Retiree Open Enrollment focus · It’s here again! This May’s Open Enrollment is the opportunity...
Transcript of Retiree Open Enrollment focus · It’s here again! This May’s Open Enrollment is the opportunity...
Retiree Open Enrollment
focus What’s New in FY18? It’s here again! This May’s Open Enrollment is the opportunity for pre-Medicare retirees and Medicare retirees to make insurance changes. Any change will be effective July 1, 2017.
Good News!! Look forward to these enhanced services and coverage starting July 1st: Introducing Delta Dental’s Prevention First program. Beginning July 1st, the Prevention First program will be in place! Costs associated with preventive care and diagnostics (typically your cleanings, oral exams and X-rays) will NOT count against the $1,500 annual maximum. This means that your annual maximum benefit of $1,500 will go further in covering your other dental services such as fillings, crowns, and extractions. Your preventive services will still be covered at 100% by Delta Dental. We have heard your frustration with Cigna’s mail order pharmacy and now have a great alternative. Cigna introduces 90 Now, a new option for filling your 90-day prescriptions at a local pharmacy! Effective July 1st, 90 Now will enable you to get your 90-day medications from certain retail stores – including CVS, Target, Walmart Pharmacy, and Harris Teeter Pharmacy – for the same two copays as mail order drugs. If you currently use a preventive medication and pay $0 through mail order, you can now do the same at one of the select retail pharmacies and you still save money! 90 Now is only available at certain pharmacies. To see a full list, go to www.cigna.com/Rx90network. Our plan requires maintenance medications to be filled via Cigna Mail Order or the new 90 Now program.
Note: Specialty medications must still be filled through Cigna’s Specialty Pharmacy.
Premiums Premiums for Delta Dental and pre-Medicare plan health insurance (Cigna & Kaiser HMO) are increasing
July 1st. Please review the charts on pages 6 & 7 to see your new share of the monthly premium.
Premium changes for the Kaiser Medicare Plus plan and the AmWINS Medicare Supplement Plan will not be known until the Fall 2017. Any changes will not be effective until January 1, 2018.
Open Enrollment Information Meetings Tuesday, May 2nd, 10:30 AM — 12:30 PM
ACREA Luncheon Little Falls Presbyterian Church 6025 Little Falls Road, Arlington
Wednesday, May 17th , 1 PM to 3 PM
Central Library Auditorium 1015 N. Quincy Street, Arlington
Open Enrollment is May 10th to May 24th
P A G E 2
Are You Eligible for Open Enrollment?
Pre-Medicare retirees may: Switch from Cigna to Kaiser or vice versa Choose a different Cigna plan Add/drop eligible dependents Enroll in or cancel Delta Dental coverage
Medicare participants may: Switch from AmWINS to Kaiser Medicare Plus or vice versa Add/drop eligible dependents Enroll in or cancel Delta Dental coverage
How Do I Make Insurance Changes? Open Enrollment is from May 10th to May 24th.
Visit www.arlingtonva.us/retirement and click on “Open Enrollment” to
access all of the enrollment forms, rate charts, and plan summaries for our
health and dental plans.
To make changes, please fill out the appropriate enrollment form(s)
Submit completed forms via mail or email no later than May 24th:
Arlington County Human Resources OR Email: [email protected]
ATTN: Benefits Subject: Open Enrollment 2100 Clarendon Blvd., Suite 511 Arlington, VA 22201
All changes are effective July 1, 2017. No changes? Sit back and relax — there’s nothing for you to do! Questions? Call us at 703-228-3500 option 1 or email your questions to [email protected]
To participate in this Open Enrollment period, you must meet one of the criteria below:
Retiree and/or dependent who is currently enrolled in Cigna or Kaiser
Retiree and/or dependent who is currently enrolled in AmWINS or Kaiser Medicare Plus
Retiree who retired after 6/30/2008, who is not currently enrolled in a County plan, but who can demonstrate continuous medical coverage in another plan
What Can I Do During Open Enrollment?
P A G E 3
Pre-Medicare Plans Overview Kaiser Permanente Signature HMO Provides “one-stop” medical care at Kaiser
facilities throughout the DC metro area Preventive Care covered at 100% Coverage for non-Kaiser providers only in cases
of emergency Most economical plan in terms of monthly
premiums and copays Cigna All Cigna Plans Offer: Open Access Plus (OAP) network — a national
network of providers and facilities Preventive Care covered at 100% Emergency and Urgent Care covered 24/7
worldwide Prescription drug coverage is the same for all
three plans Three tiers: generic, preferred brand, non-
preferred brand New! Maintenance medications may be filled
using mail order OR the new Cigna 90 Now program. (See page 1.)
Certain preventive generic drugs are FREE via mail order or 90 Now. Review the Cigna formulary on the retiree website.
If your doctor prescribes a non-preferred brand name drug, you may be required to try a generic or preferred brand drug before the more expensive drug is authorized
Delta Dental Use any licensed dentist for your dental care Save money when you use a dentist who
participates in the Delta Dental Premier or Preferred network
The plan pays: 100% of reasonable and customary fees for
cleanings and x-rays (preventive care) 80% for Basic Services (e.g., fillings) 50% for Major Services (e.g., crowns) Annual calendar year deductible for Basic and
Major Services of $55 individual/$110 family Plan pays maximum of $1,500 per calendar year.
New! Costs of preventive care do not count toward the $1,500 annual maximum.
What are the differences between Cigna plans?
Open Access Plus In-Network (OAP IN) Coinsurance Choose doctors, health professionals and
facilities that are in the Cigna OAP national network (no coverage for out-of-network providers)
You pay 10% of the allowable cost for services; the plan pays for 90%
Lowest premiums of all Cigna plans No deductible Out-of-pocket maximum (OOPM) is $2,250
individual/$4,500 family* Open Access Plus IN (OAP IN) Copay Choose the doctors, health professionals and
facilities that are in the Cigna OAP national network (no coverage for out-of-network providers)
You pay a flat dollar copay for services No deductible Out-of-pocket maximum is $6,600 individual/
$13,200 family* Open Access Plus (OAP) Most expensive premiums across all plans Choose any doctors, health professionals or
facilities that are in or out-of-network Select a provider in the Cigna OAP network and
pay 10% of the allowable cost for services Pay a deductible when you use an out-of-
network provider; the County pays 70% of allowable charges after the deductible is met
Out-of-pocket maximums are: in-network $2,250 individual/$4,500 family; and out-of-network $3,250 individual/$6,500 family
*Monthly premium deductions do not count toward your out-of-pocket maximum To see if your provider is in the OAP network: Go to www.Cigna.com and Click on “Find a
Doctor” Fill in your search criteria and Click “Search” If “OAP” is listed under Plans Accepted, your
provider is in-network.
Life Insurance Coverage and Rate Changes in
Your April 2017 Pension Payment Basic Life
If you turned 65 after April 1, 2016 your basic life insurance coverage reduced from $10,000 to $8,000 effective April 1, 2017.
Supplemental Life
If you turned 65 after April 1, 2016, your supplemental life insurance coverage reduces to $10,000 and the premium deduction will change accordingly in your April 2017 pension payment.
Supplemental life insurance premiums are based on your age and tobacco use. Rates are divided into five-year bands until you reach age 70.
If you have changed age bands since April 1, 2016 (e.g., age 59 to 60), your new deduction in April 2017 will reflect a higher premium.
Coming Soon!
Coming in May — Web Member Services is getting a new look and a new name! We think you’ll find the site easier to navigate. You’ll still use the same link: www.arlingtonva.us/retirement and your current Username and Password.
Turning 65? Welcome to Medicare! Retirees and their dependents who participate in the County health insurance plan must enroll in Medicare Part B when they turn 65 in order to continue on a County health plan. At age 65, Medicare becomes your primary health insurance, and the County plan provides access to coverage beyond traditional Medicare . Either plan is used in conjunction with Medicare Parts A and B, and provides you with Part D prescription drug coverage. Kaiser Medicare Advantage Plus: Plan A with D Only available to enrollees in the Washington, DC Metropolitan area. One-stop medical services at Kaiser facilities; referral required for network hospitals and specialists $15 copay for in-network Medicare-covered primary and specialist office visits $15 copay for diagnostic hearing exam; $15 copay for routine eye exams Retail prescription drug copays of $10 / $15/ $25 (Preferred mail order/
Preferred retail / standard retail) AmWINS Medicare Supplement See any provider who accepts Medicare No Part B deductible to meet $20 Primary and $40 Specialist office visit copays Coverage for routine hearing and vision exams Retail prescription drug copays of $10/$30/$55 (Tier 1, Tier 2, Tier 3)
P A G E 4
P A G E 5
FY
18
Pre
-Me
dic
are
He
alt
h P
lan
Op
tio
ns
Ou
t-o
f-P
oc
ke
t C
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ts (
ex
clu
din
g p
rem
ium
s)
Eff
ec
tive
Ju
ly 1
, 2
017
Serv
ice
Co
pay
P
lan
s
Co
insu
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ce
Pla
ns
Kais
er
Cig
na
OA
P IN
In
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wo
rk O
nly
C
ign
a O
AP
IN
In-N
etw
ork
On
ly
Cig
na
OA
P
In
-Net
wo
rk
Ou
t-o
f-N
etw
ork
An
nu
al D
edu
ctib
le*
$
0
$0
$0
$
0
$3
00
Ind
ivid
ual
$
60
0 F
amily
Ou
t-o
f-P
ock
et M
axim
um
**
$3
,50
0 In
div
idu
al
$9
,40
0 F
amily
$
6,6
00
Ind
ivid
ual
$
13
,20
0 F
amily
$
2,2
50
Ind
ivid
ual
$
4,5
00
Fam
ily
$2
,25
0 In
div
idu
al
$4
,50
0 F
amily
$
3,2
50
Ind
ivid
ual
$
6,5
00
Fam
ily
PC
P O
ffice
Vis
it
$2
0
$3
0
1
0%
Co
insu
ran
ce
($8
- $
12
) **
*
10
% C
oin
sura
nce
3
0%
Co
insu
ran
ce a
fter
d
edu
ctib
le
Spec
ialis
t O
ffice
Vis
it
$4
0
$6
0
1
0%
Co
insu
ran
ce
($2
0 -
$3
0)*
**
1
0%
Co
insu
ran
ce
30
% C
oin
sura
nce
aft
er
ded
ucti
ble
Ph
ysic
al T
her
apy
$4
0
$4
5
1
0%
Co
insu
ran
ce
($8
- $
12
)**
*
10
% C
oin
sura
nce
3
0%
Co
insu
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ce a
fter
d
edu
ctib
le
Pre
ven
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No
Ch
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N
o C
har
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Inp
atie
nt
Ho
spit
al
$2
00
/ad
mis
sio
n
$5
00
/ad
mis
sio
n
1
0%
Co
insu
ran
ce
($4
00
- $
2,0
00
)***
1
0%
Co
insu
ran
ce
$2
50
de
du
ctib
le p
lus
30
% C
oin
sura
nce
Ou
tpati
ent
Surg
ery/
P
roce
du
res
$1
00
/vis
it
$2
50
/vis
it
1
0%
Co
insu
ran
ce
($8
0 -
$5
59
)***
1
0%
Co
insu
ran
ce
$2
50
de
du
ctib
le p
lus
30
% C
oin
sura
nce
Spec
ialt
y Im
agin
g (M
RI,
CT
Scan
) $
75
/te
st
$1
00
/vis
it
1
0%
Co
insu
ran
ce
($5
0 -
$2
00
)***
1
0%
Co
insu
ran
ce
30
% C
oin
sura
nce
aft
er
ded
ucti
ble
Urg
ent
Car
e
$4
0/v
isit
$
75
/vis
it
1
0%
Co
insu
ran
ce
($3
0 -
$1
00
)***
1
0%
Co
insu
ran
ce
10
% C
oin
sura
nce
aft
er
ded
ucti
ble
Emer
gen
cy R
oo
m
$1
50
/vis
it
$2
00
/vis
it
1
0%
Co
insu
ran
ce
($5
0 -
$2
00
)***
1
0%
Co
insu
ran
ce
10
% C
oin
sura
nce
aft
er
ded
ucti
ble
Pre
scri
pti
on
Dru
gs-
Ret
ail
(gen
eric
/pre
ferr
ed/
no
n-
pre
ferr
ed)
$1
5 /
$3
0/
$5
5 K
P
$2
0 /
$4
5 /
$6
0 N
etw
ork
$
10
/ $
30
/ $
55
$1
0 /
$3
0 /
$5
5
$1
0 /
$3
0 /
$5
5
In-N
etw
ork
co
vera
ge
on
ly
Pre
scri
pti
on
Dru
gs
Mai
l Ord
er 9
0 d
ay s
up
ply
$
30
/ $
60
/ $
11
0
$2
0 /
$6
0 /
$1
10
C
erta
in g
ener
ics
avai
la-
ble
at
$0
via
mai
l
$
20
/ $
60
/ $
11
0
Cer
tain
gen
eric
s av
aila
ble
at
$0
via
mai
l
$2
0 /
$6
0 /
$1
10
C
erta
in g
ener
ics
avai
la-
ble
at
$0
via
mai
l
In-N
etw
ork
co
vera
ge
on
ly
NO
TE:
All
Cig
na
pla
ns u
se t
he
Op
en A
cces
s Pl
us (
OA
P) n
etw
ork.
Th
is is
a n
atio
nal
net
wo
rk o
f p
rovi
ders
. *
An
nu
al D
edu
ctib
le –
mem
ber
mu
st p
ay t
his
am
ou
nt
ou
t-o
f-p
ock
et b
efo
re t
he
pla
n w
ill c
ove
r se
rvic
es.
** O
ut-
of-
Po
cket
Max
imu
m (
OO
PM)–
th
e P
lan
will
pay
10
0%
fo
r co
vere
d s
ervi
ces
after
a m
emb
er r
each
es t
his
lim
it.
The
OO
PM is
tra
cked
on
a C
alen
dar
Yea
r b
asis
an
d r
eset
s ev
ery
Jan
uar
y 1
st.
Mo
nth
ly p
rem
ium
s d
o
no
t co
un
t to
war
d r
each
ing
the
ann
ual
OO
PM.
**
* Th
ese
are
esti
mat
ed a
vera
ge r
ange
s fo
r yo
ur
ou
t-o
f-p
ock
et c
ost
s. Y
ou
r ac
tual
co
sts
may
var
y.
2017 Medicare Plans Monthly Premiums - Retired before 1/15/12 Rates Effective January 1, 2017— December 31, 2017
P A G E 6
2017 Medicare Plans Monthly Premiums - Retired on or after 1/15/12
Coverage Level Medical
Retiree Share
Medical County
Share
Medical
Retiree Share
Medical
County Share
Retiree Share
(if not at Max.
Subsidy)
Dental
County
Share
1 on Medicare 24.74$ 222.68$ 39.60$ 356.40$ 7.24$ 28.96$
2 on Medicare 49.48$ 445.36$ 79.20$ 712.80$ 14.44$ 57.76$
1 on Medicare 42.56$ 204.86$ 68.11$ 327.89$ 9.41$ 26.79$
2 on Medicare 85.11$ 409.73$ 136.22$ 655.78$ 18.77$ 53.43$
1 on Medicare 69.28$ 178.14$ 110.88$ 285.12$ 13.03$ 23.17$
2 on Medicare 138.56$ 356.28$ 221.76$ 570.24$ 25.99$ 46.21$ -$
1 on Medicare 113.81$ 133.61$ 182.16$ 213.84$ 18.82$ 17.38$
2 on Medicare 227.63$ 267.21$ 364.32$ 427.68$ 37.54$ 34.66$
1 on Medicare 158.35$ 89.07$ 253.44$ 142.56$ 24.62$ 11.58$
2 on Medicare 316.70$ 178.14$ 506.88$ 285.12$ 49.10$ 23.10$
1 on Medicare 202.88$ 44.54$ 324.72$ 71.28$ 30.41$ 5.79$
2 on Medicare 405.77$ 89.07$ 649.44$ 142.56$ 60.65$ 11.55$
AmWINS Supplement
GROUP 5: Ch 21 & 46
10-14 years of service
Max. Subsidy $384
GROUP 4: Ch 21 & 46
15-19 years of service
Max. Subsidy $576
GROUP 3: Chapter 46
20-22 years of service
Max. Subsidy $768
GROUP 2: Chapter 46
23-24 years of service
Max. Subsidy $883
GROUP 1: Chapter 21
20+ yrs svc;
Chapter 46
25+ yrs svc
Max. Subsidy $960
GROUP 6: Ch 21 & 46
0-9 years of service
Max. Subsidy $192
Kaiser Medicare Delta Dental
Coverage Level Retiree
Share
Medical
County Share
Retiree
Share
Medical
County Share
Retiree Share
(If not at Max.
Subsidy)
Dental
County Share
1 on Medicare 24.74$ 222.68$ 39.60$ 356.40$ 7.24$ 28.96$
2 on Medicare 49.48$ 445.36$ 192.00$ 600.00$ 14.44$ 57.76$
1 on Medicare 42.56$ 204.86$ 68.11$ 327.89$ 9.41$ 26.79$
2 on Medicare 85.11$ 409.73$ 240.00$ 552.00$ 18.77$ 53.43$
1 on Medicare 69.28$ 178.14$ 110.88$ 285.12$ 13.03$ 23.17$
2 on Medicare 138.56$ 356.28$ 312.00$ 480.00$ 25.99$ 46.21$ -$
1 on Medicare 113.81$ 133.61$ 182.16$ 213.84$ 18.82$ 17.38$
2 on Medicare 227.63$ 267.21$ 432.00$ 360.00$ 37.54$ 34.66$
1 on Medicare 158.35$ 89.07$ 253.44$ 142.56$ 24.62$ 11.58$
2 on Medicare 316.70$ 178.14$ 552.00$ 240.00$ 49.10$ 23.10$
AmWINS SupplementKaiser Medicare Delta Dental
GROUP 1: Chapter 21
20+ yrs svc;
Chapter 46
25+ yrs svc
Max. Subsidy $600
GROUP 2: Chapter 46
23-24 years of service
Max. Subsidy $552
GROUP 3: Chapter 46
20-22 years of service
Max. Subsidy $480
GROUP 4: Ch 21 & 46
15-19 years of service
Max. Subsidy $360
GROUP 5: Ch 21 & 46
10-14 years of service
Max. Subsidy $240
P A G E 7
Pre-Medicare Plans Monthly Premiums – Retired before 1/15/12 Rates Effective July 1, 2017 – June 30, 2018
Coverage
Level
Retiree
Share
Medical
County
Share
Retiree
Share
Medical
County
Share
Retiree
Share
Medical
County
Share
Retiree
Share
Medical
County
Share
Retiree
Share(if not at
Max. Subsidy)
Dental
County
Share
Single 29.76$ 492.93$ 168.74$ 545.16$ 103.84$ 545.16$ 397.14$ 545.16$ 7.24$ 28.96$
Retiree + Spouse/ Adult
Dependent 140.69$ 960.00$ 503.50$ 960.00$ 370.50$ 960.00$ 971.80$ 960.00$ 14.44$ 57.76$
Retiree + Child(ren) 128.46$ 841.25$ 319.11$ 930.19$ 205.61$ 930.19$ 765.91$ 930.19$ 15.64$ 62.56$
Family 635.26$ 960.00$ 1,181.70$ 960.00$ 987.00$ 960.00$ 1,866.90$ 960.00$ 22.02$ 88.08$
1 NonMedicare +
1 Medicare 54.50$ 715.61$ 208.34$ 901.56$ 143.44$ 901.56$ 436.74$ 901.56$ 14.44$ 57.76$
Single 66.73$ 455.96$ 209.63$ 504.27$ 144.73$ 504.27$ 438.03$ 504.27$ 9.41$ 26.79$
Retiree + Spouse/ Adult
Dependent 217.69$ 883.00$ 580.50$ 883.00$ 447.50$ 883.00$ 1,048.80$ 883.00$ 18.77$ 53.43$
Retiree + Child(ren) 193.17$ 776.53$ 390.66$ 858.64$ 277.16$ 858.64$ 837.46$ 858.64$ 20.33$ 57.87$
Family 712.26$ 883.00$ 1,258.70$ 883.00$ 1,064.00$ 883.00$ 1,943.90$ 883.00$ 28.63$ 81.47$
1 NonMedicare +
1 Medicare 109.28$ 660.82$ 277.74$ 832.16$ 212.84$ 832.16$ 506.14$ 832.16$ 18.77$ 53.43$
Single 128.36$ 394.33$ 277.77$ 436.13$ 212.87$ 436.13$ 506.17$ 436.13$ 13.03$ 23.17$
Retiree + Spouse/ Adult
Dependent 332.69$ 768.00$ 695.50$ 768.00$ 562.50$ 768.00$ 1,163.80$ 768.00$ 25.99$ 46.21$
Retiree + Child(ren) 301.02$ 668.68$ 509.92$ 739.38$ 396.42$ 739.38$ 956.72$ 739.38$ 28.15$ 50.05$
Family 827.26$ 768.00$ 1,373.70$ 768.00$ 1,179.00$ 768.00$ 2,058.90$ 768.00$ 39.64$ 70.46$
1 NonMedicare +
1 Medicare 197.64$ 572.47$ 388.65$ 721.25$ 323.75$ 721.25$ 617.05$ 721.25$ 25.99$ 46.21$
Single 226.97$ 295.72$ 386.80$ 327.10$ 321.90$ 327.10$ 615.20$ 327.10$ 18.82$ $17.38
Retiree + Spouse/ Adult
Dependent 524.69$ 576.00$ 887.50$ 576.00$ 754.50$ 576.00$ 1,355.80$ 576.00$ 37.54$ $34.66
Retiree + Child(ren) 462.80$ 506.90$ 688.80$ 560.50$ 575.30$ 560.50$ 1,135.60$ 560.50$ 40.66$ $37.54
Family 1,019.26$ 576.00$ 1,565.70$ 576.00$ 1,371.00$ 576.00$ 2,250.90$ 576.00$ 57.25$ $52.85
1 NonMedicare +
1 Medicare 340.78$ 429.33$ 568.96$ 540.94$ 504.06$ 540.94$ 797.36$ 540.94$ 37.54$ $34.66
Single 325.57$ 197.12$ 495.84$ 218.06$ 430.94$ 218.06$ 724.24$ 218.06$ 24.62$ $11.58
Retiree + Spouse/ Adult
Dependent 716.69$ 384.00$ 1,079.50$ 384.00$ 946.50$ 384.00$ 1,547.80$ 384.00$ 49.10$ $23.10
Retiree + Child(ren) 635.37$ 334.33$ 879.61$ 369.69$ 766.11$ 369.69$ 1,326.41$ 369.69$ 53.18$ $25.02
Family 1,211.26$ 384.00$ 1,757.70$ 384.00$ 1,563.00$ 384.00$ 2,442.90$ 384.00$ 74.87$ $35.23
1 NonMedicare +
1 Medicare 483.92$ 286.19$ 749.28$ 360.62$ 684.38$ 360.62$ 977.68$ 360.62$ 49.10$ $23.10
Single 424.18$ 98.51$ 604.87$ 109.03$ 539.97$ 109.03$ 833.27$ 109.03$ 30.41$ $5.79
Retiree + Spouse/ Adult
Dependent 908.69$ 192.00$ 1,271.50$ 192.00$ 1,138.50$ 192.00$ 1,739.80$ 192.00$ 60.65$ $11.55
Retiree + Child(ren) 797.14$ 172.56$ 1,058.49$ 190.81$ 944.99$ 190.81$ 1,505.29$ 190.81$ 65.69$ $12.51
Family 1,403.26$ 192.00$ 1,949.70$ 192.00$ 1,755.00$ 192.00$ 2,634.90$ 192.00$ 92.48$ $17.62
1 NonMedicare +
1 Medicare 627.06$ 143.04$ 929.59$ 180.31$ 864.69$ 180.31$ 1,157.99$ 180.31$ 60.65$ $11.55
Kaiser HMO Cigna OAP IN Cigna OAP Delta Dental
GROUP 6:
Ch 21 & 46
0-9 years of service
Max. Subsidy $192
Cigna OAP IN
Coinsurance PlansCopay Plans
GROUP 1:
Chapter 21
20+ yrs svc;
Chapter 46
25+ yrs svc
Max. Subsidy $960
GROUP 2:
Chapter 46
23-24 years of
service
Max. Subsidy $883
GROUP 3:
Chapter 46
20-22 years of
service
Max. Subsidy 768
GROUP 4:
Ch 21 & 46
15-19 years of
service
Max. Subsidy $576
GROUP 5:
Ch 21 & 46
10-14 years of
service
Max. Subsidy $384
All rate charts may be found on the County’s website at www.arlingtonva.us/retirement and then by clicking on Open Enrollment.
P A G E 8
Pre-Medicare Plans Monthly Premiums – Retired on or after 1/15/12 Rates Effective July 1, 2017 – June 30, 2018
Open Enrollment is May 10th
to May 24th
Questions about Open Enrollment?
HR Benefits Customer Service at 703.228.3500, Option 1
Email [email protected]
Coverage
Level
Retiree
Share
Medical
County
Share
Retiree
Share
Medical
County
Share
Retiree
Share
Medical
County
Share
Retiree
Share
Medical
County
Share
Retiree
Share(If not at Max.
Subsidy)
Dental
County
Share
Single 29.75$ 492.94$ 168.74$ 545.16$ 103.84$ 545.16$ 397.14$ 545.16$ 7.24$ 28.96$
Retiree + Spouse/ Adult
Dependent 500.69$ 600.00$ 863.50$ 600.00$ 730.50$ 600.00$ 1,331.80$ 600.00$ 14.44$ 57.76$
Retiree + Child(ren) 369.70$ 600.00$ 649.30$ 600.00$ 535.80$ 600.00$ 1,096.10$ 600.00$ 15.64$ 62.56$
Family 995.26$ 600.00$ 1,541.70$ 600.00$ 1,347.00$ 600.00$ 2,226.90$ 600.00$ 22.02$ 88.08$
1 NonMedicare +
1 Medicare 170.11$ 600.00$ 509.90$ 600.00$ 445.00$ 600.00$ 738.30$ 600.00$ 14.44$ 57.76$
Single 66.73$ 455.96$ 209.63$ 504.27$ 144.73$ 504.27$ 438.03$ 504.27$ 9.41$ 26.79$
Retiree + Spouse/ Adult
Dependent 548.69$ 552.00$ 911.50$ 552.00$ 778.50$ 552.00$ 1,379.80$ 552.00$ 18.77$ 53.43$
Retiree + Child(ren) 417.70$ 552.00$ 697.30$ 552.00$ 583.80$ 552.00$ 1,144.10$ 552.00$ 20.33$ 57.87$
Family 1,043.26$ 552.00$ 1,589.70$ 552.00$ 1,395.00$ 552.00$ 2,274.90$ 552.00$ 28.63$ 81.47$
1 NonMedicare +
1 Medicare 218.11$ 552.00$ 557.90$ 552.00$ 493.00$ 552.00$ 786.30$ 552.00$ 18.77$ 53.43$
Single 128.36$ 394.33$ 277.77$ 436.13$ 212.87$ 436.13$ 506.17$ 436.13$ 13.03$ 23.17$
Retiree + Spouse/ Adult
Dependent 620.69$ 480.00$ 983.50$ 480.00$ 850.50$ 480.00$ 1,451.80$ 480.00$ 25.99$ 46.21$
Retiree + Child(ren) 489.70$ 480.00$ 769.30$ 480.00$ 655.80$ 480.00$ 1,216.10$ 480.00$ 28.15$ 50.05$
Family 1,115.26$ 480.00$ 1,661.70$ 480.00$ 1,467.00$ 480.00$ 2,346.90$ 480.00$ 39.64$ 70.46$
1 NonMedicare +
1 Medicare 290.11$ 480.00$ 629.90$ 480.00$ 565.00$ 480.00$ 858.30$ 480.00$ 25.99$ 46.21$
Single 226.97$ 295.72$ 386.80$ 327.10$ 321.90$ 327.10$ 615.20$ 327.10$ 18.82$ 17.38$
Retiree + Spouse/ Adult
Dependent 740.69$ 360.00$ 1,103.50$ 360.00$ 970.50$ 360.00$ 1,571.80$ 360.00$ 37.54$ 34.66$
Retiree + Child(ren) 609.70$ 360.00$ 889.30$ 360.00$ 775.80$ 360.00$ 1,336.10$ 360.00$ 40.66$ 37.54$
Family 1,235.26$ 360.00$ 1,781.70$ 360.00$ 1,587.00$ 360.00$ 2,466.90$ 360.00$ 57.25$ 52.85$
1 NonMedicare +
1 Medicare 410.11$ 360.00$ 749.90$ 360.00$ 685.00$ 360.00$ 978.30$ 360.00$ 37.54$ 34.66$
Single 325.57$ 197.12$ 495.84$ 218.06$ 430.94$ 218.06$ 724.24$ 218.06$ 24.62$ 11.58$
Retiree + Spouse/ Adult
Dependent 860.69$ 240.00$ 1,223.50$ 240.00$ 1,090.50$ 240.00$ 1,691.80$ 240.00$ 49.10$ 23.10$
Retiree + Child(ren) 729.70$ 240.00$ 1,009.30$ 240.00$ 895.80$ 240.00$ 1,456.10$ 240.00$ 53.18$ 25.02$
Family 1,355.26$ 240.00$ 1,901.70$ 240.00$ 1,707.00$ 240.00$ 2,586.90$ 240.00$ 74.87$ 35.23$
1 NonMedicare +
1 Medicare 530.11$ 240.00$ 869.90$ 240.00$ 805.00$ 240.00$ 1,098.30$ 240.00$ 49.10$ 23.10$
Single 424.18$ 98.51$ 604.87$ 109.03$ 539.97$ 109.03$ 833.27$ 109.03$ 30.41$ 5.79$
Retiree + Spouse/ Adult
Dependent 980.69$ 120.00$ 1,343.50$ 120.00$ 1,210.50$ 120.00$ 1,811.80$ 120.00$ 60.65$ 11.55$
Retiree + Child(ren) 849.70$ 120.00$ 1,129.30$ 120.00$ 1,015.80$ 120.00$ 1,576.10$ 120.00$ 65.69$ 12.51$
Family 1,475.26$ 120.00$ 2,021.70$ 120.00$ 1,827.00$ 120.00$ 2,706.90$ 120.00$ 92.48$ 17.62$ 1 NonMedicare +
1 Medicare 650.11$ 120.00$ 989.90$ 120.00$ 925.00$ 120.00$ 1,218.30$ 120.00$ 60.65$ 11.55$
GROUP 6:
Ch 21 & 46
0-9 years of
service
Max. Subsidy $120
GROUP 4:
Ch 21 & 46
15-19 years of
service
Max. Subsidy $360
GROUP 5:
Ch 21 & 46
10-14 years of
service
Max. Subsidy $240
GROUP 2:
Chapter 46
23-24 years of
service
Max. Subsidy $552
GROUP 3:
Chapter 46
20-22 years of
service
Max. Subsidy $480
GROUP 1:
Chapter 21
20+ yrs svc;
Chapter 46
25+ yrs svc
Max. Subsidy $600
Copay Plans Coinsurance Plans
Kaiser HMO Cigna OAP IN Cigna OAP IN Cigna OAP Delta Dental