Retiree Health Insurance Information

On this page you can learn about Retiree Health Insurance:

Availability

Eligibility

Plan Choices

Premiums

Medicare Eligibility

Summaries of Benefits and Coverage

Using the MAPD

Vision Benefits

 

Availability

Retiree health insurance is not a guaranteed benefit. The Metropolitan Water Reclamation District's Board of Commissioners periodically reviews the retiree health insurance plan for both terms and continuance.

On September 15, 2011, the District's Board of Commissioners approved a policy that will increase the annuitant contribution rate by 2.5% every January 1st for a 10-year period starting January 1, 2012. The table below shows the projected annuitant contribution rate for the 10-year period covered by the new policy.

Retiree Contribution Rate - Ten Year Projection
Year Annuitant Share MWRD Share Year Annuitant Share MWRD Share
2012 27.50% 72.50% 2017 40.00% 60.00%
2013 30.00% 70.00% 2018 42.50% 57.50%
2014 32.50% 67.50% 2019 45.00% 55.00%
2015 35.00% 65.00% 2020 47.50% 52.50%
2016 37.50% 62.50% 2021 50.00% 50.00%

  

Employees and retirees from the public and private sector throughout the nation are experiencing the financial pinch related to the escalating health care costs. Although it is unpleasant to increase annuitant cost for health insurance, it is necessary for the District to implement this change in order to continue to offer the health insurance benefits to the annuitants.

In 2007 the Metropolitan Water Reclamation District established the Retiree Health Trust to help fund existing liabilities.

 

Eligibility

Retiree Health Insurance Information pertains to all annuitants who qualify for retiree medical insurance under the District's eligibility policy. To determine who is eligible to enroll, click here.

 

 Plan Choices

Effective January 1, 2017, Medicare-eligible annuitants and dependents have only one carrier available for health insurance coverage. That carrier is UnitedHealthcare (UHC). The plan is a Medicare Advantage Plan with Part D (MAPD).

Non-Medicare eligible annuitants and dependents have a choice of Blue Cross Blue Shield PPO or HMO Illinois. If you live outside of Illinois, the only option is the PPO. For information regarding the differences between the two, please refer to the comparison chart in part 1 and part 2.

 

Summaries of Benefits and Coverage

For a quick summary of what is and is not covered:

Click here if you are Medicare-eligible and enrolled in UnitedHealthcare.

Click here if you have HMO.

Click here if you have PPO.

 

Premiums

As of 1/1/2017, the annuitant contribution rate is 40% with the District subsidizing 60% of the premium. Fortunately, the District continues to offer health insurance benefits to annuitants. Rates are shown below in the column reflecting the number of insured member covered under PPO and HMO policy and the number of insured members on Medicare.

 

  BCBS of Illinois PPO HMO Illinois
Retirees without Medicare1 Retiree's Rate District's Rate Retiree's Rate District's Rate
Member $403.13 $604.70 $264.35 $396.53
Couple $806.38 $1,209.57 $494.85 $742.28
Family (3 or More) $911.56 $1,367.34 $758.55 $1,137.83
  UnitedHealthcare MAPD UnitedHealthcare MAPD
Retirees with Medicare Retiree's Rate District's Rate Retiree's Rate District Rate
Member $118.06 $177.09 $118.06 $177.09
Couple, both with Medicare $236.12 $354.18 $236.12 $354.18

Rates for Those Coverage at least 1
With Medicare* and at least 1 without

UnitedHealthcare MAPD   
and BCBS PPO
UnitedHealthcare MAPD
and HMO Illinois
Retiree's Rate District's Rate Retiree's Rate District's Rate
Couple, one with Medicare $521.19 $781.79 $382.41 $573.62
Family, one with Medicare $722.76 $1,084.13 $514.59 $771.87
Family (3 or more), two with Medicare  $437.69 $656.52 $368.30 $552.44

1 Must have Parts A and B to qualify for the MAPD plan.

There may be tax implications for annuitants covering domestic partners. For more information, call the Retirement Fund office at 312-751-3222.

 

 Medicare Eligibility

When an annuitant or dependent reaches age 65, he or she is required to get Medicare Parts A and B. About three months prior to the annuitant's or dependent's 65th birthday the Fund will send a letter to the annuitant to advise him or her of the requirement. Once the annuitant becomes Medicare eligible, the retiree will be enrolled in the Medicare Advantage Plan through UnitedHealthcare. In order to put the changes into effect, the Fund will need a copy of the Medicare card showing Parts A and B.

If a retiree or his/her dependents are Medicare eligible prior to age 65 due to disability, he or she must enroll in both Parts A and B when it is offered and provide a copy of the Medicare card to the Fund. For more information, click here.

For more information relative to Medicare enrollment, consult Medicare's website by clicking here.

The health insurance premium decreases when a retiree or a dependent becomes Medicare eligible. Refer to the premium table above.

Once you become Medicare eligible, you must retain Medicare coverage in order to remain eligible for District-sponsored health insurance. This includes making payments for your Part B premium and any IRMAA that may be due. IRMAA is the Income Related Monthly Adjustment Amount. If your income exceeds a certain threshold, you may owe additional premiums to the Social Security Administration. Click here to learn more about IRMAA.

 

Prescription Drug Coverage

Retirees Prescription Drug Co-Payments for both UnitedHealthcare, Blue Cross HMO Illinois and Blue Cross Blue Shield PPO are as follows:

Rx Category Local Pharmacy Mail Order2
Monthly Annual 3-month Annual
Generic $9 $108 $18 $72
Formulary Brand Name 25 300 50 200
Non-Formulary Brand Name 45 540 90 360
Specialty 100 1,200 200 800

 

2 The mail order plan depends on whether the participant is Medicare eligible or not.


♦ Mail order benefits for non-Medicare eligible retirees and dependents are administered through Primemail. For more information on Primemail, click here.

♦ Mail order benefits for Medicare-eligible retirees enrolled in UnitedHealthcare are administered through OptumRx. For more information on OptumRx Mail order, click here.

There is a 33% savings for using the Mail Order Pharmacy. Mail order is a practical option for those medications that you take routinely.

 

Using the MAPD

The Fund would like to make the transition to the UnitedHealthcare MAPD as smooth as possible for all new retirees and for those aging in at age 65. Below you will find some helpful information for making the transition. Click on each document's name to read it:

Information Sheet for Those Reaching age 65 or newly enrolling into the MAPD - some answers to common questions when enrolling into the UHC MAPD for the first time.

Provider Guide to Healthcare - Sometimes doctor's offices do not fully understand what kind of coverage is offered through the MWRD's group MAPD through UHC. Any doctor who takes Medicare takes this plan. This document may assist the provider's office with billing.

Welcome to UnitedHealthcare - for help finding a doctor and coordinating care.

Provider Access Brochure - a guide to understanding in- and out-of-network as it pertains to this plan

 

Vision Benefits

Retirees do not have comprehensive vision insurance benefits. However, there are discounts available.

♦ Medicare eligible retirees covered on the UnitedHealthcare plan have coverage for eye exams with $0 copay. Call the number on the back of your insurance card for more information and to find a provider.

♦ Non-Medicare eligible members enrolled in either the HMO and the PPO plans qualify for discounts through either EyeMed or Davis vision.

♦ To learn more about Eyemed discounts, Blue Cross Blue Shield participants may dial 1-844-684-2254 or visit the Blue 365 Website to learn about EyeMed discounts.

Alternately, Blue Cross Blue Shield offers discounts through Davis Vision as well.  To learn more about the Davis Vision discounts, click here.

 

 

 

$20 co-payment. 1-800-321-EYES Annual Exam covered in full; $75 allowance towards the purchase of contact lenses or eye glasses every 24 months

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