Connecticut State Teachers’ Retirement Board Health Plan Administered by Stirling Benefits, Inc. 2014 Stirling Benefits, Inc.

TRB Plan Governed by the Connecticut Teachers’ Retirement Board (TRB) Covering over 22,000 retired teachers Administered by Stirling Benefits Began service to TRB in 1996 Service company, not an insurance company Based on the Blue Cross High Option Stirling Benefits, Inc.

TRB Plan Funding 1/3 Retiree 1/3 Active 1/3 State of CT Plan funding comes from three sources: Active teachers pay 1.25% of salary into the health account, The state is responsible for a third, and The retiree pays a third 1/3 Retiree 1/3 State of CT 1/3 Active Stirling Benefits, Inc.

Retirees receive either: TRB Subsidies Retirees receive either: Local Board subsidy $110 per retiree or spouse per month $220 per month if not eligible for Medicare Or TRB coverage subsidy Two thirds (66%) of the cost of Medical & Rx Once on the TRB plan, TRB no longer pays local board Stirling Benefits, Inc.

Must have Medicare Part A & Part B TRB -- Who is eligible? Retiree Spouse Surviving Spouse Must have Medicare Part A & Part B Stirling Benefits, Inc.

To obtain Medicare… Need 40 Quarters of Eligible Employment, or… Married 10 years to someone who has 40 quarters Part A -- Paid by Medicare Part B -- Cost Share with Retiree Pre 1987 hires may not have 40 quarters TRB members don’t need Part D Stirling Benefits, Inc.

TRB -- What’s Covered Medical Prescription Dental Vision and Hearing Stirling Benefits, Inc.

Any provider that accepts Medicare TRB Plan Process No Network Any provider that accepts Medicare Claims paid by Medicare first, then sent electronically to Stirling Benefits No paper claims to file Stirling Benefits, Inc.

TRB Medical Covers what Medicare allows No network, No Copayments, Same as Blue Cross High Option No network, No Copayments, No Pre-Existing Condition Limitations No Individual Underwriting Picks up remainder after Medicare pays Coverage the same everywhere in the US and Puerto Rico Stirling Benefits, Inc.

Lifetime Maximums Unlimited maximum on Hospitalizations Unlimited maximum on Basic Medical Unlimited maximum on Prescriptions $1 M max on a small portion of remaining claims (totaling about 3% of the total claims) Applies to: out of country, extra 15% on unassigned Medicare claims, extra 20 days of skilled nursing care No member has ever come close to hitting the limit. Stirling Benefits, Inc.

Assignment of Claims Medicare claims are either Assigned or Unassigned Assigned Claims (95% of all claims): Doctor agrees to accept what Medicare “allows” as full payment Medicare and TRB plan pays the doctor Doctor guaranteed to collect 100% of what Medicare allows. Un-Assigned Claims (5% of all claims) Doctor may charge 15% more than “allowed” Medicare and TRB Plan pays Member Doctor must bill and collect from member

Examples of Claim Assignment Assigned claims (95% of claims) Un Assigned Claims (5% of claims) Doctor Charge $130 Medicare Allows $100 Medicare Pays $80 TRB Pays $20 15% Extra Billing - $15 $12 Member Pays $0 $3 Stirling Benefits - November 2007

Shingles Vaccine Covered Effective 1-1-2013 Plan reimburses 80% of the cost of vaccine Up to total of $200 per person per lifetime Send proof of payment to Stirling Benefits TRB plan reimburses member by check Stirling Benefits, Inc.

Out of Country In-Patient Hospital – 30 days at 100% Physician’s charges paid at 80% Non-Emergency Only 20% for services usually covered by Medicare Cannot be used for experimental procedures. Stirling Benefits, Inc.

Rx Benefits 100% for the remainder of the year Administered by CVS Caremark $250 Annual Deductible per Person Maximum Out-of- Pocket is $1,000 ($250 deductible + $750 of cost share) 100% for the remainder of the year

Retiree Payments for Rx Generic Drugs Preferred Drugs Non-Preferred Acute at Pharmacy 5% 20% 30% Maintenance at Mail Order Maintenance at Pharmacy 10% 25% 35% Stirling Benefits - CAPSS 3-26-2008

Dental $44.00 / Month (2014) Administered by Aetna Dental $50 annual deductible 100% cleanings 80% basic restorative 50% Major Restorative $2,000 annual maximum Stirling Benefits, Inc.

Vision & Hearing $5.00 / Month Vision Exams: $75 every 12 months $100 toward frames and $60 - $200 allowance for lenses every 24 months, or $120 toward contacts every 12 months Hearing Aids: $750 every three years Administered by Stirling Benefits Stirling Benefits, Inc.

Monthly Cost Per Person 2009 2010 2011 2012 2013 2014 Medical / Rx $99 $112 $125 $124 $117 $97 Medical/Rx & Dental $144 $160 $174 $173 $141 Medical / Rx /Dental Vision & Hearing $149 $165 $179 $180 $146

How Members Enroll Complete one form per person (Stirling or TRB website) Send form with proof of Medicare to TRB (not to Stirling) Must be received by the 25th of the second month preceding coverage (25th of November for January 1st) Cancel current Board of Education coverage Stirling Benefits, Inc.

For More Information… Stirling Benefits, Inc. 20 Armory Lane, Milford, CT 06460 (203) 876-1660, ext. 0, www.StirlingBenefits.com Teachers’ Retirement Board 765 Asylum Avenue, Hartford, CT 06105-2822 (800) 504-1102, fax: (860) 622-2849, www.ct.gov/trb CVS /Caremark (800) 318-2572 Aetna Dental (855) 394-3874 Medicare (800) 772-1213 www.Medicare.gov Stirling Benefits - CAPSS 3-26-2008

Stirling Benefits, Inc.