mark your calendars! county of orange annual open

Mark your calendars!

County of Orange Annual Open Enrollment 2022October 20 – November 9, 2021

COUNTY OF ORANGE

Annual Open Enrollment 2022During Open Enrollment, you have decisions to make for yourself and your family. We are here to help you. We’ve streamlined the process, making it simple by providing one location to access the tools and resources you need.

Your Open Enrollment Calendar• Manage your communication preferences

right away so you get all the important information. Take a moment to verify your settings on your communications preferences on the Benefits Service Center website, My OC Benefits™, or the Upoint app. Remember, you can choose to be notified either by email or postal mail to your home address. Your Open Enrollment notification will NOT be mailed to you if you have your preference set for email.

• Tuesday, Oct. 5, join us for a virtual Open Enrollment presentation. REAOC, Employee Benefits and all the health plan providers will share resources and give you an opportunity to ask your questions and get answers. The Open Enrollment presentation will be held at 9:00 am. For more information, go to hrs.ocgov.com/employee-benefits.

• Starting Wednesday, Oct. 13, you can log on to My OC Benefits™ at mybenefits.ocgov.com. You can view the “Prepare to Make Your Benefits Choices” page to see the 2022 retiree health plan rates, review the Retiree Medical Plan One Page Benefits Summaries to compare offered health plans, and confirm your 2022 Grant, if applicable.

Open Enrollment runs Oct. 20 – Nov. 9, 2021. This is the time to make changes to your coverage through My OC Benefits™. Or you can:

• Call 1-833-476-2347, speak to a representative, 8 a.m. to 8 p.m. Monday through Friday PT, except holidays

• The allowable correction period is Wednesday, Nov. 10 to Friday, Nov. 19, 2021. Make sure you check your email or mailbox for any follow up actions from the Benefits Service Center. Verify your coverage changes and costs on the Benefits Service Center website and immediately review any notifications you receive from the Benefits Service Center to ensure everything is as it should be.

What’s New for 2022?

2022 Retiree Medical Grant• In accordance with plan provisions, the Grant is adjusted annually based on the average increase or decrease in Retiree

Medical Plan premiums. The adjustment is calculated by adding the percentage increases/decreases for all retiree health plans, then dividing the result by the number of retiree health plans. The Grant amount for plan year 2022 is increasing only one half of a percent to $24.63 per month for each year of County service, up to 25 years. This is because many plans have no increase or even a decrease for 2022. As of Oct. 13, you can see your 2022 Retiree Medical Grant through the online pre-enrollment event or by calling the Benefits Service Center to speak with a representative.

Medicare Part B Reimbursement Only• If you are eligible to receive a Medicare Part B Reimbursement, each year you are required to submit documentation of the

Medicare premium you pay for the upcoming plan year. This is required because some Medicare Part B premiums change from year to year due to income and other factors.

• You must submit a copy of your 2022 Medicare premium statement to the Benefits Service Center. If you are paying for Medicare Part A, you must provide proof of the monthly payment amount to the Benefits Service Center to be reimbursed accordingly. The deadline to submit documentation to receive your updated Medicare Part B Reimbursement amount for 2022 is Dec. 31, 2021. If no documentation is provided the reimbursement will revert to the standard amount of $104.90.

Virtual Open Enrollment Presentation• Tuesday, Oct. 5, join us for a virtual Open Enrollment presentation. REAOC, Employee Benefits and all the health plan

providers will share resources and give you an opportunity to ask your questions and get answers. The Open Enrollment presentation will be held at 9:00 a.m. PT. For more information, go to hrs.ocgov.com/employee-benefits. If you missed the presentation, you can view it on the Employee Benefits website and on mybenefits.ocgov.com.

Health Plan Rates Although the cost of medical treatment and prescription drugs continue to rise each year, this is known as “trend,” the impact of COVID-19 resulted in some lower utilization in certain areas and some lower cost treatment options such as telehealth because of the pandemic. That being said, Premium changes for 2022 vary greatly by plan, enrollment category, and Medicare status and range from 13 percent reductions in some plans, to 33 percent increases in other plans. Your actual rates by plan will be available online starting Oct. 13, 2021 and will be sent with your Open Enrollment notification. The overall rate changes fall within the following ranges and averages.

• The County’s self-funded PPO health plans will be increasing an average of six percent.

• Kaiser rates are decreasing in ranges from 1.8 percent to 13 percent.

• Anthem Blue Cross plan rate increases range from zero to five percent.

• SCAN rates will not change for 2022.

• COUNTY OF ORANGE •

ANNUAL OPEN ENROLLMENT 2022

For more information Refer to the reports provided for approval of the 2022 Health Plan Rates. You can access the reports by visiting board.ocgov.com. Then, go to “Board Meetings on Demand” and click on the link for the July 13, 2021 Board Meeting.

2022 Retiree Health Plans Key Benefits Comparison Chart

This is a very brief summary of just a few key plan benefits. This chart does not contain all benefits, limitations, exclusions and requirements and is not intended to replace the Plan Documents containing the complete provisions. If you need to inquire about specific medications or other categories of benefits coverage call the Customer Service Department for the health plan you are considering, consult the plan documents and other detailed resources for complete coverage information. You can request one-page summaries for each plan for a summary that includes additional benefit categories such as home health coverage, specialty care, etc.

RETIREES AND COVERED DEPENDENTS WITHOUT MEDICARE

Wellwise Retiree PPO

Sharewell Retiree PPO

Kaiser Retiree HMO

Anthem Blue Cross Select HMO

Anthem Blue Cross Traditional HMO

Annual Deductible – the amount you pay before plan begins paying benefits

Network: $500 Indiv. $1,000 Family

Non-Network $750 Indiv. $1,500 Family

$5,000 combined Network and Non-Network

None None None

Primary Care Visits

After deductible:

Network 10% co-insurance

Non-network 30% deductible

After deductible:


Non-network 30%

$20 per visit $20 per visit $20 per visit

Hospital – Inpatient

After deductible:


Non-network 30% 50% if no pre-admission review

After deductible:


Non-network 30% 50% if no pre-admission review

$100 per admission

No Charge $100 per admission

Emergency Room (as defined by plan)

After deductible:

10% co-insurance Network and Non-network

After deductible:


$50 per visit $100 per visit, waived if admitted

$50 per visit, waived if admitted

Prescription Drug *other exclusions, limits and requirements set for by plan

Through OptumRx – no deductible

Tier 1–20% co-insurance



After deductible:

20% co-insurance with important requirements and considerations – see Plan Document and one-page summaries

Generic $10

Brand $30

Up to 100-day supply

Specialty $30 / 30 days

$100 deductible

Generic $5

Preferred Brand $25

Non-Preferred Brand $45

*may be less and see other provisions

Generic $5

Preferred Brand $25

Non-Preferred Brand $45

*see other provisions

Plan Contact Information

Medical Claims – Blue Shield 888-235-1767 blueshieldca.com/oc

Pharmacy Claims – OptumRx 800-573-3583 Optumrx.com



1-800-464-4000

my.kp.org/oc

1-877-359-9653 1-877-359-9653





RETIREES AND COVERED DEPENDENTS WITH MEDICARE

Wellwise Retiree PPO (For questions about how the plan coordinates with Medicare contact Blue Shield)

Sharewell Retiree PPO (For questions about how the plan coordinates with Medicare contact Blue Shield)

Kaiser Sr. Advantage HMO

SCAN

HMO

Anthem Blue Cross Senior

Secure HMO

Anthem Blue Cross Custom PPO

Anthem Blue Cross Standard PPO

Annual Deductible- the amount you pay before plan begins paying benefits

Network: $500 Indiv.

$1,000 Family

Non-Network: $750 Indiv.

$1,500 Family

$5,000 combined Network and Non-Network

None None None None

$300

Primary Care Visits

After deductible:


Non-network 30%

After deductible:


Non-network 30%

$20 per visit $15 per visit $20 per visit $20 per visit

$25 In-network

30% Out of Network

Hospital – Inpatient

After deductible:


Non-network 30%

50% if no pre-admission review

After deductible:


Non-network 30%

50% if no pre-admission review

$100 per admission

$100 per admission $100 copay per admit, $300 inpatient maximum out-of-pocket per year

$100 per admission

$200 In-network days 1-5

30% co-insurance Out of Network

Emergency Room (as defined by plan)

After deductible:


After deductible:


$50 per visit $50 per visit, waived if admitted




Prescription Drug

Through OptumRx – no deductible




After deductible:

20% co-insurance with important requirements and considerations – see Plan Document and one-page summaries

Generic: $10 for up to 100-day supply

Brand: $35 for up to $100 a day supply

Generic: $10

Brand: $20

Specialty: 25% co-insurance

Generics: up to $5

Preferred: $25

Specialty/ non-preferred Brand: $45

Generic: $10 Preferred Brand: $30 Non-preferred Brand: $50 *Less if you use Preferred Pharmacy $5/$25/$45

$200 Rx deductible Generic: $15 Preferred Brand: $45 Non-preferred Brand: $45

*Less if you use Preferred Pharmacy $10/$40/$40

Plan Contact Information





1-800-443-0815

my.kp.org/oc

To find Plan Benefit Materials, Doctors and Drugs:

scanhealthplan.com/countyoforange

(for prospective retirees) 1-877-212-7654

(existing members) 1-800-559-3500

Pre Member: 833-848-8729 Member: 833-848-8730

anthem.com/ca/countyoforange

Pre Member: 833-848-8729 Member: 833-848-8730

anthem.com/ca/countyoforange

You have questions,let us help you get the answers.

Visit My OC Benefits™ at mybenefits.ocgov.com

• Ask Lisa – Ask Lisa, your virtual assistant. Look for the green “Need Help?” button at the lower right of every page. Click the button, and Lisa will search a library of frequently asked questions to help you.

• Start a Web Chat – From the links at the bottom of any page on My OC Benefits™, choose “Contact Us,” then “General Information.” From there you’ll be able to start a live chat with a Benefits Service Center representative.

• Visit the “Prepare to Make Your Benefit Choice Page” get a jump start before the first day of Open Enrollment.

A Qualified Life Event and Changing Your Benefits ElectionsGenerally, you may only change your benefit elections during Open Enrollment. However, you may change your benefit elections during the year if you experience a Qualified Life Event (QLE), such as:

• New family members due to marriage or domestic partnership registration.

• Divorce or other loss of dependent eligibility.

• Gaining Medicare eligibility.

• Moving outside of your plan’s service area.

Benefit changes that are made due to a QLE during the fourth quarter of 2021 (October, November and December) cannot be made online; instead, you must call the Benefits Service Center to make these changes. All QLE changes must be made within 30 calendar days of the event.

Benefits Service Center

• Call 1-833-476-2347, 8 a.m. to 6 p.m. Monday through Friday PT, except holidays.

› Oct. 20 through Nov.9, take advantage of extended hours up to 8 p.m. during Open Enrollment.

› Rather than waiting on the phone, you can select virtual hold, and a representative will call you back based on your place in line.

› Schedule an appointment to speak one on one with a representative when it is convenient for you.

NeedHelp?

Get In Touch

Contact Us

Additional information We have provided a snapshot of the most commonly used services. If you want to see additional information on each of the plans, you can view or request Retiree medical Plan One Page Benefits Summary documents:

• My OC Benefits™ - Located on the Plan documents page

• Attend the REAOC Virtual Open Enrollment presentation on Tuesday, Oct. 5 starting at 9:00 a.m. PT

• Call the Benefits Services Center at 1-833-476-2347 and request a copy be mailed to you, last day to make this request is Nov. 5, 2021.

• Call Employee Benefits at 714-834-6282 and request a copy to be mailed to you, last day to request is Nov. 5, 2021.

Address or Phone Number Change?It is important to keep your contact information updated. To change your mailing address, phone number and/or email address on file you must contact both the Benefits Service Center and OCERS. Also, be sure to report any changes to any other County of Orange organization you are affiliated with, such as REAOC.

Add or Remove a Dependent from Your County Health Coverage• If you enroll a newly eligible dependent(s), you will receive

a New Dependent Verification notice from the Benefits Service Center requesting that you verify your dependent on My OC Benefits™ and submit required documentation.

• Your deadline to submit all newly added dependent required documentation is provided on the dependent verification notice sent to you by Dependent Verification Services. If you fail to submit your required documentation by that date, your dependent will not be added to your coverage as of Jan. 1, 2022, even if you have already received your ID card(s) from the health plan. There will be no refund for the dependent premiums you pay during the period of ineligibility.

• For more details about documentation, review the Dependent Eligibility Definitions and Required Documents flyer located on the Plan Information Page on My OC Benefits™.

• If Medicare verification documentation is required it needs to be submitted 60 days from the date of your election by uploading, faxing to 1-224-607-3465 or mailing to:

US Postal Mail: Benefits Service Center PO Box 661162, Dallas TX 75266-1162

Or

Overnight Mail: Benefits Service Center MS-55 2701 East Grauwyler Rd, Irving TX 75061-1162

Make a new Health Plan Election If you enroll in a different Medicare Advantage plan for 2022, the Centers for Medicare & Medicaid Services (CMS) must approve your enrollment request. To make your new election you will need your Medicare Beneficiary Identifier Number (MBI). If you are not approved, you and your covered dependents will most likely be automatically enrolled in the Wellwise Retiree PPO plan until the next Open Enrollment period or unless you experience a QLE. If you are currently enrolled in the Sharewell Retiree PPO plan you will remain in the Sharewell Retiree PPO plan if CMS does not approve your health plan change.

Use the Resources Available to You:• Know what the plans do and do not cover, as well as how to

access services or file claims. All plans have limitations and exclusions, and some plans have prior approval requirements. It is your responsibility to review all plan materials, premiums and automatic benefits coverage.

• Contact the health plans directly through their toll-free member services phone number or visit their website for more information. Health plan phone numbers and websites can be found in the What to Know Guide for Retirees on the My OC Benefits™ Plan Information page or contact the Benefits Service Center and speak to a representative.

Voluntary Incentive Program, (VIP) Retirees If you retired and participated in the Temporary Opt Out feature of the VIP program in plan year 2020, you have the opportunity to use your One time Opt In and enroll in County retiree health coverage during this Open Enrollment. You can enroll during Open Enrollment or with a Qualified Life Event, QLE. You will need to call and speak to a representative to complete your enrollment.

VIP

Open Enrollment allows you the opportunity to:

County of Orange 9229 Delegates Row Suite 400 Indianapolis, IN 46240

453170 Copyright © 2021 The StayWell Company, LLC. StayWell is a registered trademark of The StayWell Company, LLC.

Important DatesTuesday, Oct. 5 Virtual Open Enrollment Presentation

Wednesday, Oct. 13 Prepare to Make Your Benefits Choices Page opens

Wednesday, Oct. 20 Official Open Enrollment start date

Tuesday, Nov. 9 Open Enrollment closes

Friday, Nov. 19 Correction period deadline: Last day to make any changes to your coverage

New Dependent Documentation

Refer to your Dependent Verification Documentation Notice for due date

Medicare Documentation

60 days from the date you provided your Medicare information

Jan. 1, 2022 Receive ID Cards. Anyone who makes a new plan election should receive new ID cards. Retirees currently in Anthem Blue Cross under 65 and currently in Wellwise Retiree or Sharewell Retiree will automatically get new ID cards as part of a routine card update.

Ready to Make Your 2022 Elections? You will make your Open Enrollment election through My OC Benefits™. Use mybenefits.ocgov.com or contact the Benefits Service Center at 1-833-476-2347. You can speak to a representative Monday through Friday, during the Open Enrollment, Oct. 20 through Nov. 9, 2021, from 8 a.m. to 8 p.m. PT. You can also access your benefits on the mobile app. Go to your favorite app store, search for “Upoint Mobile HR,” and download the app. For final set up, refer to the Quick Reference Guide on the My OC Benefits™ Plan Information page.

If You Take No Action If you are not making any changes to your health plan elections, we recommend that you review your current coverage and new health plan premiums for 2022 to make sure you have what you need for you and your family. If you take no action, you will have the same health coverage for 2022 that you have now at the new 2022 rates for that coverage.

Confirmation of Benefits – review for Accuracy and Special Instructions. Print your Confirmation of Benefits after you confirm your elections online, or if enrolling through the Benefits Service Center, the Confirmation of Benefits will be sent to you. If you have set your communication preference to email, check your secure mailbox on mybenefits.ocgov.com.