1. Sandia Retiree Benefits 2019
Helping You Prepare For Your Upcoming Medicare Enrollment
Retiree Benefits 2019
Sandia

2. Via Benefits (formerly OneExchange) We are here to help!
Provide assistance to help you review all of your health care options.
Individualized telephone support provided at no cost to you.
Via Benefits customer service:
1(888)
Available 6 am – 7pm MT Monday – Friday.
Introduce self.
Via Benefits is an Independent company that is here to help each of you make an INFORMED and CONFIDENT health coverage choices as you transition from your current group health plan to individual coverage.
Objective licensed benefit advisors are available to help you understand your options and enroll in the right plans. 2

3. What Should I Have Received in The Mail?
Via Benefits mailed to each Medicare household: 2019 Benefit Choices and Enrollment Guide
Note:
If you retired prior to 2012, you will received one version of the booklet .
If you retired after 2012, you will receive a different version.
Each booklet contains information for Medicare and PreMedicare participants.
If pre65 spouse/dependent eligible for Sandia Total Health, To receive the HRA funds for 2018, Health risk assessment was to be done by 9/30/2017
Confirmed last year in meetings, sent out mailers and many reminders in the open enrollment information. 3

4. What’s ”New” for 2019
YSA Reimbursement Request forms can be requested through the Via Benefits Interactive Voice Response (IVR) phone system.
Expanded online enrollment for Medicare retirees.
Prescription Coverage Checkup Tool allows retirees to evaluate their plan options for the new year.
Please see our representatives at the table if you have specific questions.

5. Do I Need to Take Action During Open Enrollment?
Coverage:
Take Action:
Medical
To enroll or disenroll in a medical plan
To change your current medical plan
To waive coverage
Dental (retirees only)
To enroll or disenroll in the dental plan
Dependent Coverage
If you wish to add a dependent, you must do so during open enrollment.
Mid-year additions require a qualifying event.
You may drop a dependent at any time.
If you are satisfied with your coverage, you do not need to take any action.

6. Sandia Medicare Options
Retired on or before 12/31/2011
Sandia Kaiser Group Sponsored Medicare Plan
Your Spending Arrangement Individual Medicare Plan
Retired on or after 1/1/2012
Your Spending Arrangement Individual Medicare Plan 6

7. Your Spending Arrangement7

8. Your Spending Arrangement (YSA)
Alternative to the Sandia-Sponsored Group Medicare Advantage Plans.
An amount provided to you to use to purchase an individual Medicare plan and use towards eligible healthcare expenses (outlined in your Benefit Choices and Enrollment Guide).
You, not Sandia, will be responsible for choosing your medical coverage.
You must be enrolled in both Medicare Part A and B and continue to pay these premiums.
Any unused balance in your account rolls over and is available to use next year. 8

9. How YSA Works
Tax-advantaged account used to reimburse you for eligible healthcare expenses.
Premiums
Out-of-pocket expenses (deductibles, medical copays, etc.)
You receive money from Sandia to pay for your expenses through the spending account.
Account is shared with your spouse.
Reimbursements are tax free.
Your funds will be automatically available January 1, 2019, if you enroll in an individual plan with Via Benefits.
You must stay enrolled with Via Benefits to continue access to the YSA allocations. 9

10. Choice of Medicare Type Plans
Guarantee Issue – same rates and benefits regardless of your healthcare condition.
No Exclusions for pre-existing conditions.
Network plans that include Medicare Part A and B benefits and often include Rx coverage.
Medicare Advantage Plan
Guarantee Issue – same rates and benefits regardless of your healthcare condition (when newly enrolling). If you change plans after first year, you may be subject to insurance underwriting.
No exclusions for pre-existing conditions, when first enrolling.
These plans pay after Medicare pays (e.g. the 20% coinsurance that Medicare does not pay)
There are no network restrictions allowing a retiree to go to ANY doctor or hospital in the country that accepts Medicare.
Medicare Supplement / MediGap Plans

11. Plan and Carrier Options
All Medicare Plan Types
Medicare Advantage
Medigap/Supplemental
Prescription Drug (Part D)
Sandia Dental Care
Individual Dental
Vision
Sample of Individual Insurance Company Partners
Plan types and insurance companies. 11

12. 2019 Plan Availability in Alameda County
Plan Type
Number of Plans Offered
2019
Monthly Premium
Company
Medicare Advantage 5
$69 - $157
Health Net, Stanford, Kaiser Permanente, UHC
Medigap/ Medicare Supplement
(71 yr. old male) 31
$48 - $184
Blue Cross Blue Shield CA, Health Net, Anthem Blue Cross, Aetna, Humana, Cigna
Part D 21
$20 - $170
Aetna, UHC, Humana, Silver Script, WellCare, Coventry, Express Scripts 12 12

13. Catastrophic Coverage
Medicare Prescription Drug Coverage 2019
You pay 25% of Brand Name and 37% of Generics until your out of pocket costs reach $5100; Pharmaceutical contributions will count towards the $5100 True Out-of-Pocket (TrOOP)
You Pay Full Retail Until Deductible is Met
$0 to $415
Catastrophic Coverage
Coverage Gap
Initial Coverage
Deductible
Only 25% reach Donut Hole
Only 4% reach Catastrophic
You pay copays for your plan coverage for the first $3820 in actual costs of Medications
You Pay $3.40 for Generics and $8.50 for Brand Name or 5% - whichever is greater

14. Your Spending Arrangement
Automatic Monthly Premium Reimbursement
Set Up Automatic Withdrawal
YOU
Your Bank
Premium
Reimburse
Automatic reimbursement is very popular because of its convenience. This type of reimbursement can be used for premiums on the plans that enroll in through Via Benefits; over 90% of the insurance carriers through Via Benefits support this feature. When you choose Automatic Reimbursement, each time that you pay your premium to the insurance provider, they will send Via Benefits notification of your payment. We will then send your reimbursement to you through the mail or deposit it directly into your designated account—whichever way you prefer. It is so convenient because YOU DO NO PAPERWORK at all.
You should be aware that it takes time to set up the notification arrangement with the insurance company. Not always, but sometimes, this process can delay your first reimbursement for up to eight weeks, but after the first reimbursement arrives, the payments will come regularly, in a timely manner.
Receipt of Payment
Insurance Provider
Up to the amount available in your YSA

15. Your Spending Arrangement
Reimbursement Option A
Automatic Reimbursement
Manual Reimbursement
Reimbursement Option B
Participant
Via Benefits
Insurance Carrier
Participant
Via Benefits
Insurance Carrier
Reimbursements are up to the amount available in the YSA

16. Educate Evaluate/Enroll Manage/Advocacy
Via Benefits Enrollment Process
Educate
Evaluate/Enroll
Let’s talk about the process. We want to educate you, etc
Manage/Advocacy

17. Educate
Benefit Choices
Prepare you for enrollment discussion
Review your plan options and important Medicare basics
Appointment confirmation reminder
Website: My.ViaBenefits.com/Sandia
Emphasize the BA’s will take as long as they need with the enrollment process. 17 17

18. Enrollment Process
Benefit Advisors can discuss coverage options with anyone – are required to speak to the participant to complete the enrollment.
Once you have made a coverage selection, enrollment is conducted via telephone.
100% of calls are recorded.
I know some of you don’t like to talk on the phone. Have your spouse do it, or your neighbor, a friend, 3-way call with someone in your family…. 18

19. Personal Advocacy For a Lifetime
A Lifetime Advocate
Reimbursement issues
Navigation
Late enrollment
Enrollment
YSA
Prescription changes
Annual plan review
Affordability concerns
The plans you select continue on year to year. No need to re-enroll in the fall unless you want to make a plan change.

20. Sandia Delta Dental Plan
There is a premium increase to the Dental Plan for 2019.
If you need an additional ID card, these can be ordered at
Retired 12/31/2009 or earlier
Retired 1/1/2009 through 12/31/2011 Monthly Premiums
Retired on or after 1/1/2012 Monthly Premiums
Retiree Only $0
$9.00
$46.00
Retiree plus one
$18.00
$90.00
Retire plus two or more
$26.00
$118.00
There are no plan changes for the Dental Care Program.
If you need more ID cards, you can go onto or call Delta Dental. 20

21. Surviving Spouse Continuation of Coverage
Medical Coverage
To continue coverage, the surviving spouse and/or dependents must elect continuation of coverage through Via Benefits.
Continued coverage cost is 50% of the full medical premium for the survivor of a retiree or employee with 15 or more years of service.
Continued coverage is available until the surviving spouse remarries, dependent children become ineligible and/or coverage is terminated with Sandia.
Your surviving spouse can continue their medical coverage with Sandia if you had medical coverage with Sandia when you die.
To continue coverage… 21

22. Surviving Spouse Continuation of Coverage (cont.)
Dental Coverage
Dental coverage for surviving spouse and/or eligible dependents is discontinued at the end of the month of retiree’s death.
Group coverage may be temporarily continued (COBRA), for up to 36 months by paying the full monthly premium COBRA surviving spouse rate $46 plus the 2% administrative fee.
Other long-term dental plan coverage information for surviving spouse is available through Via Benefits Benefit Advisor.
Surviving Spouses lose dental coverage under Sandia at the end of the month of the retiree’s death.
A surviving spouse can continue coverage for up to 36 months by paying the monthly premiums for COBRA coverage. UHC Business Services will send paperwork to the survivor for continuing under COBRA coverage.
COBRA – Consolidated Omnibus Budget Reconciliation Act of 1986 requires most employer groups sponsoring health plans to continue temporary health coverage in certain instances where coverage would otherwise end.
Coverage may be elected through Via Benefits 22

23. Dependent Eligibility
Check to ensure that your child meets the eligibility requirements to be enrolled.
Children are covered until age 26.
If your child is no longer eligible, please be sure to contact Via Benefits to disenroll.
You must disenroll dependents within 31 days of qualifying event. 23

24. Confirmation/Billing Statements
NO ACTION
You will continue with same plan options.
You will NOT receive a new confirmation statement.
You will NOT need to make any changes to your automatic debit for premium payment.
New premium amounts will be applied beginning with January premium payment for Sandia group sponsored plans. Check with insurance company on individual plans.
TAKE ACTION
You will receive a new confirmation statement of new plan coverage.
You will NOT need to make any changes to your automatic debit for premium payment for Sandia Group sponsored plans. *Individual plans may require a change.
New premium amounts will be applied beginning with the January premium payment.

25. Resource Website information
PreMedicare/Medicare SandiaRetireeBenefits.com
Via Benefits Medicare plan My.ViaBenefits.com/Sandia
Contact information is located in the front of your open enrollment guide

26. If you click on “Summary Plan Description,” that take you to the list of the various groups of Sandia employees.
Click on “Health Benefits for Retired Employees” and that will take you to the list of health plans that are offered by Sandia.

27. Kaiser Senior Advantage Plan
© 2017 Willis Towers Watson. All rights reserved. For Willis Towers Watson and Willis Towers Watson client use only.

28. Questions