Appendix_F_-_2023_Retiree_Benefits_Guide.pdf

City of St. Petersburg Benefits Retiree Guide

April 1, 2023

Our Annual Retiree Meeting will be held at Gladden Park Recreation Center 3901 30th Ave. N. St. Petersburg, FL on

Friday, March 3rd. 9 a.m. to 11 a.m.

No New Changes to Medical Plans for Plan Year 2023 No New Changes to Dental Plans for Plan Year 2023 No New Changes to Vision Plans for Plan Year 2023

This information will be made available in alternate formats for persons with disabilities upon request.

MEDICARE

Upon Medicare eligibility, (generally Age 65) Medicare automatically becomes the primary payor and the City’s plan becomes secondary, regardless of whether not you enroll in Medicare.

Medicare Parts A & B coverage is required for your benefits to properly coordinate. Failure to enroll in Part B will result in your responsibility for all claims that otherwise would have been paid had, you had Medicare Part B coverage.

Medicare Part D is not needed when a retiree is covered by UnitedHealthcare or Humana plans with the City. Your City coverage has pharmacy included which is as good or better than Medicare Part D.

If you become eligible for Social Security disability Benefits, you should enroll in Medicare Parts A & B coverage. Notify Benefits to submit a copy of your Medicare A & B card and you will be eligible to change your Healthcare plan option.

COVERAGE FOR SURVIVING DEPENDENTS

If you retired prior to March 1, 1978 – Coverage continues until the end of the period for which the surviving dependent receives pension benefits; the City contributes to health coverage premiums.

If you retired from March 1, 1978 - March 31, 1988 Coverage continues for the earlier of a) 12 months; or b) the end of the period for which pension benefits are received; the City’s contribution for health coverage continues. COBRA coverage is available for the balance of a 36-month period after the date of death at the full cost of the premium plus a 2% administrative fee. (No City contribution).

If you retired after April 1, 1988 - COBRA coverage for up to 36 months will be offered at the full cost of the premium plus a 2% administrative fee. (No City contribution).

FREQUENTLY ASKED QUESTIONS

Where can I learn more about Retiree Benefits? Join us, Friday March 3rd at Gladden Park 9:00 a.m. – 11:00 a.m.

Can I change or drop enrollments? When you or your dependent experience a qualifying life event OR you want to decrease your coverage. If you elect to drop coverage you will NOT have the option to re-enroll in that coverage.

Qualifying life events are, you (or a dependent): turning age 65, being approved for Social Security Disability, marriage, birth of a child, adoption, divorce, loss of benefit coverage, death.

How long do I have to report a qualifying life event to the Benefits Division? You have 30 days after a qualifying life event effective date to contact the Benefits Division and complete required forms and provide certified documentation.

What happens if I sign up for an outside supplemental Medicare plan while enrolled in a medical plan offered by the City? Your City medical plan will be terminated; you are not eligible to return.

How long does someone turning 65 have to change to a Medicare plan with the City of St.

Petersburg? Retirees age 65 and over can make this election at any time. Retirees must be enrolled in Medicare Parts A & B. Enrollment is not retroactive.

Can a life insurance/AD&D beneficiary be changed? Retirees can change their life insurance and or AD&D beneficiary at any time. A beneficiary change form must be notarized and sent to the Benefits Division; you can request a form by calling 727-893-7819.

What is the difference between the Choice Plus and Choice Plus Base Option? The Choice Plus Base Option Plan has a lifetime maximum benefit of $100,000. The Choice Plus Plan has no lifetime maximum.

If enrolled in the Choice Plus Base Option, how can I track my lifetime maximum benefit of $100,000? You can check your balance by (1) Calling UHC Customer service at 1-800-396-8810: or

(2) Call our UHC rep, Lauren Gibson at 727-893-7911, (3) Visit the myuhc website at www.myuhc.com; or (4) Review your EOB’s.

What happens if I reach the maximum benefit of $100,000? You are ineligible to stay in the Choice Plus Base Option plan and will have a onetime opportunity to enroll in another plan the City offers.

What happens if I am traveling and have an emergency? All plans cover emergency services.

Contact the carrier as soon as possible if you have an emergency.

What happens if I am on the Humana HMO plan, and I move out of the service area? You’ll have a onetime opportunity to transfer to the Humana Choice PPO plan or United Choice Plus Base Option plan.

Where can I get bloodwork? Laboratory tests can be completed at a LabCorp or Quest Diagnostics Facility. Visit labcorp.com or questdiagnostics.com for locations.

Where can I register for UnitedHealthcare’s Diabetes Program? You register online dhp.healthmine.com or by calling 1-866-944-9001

Health and Wellness Center The City of St. Petersburg Health and Wellness Center is open only to Retiree’s currently covered under one of the City’s group medical plans, and Dependents (age 14 & over) of Retirees who are covered under one of the City’s group medical plans. If you do not have City Medical coverage, you are not eligible for Health and Wellness Center services.

603 7th Street South, Suite 350. St. Petersburg, FL, 33701 Hours of operation: Monday – Friday 8:00am to 5:00pm

Closed 12:00 – 1:00 for Lunch Phone number: (727) 553-7474

Dr. Israel Wojnowich and his staff offer primary care services, chronic disease management and episodic illness treatment along with other services. Benefits of the Wellness Center include:

High Quality Health Care provided by a Board-Certified Family Practice Physician Secure, Private, HIPAA Compliant Evaluation and Coaching to Minimize Health Risks and Improve Quality of Life No Co-pay if eligible and covered by City medical insurance.

No Co-pay for Prescriptions dispensed at Center, if eligible and covered by City medical insurance.

Bayfront Health MyChart Communicate with your doctor. Stay connected to your healthcare with Bayfront Health St.

Petersburg MyChart. Manage appointments, access test results, request prescription refills and pay bills—for yourself and your approved appointees. Sign up for MyChart by visiting https://mychart.bayfrontstpete.com

Pensioner Self-Service Retiree Website

The Self-Service Portal allows retirees to make changes to personal information and access electronic information about their retiree benefits. To access, please go to http://athena.stpete.org. For more detailed information, including assistance with logging in to the Self-Service portal, please contact the Pension Division 727-893-7367 or pension@stpete.org Information about the City’s benefit programs is now available on the City’s retiree website. Go to www.stpete.org/retireebenefits and enter your retiree ID number to register. Add your email address and you’ll be added to our electronic mailing list. This site contains electronic versions of plan summaries, forms, and other benefit information.

Humana Dental Plans

Retirees enrolled in the DHMO must select a participating provider. You will need to contact Humana directly to designate/update your participating provider. Call customer service at 1- 800-979-4760 for participating providers and to request a copy of your card. Group

ID#782141.

Monthly Cost Single Two Person Family

Humana DHMO HS195 $15.46 $27.05 $42.53 Humana PPO $27.56 $58.42 $90.20

Humana Vision Plans

Call customer service at 1-800-979-4760 for participating providers and to request a copy of your card. Group ID#782141.

Monthly Cost Single Two Person Family

Vision Basic $0.92 $1.40 $2.33 Vision High Option $5.79 $11.53 $15.42

Basic Life and AD&D – Standard Life Insurance Company Policy Group Policy #631957

Life Insurance is offered by The Standard Life Insurance Company. The amount of your coverage amount was determined at the time you retired and cannot be changed. Rates are unchanged for 2023.

Monthly Rates, Per $1,000 of Coverage

Basic Life $5.366 AD&D - Single $.023 AD&D - Family $.035

2023 – 2024 Group Health Plans UnitedHealthcare and Humana will continue to administer the City’s group health plans for retirees. See the “Summary of Benefits and Coverage” for more details. There are no changes for 2023 - 2024 plan year.

Retiree Group Health Plan Comparison & Rates Plan UHC Choice (EPO) In-

Network Only UHC Choice Plus (PPO)

In-Network * UHC HDP plan In-Network *

Annual Deductibles $750 Individual $1,500 Family

$750 Individual $1,500 Family

$1,750 Individual $3,500 Family

Coinsurance 0% 10% 10%

Hospital $300 / 3 days and deductible $300 / 3 days then co-ins and deductible $300 / 5 days then co-ins and deductible

Emergency Room $250 co-pay and deductible

$250 co-pay and deductible

$250 co-pay and deductible

Physician:

$30 - $50 co-pay $30 - $50 co-pay $25 - $45 co-pay Urgent Care Center $50 and deductible $50 and deductible $50 and deductible

Preventative Care 100% Coverage 100% Coverage 100%

Coverage

Skilled nursing facility 100% coverage and deductible (Limit: 60 days per plan year)

10% co-ins and deductible (Limit: 60 days per plan year)

10 % co-ins and deductible

(Limit: 60 days per plan year)

Rehabilitation Services

$30 co-pay per visit (limit 60 visits each type of service, multiple visits per day)

$35 co-pay per visit (limit 60 visits each type of service, multiple visits per day)

$35 co-pay per visit (limit 60 visits each type of service, multiple visits per day)

Outpatient Surgery -hospital

100% coverage after deductible

10% co-ins and deductible 10% co-ins and deductible

Annual Out of Pocket Limit

$3,000 individual, $6,000 Family

$3,000 individual, $6,000 Family

$3,500 individual, $7,000 Family

Lifetime Maximum Benefit

No lifetime maximum benefit

No lifetime maximum benefit

No lifetime maximum benefit

Prescription Drug Coverage (Tier 1-4)

$15; $35; $50; 25% Tier 2-4 $200/$400 deductible. Accumulates to Annual Out of Pocket

$15; $35; $50; 25% Tier 2-4 $200/$400 deductible. Accumulates to Annual Out of Pocket

$15; $35; $50; 25% Tier 2-4 $200/$400 deductible. Accumulates to Annual Out of Pocket

*Out of Network Benefits available. See the SBC or SPD for more information. Find the SBC and SPD at www.stpete.org/retireebenefits

NOTE: The information shown above is general information only. Benefit plan provisions are governed by the applicable plan documents. All questions and concerns regarding specific coverage and benefits should be directed to the respective insurance carrier. Anything in this summary that is inconsistent with the plan documents shall be suspended by and governed by the plan documents.

UHC HDP Basic Plan In-network (must pay

$5,000 first)

UHC Choice Plus Base

(PPO)

In-network *

Humana Gold (HMO) In-Network

Humana Choice (PPO) In-network

$5,000 Individual $10,000 Family

$750 Individual $1,500 Family

N/A N/A

100% after deductible 10% N/A N/A

100% after deductible $300 / 3 days then co-ins and deductible

$150 / 5 days per admission then 100% coverage

$150 / 5 days per admission then 100% coverage

100% after deductible $250 co-pay and deductible $65 co-pay $65 co-pay

100% after deductible $30 - $50 co-pay $5-$20 co-pay

$10-$20 co-pay

100% after deductible $50 and deductible $5-$20 co-pay

$10-$20 co-pay

100% Coverage 100% Coverage 100% Coverage 100% Coverage

100% after deductible co-ins and deductible

(Limit:60 days per plan year)

$25 co-pay per day

(days 21-100)

$75 co-pay per day

(days 21-100)

100% after deductible

$35 co-pay per visit (limit 60 visits each type of service, multiple visits per day)

$20 - $40 co-pay based on services received

$20 co-pay per visit

100% after deductible co-ins and deductible $100 co-pay per visit

$50 co-pay per visit

$5,000 individual $10,000 Family

$3,000 individual, $6,000 Family

$2,500 per plan year $4,000 per plan year

No lifetime maximum benefit

Combined Network and Non-network maximum of $100,000 per covered person.

Benefits apply to Medicare covered services.

Benefits apply to Medicare covered services.

100% after deductible

$15; $35; $50; 25% Tier 2-4 $200/$400 deductible. Accumulates to Annual Out of Pocket

$4; $25; $40; 33% $4; $25; $40; 33%

Group 1 If you retired prior to October 1, 2008, the City will continue to subsidize your health insurance premiums at 75% of the Retiree Choice Plus Base Option PPO rate.

Total Cost City Contribution Retiree Cost

Benefit Plan Monthly Monthly Monthly UnitedHealthcare CHOICE (EPO)

Single $814.79 $360.23 $454.56 Two Person $1,751.81 $727.64 $1,024.17

Family $2,305.85 $1,008.59 $1,297.26 UnitedHealthcare CHOICE PLUS (PPO)

Single $901.87 $360.23 $541.64 Two Person $1,821.84 $727.64 $1,094.20

Family $2,525.35 $1,008.59 $1,516.76 UnitedHealthcare (PPO) HDP

Single $701.75 $360.23 $341.52 Two Person $1,508.78 $727.64 $781.14

Family $1,985.99 $1,008.59 $977.40 UnitedHealthcare HDP Basic

Single $557.17 $360.23 $196.94 Two Person $1,197.93 $727.64 $470.29

Family $1,576.81 $1,008.59 $568.22 The Plans Below are Medicare Plans available to retirees and covered dependents with Medicare Parts A & B UnitedHealthcare CHOICE PLUS-BASE OPTION (PPO)

Single $480.31 $360.23 $120.08 Two Person $970.18 $727.64 $242.54

Family $1,344.78 $1,008.59 $336.19

HUMANA GOLD (HMO)

Single $13.40 $13.40 $0 Two Person $26.80 $26.80 $0

HUMANA CHOICE (PPO)

Single $246.15 $246.15 $0

Two Person $492.30 $492.30 $0

Group 2 If you were hired prior to January 1, 2009, and retire after October 1, 2008, the City will contribute the following amount: $297.72 for Single Coverage, $601.37 for Two Person Coverage & $833.58 for Family Coverage NOTE! The amounts shown are the maximum amounts the City will contribute.

Total Cost City Contribution Retiree Cost

Benefit Plan Monthly Monthly Monthly UnitedHealthcare CHOICE (EPO)

Single $814.79 $297.72 $517.07 Two Person $1,751.81 $601.37 $1,150.44

Family $2,305.85 $833.58 $1,472.27 UnitedHealthcare CHOICE PLUS (PPO)

Single $901.87 $297.72 $604.15 Two Person $1,821.84 $601.37 $1,220.47

Family $2,525.35 $833.58 $1,691.77 UnitedHealthcare (PPO) HDP

Single $701.75 $297.72 $404.03 Two Person $1,508.78 $601.37 $907.41

Family $1,985.99 $833.58 $1,152.41 UnitedHealthcare HDP Basic

Single $557.17 $297.72 $259.45 Two Person $1,197.93 $601.37 $596.56

Family $1,576.81 $833.58 $743.23 The Plans Below are Medicare Plans available to retirees and covered dependents with Medicare Parts A & B UnitedHealthcare CHOICE PLUS-BASE OPTION (PPO)

Single $480.31 $297.72 $182.59 Two Person $970.18 $601.37 $368.81

Family $1,344.78 $833.58 $511.20

HUMANA GOLD (HMO)

Single $13.40 $13.40 $0 Two Person $26.80 $26.80 $0

HUMANA CHOICE (PPO)

Single $246.15 $246.15 $0

Two Person $492.30 $492.30 $0 Group 3 All employees hired after January 1, 2009, who retire will pay the TOTAL cost of the Plan Coverage. The City will not contribute to the cost of the monthly premiums.

Contact Information

Retiree Benefits, contact Morgan Morrow 727-893-7819 or benefits@stpete.org

UnitedHealthcare, Lauren Gibson 727-893-7911 or lauren_gibson@uhc.com

Humana (Medical Plans), Tanya Dingman 727-316-1599 or TDingman@humana.com

Humana Dental – Customer Service 1-800-979-4760 Humana Vision – Customer Service 1-877-398-2980 Ameriflex - Retiree Billing 1-888-868-3539 or service@myameriflex.com Mission Square (457 Deferred Compensation, Roth IRA &401(a) Plans:

o Elvin Ramirez 202 759-7078 eramirez@missionsq.org o Sharyn Hyla 202-759-7219 shyla@missionsq.org

Pension Questions/Assistance:

o Last name begins with A-L: Steven Fyalkowski 727-893-7045 or steven.fyalkowski@stpete.org o Last name begins with M-Z: Sherri McLean 727-893-7044 or sherri.mclean@stpete.org Florida Relay Service is a link for individuals who are deaf, hard of hearing, deaf/blind or have speech disabilities. Florida Relay Service uses specialized equipment to communicate with others using standard telephone equipment.

Dial 711, toll free, and a relay operator will assist you.

SHINE (Serving Health Insurance Needs of Elders) counselors can help answer your questions and assist with enrollment in Medicare Savings Programs and or Medicare coverage issues. Call SHINE helpline 1-800-963-5337