Health Benefits Programs and Medicare Parts A & B

1 Health Benefits Programs and Medicare Parts A & B. for retirees Information for: State Health Benefits Program (SHBP). School Employees' Health Benefits Program (SEHBP). Medicare AND YOUR Health plan which means that eligible claims are paid by the med- Participating Providers ical plan . You do not need to coordinate coverage be- Enrolling in Medicare Parts A and B when you and/ To find a participating physician, contact the plans tween Medicare and Aetna. or your dependent are eligible is a requirement that directly: must be met in order to maintain your Health bene- Aetna plans are combined with Medicare and pay eli- Aetna Medicare Advantage plans: fits coverage under the SHBP or SEHBP. Members gible expenses directly, replacing the need for claims (SHBP) 1-866-234-3129.

2 Who enroll will have the option to choose a Medicare to first be paid by Medicare and then by a secondary (SEHBP) 1-866-816-3662 or Aetna's website. Advantage plan through Aetna or a Medicare Sup- plan . plemental plan through Horizon. With either plan , it Horizon supplemental plans: 1-800-414-7427 or is important to verify that your doctor accepts Medi- Horizon Supplemental Plans on Horizon's website. care; if they do not accept Medicare , all expenses Under the Horizon supplemental plans, claims are Note: If a provider is not registered with or opts out of incurred for services rendered by these doctors are coordinated by first submitting them to Medicare . Medicare , no Benefits are payable under the SHBP/. not eligible for coverage under your medical plan and This coordination of Benefits with Medicare is han- SEHBP for the provider services.

3 The charges would will not be paid. dled by Horizon. not be considered under the medical plan , and the The charts in this fact sheet provide an easy way to Benefits and plan procedures remain the same as member will be responsible for the charges. compare the Benefits of Medicare and the plans of- they did prior to enrolling in Medicare ; simply pay the fered by the Health Benefits program by summarizing Medicare COVERAGE IS. normal copayments to the provider. The deductibles what each plan provides for a specified service. The REQUIRED IF ELIGIBLE. and coinsurance required by Medicare will be paid in Benefits listed on the charts are selected as those full by your medical plan . Upon retirement, if you and/or your dependent are most likely to be of interest to you.

4 To be eligible for age 65 or have been on Social Security Disability for these Benefits , both Parts A and B of Medicare must You may still have out-of-pocket expenses such as 24 months or more, you are required to enroll in Medi- be obtained once you become eligible for Medicare . deductibles, coinsurance, and costs above reason- care Parts A and B in order to continue participating able and customary allowances. These plans will not No one plan is best suited for everyone, so be sure to in the SHBP/SEHBP. If you have not enrolled in both pay for Benefits which should have been covered by review plan information on copayments, deductibles, Parts of Medicare , you should contact Social Security Medicare . prescription drug costs, and premiums ( for retirees to apply 90 days prior to your retirement date.)

5 Who pay the full cost of coverage). If Horizon does not receive your Medicare claim in- Note: CMS can take up to 90 days to approve your formation automatically, you must submit a Medicare application and provide proof of enrollment. To avoid Aetna Medicare Advantage Plans Summary Notice directly to your plan (this comes a disruption of your services, it is advisable to apply with your Medicare reimbursement). Be sure your Aetna serves as the carrier for the SHBP/SEHBP for Medicare enrollment as early as possible if you physician's or provider's name is clearly indicated on Medicare Advantage Plans. Under Aetna plans, the are required to submit proof. the Medicare Summary Notice. coverage provided is a Medicare Advantage plan , Page 1 January 2022 Fact Sheet #23.

6 This fact sheet is a summary and not intended to provide all information. Health Benefits Programs and Although every attempt at accuracy is made, it cannot be guaranteed. Medicare Parts A & B for retirees If you are paying the full cost of your SHBP/SEHBP Medicare Part D. coverage, that cost generally decreases when you Retired members of the SHBP/SEHBP who are en- and/or your dependents enroll in Medicare Parts A. rolled in Medicare are automatically enrolled in the and B because most medical plans charge lower pre- OptumRx Medicare Part D Prescription Drug plan miums for Medicare -eligible members. (PDP). Submitting Proof of Coverage You may waive the OptumRx Medicare PDP only if If you are already collecting Social Security retire- you are enrolled in another Medicare Part D plan .

7 To ment Benefits , the Centers for Medicare and Medic- request that your coverage be waived, you must sub- aid Services (CMS) will notify the SHBP/SEHBP of mit a Cancel/Decline/Waive Retired Coverage Form your enrollment. This generally requires no addition- along with proof of other Medicare Part D coverage al action on your part unless specifically requested. to the New Jersey Division of Pensions & Benefits (NJDPB). If you are retiring from a non-participating location, or receive correspondence from the SHBP/SHEBP If you enroll in another Medicare Part D plan , you will requesting proof of your Medicare enrollment just be- lose your prescription drug Benefits provided by the fore turning 65, you are required to provide a photo- SHBP/SEHBP; however, your medical Benefits will copy of your Medicare ID card, or a letter of confirma- continue.

8 Tion from Social Security stating the effective dates of Note: If you are enrolled in a Medicare Advantage Medicare Parts A and B and your Health Insurance plan , you can only waive your prescription drug cov- Claim Number (HICN) or Medicare Beneficiary Iden- erage for another group Medicare Part D plan . If you tifier (MBI) number. waive coverage for an individual Medicare Part D. plan , your SHBP/SEHBP Medicare Advantage plan Reinstatement if Terminated will be terminated. If you have previously waived your If you and/or your dependent are eligible for Medi- prescription drug coverage for another Medicare Part care Parts A and B but fail to enroll, your SHBP/ D plan , and you wish to re-enroll in the OptumRx SEHBP coverage will be terminated. Once terminat- Medicare PDP, you must send proof of your termina- ed, your coverage will only be reinstated once the tion from the other Medicare Part D plan .

9 Acceptable appropriate documentation is received, and all rein- proof is a letter from the other Medicare Part D plan statements will be processed prospectively. Please confirming the date upon which you are disenrolled. contact your local Social Security office to obtain or We must receive this proof within 60 days of the ter- reinstate your Medicare coverage. Open enrollment mination from the other Medicare Part D plan . for Medicare is held from January 1 through March 31 of the current year with an effective date of July 1 This fact sheet has been produced and distributed by: of the current year. New Jersey Division of Pensions & Benefits If you have been terminated due to a lapse in your Box 295, Trenton, NJ 08625-0295. Medicare Part B premium, you will be reinstated pro- (609) 292-7524.

10 Spectively unless a good faith letter from Social Se- For the hearing impaired: TRS 711 (609) 292-6683. curity is provided. Fact Sheet #23 January 2022 Page 2. Health Benefits Programs and This fact sheet is a summary and not intended to provide all information. Medicare Parts A & B for retirees Although every attempt at accuracy is made, it cannot be guaranteed. SHBP/SEHBP Medicare PART A HOSPITAL INSURANCE FOR CALENDAR YEAR 2022. HORIZON. Medicare . AETNA SUPPLEMENT PLANS. Medicare IN-NETWORK HORIZON. ADVANTAGE PLANS Medicare . NJ DIRECT1525. SUPPLEMENT PLANS. Aetna Freedom10 NJ DIRECT2030. OUT-OF-NETWORK. Aetna Freedom15 Horizon HMO. Medicare Aetna HMO Horizon HMO1525 NJ DIRECT1525. SERVICE BENEFIT PAYS Aetna HMO1525 Horizon HMO2030 NJ DIRECT2030. Hospitalization First 60 days.