself for the cost of non-Intel sponsored health insurance

Using SERMA for Non-Intel Healthcare Premiums

You may use your SERMA to reimburse yourself for premiums paid for you and your eligible dependents until you exhaust your account. Eligible reimbursements may include premium payments for:

• Individual health insurance

• Individual dental insurance

• Individual vision insurance

• Other employer retiree group plans

• COBRA

• Medicare

• Medigap

• TRICARE

• Long-term care insurance premiums

serMa reiMburseMenTsThe SERMA plan year runs from January 1 through December 31 of each year. You may submit premiums incurred during these dates as long as:

• You were eligible for a SERMA reimbursement on the date the coverage began.

• You file your claim after your coverage began.

• You file your claim before the run-out period ends on March 31 of the following year.

You’re allowed to submit claims for the prior year during the run-out period (January 1 to March 31), as long as the premi-ums occurred while you were eligible to utilize your SERMA. For example, you have until March 31, 2016 to submit a claim for June 2015 premiums. The run-out period provides you extra time to submit your claims. If you do not submit your claims with complete supporting documentation by March 31, your claim will be denied.

If you are enrolled in IRMP, you may also use your SERMA on other eligible healthcare premiums. For example, if you are on the IRMP plan and your spouse is enrolled in another retiree group health plan, you may use your SERMA toward both your IRMP premium and your spouse’s non-Intel retiree premium expense.

Checking Your SERMA

Call the Intel Health Benefits Center at (877) GoMyBen (466-9236) or go to the website at www.intel.com/go/myben click on the My Health Benefits website link, login to UPoint and select the “Your Spending Account” tile. If you are accessing the UPoint site for the first time, you will be asked to create a user ID and password to login. Here, you can:

• View your SERMA balance – Note it takes 45-60 days AFTER your retirement date for your SERMA to be calculated and loaded into the tool

• Submit claims (you have the option to submit claims online, by fax, or by mail)

• Check the status of your claims

• Learn more about eligible expenses

Using SERMA for IRMP

If you enroll in IRMP, you may use your SERMA to offset your monthly premium for medical and/or vision coverage until you exhaust your account. Upon enrollment, you may elect how much of your IRMP premium you would like paid from your SERMA each month; 25%, 50%, 75%, or 100%. Your IRMP premium payments will be paid directly from your SERMA; you do not need to submit a claim for reimbursement. The percentage you elect will apply to both you and your enrolled dependent’s premiums. If you choose a SERMA contribution other than 100%, you are responsible for paying the remainder of the premium cost.

SERMA “Opt Out” Option

Non-Medicare retirees with access to SERMA will not qualify to receive federal premium tax credits. If you are considering using Federal premium tax credits to reduce the cost of health insur-ance purchased through an eligible exchange, you should seek advice from a tax advisor. If you are enrolled in Medicare, you are ineligible for federal premium tax credits so the SERMA Opt Out program does not pertain to you.

If you are not Medicare eligible and you determine that you are eligible for the premium tax credit, you may choose to “Opt Out” of SERMA for the remainder of the current calendar year in order to qualify. When you “Opt Out,” your SERMA balance is frozen and you will not be able to use SERMA to pay for Intel or non- Intel sponsored healthcare premiums mentioned above for you or your dependents. Your “Opt Out” election will carry over from year to year unless you “Opt In” again during the next Annual Enrollment following the same process.

There are online tools that help you identify if your income levels are such to qualify for federal premium tax credits, and the Benefits Advisors at the Aon Retiree Health Exchange can guide you through that process, if needed. If you want to learn more now, these sites are helpful: www.healthcare.gov and kff.org/health-reform.

For those retiring during the year, you will have 31 days from the date of your retirement to notify the Intel Health Benefits Center, Your Spending Account that you want to “Opt Out” of SERMA so that you may qualify for the Federal premium tax credits. If you take no action, the default is to “Opt In” to SERMA. Remember, your “Opt Out” election will carry over from year to year unless you “Opt In” again during the next Annual Enrollment.

If you have questions about the option to “Opt Out” of your SERMA, or you wish to “Opt Out,” please contact the Intel Health Benefits Center by calling (877) GoMyBen (466-9236) and select Your Spending Account option. You must call to “Opt Out” as it cannot be completed online.


http://kff.org/health-reform/


Frequently Asked Questions about SERMA

Q: Can I be enrolled in IRMP and use my SERMA to purchase other insurance as well?

Yes, you can enroll in IRMP and also request SERMA reimburse-ment for eligible premiums such as the MetLife Dental Plan.

Q: Can I use my SERMA to enroll in only the IRMP Vision plan and use my SERMA to purchase other insurance as well?

Yes, you can enroll in only the IRMP Vision plan and be reimbursed other eligible premiums you may have in 2016.

Q: Can I use SERMA to purchase coverage for my spouse or dependent children?

Yes, you can use your SERMA to purchase individual insurance for yourself, your spouse, and your eligible dependent children.

Q: If I want to remain enrolled in IRMP, may I use SERMA to purchase other coverage for my family?

Yes. You may request reimbursement for eligible non-IRMP premiums for your eligible dependents.

Q: I am enrolled in my spouse’s employer group health plan. Can I use SERMA to pay the premium?

No, you may not use SERMA to reimburse yourself for another company’s active employee group health plan.

Have a different question? Contact the Intel Health Benefits Center at (877) GoMyBen (466-9236).

The medical plan options available under IRMP to eligible retirees and their eligible dependents are:

• Cigna Coinsurance Plan – available to non-Medicare (typically under age 65) retirees. For more information, go to page 10.

• Cigna Indemnity Plan with Rx – available to Medicare (typically age 65+) retirees. For more information, go to page 12.

• Cigna Indemnity Plan without Rx – available to Medicare (typically age 65+) retirees. For more information, go to page 12.

Additional plans:

• IRMP Vision Plan through VSP – available to all retirees. For more information, go to page 16.

• Dental Plan through MetLife – available to all retirees. For more information, go to page 18.

all Plans


IRMP Cigna Coinsurance Plan Benefit Summary: Additional details available at www.intel.com/go/myben or in the IRMP Summary Plan Description (SPD); call Intel Benefits Center at 877-GoMyBen (466-9236) to request the IRMP SPD. Benefits In-Network Out-of-Network

Annual Deductible $600 Individual/$1,200 Family$600 Individual/$1,200 Family (separate from in-network deductible)

Out-of-Pocket Maximum $3,000 Individual/$6,000 Family $3,000 Individual/$6,000 Family

Major Medical Lifetime Maximum Unlimited Unlimited

Inpatient In-Network: Coinsurance applies after deductible is met

Out-of-Network: Coinsurance applies after deductible is met and is subject to reasonable and customary costs

Inpatient Hospital 20% coinsurance 40% coinsurance

Skilled Nursing Facility

20% coinsurance; limited to 100 days per calendar year 40% coinsurance

Home Health 20% coinsurance; $5,000 lifetime maximum

40% after deductible is met with a $5,000 lifetime maximum

Inpatient Mental Health (preauthorization required)

100% covered 40% coinsurance

Outpatient In-Network: Coinsurance applies after deductible is met


Physician Office Visit 20% coinsurance 40% coinsurance

Ambulatory Surgical Center 20% coinsurance 40% coinsurance

Outpatient Hospital 20% coinsurance 40% coinsurance

Occupational and Physical Therapy 20% coinsurance 40% coinsurance

Speech/Language Therapy 20% coinsurance 40% coinsurance

Ambulance 20% coinsurance 40% coinsurance

Emergency Room 20% coinsurance 40% coinsurance

Emergency Worldwide Coverage 20% coinsurance 40% coinsurance

Urgent Care 20% coinsurance 40% coinsurance

Urgent Care Worldwide Coverage 20% coinsurance 40% coinsurance

Prosthetic Devices 20% coinsurance 40% coinsurance

Mental Health & Substance Abuse 20% coinsurance 40% coinsurance

2016 Monthly PremiumYou Only, Spouse* Only, Child(ren)** Only

You + Spouse, You + Child(ren),** Spouse + Child(ren)** You + Spouse + Child(ren)**

$1,017 $2,033 $3,050

irMP CiGna CoinsuranCe (non-Medicare, typically under age 65, retirees) What you need to know before you enroll in this plan:

• Certain compound medications are not covered.

• Resources are available to help you through Aon Retiree Health Exchange. Benefits Advisors can help you navigate the many comparable plans available if you’d like to choose one of those options.

* For a complete description of the spouse and dependent eligibility requirements, refer to the IRMP Summary Plan Description (SPD).

** Same price for child or multiple children.

http://www.intel.com/go/myben


IRMP Cigna Coinsurance Plan Benefit Summary – Continued

Outpatient In-Network: Coinsurance applies after deductible is met


Diagnostic Tests/ Lab Services 20% coinsurance 40% coinsurance

Routine Outpatient X-Ray includes Radiation Therapy

20% coinsurance 40% coinsurance

Routine Physical Covered at 100% Covered at 100%

Additional Benefits In-Network: Coinsurance applies after deductible is met


Routine Chiropractic20% coinsurance; limited to 30 visits per year combined in- and out-of-network

40% coinsurance; limited to 30 visits per year combined in- and out-of-network

Routine Podiatry 20% coinsurance 40% coinsurance

Non-Emergency Transportation 20% coinsurance 40% coinsurance

Acupuncture 20% coinsurance; limited to 30 visits per year combined in- and out-of-network

40% coinsurance; limited to 30 visits per year combined in- and out-of-network

Preventive Dental Not covered Not covered

Vision Exam Not covered Not covered

Routine Hearing 20% coinsurance 40% coinsurance

Prescription Benefit (Certain compound medications are no longer covered; if this applies to you, Express Scripts will be in touch.)

Retail (34 day supply)

Mail/Walgreens/Costco (90 day supply)

Retail Penalty* (34 day supply)

Generic $10 $20 $20**

Preferred Brand20% coinsurance$25 minimum/ $60 maximum

20% coinsurance $62.50 minimum/ $150 maximum

50% coinsurance**$25 minimum

Non-Preferred Brand40% coinsurance $40 minimum/ $100 maximum

40% coinsurance $100 minimum/ $250 maximum

50% coinsurance** $40 minimum

Formulary (list of plan approved drugs) Please review at www.express-scripts.com/intel

Note: IRMP Indemnity with RX is Creditable to Medicare Part D. * Penalty applies after the first two purchases of a maintenance (long-term) prescription at a retail pharmacy.** The out-of-pocket costs beyond the standard benefit will not apply toward deductible/out-of-pocket maximums.

http://www.express-scripts.com/intel


IRMP CIGNA Indemnity Plan with Rx AND without Rx Benefit Summary: Additional details available at www.intel.com/go/myben or in the IRMP Summary Plan Description (SPD); call Intel Health Benefits Center at 877-GoMyBen (466-9236) to request the IRMP SPD. Also refer to Medicare Part A & B (www.medicare.gov).Benefits Medicare* IRMP Cigna Indemnity Medicare-eligible

Annual DeductiblePart B Deductible = $167 (projected for 2016) See Inpatient Hospitalization section for Inpatient Deductible

$500 Individual/$1,000 Family

Out-of-Pocket Maximum Not applicable $2,000 Individual/$4,000 Family

Major Medical Lifetime Maximum (if applicable) Not applicable Unlimited

Inpatient Medicare* Coinsurance applies after deductible is met

Inpatient Hospital $1,132 deductible (Days 1–60); $283 (Days 61–90); $566 (Days 91–150)

20% of Medicare allowable after deductible is met

Skilled Nursing Facility

Pay for each benefit period, following at least a three day covered hospital stay. Days 1-20: $0 for each day; Days 21-100: $141.50 for each day. There is a limit of 100 days for each benefit period.

20% of Medicare allowable after $500 plan deductible; 100 days per calendar year

Home HealthCovered 100% by Medicare. There are no copayments for Medicare-covered home health visits.

Covered 100% by Medicare. There are no copayments for Medicare-covered home health visits.

Inpatient Mental Health 20% of Medicare approved 20% of Medicare allowable after deductible is met

Outpatient Medicare* Coinsurance applies after deductible is met

Physician Office Visit 20% of Medicare approved 20% of Medicare allowable

Mental Health and Substance Abuse 20% of Medicare approved 20% of Medicare allowable

Ambulatory Surgical Center 20% of Medicare approved 20% of Medicare allowable

Outpatient Hospital 20% of Medicare approved 20% of Medicare allowable

2016 Monthly Premium

With or Without Rx You Only, Spouse* Only, Child(ren)** Only

You + Spouse, You + Child(ren),** Spouse + Child(ren)** You + Spouse + Child(ren)**

With Rx $584 $1,167 $1,750

Without Rx $188 $375 $562

* For a complete description of the spouse and dependent eligibility requirements, refer to the IRMP Summary Plan Description (SPD).** Same price for child or multiple children.

irMP CiGna indeMniTY WiTh and WiThouT rx (for Medicare, typically age 65+, retirees)IMPORTANT: Both IRMP plans coordinate with Medicare, and that means they only provide a benefit for services not covered by Medicare. It is not a supplemental plan for Medicare.

What you need to know before you enroll in this plan:

• New resources are available to help you through Aon Retiree Health Exchange. Benefits Advisors can help you navigate the many comparable plans available if you’d like to choose one of those options.

• Retirees and dependents who are eligible for Medicare can enroll in the IRMP Cigna Indemnity with Rx Plan or the IRMP Cigna Indemnity without Rx Plan.

• If you choose the with Rx Plan, prescription drug coverage is included and you do not need to purchase a Medicare Part D plan to provide prescription drug benefits. Additionally, certain compound medications are not covered.

• If you choose the without Rx Plan, this option does not cover prescription drugs. If you choose this plan, it is strongly recommended that you purchase a Medicare Part D program to obtain prescription drug benefits.

• If you choose the without Rx Plan, you can get additional peace of mind through the Catastrophic Rx HRA. No enrollment or election is necessary for the Catastrophic Rx HRA benefit, but you must be enrolled in Medicare Part D for your prescrip-tion drug coverage to receive reimbursement through the Catastrophic Rx HRA.

http://www.intel.com/go/myben

http://www.medicare.gov


IRMP CIGNA Indemnity Plan with Rx AND without Rx Benefit Summary – ContinuedOutpatient Medicare* Coinsurance applies after deductible is met

Occupational and Physical Therapy 20% of Medicare approved 20% of Medicare allowable

Speech/Language Therapy 20% of Medicare approved 20% of Medicare allowable

Ambulance 20% of Medicare approved 20% of Medicare allowable

Emergency Room/Urgent Care 20% of Medicare approved 20% of Medicare allowable

Emergency/Urgent Care Worldwide Coverage Limited coverage outside U.S. 20% of Medicare allowable

DME/Supplies/Medical Rx Medicare* Coinsurance applies after deductible is met

Durable Medical Equipment 20% of Medicare approved 20% of Medicare allowable (Wigs and hair pieces covered up to $500 per calendar year.)

Prosthetic Devices 20% of Medicare approved 20% of Medicare allowable

Outpatient – Office-Based 20% of Medicare approved 20% of Medicare allowable

Procedures Medicare* Coinsurance applies after deductible is met

Diagnostic Tests/Lab Services Generally 20% of Medicare approved ($0 for certain approved lab services) 20% of Medicare allowable

Routine Outpatient X-Ray includes Radiation Therapy 20% of Medicare approved 20% of Medicare allowable

Routine Physical Once during initial six months (MIPPE) 80% of Medicare allowable

Additional Benefits Medicare* Coinsurance applies after deductible is met

Chiropractic Not covered 20% of plan allowed; limited to 30 visits per calendar year

Routine Podiatry Not covered 20% of plan allowed

Non-Emergency Transportation Not covered 20% of plan allowed

Acupuncture Not covered 20% of plan allowed; limited to 30 visits per calendar year

Preventive Dental Not covered Not covered

Vision Exam Not covered Not covered

Eye Wear Not covered Not covered

Contact Lenses Not covered Not covered

Routine Hearing Not covered 20% coinsurance

Hearing Aid Allowance Not covered 20% coinsurance

* 2015 Medicare benefits provided. For 2016 benefits and complete details, visit www.medicare.gov, or call (800) 633-4227.Note: Part B premium is dependent on income. For complete details please refer to www.medicare.gov.

Prescription Benefit (The benefit below applies only to IRMP Cigna Indemnity with Rx Plan. Certain compound medications are no longer covered.)

Retail (34 day supply)

Mail/Walgreens/Costco (90 day supply)

Retail Penalty* (34 day supply)

Generic $10 $20 $20**

Preferred Brand $20 $40 $40**

Non-Preferred Brand $30 $60 $60**

* Penalty applies after the first two purchases of a maintenance (long-term) prescription at a retail pharmacy.** The penalty out-of-pocket costs beyond the standard mail benefit will not apply towards deductible/out-of-pocket maximums.

Prescription Coverage Medicare IRMP Cigna Indemnity with Rx IRMP Cigna Indemnity without Rx

Medicare Prescriptions are not covered (available via Medicare Part D) See Prescription Benefit below Prescriptions are not covered

Out-of-Pocket Max (TrOOP) Prescriptions are not covered (available via Medicare Part D) None – See Prescription Benefit below Prescriptions are not covered

Formulary (list of plan approved drugs)

Prescriptions are not covered (available via Medicare Part D)

Please review at: www.express-scripts.com/intel Prescriptions are not covered

Pharmacy Network Prescriptions are not covered (available via Medicare Part D)

Please review at: www.express-scripts.com/intel Prescriptions are not covered

http://www.medicare.gov




a noTe on hoW The CiGna indeMniTY Plans WorkThe IRMP CIGNA Indemnity plans assume you are enrolled in Medicare Part A and B. The plans will only cover eligible expenses not covered by Medicare. After you reach the plan deductible, the plan then pays a percentage of covered charges (based on Medicare allowable charges), and your coinsurance amount is 20 percent or a copayment based on the service received (see plan comparison on page 12 for details).

Here are two examples of how the plan works:

You have met your annual IRMP deductible. You visit your doctor and the bill is $100. Medicare considers $65 of the charge an allowable Medicare reimbursement.

You have met your annual IRMP deductible and out of pocket maximum. The hospital bill is $56,557.14. Medicare considers $44,528.71 as allowable Medicare reimbursement. The Medicare deductible for this hospitalization is $1,260.00.

Why does the plan pay $0?

The IRMP Cigna Indemnity plan reimburses 80% of the $65 allowed by Medicare. The IRMP Cigna Indemnity amount is reduced by the amount paid by Medicare. In this case, Cigna’s benefit of $52 (80% of $65) is the same amount paid by Medicare, therefore, the amount paid by the IRMP Cigna Indemnity plan is $0.

Why does the member pay $0?

Cigna pays the Medicare deductible of $1,260 and, since the member met their annual out-of-pocket maximum, the member pays $0.

exaMPle 1:

exaMPle 2:

Doctor submits bill $100

Medicare allowable on this bill $65

Medicare pays 80% of allowed amount $52 (65 x .80)

Your coinsurance amount (20% of allowed amount) $13 (65 x .20)

IRMP Cigna Indemnity Plan pays $0

Your total out-of-pocket $13

Hospital billed amount $56,557.14

Medicare discount $12,028.43

Medicare allowable $44,528.71

Medicare pays $43,268.71

Your Medicare Deductible This is the amount you would owe the provider if you were not enrolled in IRMP

Your IRMP Cigna out-of-pocket $1,260.00

Out-of-pocket met $2,000.00

Allowed amount applied to IRMP $2,000.00

IRMP Cigna Indemnity plan pays (100% of the allowed amount) $1,260.00

Your total out-of-pocket on the IRMP Indemnity $0

benefiTs of The irMP CiGna indeMniTY PlansOnce you have met the Indemnity plan out-of-pocket maximum, the plans will pay 100% of your eligible expenses. Also the plans will cover some non-Medicare eligible expenses such as hearing aids, chiropractic and acupuncture services, and prescriptions (creditable to Medicare Part D) for those enrolled in IRMP w/Rx.


sTaY ConneCTed Stay connected to Intel through the Retiree web site. Here you can find information which includes:

• Staying In Touch

• Benefits & Programs

• Items of Interest

Visit the Intel U.S. Retiree site at: www.intel.com/employee/retiree

http://www.intel.com/employee/retiree


VSP Basic Vision PlanVSP Provider Network: VSP Choice

Benefit Description CopayYour Coverage with a VSP Provider

WellVision Exam**

• Focuses on your eyes and overall wellness• Every calendar year

$0

Retinal Screening

• Takes a picture of the back of your eyes and helps your VSP doctor find possible signs of eye disease

• Every calendar year$25

Prescription Glasses

Frame

• $130 allowance for a wide selection of frames• $150 allowance on featured frame brands*• $70 allowance at Costco• 20% savings on the amount over your allowance• Every other calendar year

$25

Lenses• Single vision, lined bifocal, and lined trifocal lenses• Polycarbonate lenses for dependent children• Every calendar year

$25

Lens Enhancements

• Standard progressive lenses• Premium progressive lenses• Custom progressive lenses• Average savings of 20% – 25% on other lens enhancements

$55$95 - $105$150 - $175

Contacts (instead of glasses)

• $130 allowance for contacts; copay does not apply• Contact lens exam (fitting and evaluation)• Every calendar year

Up to $55

Primary Eye Care

• Treatment and diagnosis of eye conditions like pink eye, and vision loss; and monitoring of cataracts, Glaucoma, and diabetic retinopathy. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details.

• As needed

$15

Exclusive Member Extras

Glasses and Sunglasses• Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers

for details.• 20% savings on additional glasses and sunglasses, including lens

enhancements, from any VSP doctor within 12 months of your last WellVision Exam.

Laser Vision Correction• Average 15% off the regular price or 5% off the promotional price;

discounts only available from contracted facilities.

Your CoveraGe WiTh ouT-of-neTWork Providers on The basiC Plan• Exam: up to $40

• Frame: up to $70

• Single Vision Lenses: up to $30

• Lined Bifocal Lenses: up to $50

• Lined Trifocal Lenses: up to $70

• Progressive Lenses: up to $50

• Contacts: up to $130

* Brands/Promotion subject to change.

** Allowances and out-of-network reimbursement apply to single purchase, no declining balance.

2016 Monthly Premium for VSP Basic Vision Plan

PlanYou Only, Spouse* Only, Child(ren)** Only

You + Spouse, You + Child(ren),** Spouse + Child(ren)**

You + Spouse + Child(ren)**

VSP Basic Vision $6 $11 $14



irMP vision Plan What you need to know before you enroll in this plan:

• There are two options for vision coverage – VSP Vision Plan and VSP Vision Plus Plan.

• Retirees can enroll themselves or their dependents in the IRMP Vision Plan without enrolling in IRMP medical coverage.

• Anyone who enrolls in the VSP Vision Plus Plan receives the added benefit of laser vision correction (Lasik) coverage. The benefit is a $2,000 allowance per lifetime per covered member.

• To locate a VSP doctor prior to enroll-ment, go to www.vsp.com/advantage or call member services at (855) 663-2836.

http://vsp.com/specialoffers


VSP Vision Plus Plan VSP Provider Network: VSP Choice

Benefit Description CopayYour Coverage with a VSP Provider

WellVision Exam**

• Focuses on your eyes and overall wellness• Every calendar year

$0

Retinal Screening

• Takes a picture of the back of your eyes and helps your VSP doctor find possible signs of eye disease

• Every calendar year$25

Prescription Glasses

Frame

• $200 allowance for a wide selection of frames• $220 allowance on featured frame brands*• $110 allowance at Costco• 20% savings on the amount over your allowance• Every calendar year

$10

Lenses• Single vision, lined bifocal, and lined trifocal lenses• Polycarbonate lenses for dependent children• Every calendar year

$10

Lens Enhancements

• Standard progressive lenses• Premium progressive lenses• Custom progressive lenses• Average savings of 20% – 25% on other lens enhancements

$55$95 - $105$150 - $175

Contacts (instead of glasses)

• $200 allowance for contacts; copay does not apply• Contact lens exam (fitting and evaluation)• Every calendar year

Up to $55

Primary Eye Care

• Treatment and diagnosis of eye conditions like pink eye, and vision loss; and monitoring of cataracts, Glaucoma, and diabetic retinopathy. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details.

• As needed

$15

Exclusive Member Extras

Glasses and Sunglasses• Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers

for details.• 20% savings on additional glasses and sunglasses, including lens

enhancements, from any VSP doctor within 12 months of your last WellVision Exam.

Laser Vision Correction• Anyone who enrolls in the VSP Vision Plus Plan receives the added benefit

of laser vision correction (Lasik) coverage. The benefit is a $2,000 allowance per lifetime per covered member.

* Brands/Promotion subject to change.

** Allowances and out-of-network reimbursement apply to single purchase, no declining balance.

2016 Monthly Premium for VSP Vision Plus Plan

PlanYou Only, Spouse* Only, Child(ren)** Only

You + Spouse, You + Child(ren),** Spouse + Child(ren)**

You + Spouse + Child(ren)**

VSP Vision Plus $13 $24 $30



Your CoveraGe WiTh ouT-of-neTWork Providers on The Plus Plan• Exam: up to $40

• Frame: up to $110

• Single Vision Lenses: up to $30

• Lined Bifocal Lenses: up to $50

• Lined Trifocal Lenses: up to $70

• Progressive Lenses: up to $50

• Contacts: up to $200

http://vsp.com/specialoffers


MeTlife denTalIntel partners with MetLife to offer retirees a voluntary plan that offers access to comprehensive dental coverage. You may use SERMA to reimburse yourself for any eligible dental premiums. MetLife will send you a letter offering enrollment options within approximately 60 days of your retirement date. For more information, call MetLife at (866) 832-5756.Note: This voluntary dental plan is not an Intel-sponsored benefit and is not an ERISA welfare benefit plan.

GeT The helP You need before You enrollContact the Intel Health Benefits Center at (877) GoMyBen (466-9236) for answers to your questions about:

• IRMP medical and vision plans

• SERMA

• Catastrophic Rx HRA

• Health plan options through Aon Retiree Health Exchange and to schedule an appointment with a Benefits Advisor

• Online resources available at www.intel.com/go/myben

Representatives are available Monday through Friday, 7 a.m. to 5 p.m. Pacific. When calling the Intel Health Benefits Center you will be asked to provide certain information while you navigate the Access Direct phone menu.

sTaY ConneCTed Stay connected to Intel through the Retiree web site. Here you can find information which includes:

• Staying In Touch

• Benefits & Programs

• Items of Interest

Visit the Intel U.S. Retiree site at: www.intel.com/employee/retiree

Call (800) 468-3510 or visit Cigna online at www.mycigna.com.

Call (800) 633-4227 or visit Medicare online at www.medicare.gov.

Call VSP at (855) 663-2836 or visit VSP online at www.vsp.com/advantage.

Call MetLife (866) 832-5756.

Call Express Scripts at (800) 899-2713 or visit Express Scripts online at www.express-scripts.com/intel.

More resourCesYour Intel Benefits Center is typically your one-stop shop, but here are more resources if your questions are specific to a vendor or plan:

CIGNA PLANS

MEDICARE PART D

VISION COVERAGE

OPTIONAL DENTAL COVERAGE

PRESCRIPTION DRUG COVERAGE

Rx


Make Your enrollMenT deCisionsIf You’re Choosing Any of the IRMP Options

You can make elections at My Health Benefits online or by calling the Intel Health Benefits Center at (877) GoMyBen (466-9236). Here are the online steps to further guide you:

• Go to www.intel.com/go/myben and click on “My Health Benefits website” then log on by entering your User ID and password

• If you are using the site for the first time, you will be asked to create a User ID and password to log on:

– To create your User ID, select “Create Your User ID” or “Are you a new user?” and follow the instructions

– You will be asked to create a password and answer a series of security questions

– Your password is not required when accessing your account by calling the Intel Health Benefits Center

• Click the “Enroll” button, then click the medical plan or vision plan

• Select the plan option in which you want to enroll

• Save your choices by selecting the “Complete Enrollment” button

• Print a copy of your confirmed elections for your records. You can visit My Health Benefits at any time to view your elections

If You’re Choosing Options through Aon Retiree Health Exchange

• Complete your enrollment online through eHealth; if you need assistance, then the Aon Benefits Advisor and the eHealth expert can assist over the phone and help you navigate the website to complete your online enrollment.

• After calling the Intel Health Benefits Center at (877) GoMyBen (466-9236) and saying “Aon Retiree Health Exchange,” you have the option to reach your Benefits Advisor using their extension (the extension will typically be given to you during your appointment) or obtain answers to any other questions.

Some changes are NOT available online

• You must call the Intel Health Benefits Center at (877) GoMyBen (466-9236) to complete your enrollment if:

– You have dependents with split eligibility (i.e., one who is Medicare eligible and one who is not Medicare eligible)

– You have experienced a qualifying change-in-status event (e.g., marriage)

– Adding a dependent for the first time

When benefiT eleCTions Take effeCT The benefit elections you make during your enrollment will become effective the first of the month following your retirement or the first of the month after your COBRA coverage ends. The next opportunity for you to make IRMP or SERMA changes will be during the 2017 Annual Enrollment, or if you experience a qualifying change-in-status event during 2016. You may be required to provide proof of 18 months of continuous health coverage.


The information in this guide is a summary of your benefits and is not intended to take the place of or change official plan documents in any way. In the event of a discrepancy between the information in this guide and the 2016 Intel Retiree Medical Plan (IRMP) and the Sheltered Employee Retirement Medical Account (SERMA) Summary Plan Description (SPD), the SPD will prevail. For a copy of the current SPD, contact the Intel Health Benefits Center at (877) GoMyBen (466-9236) or online at www.intel.com/go/myben. The SPD will be available with 2016 updates in Q1 2016. Intel reserves the right to modify, change, or discontinue benefit plans at any time, at its sole discretion.

Copyright © 2015 Intel Corporation. All rights reserved. Intel and the Intel logo are trademarks of Intel Corporation in the U.S. and/or other countries.

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2016 Healthcare Enrollment Guide for New Intel Retirees · MetLife Dental ... You have the option...

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