Category: 01 – Health Benefits

Greetings Retirees!

My apologies for not responding to your inquiries sooner. There were WiFi issues where I’ve been for the last few days, so my connectivity has been sketchy at best.

Many of you heard me refer to “Part 2” of our annual meeting that was planned for June, where we hoped to converse with representatives from SISC, Navitus, Burnham Benefits and the District Office. Our challenge has been finding a physical location for another hybrid meeting. Seems all three colleges are conducting freshman orientations and activities during June, using their best tech-equipped facilities and those are booked solid.

We are looking at dates in July at this time. Should a physical location still prove elusive we will convert to a Zoom only meeting, and will still hold it in July.

You have my sincere apologies for the confusion and any inconvenience caused by this delay. It is our desire to proceed with the hybrid format in consideration of the many requests we have received for a return to in-person meetings and events. We will know within a few days if that will be possible, and I will let you all know what to expect for the July meeting.

Sincerely,

Susan Bricker, President
VCCCD Retirees’ Association

P.S. Please don’t forget that this is your last chance to pay your annual dues or join as a life member at the current rate of $20 per year or $200, respectively. On 1 July, the dues increase to $25 or $250. Please send your check to VCCCDRA P.O Box 6216, Ventura, CA 93006, today!

SISC Health Plans – Open Enrollment Presentation – Tuesday, 10/10/2023 – Zoom Meeting

Dear VCCCD Retirees:

Open Enrollment for the SISC health plans starts Wednesday, October 11^th and ends on Wednesday, November 1^st.

 We’ll share more details soon regarding the health plans and how to enroll.

You will need to take action to enroll in a SISC health plan during Open Enrollment.

Please be sure to attend the virtual SISC Open Enrollment Retiree Presentation via Zoom using the log-in information below.

Representatives from SISC, Navitus (the Anthem pharmacy manager), Burnham Benefits, and the District will be available during the presentation.

Tuesday, October 10, 2023
10:30am – 12:00pm
https://burnhambenefits.zoom.us/j/93801047888?from=addon
Meeting ID: 938 0104 7888
or Phone 1 669 444 9171 US

The meeting will be recorded and posted to the Benefits website next week.

The Benefits Department will also be offering weekly Q&A sessions via Zoom regarding Open Enrollment during October.  The schedule and log-in information will be provided via email soon.

Please contact the Benefits Department with any questions.  We look forward to seeing you on the call next week.

Katy Lyon
Benefits Analyst
Ventura County Community College District
761 East Daily Drive, Suite 200
Camarillo, CA  93010
(805) 652-5535 phone
(805) 652-7711  fax
klyon@vcccd.edu

Dear Friends and Colleagues,

Many of you have already learned that the District is considering a decision to move from CalPERS to SISC as our health benefits provider. The District’s decision is motivated by the substantial increase in CalPERS premiums for the coming year. While everyone can pretty much agree that the cost of health care and benefits is expensive, the cost increases with CalPERS are exactly what the Retiree’s Association had warned District officials about when the move to CalPERS was being considered. It is what we learned from other colleges that already opted for CalPERS. Since saving money is the motivation, it is highly likely that benefit coverage will be reduced or more difficult to access with the new provider. We have and continue to express our concerns to the District and request clarification. As with most things, the Devil will be in the details.

Here are a few thoughts we have based upon the single information session that was conducted for retirees; please keep in mind that we have very little factual information at this time but we do have some common-sense suggestions that you may want to consider:

1.  We know that three types of plans were presented to retirees and will likely be offered to us during open enrollment for SISC (Self-Insured Schools of California). They are:
   A) Companion Care – a straight-up Medicare supplemental plan that will only pay for Medicare approved services,B) Anthem PPO – a coordinated benefits plan that may offer coverages beyond Medicare approved services but we are lacking details,
   C) Kaiser Permanente Senior Advantage – as far as we understand, this is the basic Kaiser plan and does have copays. It is not as good as Kaiser Summit Senior Advantage plan which some of you on Kaiser have now.

The coverage booklets for these plans can be found on the District website under Benefits: https://www.vcccd.edu/departments/human-resources/benefits

2) If you have Medicare, your Medicare coverage will not change. However, your District-paid additional coverage with SISC could introduce changes in the following areas, among others:

A) Benefits such as hearing, chiropractic, physical therapy, acupuncture, and days covered for stays in the hospital, rehab facilities, and nursing homes
B) Required pre-authorizations
C) Freedom to choose doctors or treatment facilities

3). Kaiser coverage will not be available to retirees living out-of-state, nor will any other type of managed care coverage.

4) Prescription coverages may be changed, and the provider will definitely be changed to Navitas instead of OptumRX. For example, we have been told that compound drug prescriptions will not be covered, but there seems to be some contradiction to that, and we are requesting clarification. There may be restrictions on brand name access, more prescriptions that require pre-authorization, or requirements to try less expensive drugs before authorization of doctors drug of choice, higher costs due to tier placement, more limited in-network pharmacy choices.

5) We do not know how Retirees over 65 who don’t have Medicare A & B will be served. They will be provided coverage until they are able to fully enroll for Medicare parts A & B.  We do not have details on the type of coverage or process for enrollment in Medicare yet. Those under age 65 will be provided access to the same plans as active employees get.

6) Spouses of deceased Retirees who were eligible for District paid benefits also received District paid benefits because CalPERS required it. District contract language does not require such coverage and those spouses may again have to find and pay for their own coverage.

New plan coverage will begin January 1, 2024 with new enrollment likely beginning October 1, 2023. You know what an ordeal the last transition was, and we have no reason to believe we will receive even as much help this time as was available last time.

WHAT TO DO NOW IN THE NEXT THREE MONTHS?

 1) Maximize all of your prescription refill opportunities starting now through the end of the year. (Fill as many as you can, as many times as you can.)  This is especially important with any compound medications or ones that you know will require approvals.

2) If you are considering treatments, elective procedures, new medical equipment, visits to specialists, or other medical services, it may be wise to consider them now, before January 1, if it is appropriate for you, especially in treatment areas that may disappear or be greatly reduced under the new plan.  An example of this is hearing aid coverage for those with Anthem plans.

3) If you are a spouse of a deceased Retiree who was eligible for District paid benefits and have been receiving spousal benefits while the District contracted with CalPERS, you may need to find and pay for your own benefits because the District is not contractually required to provide them under the new plan, and will probably no longer do so. Please explore your options for insurance now.

4) If you live outside California and are on Kaiser, you will need to find medical providers that are either covered by Blue Cross or, if you are over 65, by Medicare or by both.  You should also get whatever care you need no later than Dec. 31, 2023, so that the transition will be easier for you.

Susan Bricker, President
Ventura Community College District Retirees Asso.

HELP US LOCATE SPOUSES WHO QUALIFY!

From Gary Johnson

The Association became aware that under CalPERS rules the District must provide most spouses of deceased retirees District paid health benefits that are the same as their spouse would have received had they still been alive.

• • • The retiree must have been eligible for lifetime District benefits (Tier I or Tier II)
    • The spouse must be a recipient of a monthly allowance pension through CalPERS or CalSTRS sufficient to cover the cost of the benefit
    • The spouse must enroll in Medicare Part A and Part B if they are eligible for Medicare. (Note: if deceased retiree was eligible for Medicare, then the spouse is eligible for Medicare)
    • The District will reimburse the spouse for the cost of Medicare Part B, plus any part B late enrollment penalties and surcharges for excessive income (IRMAA), and the District will pay for a Medical supplement health plan to Medicare Part B, including Part D drug coverage

• • • The spouse must enroll In a CalPERS health plan by October 31!  (This requirement may be waived under certain circumstances)
    • This surviving spouse benefit, that is, District paid coverage for the spouse, will last only as long as the District contracts with CalPERS for healthcare benefits

• • • If you know any of them or of them, contact them to see if they know of this opportunity. Then, forward their name and contact information to the Retirees’ Association for our records and possible assistance
    • If they are interested in more information and/or enrollment, have them contact both the Association and the District.

Lester Tong was kind enough to email us his summary of the Zoom meeting sponsored by the District on 10/7/2020.

On 10/7/2020 9:50 PM, Lester & Mae Tong wrote:

Today from 10:00am till 11:00am, I attended the “CalPERS Medical Plan Open Enrollment” Zoom Meeting (along with 47 others) presented by Katy Lyon.  I found it to be very helpful.  This Zoom Meeting was recorded and will be made available for playback at the District’s Benefit website at: https://www.vcccd.edu/departments/human-resources/benefitsLook for the section “CalPERS MEDICAL”Then subsection “Retirees”Under the “Zoom meeting Q&A – Recording 7/17/2020” (when they get it posted).
Also, I would encourage all retirees to go to this website and review the “CalPERS MEDICAL – OPEN ENROLLMENT” section for more detailed information.
Here are the highlights from my notes:
__ CalPERS Health Benefit is on a Calendar Year which is from Jan 1 to Dec 31.
     Open Enrollment for 2021 is from Sep 21 to Oct 16, 2020.     Any changes to your existing Medical Plan must be completed during Open Enrollment.     Changes are done online with your account login at www.calpers.ca.gov
__ For CalPERS Anthem “PPO Basic Plans” (without Medicare), it is either “PERS Choice” or “PERSCare”    Comparision of Benefits is found in “2021 CalPERS Health Benefit Summary” starting on page 16.  It can be downloaded from the District’s Benefit website (see link above). 
__ For CalPERS Anthem PPO with Medicare, it is either “PERS Choice” or “PERSCare”    Comparision of Benefits is found in “2021 CalPERS Health Benefit Summary” starting on page 24.  It can be downloaded from the District’s Benefit website (see link above). 
__ If you are over 65 and do not have both Medicare parts A & B,

Regarding Medicare eligible by age but not enrolled – CalPERS allows newly contracting members to enroll in a Basic plan until they can secure Medicare. They must then enroll in the required Medicare during the upcoming general enrollment, January 1, 2021 – March 31, 2021.

 Upon receiving Medicare, that is a qualifying event for retirees to change plans. For example, if a retiree becomes effective for Medicare July 1, 2021, that would be a qualifying event for them to change plans.

 Additional information can be found at http://www.calpers.ca.gov/newhealthmember.
__ Medicare Part B (Non-hospital cost) monthly premiums including IRMAA (Income-Related Monthly Adjustment Amount based on your tax returns) will be reimbursable with proof of payment starting September 2020.    Also, Medicare Part D (Prescription cost) IRMAA (Income-Related Monthly Adjustment Amount based on your tax returns) will be reimbursable with proof of payment starting September 2020.     Reimbursements will be handled by a 3rd party, BCC (Benefit Coordinators Corporation) using the SMARTCARE program.  VCCCD can not pay these premiums directly as it is prohibited by law.  Further instructions from BCC are mailed to your home address.

__ MES Vision & Delta Dental will remain the same and separate from CalPERS Medical.
Lester Tong, Classified Retiree, June 2016

Please note that a page has been added to the BLOG for the purpose of providing updated information on the lawsuit regarding CalPERS Long Term Care.  You can find this page on the right side of this post, scroll down to the PAGES section.  It is the second page listed in this section.

A big THANK YOU to Harry Culotta, VCCCDRA Past President, for providing updates on this lawsuit regarding long term care.

Gary Johnson reminds us that for Retirees covered by the Settlement  Agreement, especially those of you 80 years or older, the move to CalPERS may trigger reimbursement opportunities for medical and prescription expenses. The Association will be studying this over the next few months. If such opportunities exist for reimbursement, the application time will not be for about a year.

We advise you to retain all of your medical and prescription receipts during this first year of transition to CalPERS in case reimbursement opportunities  materialize.

The following was emailed today by Rene Rodriguez, President, to retirees for whom we have email addresses.

Gary Johnson and Marta Freixas have put together the important things you need to know about CalPERS and OptumRx as the starting date of September 1 for CalPERS insurance plans approaches.

 Retirees Be Aware!!!

We are all entering a different health benefit world than we have experienced in our history with the District, particularly for those of us on Medicare plans. We have been warned by other Community Colleges contracting with CalPERS that the District will be less able to assist or intercede for us than we are accustomed to.  We will be more on our own interacting with CalPERS, Medicare, Anthem, OptumRx and Kaiser.  We will be more dependent on on-line sources for information.

As they become available, study carefully all CalPERS, Medicare, Anthem, OptumRx and Kaiser documents that apply to you.  There are rules, access requirements, limitations, reimbursement responsibilities and prerequisites we must understand and figure out how to work with to get the best use of the plans.

Medicare Supplement Plans:  Transfer your prescription enrollment to OptumRx

Everyone on a Medicare Supplement Plan thus far has received a letter from OptumRx that states that by 8/28/2020 those on Choice and Care Plans must call OptumRx at 1-866-420-4471 and request to transfer your current Anthem prescription coverage to OptumRx so they can enroll you through Medicare and accept responsibility for your coverage.  If you do not do this, you will lose all coverage, both medical and prescription.

CalPERS Basic Care Level Plan:

If you received a letter from CalPERS stating that you are delinquent in paying your monthly premium of $125.48, do not be alarmed.  You will not be covered by this plan until 9/1/20 and prior to the unfortunate tone of this letter, neither CalPERS nor the District has provided any information as to the due dates or options for paying this premium.  If you do not understand the best payment option for you, call CalPERS at 1-888-225-7377.  Also, call and ask the District if they are paying for half of the Care Plan premium as previously indicated during negotiations at 805-652-5535.

Prescriptions with OptumRx:

You need to call OptumRx at to find out how your prescription information will be transferred from IngenioRx to OptumRx.  Call 1-866-420-4471 if you have a Medicare Supplement Plan, and 1-855-505-8110 if you have a Basic plan.  For a new start with prescriptions, especially if you want to take advantage of cost savings with a 90 day supply and to coordinate your refills coming due at the same time, your best option may be to have all of your doctors provide full new prescriptions and refill numbers to OptumRx on 9/1/2020, or as soon as possible afterward.

Make sure you fill prescriptions with an OptumRx Network Pharmacy.  The best savings will be with designated “Preferred 90” pharmacies for Medicare plans, and “Select 90” Pharmacies for Basic plans.

CalPERS open enrollment period:

Given the limited information available on plans, the timing of the availability, and the quick deadlines for decisions, it is possible that some retirees chose a health care plan that does not best serve their needs.  CalPERS has an open enrollment period yearly between October 1 and December 31 where you can change your enrollment from your initial choice to another plan.  If this is you, take a more detailed look at the options and take advantage of this quick opportunity to change your mind.

Medicare Doctors/ Medicare Assignment:

Make sure your healthcare providers take Medicare, and know whether or not they accept “Medicare Assignment”.  “Assignment” means the provider accepts the Medicare approved amount as full payment for covered services, which saves you money by not being responsible for the difference between what Medicare paid and what the provider bills.  An increasing number of Doctors, and especially specialists and anaesthesiologists, do not accept Medicare.  Be sure to learn how the doctors you choose, and the hospitals you utilize, handle Medicare.  In addition, be aware that some of the doctors working and caring for you in hospitals do not take Medicare even if the hospital itself does.

HOW TO TELL IF YOU HAVE SUCCESSFULLY ENROLLED IN A CALPERS PLAN

If you have Medicare Part A and Medicare Part B and have successfully enrolled in either PERS Choice Supplement to Medicare or PERSCare Supplement to Medicare, you will have received two insurance cards.  One will be from Anthem for a PERS Supplement Plan, and one will be from OptumRx.   If you have not received your Anthem card, please call 1 (877) 737-7776. If you have not yet received your OptumRx insurance card, please call 1 (866) 420-4471.  You MUST be enrolled in both plans.

If you have no Medicare or Medicare Part A only and are enrolled in either PERS Choice Basic Plan or PERSCare Basic Plan, you should have received only one card from Anthem for a PERS Basic Plan.  If you haven’t yet received your card, please call  1 (877) 737-7776.

Because of current issues with the postal service,  your cards may merely be delayed.  We currently have no way for those of you who need to check on your OptumRx enrollment to achieve that without calling.  However, for those of you with online Anthem access, you can check to see if your enrollment with  PERS Choice or PERSCare was successful by:

1. 1. Logging into your current Anthem account;
   2. Hover your mouse over “My Plan”; and
   3. Select ID Cards from the drop-down menu
   4. Two Anthem cards should show for each person enrolled.  One is for our current plan, and one has CalPERS in the upper right.  If you find your CalPERS card here, you are have successfully enrolled in a Medical plan.  These cards can be downloaded and printed.
   5. If you go back to “My Plan” and select Benefits from the drop-down menu, you should see that the words “California Public Employees Retirement System” appear to the right of our current plan.  It will also show an effect date of Sept. 1, 2020
   6. If your card shows the word “Supplemental” in the upper right in addition to CalPERS, you must check your enrollment in OptumRx too!

CalPERS and OptumRx INFORMATION ON THE VCCCDRA BLOG: blog.vcccdra.org

Blogmaster Carmen Guerrero and Marta Freixas have created some pages in the Pages category of the Blog on the right hand side of the Home Page when you first enter the Blog.  Just scroll down until you see the “Pages” category, and select the desired page.   Here you can get a copy of the PERS Care Medicare Supplement plan, or a copy of the  PERS Choice Basic Plan, plus you can download a copy of the expanded Select90 and Preferrred90 pharmacy list. Explore these pages to see what other valuable information is available to you here.