A snapshot of the State Health Benefit Plan for retirees for 2011 [Jan. 2011]

An Option of the Division of State health Benefit Plan
A SNAPSHOT OF
State Health Benefit Plan for Retirees for 2011

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 State Health Benefit Plan (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

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

system and do not receive a monthly retirement benefit

Medicare does not impose penalties if you

payment

enroll in Medicare after you first become

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 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.

eligible if the reason for delay is that you were actively working and had creditable group health insurance. The HDHP is not considered creditable coverage. 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 website at www.medicare.gov

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

Medicare, coverage will roll to the Medicare Advantage PPO

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 in 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 change coverage to You Only or discontinue your coverage at anytime, but once you discontinue the

coverage, you cannot get it back unless you return to work in a position that offers SHBP coverage

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 address updated.

Please send a letter with the retiree's name, social security number and new address to SHBP, P.O. Box 1990,

Atlanta, GA 30301-1990

Your tier choices are: you, you + spouse, you + child(ren) or you + family

If you and your spouse are retired and under age 65
The $80 tobacco and $50 spousal surcharges apply SHBP will remain your primary insurer and options and premiums will be the same as an active employee until
you or your spouse turn 65 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
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.
You will pay a higher premium 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 the first of the month prior to the month you turn 65 to: SHBP, P. O. Box 1990, Atlanta, GA 30301-1990 or via a secure fax line at 866-828-4796.

2 Peachtree Street, Atlanta, Ga 30303 w www.dch.georgia.gov January 2011

A Snapshot Of State Health Benefit Plan Retirees

D elay in submission of Medicare information does not qualify for a refund of the difference in premiums You must enroll in one of the Medicare Advantage PPO Standard or Premium plans if you wish to continue to receive
the state contribution toward your health insurance premiums The SHBP MA PPO options include Part D, prescription drug coverage. You should enroll in Medicare Part D only if
you wish to be covered in the HRA, HMO or HSHP option. If you enroll in one of these options you will pay the entire cost of the premium If you enroll in one of the SHBP MA PPO options and decide during a Retiree Option Change Period (ROCP) to change to one of the non-MA options or if the Centers for Medicare and Medicaid (CMS) denies your enrollment in the MA PPO, SHBP will return you to your previous option and you will return to your regular Medicare Part A and Part B coverage. Open Enrollment for Part D is November 15 - December 31, if you miss the initial enrollment period You may enroll in the HRA, HMO, HDHP options but you will pay the entire cost of the premium CMS requires a physical address for all participants. If the only address SHBP has on file is a PO Box your request for enrollment in SHBP MA PPO will be denied by CMS

Changing Options An annual 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 Enroll in one of the SHBP MA PPO Options

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

adoption or Qualified Medical Child Support

required

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

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 Cannot add dependents to 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 you + family coverage because you need to cover a dependent, the retiree or active employee may take "you + family" coverage. However, the retiree must have picked up, you + 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 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 you + spouse or you + 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.