Exhibit_C_-_Medicare_Retiree_Benefit_Guide_2025.pdf

Medicare Retiree Benefits Guide

When you become eligible for Medicare, you will have access to the County’s Group Medicare Supplement Plans, Medicare Advantage-Prescription Drug Plan, and Medicare Part D Plan.

If you decide not to enroll in one of those health insurance plans and choose to purchase an individual plan on your own, you will not be able to re-enroll in one of Brevard County’s health insurance plans in the future. In addition, your health insurance premiums will not be deducted from your monthly FRS retirement benefit. You will have to pay the insurance carrier directly for that insurance coverage or call FRS at 1-866-446-9377 for assistance with setting up a payment plan.

Please carefully review this guide to ensure you understand all of our current benefit offerings. If you have any questions, we’d be happy to assist you by contacting the Employee Benefits Office at (321) 633-2031 or benefits@brevardcounty.us

If you or your dependents are not yet eligible for Medicare, please see our Non-Medicare Retiree Benefits Guide.

Making Benefit Selections

Retiree Benefits

Medicare Plan Options

As a Brevard County retiree, you are eligible to continue receiving medical, dental, vision and life insurance benefits.

Your spouse and/or dependents will be eligible for coverage as long as they were covered under your health insurance plan(s) on the date of your retirement. Your monthly insurance premiums for retiree benefits will vary from the amounts that you were previously paying through payroll deductions. Detailed information regarding the cost of coverage as a retiree is provided throughout this Guide.

Mid-Year Changes You may cancel your insurance coverage at any time. If you elect to cancel coverage for you and/or your Dependents anytime during your retirement, you will not be allowed to re-enroll at a later date.

If a covered member experiences certain qualified life events outside of Open Enrollment, you may be able to make changes to your current coverage. Some events that qualify you to make mid-year changes include marriage, birth, adoption, divorce, and gain of other coverage.

It is your responsibility to remove any Dependents that cease to be eligible for coverage under Brevard County’s health plan within thirty (30) days of the date eligibility is lost. You will be responsible for repayment of any claim dollars paid out for an ineligible dependent.

Special Enrollment Retirees are not permitted to add new dependents if your dependent(s) does not remain continuously enrolled on Brevard County’s health plan. If you cancel your dependent coverage then you will not be able to re-enroll them at a later date unless you acquire a new dependent through birth, marriage, or adoption during your retirement. You must notify Employee Benefits and provide the required documentation within 30 days of the event.

Phone: (321) 633-2031 Email: benefits@brevardcounty.us mailto:benefits@brevardcounty.us https://view.onedigital.com/nonmedicareretireebrevardcounty2025 https://view.onedigital.com/requireddocumentationbrevardcounty https://present.onedigital.com/dependent-documentation-needed/full-view.html mailto:benefits@brevardcounty.us

Making Benefit Selections

Dependent Verification As part of the County's ongoing efforts to monitor cost and affordability of our benefit plans, we want to ensure that only eligible dependents are enrolled as covering ineligible dependents increases our cost for health coverage.

The County kindly asks you to review the dependent eligibility requirements, which can be found on the next page, to ensure your dependents continue to meet the guidelines.

If you are a surviving dependent, enrolling your spouse, and/or have a 26 to 30-year-old dependent child covered under Brevard County's health plan, then you are required to complete a Dependent Eligibility Affidavit on an annual basis. If not currently on file, you will need to submit the appropriate documentation to verify the dependent’s eligibility.

All required documentation and applicable affidavit(s) must be submitted to Benefits by November 1, 2024 or your dependent(s) may not have coverage January 1, 2025. If you experience a qualifying life event, you must submit documentation within 30 days of the event.

You will be charged a $200 per month surcharge per over age dependent child enrolled. If you do not submit the annual affidavit by November 1, 2024, then your over age dependent will not have coverage January 1, 2025.

If your spouse has health insurance available through their employer and you choose to enroll them in Brevard County's plan, then you will be subject to the Working Spouse Surcharge of $200 per month. If you do not complete the annual affidavit by November 1, 2024, then you will be automatically charged the Working Spouse Surcharge.

If the eligibility of your dependent changes during the year, it is your responsibility to notify the Brevard County Benefits Department within 30 days of the change. If the Dependent is to be discontinued due to a change, there will be no premium or surcharge refund if the Brevard County Benefits Department is not notified within 30 days of the change.

Please ensure during enrollment that all Social Security Numbers for yourself and your dependents are reviewed and updated accordingly.

https://view.onedigital.com/annualaffidavitbrevardcounty#page=1 https://view.onedigital.com/requireddocumentationbrevardcounty

Is My Dependent Eligible?

Spouse Criteria:

Legally married spouse (an ex-spouse does not meet eligibility criteria even if insurance coverage is specified by a judge in a divorce decree)

Required Documentation:

• Copy of Marriage Certificate or Marriage License;

• Copy of Social Security card; and

• A completed Dependent Eligibility Affidavit

Children Criteria:

Includes the employee's natural born, adopted, foster, or stepchild, and a child for whom the employee has been court-appointed as legal guardian or legal custodian. Dependent children are eligible for coverage until end of the calendar year in which they turn 26 years old.

Required Documentation:

• Birth Certificate OR Adoption Certificate OR Copy of Legal Guardian Documents; and

• A copy of Social Security Card

Grandchildren Criteria:

Grandchildren can be covered up to 18 months of age (only eligible if the parent, i.e.

employee's dependent, remains a covered dependent)

Required Documentation:

• Verify parent of child is eligible as noted above and currently enrolled

• Copy of grandchild's Birth Certificate

• Copy of grandchild's Social Security Card

Disabled Children Criteria:

Children who are physically or mentally disabled may be eligible to continue coverage beyond age 26

Required Documentation:

• Verify child is otherwise eligible as noted under "Children"

• Written statement from child's physician indicating disability & diagnosis OR Social Security Award Letter

Over Age (26-30) Children Criteria:

Must meet all the following requirements:

the child is unmarried and has no children of his or her own

1.

the child is a Florida resident OR is a full or part-time student AND

2.

the child does not have health insurance available to them elsewhere

3.

Required Documentation:

• Verify eligibility under "Children"

• Completion of a Dependent Eligibility Affidavit

Surviving Spouse/Children Criteria:

If a Covered Retiree who is fully vested in the Florida Retirement System dies, the eligible dependents covered at the time of death may remain covered if they continue to meet the eligibility criteria. Dependent children must be linked to the surviving spouse to be eligible to continue health insurance benefits. If a Surviving Spouse remarries, they must notify the Employee Benefits Office immediately and their coverage will end on the last day of the month.

Required Documentation:

• Verify eligibility as noted under "Children" and/or "Spouse"

• Dependent Eligibility Affidavit https://view.onedigital.com/annualaffidavitbrevardcounty#page=1 https://view.onedigital.com/annualaffidavitbrevardcounty#page=1 https://view.onedigital.com/annualaffidavitbrevardcounty#page=1 https://view.onedigital.com/annualaffidavitbrevardcounty

Balance billing When you use an out-of-network medical or dental provider, they may bill you the difference between what they charge and the amount your insurance pays.

Medical: balance billing is in addition to – and does not count towards – your out-of-pocket maximum.

Coinsurance After you’ve met your deductible, you’re sometimes responsible for a percentage of the cost of the medical care, dental care, or prescription medication you received. This percentage is coinsurance.

Copay A flat fee you pay each time you receive a copay-eligible medical, dental, or vision service or prescription medication.

Deductible The amount you’re responsible for paying in care expenses before the medical or dental plan starts paying deductible-eligible expenses.

In-network In-network care is always your lowest-cost option. Networks are groups of medical, dental, and vision providers, pharmacies, and facilities that agree to discount the cost of their care or service.

Out-of-pocket maximum The most you’ll pay for covered in-network medical care in a year. This includes your deductible, any coinsurance or copays, and prescription drugs.

The out-of-pocket maximum does not include your premium (the amount you pay for coverage), non-covered expenses, or out-of-network care that’s been balance billed.

Primary care physician A primary care physician (PCP) is your main medical doctor – usually a general practitioner (GP), family doctor, internist, OB/GYN, or pediatrician (for children).

Referral/pre-authorization Some specialty medical providers and services require a referral from a primary doctor. These may include

- but are not limited to -cardiology, psychiatry, orthopedic surgeons, rheumatology, surgery, and imaging (CT or MRI).

Have questions?

Your employee benefits team is here to help you with all things benefits.

See their contact information on the next page.

How to handle medical bills (4:46)

Helpful Terms & Resources

We've removed as much jargon as possible.

But you’ll probably still encounter some terms as you enroll in and use your benefits, and we want you to be prepared!

Annual Notices We’re required to tell you about certain rights and responsibilities you have as an employee of Brevard County Government.

You can request a paper copy at no charge from:

Rebecca Acosta Rebecca.Acosta@brevardfl.gov

Download now https://share.transistor.fm/s/b1639d48 https://share.transistor.fm/s/b1639d48 https://share.transistor.fm/s/b1639d48 https://share.transistor.fm/s/b1639d48 mailto:%20Rebecca.Acosta@brevardfl.gov https://view.onedigital.com/untitled9

Benefits Manager Rebecca Acosta rebecca.acosta@brevardfl.gov 321-637-5454

Benefits Specialists Becca O’Rear Services last names A-L

Nate Dubidat Services last names M-Z rebecca.orear@brevardfl.gov 321-637-5456 nathaniel.dubidat@brevardfl.gov 321-637-5455

Medical insurance Cigna

Humana

United Healthcare

UMR

1-800-244-6224 mycigna.com

1-866-396-8810 humana.com

1-877-714-0178 (Pre-enrollment Line) uhcretiree.com

1-800-826-9781 umr.com

Vision insurance Davis Vision 1-877-923-2847 davisvision.com

Dental insurance Cigna 1-800-244-6224 mycigna.com

Life and AD&D insurance The Standard 1-800-628-8600 standard.com

Deferred Compensation Nationwide 1-877-677-3678 nrsforu.com

Medicare Counseling Shine 407-450-7234 floridashine.org

Contact Information

2725 Judge Fran Jamieson Way Building B, Viera FL, 32940 P: 321-633-2031 / F: 321-633-2036 5 http://mycigna.com/ http://humana.com/ http://uhcretiree.com/ http://umr.com/ http://davisvision.com/ http://mycigna.com/ http://standard.com/ http://nrsforu.com/ http://www.floridashine.org/

DPPO Low Option DPPO High Option DHMO Dental Care

In-Network Out-of-Network In & Out-of-Network In-Network Only

Annual Deductible (DED) $50 per person $150 family max

$75 per person $225 family max

$50 per person $150 family max

None

Annual maximum benefit (Class I does not apply)

$1,000 $750 $1,500 per person None

Preventive care 100% covered 100% covered Click here to view the DHMO schedule of benefits

In order to utilize the plan benefits, you must select a contracted dentist.

Basic care 70% after deductible 60% after deductible 80% after deductible

Major care 40% after deductible 40% after deductible 50% after deductible

Orthodontic care Coverage Lifetime max benefit

19 years old and under 40%

$1,000 50%

$1,000

Covered - See page 23 of DHMO schedule of benefits

See plan details

Dental Insurance

See plan details See plan details

Select from three dental insurance plans through Cigna.

All plans cover in-network preventive care at 100%. The differences are:

what you pay for the plan, what you pay when you get care, the maximum amount Cigna will pay each year for dental care (annual maximum benefit), and whether orthodontic care is covered.

DPPO plan deductibles and plan maximums cross accumulate between In-Network and Out-of-Network

Orthodontia benefits are available to both adults and children covered under the plan

In order to utilize DHMO plan benefits, you must select a contracted dentist.

Need help finding a contracted dentist? Click Here!

https://view.onedigital.com/dhmobenefitsbrevardcounty https://view.onedigital.com/dhmobenefitsbrevardcounty https://view.onedigital.com/dhmobenefitsbrevardcounty https://view.onedigital.com/lowdentalplanbrevardcounty https://view.onedigital.com/dentalhighplanbrevardcounty https://view.onedigital.com/dhmobenefitsbrevardcounty http://mycigna.com/ https://view.onedigital.com/howtofinddentistbrevardcounty

In-network care

Low Option High Option

Annual eye exam (once every calendar year)

$15 copay $15 copay

Frame Allowance (every 24 months)

$100 allowance + 20% discount on balance

$130 allowance + 20% discount on balance

Lenses (once every calendar year) Bifocals Scratch-Resistant Coating Transitions

$25 $0 $65

$25 $0 $65

Contact Lens Evaluation & Fitting (once every calendar year)

$0 $0

Collection Contact Lenses (in lieu of eyeglass lenses)

Up to 4 boxes included Up to 4 boxes included

Non-Collection Contact Lenses (in lieu of eyeglass lenses)

$105 allowance $130 allowance

Locate a provider via davisvision.com

Client Code 3179 Client Code 3180

See plan details

Vision Insurance

See plan details

All plans cover annual exams, lenses and frames, or contacts in lieu of glasses.

The differences are:

what you pay for the plan, what you pay when you get care, and the materials allowance (how much the plan will pay) for frames or contact lenses.

Select from two vision insurance plans through Davis Vision.

For more details, log on to the Open Enrollment section of your Member Portal at davisvision.com http://davisvision.com/ https://view.onedigital.com/visionsummarybrevardcounty https://view.onedigital.com/visionsummarybrevardcounty http://davisvision.com/

High Option 1 Value Option 2 Low Option 3

Network In & Out-of-Network In & Out-of-Network In & Out-of-Network

Medical Deductible

Medical Out-of-Pocket Maximum

$0

$200

$2,000

$400

$5,500

Primary care visit Specialist visit Telehealth

$0 copay $0 copay $0 copay

$20 copay $40 copay $0 copay

$30 copay $50 copay $0 copay

Urgent care Inpatient Hospitalization Outpatient Surgery Emergency room

$0 $0 per admission

$0 $0

$40 $250 per admission

$225 $90

$40 $260 per day

$250 $90

Physical, Occupational, Speech Therapy visits

$0 $25 $25

Part D - Prescription Drug Benefits (30-day/90-day supply

Pharmacy Deductible

Pharmacy Out-of-Pocket Maximum

$300

$400

Tier 1 (Generic) Tier 2 (Preferred Brand) Tier 3 (Non-preferred) Tier 4 (Specialty)

$10/$20 $30/$60

$50/$100 $50 (30-day supply)

$10/$20 $15/$30

$45/$112.50 $90 (30-day supply)

$10/$20 $15/$30

$45/$112.50 $90 (30-day supply)

Value-Add Benefits

Dental Benefits None Free exams, X-rays, cleanings & maintenance Free exams, X-rays, cleanings & maintenance

Vision Benefits (per 12 months)

Eye Exam: FREE Eyeglasses: None

Eye Exam: FREE Eyeglasses: $150 allowance

Eye Exam: FREE Eyeglasses: $150 allowance

Plan details coming soon

UHC MA-PD

UHC is offering three (3) Medicare Advantage Prescription Drug plan options for you to choose from. All include free preventive care, Medicare Part D coverage, and emergency care services.

The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Final rates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract, and other notices contained in this document, applications, and other corresponding communications for additional information. 8

Questions?

UHC Pre-Enrollment Line: 877-714-0178

UHCRetiree.com

Plan details coming soon Plan details coming soon http://uhcretiree.com/

Network In-Network Out-of-Network

Deductible Out-of-pocket maximum

None $4,800

None $8,950

Hospital Care

Inpatient Hospitalization Outpatient Surgery

$290 per day (1-5 days) $225 per day (1-5 days)

$490 per day (1-27 days) 50%

Physician and Facility Services

Primary care provider Specialist Ambulatory surgical center Durable medical equipment

$0 copay $40 copay

$150 copay 18%

$65 copay $65 copay

50% 25%

Emergency Services

Emergency room care Urgent care

$90 $0

$90 $0

Humana MA-PD

See plan details

Choose any provider that accepts Medicare, but you will pay less for in-network services.

No copay for certain in-network preventive care Worldwide emergency coverage Medicare Part D Pharmacy Coverage included!

The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Final rates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract, and other notices contained in this document, applications, and other corresponding communications for additional information. 10

Stay Connected with Humana

• Call Customer Care: 866-396-8810

• Create an online account:

Humana.com/registration

• Download the Mobile App:

Humana.com/mobile-apps

Tiers 30-day supply 90-day supply

Pharmacy Out-of-Pocket Max $2,000

Tier 1 (Generic) $0 $0

Tier 2 (Preferred brand) $47 $141

Tier 3 (Non-preferred brand) $160 $480

Tier 4 (Specialty) 30% n/a https://view.onedigital.com/2025brevardhumanamapd https://account.humana.com/registration https://account.humana.com/registration https://www.humana.com/member/mobile-apps

This information is only a brief summary. For more plan details and for information on the monthly premiums, click the icon that say “see plan details”

Medicare Surround - Plans F, N & G Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Surround, or Supplement, policy can help pay some of the remaining health care costs, such as, copays, coinsurance, and deductibles.

Medicare Supplement plans are age-banded. Once you are enrolled in one of Brevard County's Cigna Supplement plans, you will receive the issue-age rate until you disenroll or change plans. If you are considering switching to a MA- PD plan this year, then you could potentially move into a different age band and pay a higher premium, should you choose to re-enroll in the future.

The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Final rates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract, and other notices contained in this document, applications, and other corresponding communications for additional information. 11

Plan F Plan N Plan G

Deductible $0 $240 (Part B Deductible) $240 (Part B Deductible)

Out-of-pocket maximum $0 $0 $0

Office Visits

PCP: $0

Specialist: $0

PCP: $20

Specialist: $20

PCP: $0

Specialist: $0

Emergency Room $0 $50 $0

Inpatient Hospitalization $0 $0 $0

Outpatient Surgery $0 $0 $0

*Plan F is no longer open to new enrollees after 12/31/2019

See plan details See plan details See plan detailsPlan Rates https://view.onedigital.com/brevard2025cignaplanf https://view.onedigital.com/brevard2025cignaplann https://view.onedigital.com/brevard2025cignaplang https://view.onedigital.com/brevardmedicaresupplementrates2025 http://mycigna.com/

Find a pharmacy: www.humana.com/finder/pharmacy/ Check if your prescriptions are covered:

www.humana.com/medicaredruglist Click on the link, scroll down to “Plan Type” and select Group

Medicare, then the applicable plan year, Find Drug Guide, GRP 01

Prescription Drug Plan Medicare Retirees can elect the Humana Prescription Drug Plan (PDP). Keep in mind, when you elect a Medicare Supplement Plan, coverage is for medical expenses only, so consider electing the Humana PDP for Medicare Part D prescription drug coverage. Effective January 1, 2025 you will have a $0 cost share when you reach your $2,000 annual out-of-pocket maximum.

The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Final rates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract, and other notices contained in this document, applications, and other corresponding communications for additional information. 12

You must be entitled to Medicare Part A and be enrolled in Medicare Part B.

Tiers 30-day

Retail & Mail

90-day

Retail & Mail

Deductible $100

Out-of-Pocket Maximum $2,000

Tier 1 (Generic) $12 $24

Tier 2 (Preferred brand) $60 $120

Tier 3 (Non-preferred brand) $100 $200

Tier 4 (Specialty) $150 n/a https://www.humana.com/finder/pharmacy/ http://www.humana.com/medicaredruglist

2025 Medicare Monthly Premiums

Please contact the Employee Benefits Department for assistance with dependent premiums.

Medicare Supplement Plan N (no pharmacy)

Age Band Under 65 65-69 70-74 75-79 80+

Retiree Only $410.42 $180.80 $217.66 $248.05 $281.56

Retiree + Spouse/Dependent(s)

These rates will depend on the age of the retiree and the age of their spouse or dependent.

Medicare Supplement Plan G (no pharmacy)

Age Band Under 65 65-69 70-74 75-79 80+

Retiree Only $492.22 $216.84 $256.27 $290.86 $328.58

Retiree + Spouse/Dependent(s)

These rates will depend on the age of the retiree and the age of their spouse or dependent.

Medicare Supplement Plan F (no pharmacy)

Age Band Under 65 65-69 70-74 75-79 80+

Retiree Only $547.26 $241.09 $281.86 $317.00 $354.81

Retiree + Spouse/Dependent(s)

These rates will depend on the age of the retiree and the age of their spouse or dependent.

Humana Prescription Drug Plan

Retiree Only $264.68

Retiree + Spouse/Dependent(s)

Contact the Employee Benefits Department for assistance with calculating dependent premiums.

MA-PD Plans UHC High Plan

UHC

Value Plan

UHC

Low Plan

Humana $0 Plan

Retiree Only $336.28 $247.98 $176.37 $0.00

Retiree + Spouse/Dependent(s) Contact the Employee Benefits Department for assistance with calculating dependent premiums.

Dental Plan Cigna DHMO Cigna DPPO Low Option

Cigna DPPO High Option

Retiree Only $12.91 $27.08 $34.53

Retiree + Spouse $26.00 $53.48 $67.99

Retiree + Child(ren) $24.09 $49.33 $62.55

Retiree + Family $36.03 $83.16 $106.07

Vision Plan Davis Vision Low Option

Davis Vision High Option

Retiree Only $4.31 $4.96

Retiree + Spouse $8.62 $9.92

Retiree + Child(ren) $7.54 $8.68

Retiree + Family $10.72 $13.63

Coverage Amount Cost per Month

$5,000 $35.95

$10,000 $71.90

Now that your Brevard County Board of County Commissioners employment is ending, you need to make several important decisions about your health insurance benefits. Maintaining a life insurance benefit for your family is one of those important decisions.

Retiree Life Insurance

If you elect Retiree Life Insurance Coverage, you have the option to pay for the health insurance premium either on a monthly basis, or for a period of six or twelve months. The payment must be made by check or money order payable to Brevard County Board of County Commissioners, and mailed to: Brevard County Board of County Commissioners, Human Resources Department, 2725 Judge Fran Jamieson Way, Suite B209, Viera, FL 32940.

What is retiree life insurance?

Retiree life insurance is an option that enables you to obtain life insurance coverage after you terminate your current employment. Under the Retiree Life Insurance Benefit, the terms and conditions may differ from your employer’s group coverage. Some of these differences are highlighted below.

What are the advantages of choosing the retiree life insurance coverage?

There is no interruption in life insurance coverage after your employment ends.

You pay group rates, which may be lower than individual life insurance rates you would find on your own.

You are not required to provide proof of good health. This is a statement or proof of your physical condition that determines the acceptance or denial of a group life insurance application.

Am I automatically eligible for retiree life insurance coverage?

Yes. You can choose a flat retiree life insurance benefit of $5,000 or $10,000 through The Standard as long as you are actively at work on the day before your employment terminates.

You are also eligible to port or convert your life insurance benefits. Portability allows eligible insured employees to “port” (or buy) Group Life Insurance coverage when they are losing coverage because their coverage is being voluntarily or involuntarily terminated.

Conversion allows eligible insured employees to convert some or all of their Group Life coverage to an individual whole life policy when their coverage is reduced or terminated for any reason other than non-payment of premiums.

Please click here for additional information about the Group Life Insurance Portability and Conversion options.

When does retiree coverage end?

Retiree coverage for you ends when your premiums are not paid or when the group contract ends.

How do I apply for retiree coverage?

An application form will be provided to you with your retiree health insurance paperwork.

What are the current premiums for retiree life insurance coverage?

What is the billing cycle for retiree life insurance coverage?

https://view.onedigital.com/retireelifeinsurancebrevardcounty https://view.onedigital.com/retireelifeinsurancebrevardcounty

2025 Retiree Benefits