2013 enrollment guide...2013 retiree health program serma: the flexibility to spend your healthcare...

2013 Enrollment Guide

Intel Retiree Health Program

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Table of Contents

The Purpose of this Guide ..........................................................................2

Where Can You Get Help? ...........................................................................2

A Message from Richard Taylor ................................................................3

Retiree Health Programs Overview .........................................................4

Sheltered Employee Retiree Medical Account (SERMA) .....................5

Considering Coverage Outside of Intel? Here Are Some Key Questions to Ask .....................................................6

Intel Retiree Medical Plan (IRMP) Overview ..........................................7

IRMP CIGNA Coinsurance ............................................................................8

IRMP CIGNA Indemnity with Rx ................................................................9

IRMP CIGNA Indemnity without Rx ....................................................... 10

A Note on How the CIGNA Indemnity Plans Work ..............................11

Aon Hewitt Navigators: A Resource for Medicare-Eligible Retirees ................................................................ 12

Making Your Enrollment Elections ........................................................ 13

Appendix ...................................................................................................... 14

2013 IRMP Premiums ............................................................................... 15Annual Enrollment typically occurs October/November each calendar year and plan election made during Annual enrollment will be effective January 1 of the next year. You may have an opportunity to change plans outside of Annual Enrollment if you experience a qualified change in status. Also if you do not enroll during this enrollment period, you are required to provide proof of continuous coverage. See the Intel Retiree Medical Plan Summary Plan Description for more information.

Congratulations on your retirement from Intel. This Enrollment Guide will outline the medical and prescription drug benefit options available to you and provide important information about your SERMA.

You have 30 days from your retirement date at Intel to enroll in IRMP. This 30-day period is your enrollment period. It is important that you take time to evaluate your healthcare coverage needs and, if appropriate, make an election during this enrollment period. If you do not make an election during this 30-day enrollment period, your next opportunity to enroll in IRMP will be the next Annual Enrollment.1

Where Can You Get Help?Contact an Intel Health Benefits Center representative at (877) GoMyBen (466-9236) for answers to your questions about:

• Enrollment

• IRMP

• SERMA

The Intel Health Benefits Center is available Monday through Friday, 7 a.m. to 5 p.m. (Pacific). When calling the Intel Health Benefits Center you will be prompted to enter your password. If you have forgotten your password, or haven’t created one yet, just say “representative” and your call will be routed to a representative who can help you.representative who can help you.

The Purpose of this Guide

1 Annual Enrollment typically occurs October/November each calendar year and plan election made during Annual enrollment will be effective January 1 of the next year. You may have an opportunity to change plans outside of Annual Enrollment if you experience a qualified change in status. Also if you do not enroll dur-ing this enrollment period, you are required to provide proof of continuous coverage. See the Intel Retiree Medical Plan Summary Plan Description for more information.

This guide is intended to satisfy the requirement to provide a summary of material modifications and should be kept with your IRMP Summary Plan Description (SPD). The information in this guide is a summary of your benefits and is not intended to take the place of or change official plan docu-ments in any way. In the event of any discrepancy between the information in this guide and the 2013 Intel Retiree Medical Plan SPD, the SPD will prevail. Intel reserves the right to modify, change, or discontinue benefit plans at its sole discretion.

2013 Retiree Health Program

Intel Retiree,

Congratulations on your retirement from Intel! As the executive sponsor for the Intel Retiree Organization, I want you to know that Intel is committed to providing retirees with the flexibility needed to make the best healthcare decisions possible.

One of the benefits you receive as an Intel retiree is a Sheltered Employee Retiree Medical Account (SERMA). Your SERMA is based on your years of services and allows you the flexibility to reimburse yourself for eligible medical, dental, and vision coverage if you choose to purchase coverage outside of Intel. To find out your current SERMA balance, contact the Intel Health Benefits Center at (877) GoMyBen (466-9236), or visit the My Health Benefits website.

Also, as a retiree, you have access to the Intel Retiree Medical Plan, which provides healthcare plan options based on your eligibility for Medicare. This guide is your overview and reference for your Intel Retiree Medical Plan benefits. It contains useful information to help you make an informed choice.

As you approach your enrollment options, I’d ask that you invest the time and attention to make an informed decision for you and your family. I encourage you to use the decision support resources available, including the Intel Health Benefits Center and Aon Hewitt Navigators (for Medicare-eligible retirees). These resources can help you navigate the options available and help you get the information necessary to make the right decisions.

Healthcare decisions are some of the most important choices we make for ourselves and our families. We hope we’ve give you all the information and support you need in this process.

Again, congratulations on retirement and reaching such a wonderful milestone in your career.

Best,

Richard Taylor Senior Vice President, Human Resources Intel Corporation

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A Message from Richard Taylor

Richard Taylor, Senior Vice President,

Human Resources Intel Corporation

1. Sheltered Employee Retirement Medical Account (SERMA) SERMA is provided to help purchase health insurance for you and your eligible depen-dents once you have retired from Intel and have met the eligibility requirements.

When you retired from Intel as a U.S. em-ployee, Intel established a SERMA2 for you. You may use your SERMA credits to pay for Intel Retiree Medical Plan premiums or you may reimburse yourself for eligible non-Intel sponsored healthcare premiums.

For more information on SERMA, go to page 5.

2. Intel Retiree Medical Plan (IRMP)The IRMP is the medical plan available from Intel Corporation to eligible retirees and their eligible dependents.

The plan is designed to provide access to comprehensive medical coverage for:

• Retirees and their eligible dependents who are Medicare-eligible (typically, age 65 and over); or

• Retirees and their eligible dependents who are unable to purchase health insur-ance coverage elsewhere due to a medical condition (IRMP does not exclude cover-age for pre-existing conditions).

If you are not Medicare-eligible (typically if you under age 65 you are not eligible for Medicare), you may enroll in the CIGNA Coinsurance Plan. For more information go to page 8.

If you are Medicare eligible, you may enroll in either the CIGNA Indemnity Plan with RX or the CIGNA Indemnity plan without Rx. The difference between the plans is the “with Rx” plan includes a prescription drug benefit where as the “without Rx” plan does not. For more information, go to pages 9-10.

If you are enrolling your dependents in IRMP; please review the eligibility rules on page 7.

The IRMP may not be the best plan for all retirees. Retirees under age 65, who are healthy, can often purchase health insurance that costs much less than the comprehensive coverage offered by the IRMP.

Intel’s retiree health program has two elements:

Retiree Health Programs Overview

2 For information on your SERMA balance, contact the Intel Health Benefits Center at (877) GoMyBen (466-9236), or online at www.intel.com/go/myben under Your Spending Account tab.

For additional information and program details see information in the Intel Pay, Stock and Benefits Handbook, Retirement Chapter. For detailed information on the IRMP plan, see the IRMP Summary Plan Description (SPD) document or Contact the Intel Health Benefits Center at (877) GoMyBen (466-9236).

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SERMA: The Flexibility to Spend Your Healthcare Dollars How You See FitYou have the ability to use SERMA to pay for all or part of your IRMP premium, or to reimburse yourself for the cost of other eligible health insurance premiums. With the ability to pay for the plan that best meets your needs, SERMA can increase your health insurance options and help you make the most out of your SERMA credits.

Using SERMA for Non-Intel Sponsored Healthcare PremiumsYou may use your SERMA credit to reimburse yourself for premiums paid for you and your eligible dependents until you exhaust your account. Eligible reimbursements may include premium payments for:

• Individual health insurance

• Individual dental insurance

• Individual vision insurance

• Other employer retiree group plans

• COBRA

• Medicare

• Medigap

• Long-term care

If you are enrolled in IRMP, you may also use your SERMA credit toward other eligible healthcare premiums. For example, if you are on the IRMP plan and your spouse is enrolled in a non-employer sponsored medical plan, you may now use your SERMA toward both your IRMP premium and your spouse’s non-Intel premium expenses.

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Sheltered Employee Retiree Medical Account (SERMA)

Frequently Asked Questions

Q: Can I be enrolled in IRMP and use my SERMA to purchase other insurance as well?

A: Yes, new in 2013 you can enroll in IRMP and also request SERMA reimbursement for eligible premiums such as the MetLife Dental Plan.

Q: Can I use SERMA to purchase coverage for my spouse or dependent children?

A: Yes, you can use your SERMA to purchase individual insurance for yourself, your spouse, and your eligible dependent children.

Q: If I want to remain enrolled in IRMP, may I use SERMA to purchase other coverage for my family?

A: Yes, if you are enrolled in IRMP you may use SERMA towards IRMP premiums for yourself, while also requesting reimbursement for eligible non-IRMP premiums for your dependents.

Q: I am enrolled in my spouse’s employer group medical plan. Can I use SERMA to pay the premium?

A: No, you may not use SERMA to reimburse yourself for another company’s active employee group coverage.

For information on your SERMA balance, contact the Intel Health Benefits Center at (877) GoMyBen (466-9236), or online at www.intel.com/go/myben under Your Spending Account tab. The Your Spending Account website allows you to:

• View your SERMA account balance

• Submit claims (you have the option to submit claims online, by fax, or by mail)

• Check the status of your claims

• Learn more about eligible expenses

Using SERMA for IRMPIf you are enrolled in IRMP, you may use your SERMA credits to off-set your monthly premium until you exhaust your account. During this Enrollment period you may elect how much of your IRMP premium you would like paid from your SERMA each month; 25%, 50%, 75%, or 100%. Your IRMP premium payments will be paid directly from your SERMA; you do not need to submit a claim for reimbursement. The percentage you elect will apply to both you and your enrolled dependent’s premiums. If you chose a SERMA contribution other than 100 percent, you are responsible for paying the remainder of the premium cost.

• What is important to you: provider choice (primary care/specialist), out of pocket cost, monthly premium cost, drug coverage, etc.?

• Does the plan have service area or residency limitations? (Hint: this is typical with an HMO or Medicare Advantage Plan.)

Financial considerations:

• What is the monthly premium?

• What is your monthly healthcare budget? (Be sure to include premium and out of pocket cost which includes copays/coinsur-ance for provider visits and prescription drugs obtained on a regular basis.)

• Does the plan include an annual out of pocket maximum?

• Does the plan include any pre-existing medical benefit limitations?

• Does the plan include a prescription ben-efit, routine vision benefit, chiropractic care or any other services you currently receive? If no, is there an option to add it?

Providers do not accept all plans. If you don’t want to change providers you should understand what benefit plans your providers accept. Here are a few recommended questions to ask our providers:

• Ask provider if they participate in the plan(s) you are considering.

• Ask provider, as a specialist, which plan provides the best ease in use (i.e., less paperwork, easy to get authorizations).

• Ask provider if plan covers treatment facilities they generally use (outpatient services such as radiation, chemo, other lab or x-ray facilities as well as inpatient).

• Ask provider to share their experience with plans (if they participate in multiple). Does the plan provide a good transition in care, i.e., no disruption in current treat-ment plan? (a good transition in care plan ensures you do not experience any disruption in service or treatment).

METLIFE OFFERS DENTAL COVERAGE

MetLife is offering voluntary dental plans to Intel Retirees. These plans offer access to comprehensive dental coverage. You will be receiving com-munications directly from MetLife on when and how to enroll.

You may use your existing SERMA balance to reimburse yourself for any eligible dental premium.

Considering Coverage Outside of Intel? Here Are Some Key Questions to Ask.

First consider your personal situation:

• Are you currently undergoing any treat-ment that may be disrupted as a result of a change in health plans?

• Do you have a pre-existing medical condition which could result in denial or limitation of medical coverage?

• Are you taking any prescription medications?

• Does the plan have a list of approved drugs? If yes, are the drugs you are taking covered?

• Are you taking any specialty drugs?

• Are you receiving treatment from either an inpatient or outpatient facility? If yes, are these facilities participating in the plans you may be considering?

• If you are not currently undergoing any treatment, is there treatment planned for the future? (For example do you have a planned outpatient surgery?)

As you explore your health benefit options, here are some key items you should consider as you make your decision on what the best health plan option is for you and your family.

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Intel Retiree Medical Plan (IRMP) Overview

Using SERMA for IRMP

If you are enrolled in IRMP, you may use your SERMA credits to offset your monthly IRMP premium until you exhaust your account. During this enrollment period you may elect how much of your IRMP premium you would like paid from your SERMA each month; 25%, 50%, 75%, or 100%. The percentage you elect will apply to both your and your dependent’s premiums. If you choose a SERMA contribution other than 100 percent, you are responsible for paying the remainder of the premium cost. Your IRMP premium payments will be paid directly from your SERMA; you do not need to submit for reimbursement. See Appendix for additional details on IRMP premium and SERMA contributions.

IRMP Member Eligibility

Make Sure Your Family Members Are Eligible for Coverage

Intel’s medical plans have specific require-ments for who can be covered as an eligible dependent. It is your responsibility to ensure that only your eligible depen-dents are enrolled and to make necessary adjustments if needed. If you are Medicare-eligible and your eligible dependent is not, or vice-versa, the Medicare-eligible person will be eligible to enroll in one of the IRMP Indemnity options, and the non-Medicare-eligible person will be eligible to enroll in

the CIGNA Coinsurance plan. For a complete description of the dependent eligibility requirements, refer to the IRMP Summary Plan Description (SPD). For a copy of the SPD, contact the Intel Health Benefits Center at (877) GoMyBen (466-9236), or visit the “Your Resources” tab on the Intel Health Benefits website, at www.intel.com/go/myben.

Proof of Continuous Healthcare Coverage (HIPAA Certificate) May Also Be Required

If you do not enroll in IRMP during the 30-day enrollment period following your retirement from Intel, or at the end of Intel COBRA coverage, you will be required to provide a HIPAA certificate when you enroll in IRMP during a future Annual Enrollment. Generally, in order to enroll in the IRMP, you and your eligible dependents are required to provide a HIPAA Certificate showing proof of continuous healthcare coverage for the previous 18 months. The HIPAA Certificate must be received by the Intel Health Benefits Center within 30 days of your enrollment.

Intel has partnered with the Mayo Clinic, a world-renowned medical group operated by the Mayo Foundation, to provide you a convenient and confidential way to understand and evaluate the state of your health. The Mayo Clinic Health Assessment is voluntary and available at no cost to you. You can use the Mayo Clinic website anytime during the year.

Step 1: Start with an Initial Health Check Obtain your health check measurements from your healthcare provider. Your health check measurements should include cholesterol and glucose levels, as well as your height, weight, and blood pressure.

Step 2: Complete the Mayo Clinic Online QuestionnaireUse your health check results to complete the online Mayo Clinic Health Assessment questionnaire at www.intel.mayoclinic.com (you will need to create a user name and password to access the site.) The assessment takes about 20 minutes. The results will be available to you online immediately in the form of a Personal Health Report.

Step 3: Review your Results The information in your Mayo Clinic Personal Health Report will contain recommenda-tions and directions to improve and/or maintain your health. It will outline any health risks you may have and link you to Mayo Clinic and Intel-based programs and tools to address these risks.

Your Privacy is Our PromiseIntel understands the importance of your privacy and is committed to making sure your personal information remains private and completely confidential. You will interact with and share personal information directly with Mayo Clinic. Intel will only receive information pertaining to individual health in an aggregated and unidentified form for use in the design of health and wellness programs.

Be Well by Choosing a Healthy Lifestyle

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IRMP CIGNA Coinsurance

What You Need to Know Before You Enroll in this Plan: • Retirees and dependents who are not

eligible for Medicare (typically those who are under the age of 65) can enroll in the IRMP CIGNA Coinsurance Plan.

• Retirees, who are healthy, can often purchase individual health insurance that costs much less; contact your local health insurance agent or State’s Department of Insurance for health insurance information and pricing.

2013 Monthly Premium

You Only Spouse3 Only

Child(ren)4 Only

You + Spouse You + Child(ren)

Spouse + Child(ren) You + Spouse + Child(ren)

$896 $1,792 $2,688

3 Spouse definition includes eligible Domestic Partners.4 Same price for child or multiple children.

IRMP CIGNA Coinsurance Plan Benefit SummaryAdditional details available at www.intel.com/go/myben or in the IRMP Summary Plan Description (SPD); call the Intel Health Benefits Center at (877) GoMyBen (466-9236) to request the IRMP SPD.

In-Network Out-of-Network

Deductible $600 Individual/$1,200 Family $600 Individual/$1,200 Family

There is a separate deductible for in-network and out-of-network care

Out-of-Pocket Maximum $3,000 Individual/$6,000 Family

Medical Services(e.g., office visit, hospital inpatient, outpatient, ancillary services)

20% coinsurance 40% coinsurance

Vision Exam $0 copayment Reimbursed up to $42

EyewareLimits apply

$25 copayment for lenses

$130 allowance for frames or contacts

Lens reimbursement:

Single – $40; Bifocal – $60

Trifocal – $80; Lenticular – $125

Frame reimbursement: $70; or,

Contact reimbursement: $130

Prescription Benefit

Retail (34-day supply)

Mail (90-day supply)

Retail Penalty5

(34-day supply)

Generic $10 $20 $206

Preferred Brand 20% coinsurance

$25 minimum/$60 maximum

20% coinsurance

$62.50 minimum/$150 maximum

50% coinsurance6

$25 minimum

Non-Preferred Brand 40% coinsurance


40% coinsurance


50% coinsurance6

$40 minimum

Formulary (list of plan approved drugs)

Please review at www.medco.com/intel

5 Penalty applies after the first two purchases of a maintenance (long-term) prescription at a retail pharmacy. 6 The out-of-pocket costs beyond the standard benefit will not apply towards deductible/out-of-pocket maximums.

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IRMP CIGNA Indemnity with Rx

What You Need to Know Before You Enroll in this Plan: • Retirees and dependents that are eligible

for Medicare can enroll in the IRMP CIGNA Indemnity with Rx Plan.

• This plan includes prescription drug coverage. If you enroll in this plan, you do not need to purchase a Medicare Part D program to provide prescription drug benefits.

• This plan coordinates with Medicare which means that it will only provide a benefit for services not covered by Medicare. See note on page 11 and the examples on pages 18-19.

Medicare Part D Creditable Coverage Disclosure NoticeIf you, your spouse or domestic partner are Medicare-eligible, the Creditable Coverage Disclosure Notice is included in this packet. The notice contains important information that notifies you whether or not your cur-rent plan provides you coverage that is at least equivalent to Medicare Part D plan.



Child(ren)8 Only



$545 $1,090 $1,635


IRMP CIGNA Indemnity Plan with Rx Benefit SummaryAdditional details available at www.intel.com/go/myben or in the IRMP Summary Plan Description (SPD); call the Intel Health Benefits Center at (877) GoMyBen (466-9236) to request the IRMP SPD. Also refer to Medicare Part A & B (www.medicare.gov).

Medicare Indemnity Plan

Deductible Part B deductible may apply $500 Individual/$1,000 Family



Vision Exam Not covered $0 copayment

EyewareLimits apply

Not covered $25 copayment for lenses





Retail Penalty9

(34-day supply)

Generic $10 $20 $2010

Preferred Brand $20 $40 $4010

Non-Preferred Brand $30 $60 $6010

Formulary (list of plan approved drugs)

Please review at www.medco.com/intel

9 Penalty applies after the first two purchases of a maintenance (long-term) prescription at a retail pharmacy.10 The out-of-pocket costs beyond the standard benefit will not apply towards deductible/out-of-pocket maximums.

Resources Available to Help You: Aon Hewitt Navigators is an optional resource offered through Hewitt, to help Medicare-eligible retirees navigate the complex health insurance market. This service is available at no cost to you. To contact Aon Hewitt Navigators, call the Intel Health Benefits Center at (877) GoMyBen (466-9236) and select the Aon Hewitt Navigators option.

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IRMP CIGNA Indemnity without Rx

What You Need to Know About This Plan Before You Enroll: • Retirees and dependents who are eligible

for Medicare can enroll in the IRMP CIGNA Indemnity without Rx Plan.

• This plan does not cover prescription drugs. If you enroll in this plan, it is recommended that you purchase a Medicare Part D program to obtain prescription drug benefits.

• This plan coordinates with Medicare which means that it will only provide a benefit for services not covered by Medicare. See note on page 11 and the examples on pages 18-19.

Medicare Part D Creditable Coverage Disclosure NoticeIf you, your spouse or domestic partner are Medicare-eligible, the Creditable Coverage Disclosure Notice is included in this packet. The notice contains important information that notifies you whether or not your cur-rent plan provides you coverage that is at least equivalent to Medicare Part D plan.

Resources Available to Help You: Aon Hewitt Navigators is an optional resource offered through Hewitt, to help Medicare-eligible retirees navigate the complex health insurance market. This service is available at no cost to you. To contact Aon Hewitt Navigators, call the Intel Health Benefits Center at (877) GoMyBen (466-9236) and select the Aon Hewitt Navigators option.



Child(ren)12 Only



$175 $350 $525


IRMP CIGNA Indemnity Plan without Rx Benefit SummaryAdditional details available at www.intel.com/go/myben or in the IRMP Summary Plan Description (SPD); call the Intel Health Benefits Center at (877) GoMyBen (466-9236) to request the IRMP SPD. Also refer to Medicare Part A & B (www.medicare.gov).

Medicare Indemnity Plan

Deductible Part B deductible may apply $500 Individual/$1,000 Family



Vision Exam Not covered $0 copayment

EyewareLimits apply

Not covered $25 copayment for lenses


Prescription Drugs Not covered Not covered

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A Note on How the CIGNA Indemnity Plans Work

The IRMP CIGNA Indemnity plans assume you are enrolled in Medicare Part A and B. The plans will only cover eligible expenses not covered by Medicare. After you reach the plan deductible, the plan then pays a percentage of covered charges (based on Medicare allowable charges), your coinsurance amount is 20 percent or a copayment based on the service received (see plan compare for details). Below are two examples of how the plan works:

Why does the plan pay $0? The IRMP CIGNA Indemnity plan reimburses 80 percent of the $65 allowed by Medicare. The IRMP CIGNA Indemnity amount is reduced by the amount paid by Medicare. In this case, since the CIGNA’s benefit of $52 (80 percent of $65) is the same amount paid by Medicare, therefore, the amount paid by the IRMP CIGNA Indemnity plan is $0.

Example: You have met your annual IRMP deductible. You visit your doctor and the bill is $100. Medicare considers $65 of the charge an allowable Medicare reimbursement.

Doctor submits bill $100

Medicare allowable on this bill $65

Medicare Pays 80% of allowed amount $52 (65 x .80)

Your coinsurance amount (20% of allowed amount) $13 (65 x .20)

IRMP CIGNA Indemnity Plan pays $0

Your Total Out-of-Pocket $13

Example: You have not met your annual IRMP deductible and are hospitalized. The bill is $50,000. Medicare considers $11,951 of the charge an allowable Medicare reimbursement.

Hospital submits bill $50,000

Medicare allowable This is the maximum amount the provider may charge for the services provided.

$11,951

Medicare pays $10,795

Your Medicare Deductible This is the amount you would owe the provider if you were not enrolled in IRMP.

$1,156

Your IRMP CIGNA Plan deductible $500

Allowable amount applied to IRMP $ 656

Your coinsurance amount (20% of allowed amount) $131.20 (656 x .20)

IRMP CIGNA Indemnity Plan pays (80% of allowed amount) $524.80 (656 x .80)

Your Total Out-of-Pocket on IRMP Indemnity The $500 deductible plus the $131.20 coinsurance.

$631.20

If you are enrolled in IRMP your total out of pocket cost for this hospitalization is $631.20 vs. $1,156 if you were only enrolled in Medicare.

In this example, Medicare pays $10,795, the IRMP Cigna Indemnity plan pays $524.80, and you pay $631.20.

Benefits of the IRMP CIGNA Indemnity Plans

Once you have met the Indemnity plan out-of-pocket maximum, the plans will pay 100 percent of your eligible expenses. Also the plans will cover some non-Medicare eligible expenses such as vision and for those enrolled in IRMP w/Rx, prescription drugs.

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Aon Hewitt Navigators: A Resource for Medicare-Eligible Retirees15 Aon Hewitt Navigators is an optional resource offered to help Medicare-eligible retirees navigate the complex health insurance market. This service is available at no cost to you.

Aon Hewitt Navigators works with many insurance companies, which allows them to offer unbiased, expert advice. They will work with you to compare many plans to find coverage that is right for your specific healthcare needs and budget.

To contact Aon Hewitt Navigators, call the Intel Health Benefits Center Monday through Friday at (877) GoMyBen (466-9236) and select the Aon Hewitt Navigators option.

15 Aon Hewitt Navigators is a service offered through Aon Hewitt, not an Intel sponsored program.

The healthy choices you make can help you live a longer, healthier life, and reduce your overall healthcare costs. Given the substantial investment you make in your health coverage, it makes sense to use your plan well and make healthy lifestyle choices.

Use Your Preventive Care Benefits

Taking advantage of preventive care such as annual exams and health screens allows you to keep yourself on the road of good health by addressing health issues before they become more serious.

If you choose to participate in IRMP, you can help reduce your costs by:

• Accessing in-network care13 instead of out-of-network care.14 Costs are higher for you and for Intel when you use out-of-network providers.

• Accessing a primary care provider before going to a specialist.

• Scheduling an in-office doctor appointment instead of using the emergency room for minor injuries or routine care.

• Using the nurse line (800) 468-3510 has no cost to retirees, and nurses can assist you in determining the type of care you should seek.

• Requesting generic drug(s) or using mail order service (or both).

Good Health Pays Off In More Than One Way

13 In-network care providers, such as physicians and hospitals, have contracted with the provider’s network to provide services at a discounted rate.

14 Out-of-network care providers have not contracted with the provider’s network.

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2013 Retiree Medical Enrollment Guide

Making Your Enrollment Elections

You have 30 days from the date of your retirement from Intel to enroll in IRMP. This is your enrollment period.

The My Health Benefits website will provide you tools and resources to allow you to prepare, understand, and enroll in the IRMP.

• You can access the website from www.intel.com/go/myben.

• You will need to login with your User ID and password.

• If you are accessing the site for the first time, you will be asked to create a User ID and password to login.

• To create your User ID, select “Register as a New User” and follow the instructions.

• You will be asked to create a password and answer a series of security questions.

• You can also make your elections over the phone by contacting the Intel Health Benefits Center at (877) GoMyBen (466-9236).

How to Enroll in IRMP:• Click the “Enroll” button. Then click

the medical plan.

• Select the plan option you want to enroll in.

• Save your choices by selecting the “Complete Enrollment” button.

• Print a copy of your confirmed elections for your records. You can visit the My Health Benefits website at any time to view your elections. You may also make changes to your elections multiple times during your enrollment period.

There are certain changes not available on the web.

You must call the Intel Health Benefits Center to complete your enrollment if:

• You have dependents with split eligibility (i.e., one who is Medicare eligible and one who is not Medicare eligible).

• You are enrolling in IRMP for the first time.

• You have experienced a qualifying change-in-status event (e.g., marriage).

When Do Benefit Election Changes Take Effect?The benefit elections you make during this enrollment period will become effective as of the day of your retirement. The next opportunity for you to make IRMP or Shel-tered Employee Retiree Medical Account (SERMA) changes will be during next year’s Annual Enrollment, or if you experience a qualifying change-in-status event during the year. You will be required to provide proof of 18 months of continuous health coverage (see page 7).

If You Elect Coverage Other than IRMPYou are encouraged to explore options out-side of IRMP to get the best value for your healthcare dollars. However, if you choose not to enroll in IRMP, you may be required to show proof of continuous health coverage if you have a qualifying reason to enroll at a later date (see page 7).

As You Explore Obtaining Health Insurance Outside of Intel, Please Be Aware:

Companies selling individual health insur-ance typically require a review of your medical history that could result in a higher premium or a denial of coverage. You may wish to contact your local health insurance agent or your state’s Department of Insur-ance to assist you in selecting and enrolling in a health insurance plan.

Have Questions: Call the Intel Health Benefits Center at (877) GoMyBen (466-9236), if you do not remember your password state the word “representative” until you reach a live agent.

Need Help?• To explore your Health Insurance

options call (877) GoMyBen (466-9236)

– If you are not Medicare-Eligible, an Intel Health Benefits Center representative will help you explore coverage options in your area.

– If you are Medicare-Eligible, call the number above and select the Aon Hewitt Navigators option. A representative will help you find and enroll in a Medicare supplemental plan that is right for you.

• If you have questions regarding the CIGNA plans, call (800) 468-3510 or visit CIGNA online at www.mycigna.com

• If you have questions regarding Medicare, call (800) 633-4227 or visit Medicare online at www.medicare.gov

• If you have questions regarding pre-scription drug coverage, call Medco at (800) 899-2713 or visit Medco online at www.medco.com

• If you have questions regarding your vision coverage, call EyeMed at (866) 798-9193 or visit EyeMed online at www.eyemedvisioncare.com/intel 13

Appendix: Intel Retiree Medical Plan Benefit Summary and Premiums with SERMA Contributions

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2013 IRMP Premiums and SERMA Contribution

Non-Medicare (typically under age 65) – IRMP CIGNA Coinsurance Plan

Medicare (typically age 65 and over ) – IRMP Indemnity Plan with Rx

Medicare (typically age 65 and over ) – IRMP Indemnity Plan without Rx

Monthly

SERMA Election You Only16

You +Spouse/DP

You + Child(ren) or Spouse/DP +

Child(ren)You + Spouse/DP + Child(ren)

0% (or No SERMA)

$896 $1,792 $1,792 $2,688

25% $672 $1,344 $1,344 $2,016

50% $448 $896 $896 $1,344

75% $244 $488 $488 $672

100% $0 $0 $0 $016 You only = Individual coverage of any eligible retiree, spouse or domestic partner, or child.

Monthly17


You +Spouse/DP You + Child(ren)

You + Spouse/DP + Child(ren)

0% (or No SERMA)

$545 $1,090 $1,090 $1,635

25% $409 $818 $818 $1,226

50% $273 $545 $545 $818

75% $136 $273 $273 $409

100% $0 $0 $0 $017 Rounded to the nearest whole number.18 You only = Individual coverage of any eligible retiree, spouse or domestic partner, or child.

Monthly




0% (or No SERMA)

$175 $350 $350 $525

25% $131.25 $262.50 $262.50 $393.75

50% $87.50 $175 $175 $262.50

75% $43.75 $87.50 $87.50 $131.25

100% $0 $0 $0 $0 19 You only = Individual coverage of any eligible retiree, spouse or domestic partner, or child.

Annually


You +Spouse/DP

You + Child(ren) or Spouse/DP +

Child(ren)You + Spouse/DP + Child(ren)

0% (or No SERMA)

$10,752 $21,504 $21,504 $32,256

25% $8,064 $16,128 $16,128 $27,192

50% $5,376 $10,752 $10,752 $16,128

75% $2,688 $5,376 $5,376 $8,064

100% $0 $0 $0 $0

Annually




0% (or No SERMA)

$6,540 $13,080 $13,080 $19,620

25% $4,905 $9,810 $9,810 $14,715

50% $3,225 $6,540 $6,540 $9,810

75% $1,613 $3,270 $3,270 $4,905

100% $0 $0 $0 $0

Annually



You + Spouse/ DP + Child(ren)

0% (or No SERMA)

$2,100 $4,200 $4,200 $6,300

25% $1,575 $3,150 $3,150 $4,725

50% $1,050 $2,100 $2,100 $3,150

75% $525 $1,050 $1,050 $1,575

100% $0 $0 $0 $0

The following charts provide you a glance of the monthly and annual cost of the IRMP premiums and how much you would pay if you elect SERMA to pay for a portion of your premium.

15

IRMP CIGNA Coinsurance Benefit Summary (non-Medicare)

Monthly Premium (individual) $896

BENEFITS In-Network Out-of-Network

Annual Deductible $600 individual/$1,200 family $600 individual/$1,200 family (separate from in-network deductible)

Out-of-Pocket Maximum $3,000 individual/$6,000 family $3,000 individual/$6,000 family

Major Medical Lifetime Maximum Unlimited $2 million out-of-network

INPATIENT In-Network Coinsurance applies after deductible is met

Out-of-Network Coinsurance applies after deductible is met and is subject

to reasonable and customary

Inpatient Hospital 20% coinsurance 40% coinsurance

Skilled Nursing Facility 20% coinsurance; limited to 100 days per calendar year 40% coinsurance

Home Health 20% coinsurance; $5,000 lifetime maximum 40% after deductible is met with a $5,000 lifetime maximum

Inpatient Mental Health (preauthorization required) 100% covered 40% coinsurance

OUTPATIENT In-Network Coinsurance applies after deductible is met



Physician Office Visit 20% coinsurance 40% coinsurance

Ambulatory Surgical Center 20% coinsurance 40% coinsurance

Outpatient Hospital 20% coinsurance 40% coinsurance

Occupational and Physical Therapy 20% coinsurance 40% coinsurance

Speech/Language Therapy 20% coinsurance 40% coinsurance

Ambulance 20% coinsurance 40% coinsurance

Emergency Room 20% coinsurance 40% coinsurance

Emergency Worldwide Coverage 20% coinsurance 40% coinsurance

Urgent Care 20% coinsurance 40% coinsurance

Urgent Care Worldwide Coverage 20% coinsurance 40% coinsurance

Prosthetic Devices 20% coinsurance 40% coinsurance

Mental Health and Substance Abuse 20% coinsurance 40% coinsurance

Diagnostic Tests/Lab Services 20% coinsurance 40% coinsurance

Routine Outpatient X-Ray Includes Radiation Therapy 20% coinsurance 40% coinsurance

Routine Physical 20% coinsurance 40% coinsurance

16


IRMP CIGNA Coinsurance Benefit Summary (non-Medicare) – continued




Retail Penalty20

(34-day supply)

Generic $10 $20 $2021

Preferred Brand 20% coinsurance $25 minimum/$60 maximum

20% coinsurance $62.50 minimum/$150 maximum

50% coinsurance21 $25 minimum

Non-Preferred Brand 40% coinsurance $40 minimum/$100 maximum

40% coinsurance$100 minimum/$250 maximum

50% coinsurance21 $40 minimum

Formulary (list of plan approved drugs) Please review at www.medco.com/intel20 Penalty applies after the first two purchases of a maintenance (long-term) prescription at a retail pharmacy. 21 The out-of-pocket costs beyond the standard benefit will not apply towards deductible/out-of-pocket maximums.

ADDITIONAL BENEFITSIn-Network

Coinsurance applies after deductible is met



Routine Chiropractic 20% coinsurance; limited to 30 visits per year combined in- and out-of-network

40% coinsurance; limited to 30 visits per year combined in- and out-of-network

Routine Podiatry 20% coinsurance 40% coinsurance

Non-Emergency Transportation 20% coinsurance 40% coinsurance

Acupuncture 20% coinsurance; limited to 30 visits per year combined in- and out-of-network

40% coinsurance; limited to 30 visits per year combined in- and out-of-network

Preventive Dental Not covered Not covered

Vision Exam $0 copayment; limited to once every 12 months Reimbursed up to $42

Eye Wear $25 copayment for standard lenses; lenses limited to once every 12 months; frames $130 allowance;

limited to once every 24 months

The following reimbursements apply: single vision $40; bifocal $60; trifocal lenses $80; lenticular lenses $125;

frames $70 once every other year

Contact Lenses $130 allowance for elective; 100% covered; must be medically necessary; preauthorization required; limited to once every

12 months, in lieu of spectacle lenses

$105 allowance for elective; limited to $210 if medically necessary; preauthorization required

Routine Hearing 20% coinsurance 40% coinsurance

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Medicare22 IRMP CIGNA Indemnity Medicare-Eligible

Monthly Premium (individual) Part B Premium23 = $115.40 (required for enrollment)CIGNA Indemnity with Rx = $500

CIGNA Indemnity without Rx = $175

BENEFITS

Annual Deductible Part B Deductible = $162See Inpatient Hospitalization section for Inpatient Deductible

$500 individual/$1,000 family

Out-of-Pocket Maximum Not applicable $2,000 Individual/$4,000 family

Major Medical Lifetime Maximum (if applicable) Not applicable $2 million out-of-network

INPATIENT Coinsurance applies after deductible is met

Inpatient Hospital $1,132 deductible (Days 1-60); $283 (Days 61-90); $566 (Days 91-150)

20% of Medicare allowable after deductible is met

Skilled Nursing Facility Pay for each benefit period, following at least a 3-day covered hospital stay;

Days 1-20: $0 for each day; Days 21-100: $141.50 for each day(there is a limit of 100 days for each benefit period)

20% of Medicare Allowable after $500 plan deductible 100 days per calendar year

Home Health Covered 100% by MedicareThere are no copayments for Medicare-covered home health visits

Covered 100% by MedicareThere are no copayments for Medicare-covered home health visits

Inpatient Mental Health 20% of Medicare approved 20% of Medicare allowable after deductible is met

OUTPATIENT Coinsurance applies after deductible is met

Physician Office Visit 20% of Medicare approved 20% of Medicare allowable

Mental Health and Substance Abuse 20% of Medicare approved 20% of Medicare allowable

Ambulatory Surgical Center 20% of Medicare approved 20% of Medicare allowable

Outpatient Hospital 20% of Medicare approved 20% of Medicare allowable

Occupational and Physical Therapy 20% of Medicare approved 20% of Medicare allowable

Speech/Language Therapy 20% of Medicare approved 20% of Medicare allowable

Ambulance 20% of Medicare approved 20% of Medicare allowable

Emergency Room/Urgent Care 20% of Medicare approved 20% of Medicare allowable

Emergency/Urgent Care Worldwide Coverage Limited coverage outside U.S. 20% of Medicare allowable

DME/SUPPLIES/MEDICAL Rx Coinsurance applies after deductible is met

Durable Medical Equipment 20% of Medicare approved 20% of Medicare allowableNote: Wigs and hair pieces covered up to $500 per calendar year.

Prosthetic Devices 20% of Medicare approved 20% of Medicare allowable

Outpatient Injectable: Office-Based 20% of Medicare approved 20% of Medicare allowable22 2013 Medicare benefits provided. For complete details, visit www.medicare.gov, or call (800) 633-4227. 23 Part B premium is dependent on Income. For complete details please refer to www.medicare.gov.

IRMP CIGNA Indemnity Benefit Summary (Medicare)

18


Medicare22 IRMP CIGNA Indemnity Medicare-Eligible

PROCEDURES Coinsurance applies after deductible is met

Diagnostic Tests/Lab Services Generally 20% of Medicare approved ($0 for certain approved lab services)

20% of Medicare allowable

Routine Outpatient X-Ray includes Radiation Therapy 20% of Medicare approved 20% of Medicare allowable

Routine Physical Once during initial six months (MIPPE) 20% of Medicare allowable

ADDITIONAL BENEFITS Coinsurance applies after deductible is met

Chiropractic Not covered 20% of Plan allowed; limited to 30 visits per calendar year

Routine Podiatry Not covered 20% of Plan allowed

Non-Emergency Transportation Not covered 20% of Plan allowed

Acupuncture Not covered 20% of Plan allowed; limited to 30 visits per calendar year

Preventive Dental Not covered Not covered

Vision Exam Not covered In-network: 100% covered; limited to once every 12 months

Eye Wear Not covered In-network: $25 copay; lenses limited to once every 12 months; frames $130 allowance; limited to once every 24 months

Contact Lenses Not covered In-network: $130 allowance; elective; medically necessary covered at 100% preauthorization required; contacts limited

to once every 12 months

Routine Hearing Not covered 20% coinsurance

Hearing Aid Allowance Not covered 20% coinsurance

PRESCRIPTION COVERAGE Medicare IRMP CIGNA Indemnity with Rx

Medicare Prescriptions are not covered (available via Medicare Part D) See Prescription Benefit Below

Out-of-Pocket Max (TrOOP) Prescriptions are not covered (available via Medicare Part D) None – See Prescription Benefit Below

Formulary (list of plan approved drugs) Prescriptions are not covered (available via Medicare Part D) Please review at: www.medco.com/intel

Pharmacy Network Prescriptions are not covered (available via Medicare Part D) Please review at: www.medco.com/intel

IRMP CIGNA Indemnity Benefit Summary (Medicare) – continued

Prescription Benefit The benefit below applies only to IRMP CIGNA Indemnity with Rx Plan



Retail Penalty24

(34-day supply)

Generic $10 $20 $2025

Preferred Brand $20 $40 $4025

Non-Preferred Brand $30 $60 $6025 24 Penalty applies after the first two purchases of a maintenance (long-term) prescription at a retail pharmacy. 25 The out-of-pocket costs beyond the standard benefit will not apply towards deductible/out-of-pocket maximums.

19

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