A snapshot of the State Health Benefit Plan for retirees [Jan. 2010]

An Option of the Division of State health Benefit Plan
A SNAPSHOT OF
State Health Benefit Plan for Retirees for 2010

When You Retire General Information

You may keep your health coverage if you are eligible

Medicare and You

to receive a monthly retirement benefit from a Georgiasponsored retirement system and are enrolled in SHBP coverage at the time you retire. You cannot enroll in SHBP after you retire You cannot continue your health insurance if you take a lump sum distribution from a Georgia-sponsored retirement system

If you are actively working for the state at age 65 or older, State Health Benefit Plan (SHBP) will pay primary benefits on you and your spouse; you are not required to enroll for Medicare until you retire

and do not receive a monthly retirement benefit payment Your eligible dependents must also be enrolled in SHBP
coverage at the time you retire to continue their coverage. Dependents may not be added after retirement unless you experience a qualifying event Your health insurance automatically "rolls over" into retirement with the same coverage tier ( family or single) and dependents you currently have covered if you are receiving your annuity from the Employees Retirement System, Teachers Retirement System or the Public School Employees Retirement System.

Medicare does not impose penalties if you enroll in Medicare after you first become eligible if the reason for delay is that you were actively working and had group health insurance. However, you must apply within Medicare's time limits once you retire. For information regarding Medicare enrollment call 1-800-MEDICARE (1-800-633-4227) or visit the Web site at www.medicare.gov

However, if you and/or a covered dependant are covered

by Medicare, coverage will roll to the Medicare Advantage

Standard Plan of the health care vendor the retiree had as an

active employee provided SHBP has received and processed your Medicare information. If you are covered by

another Georgia sponsored Retirement System, you must complete a Retiree/Surviving Spouse form to continue

your health insurance into retirement

Once you are set up as a retiree at a Georgia-sponsored retirement system, you will receive a letter from SHBP

that allows you to change your option within 31 days of the receipt of the letter

You may drop to single coverage or discontinue your coverage at anytime, but once you drop the coverage, you

cannot get it back

If your address changes, you must notify SHBP to continue to receive health plan information. SHBP will not be

responsible for missed enrollment change opportunities or deadlines if you do not keep your contact information

updated. Please send a letter with our retiree's name, social security number and new address to SHBP, P.O.

Box 1990, Atlanta, GA 30301-1990

You do not pay tobacco or spousal surcharges

Your choices are single or family coverage

If you and your spouse are retired and under age 65

SHBP will remain your primary insurer and premiums will be the same as an active employee until you or your spouse turn 65 or become eligible for Medicare
You may want to consider one of the consumer driven health plan options HDHP or HRA
When you and/or your spouse or eligible dependents reach age 65 or become eligible for Medicare due to a disability

You should enroll in Medicare Parts A and B as soon as you are eligible. Part A covers hospitalization and B covers your physician visits, tests etc.

2 Peachtree Street, Atlanta, Ga 30303 January 2010

www.dch.georgia.gov

A Snapshot Of State Health Benefit Plan Retirees

You will pay the higher premiums until the SHBP receives proof of your Medicare enrollment and the change in premium is processed by the retirement system. You should submit copies of your Medicare cards to the SHBP as soon as you receive them to: SHBP, P. O. Box 1990, Atlanta, GA 30301-1990. Delay in submission of Medicare information does not qualify for a refund of the difference in premiums.
Your options change to the Medicare Advantage Standard or Premium plans if you wish to continue to receive the state contribution toward your health insurance premiums
You may still enroll in the HRA, HMO, HDHP or OAP options but will pay the entire cost of the premium change is process by the retirement system. ou should submit copies of your Medicare cards to the SHBP as soon as you receive them to: SHBP, P. O. Box 1990, Atlanta, GA 30301-1990. Delay in submission of Medicare information does not qualify for a refund of the difference in premiums
Your options change to the Medicare Advantage Standard or Premium plans if you wish to continue to receive the state contribution toward your health insurance premiums
You may enroll in the HRA, HMO, HDHP or OAP options but will pay the entire cost of the premium
Changing Options
Annual Retiree Option Change Period (ROCP) is held each fall and corresponds with the annual open enrollment period. During this time period, you may change your options for the next plan year. An ROCP packet will be mailed to your home prior to the start of the ROCP if SHBP has your correct address
Any changes made during the ROCP will be effective the following January 1
Qualifying Events
Qualifying events allow you to make changes in your health insurance. You must submit the request to SHBP within 31 days prior to or after the qualifying event. The effective date of the change in coverage will be the first of the month following the request. If SHBP needs more information, you will receive a letter requesting information. If SHBP receives the documentation within the Plan Year, coverage will be retroactive to the later of the qualifying event date or the first of the Plan year. If the request is not received within this time frame, you will not be able to add the dependent to your coverage unless you experience another qualifying event.

Qualifying Event
Eligibility for retiree coverage Annuity no longer covers premium amount Become eligible for Medicare Parts A and B

Action Allowed
Change to another option

Acquire dependent because of marriage, birth, adoption or Add dependent(s) proper documentation required

Qualified Medical Child Support Order

Change coverage tier

Loss of dependent's health benefit coverage through

spouse's or former spouse's coverage through active

employment, COBRA coverage, or loss of eligibility for

coverage at retirement

Spouse or enrolled dependent's employment status changes affecting coverage eligibility

Change coverage tier - proper documentation is required

A Snapshot Of State Health Benefit Plan Retirees
Surviving Spouses (living spouse of a deceased retiree) and eligible dependents
If your surviving spouse or eligible children will receive(s) an annuity: Apply within 31 days of retiree's death Current coverage can continue Premium deducted from annuity if the annuity is large enough to cover the premium. If not, payments must be made
directly to the Plan New dependents or spouses cannot be added to survivor's coverage
If your surviving spouse will not receive an annuity: Coverage can continue if married at least one year Apply within 31 days of retiree's death Premium paid directly to Plan Coverage ends if spouse remarries Cannot add new dependents to coverage
If your surviving child will not receive an annuity and there is no surviving spouse the child may continue the coverage for 36 months through COBRA provisions.
What if you and your spouse both work for the state and are eligible for SHBP coverage?
If you need family coverage because you need to cover a dependent, the retiree or active employee may take family coverage. However, the retiree must have picked up family coverage during the last Open Enrollment period as an active employee
If you are retiring and are covered as a dependent under your active spouse's SHBP coverage, you have two options: Remain as a covered dependent under your active spouse's coverage or Enroll as a single employee during the last Open Enrollment period as an active employee
If one spouse is retired and the other spouse is still actively working, when your last dependent becomes ineligible for coverage, the active employee can drop to single coverage and the retiree can pick up single coverage. The request must be submitted for both members within 31 days of the qualifying event. Both members must request the change to single. One cannot keep family while the other requests single coverage
If you or your spouse have family coverage as a retiree, you may drop to single coverage at any time and the spouse may pick up single coverage if the request is made within 31 days of your spouse dropping to single coverage
If you and your spouse are retired, covered by SHBP and are both drawing a monthly retirement benefit from a Georgia sponsored retirement system you may change from family coverage to each having single coverage at any time. (The request for you and your spouse must be filed at the same time)
For more detailed information, please refer to the Decision Guide or Summary Plan Descriptions (SPD) available at www.dch.georgia.gov/shbp.
Disclaimer: This material is for informational purposes and is not a contract. It is intended only to highlight principal eligibility and benefits. Every effort has been made to be as accurate as possible; however, should there be a difference between this information and the Plan documents, the Plan documents govern. It is the responsibility of each member, active or retired, to read the Summary Plan Description and all Plan materials provided in order to fully understand the eligibility and option provisions.