OUC knows that benefits are important to you and your family. OUC offers a comprehensive benefits package designed to provide you and your family peace of mind and focus on your total wellbeing. This Benefits Guide includes descriptions of the individual benefits offered by OUC to all benefit eligible retirees The coverage you elect begins with your initial eligibility date and continues through the end of the enrollment year, unless you experience a qualifying life event as outlined on page 6. The OUC benefit plan year begins each January 1 and ends each December 31.
WHAT’S NEW FOR 2024
v Reduced deductibles – Core and HRA medical plans
v Reduced out-of-pocket maximums – Core and HRA medical plans
v Reduced co-payments in the HRA Plan – PCP/Specialist/Convenience/Urgent
v Reduced cost for non-hospital advanced imaging – Core and HRA medical plans
v Reduced cost for non-hospital outpatient surgery – Core and HRA medical plans
v One phone number for Aetna Insurance Services – (866) 253-0659
v More opportunities to earn points
v No gatekeeper goals
v Increased point values and frequency for goals
v Higher incentive amounts (min. of $100 – max. of $400)
ELIGIBILITY AND ENROLLMENT
E l i g i b l e D e p e n d e n t s
Your legal spouse
§ Retiree’s legally married spouse. Common law marriage partners are not recognized by the state of Florida and are not eligible.
§ Separated spouses are eligible as there is no defined “legal separation” in the state of Florida.
§ Biological or stepchild(ren)
Your child(ren) up to age 26
Your child with a disability
Grandchild(ren)
§ Legally adopted child(ren) or child(ren) who have been placed for adoption
§ Other children for whom the retiree is the legal guardian or has legal responsibility for providing medical coverage as defined by a court order
§ Age 26 and older, unmarried and incapable of self-sustaining employment by reason of mental or physical disability which arose while the child was covered as an under-26 dependent under this plan, or while covered as an under-26 dependent under a prior plan with no break in coverage.
§ Child(ren) of covered dependent child(ren) can be covered through the end of the month the grandchild(ren) turns 18 months of age if the parent is covered under the plan
All of the following criteria must be met:
§ Biological child or legally adopted child
Overage dependent (Independent Plan)
§ Between ages 26 to 30
§ Unmarried
§ No dependent of their own
§ Does not have insurance coverage under any other individual/group health plan
§ Not entitled to benefits under Medicare or Medicaid
§ Resides in the state of Florida or is a full-time or part-time student
Q u a l i f y i n g L i f e E v e n t
Benefit elections and their related payroll deductions can only be changed at the annual Open Enrollment period unless you, your spouse, or your dependent child(ren) experience an IRSdefined qualifying life event. Generally, you have 31 days from the qualifying life event to make benefit changes. Examples of a qualifying life event include:
§ Marriage or divorce
§ Birth or adoption of a child
§ Change in child’s dependent status
§ Death of a spouse, child or other qualified dependent
§ Commencement or termination of adoption proceedings
§ Change in spouse’s benefits or employment status
§ Expiration of COBRA coverage
To report a qualifying life event, contact Human Resources/Benefits at benefits@ouc.com (407) 434-2284. Supporting documentation must be provided regarding the life event.
MEDICAL INSURANCE
Medical Plans
§ Core Medical Plan
§ Health Reimbursement Account (HRA) Medical Plan
§ Medicare Advantage
Annual Deductible
This is the amount paid by the employee/retiree/dependent during the plan year before the insurance shares the cost. This excludes co-payments reflected in the plan designs. When you are covering dependents on the plan, one member can meet the deductible for the entire family or it can be met by a combination of members. The Medical Plan Comparison reflects the in-network deductible.
Copayments
Copayments (copays) are fixed dollar amounts paid for healthcare services. They do not count toward the deductible. They do count toward the out-of-pocket maximum.
Co-Insurance
Co-insurance is the cost sharing between you and the plan which occurs after the deductible is met. Members’ co-insurance responsibility is 20%, and the plan’s responsibility is 80%.
Out-of-Pocket Maximum
The out-of-pocket (OOP) maximum is the most you will pay in the plan year for the deductible, co-pays and co-insurance for covered medical and pharmacy benefits.
MEDICARE
If you or your dependent become eligible for Medicare, you must enroll in Medicare Part A and Part B. Medicare becomes your primary insurance, and the Core or HRA Medical Plan becomes your secondary coverage OUC offers the Aetna Medicare Advantage plan as the preferred complement plan for Medicare benefits. If you or your dependent become Medicare Eligible, you should do the following.
1. At least two (2) months before you become Medicare eligible, please contact OUC HR/Benefits at (407) 434-2284 or benefits@ouc.com
2. Choose from OUC's three (3) Health Plan Options (Medicare Advantage/Core/HRA) or waive coverage.
3. Complete and return the Retiree Enrollment/Change Form with a copy of your Medicare card. If choosing Medicare Advantage, please contact HR/Benefits at benefits@ouc.com or (407) 4342284 to receive the Medicare Advantage Enrollment form.
4. If you choose the (Core or HRA) Plan as your supplemental coverage you must: Contact Medicare at (800) 633-4227 to inform them that Medicare is primary and Aetna is secondary coverage. Contact Aetna at (855) 281-8858 to inform them that Medicare is primary and Aetna is secondary coverage and enroll in the Aetna Medicare Direct Program. This is Aetna’s electronic filing system with Medicare.
5. Dental coverage ends when you become Medicare Eligible. You must enroll to continue coverage.
MEDICAL PLAN COMPARISON
Preventive Care Visit: (Includes: Annual Physicals, Well Women Examinations, Immunizations, Routine Eye Exam, Dental-Preventive Care)
*Medicare Advantage Plan does not include Dental **Some Medicare Advantage Plan coverage is subject to the deductible (ex. skilled nursing facility); refer to Aetna Advantage Plan booklet. Member copays do NOT apply to the deductible but are applied to the out-of-pocket maximum. Only in-network medical deductible, copayments and coinsurance expenses apply to the calendar year out-of-pocket maximum
PRESCRIPTION DRUG COVERAGE
Part C) Retail – 30-day supply
/ $50 / $75 $0 / $50 / $75
Retail: $0 /$30 / $45 (No coverage gap) Mail / In-Store –
/ $150
DENTAL BENEFITS
Mail: $0 / $60 / $90 (No coverage gap)
Preventive Care (dental cleanings and check-ups) is extremely important to your overall health; OUC encourages you to take advantage of your preventive dental benefits. You are automatically enrolled in the Aetna PPO Dental Plan when you enroll in either the Core or HRA medical plans The plan allows you to seek care from network and non-network dentists However, you will pay a bit more by choosing a non-network provider. Find an Aetna in-network provider online at aetna.com. For more information visit our OUC360 at www.ouc360.com/retiree
Preventive Care (two visits per plan year)
Oral exams, cleanings, routine x-rays, fluoride
Basic Services
Sealants; fillings; oral surgery; root canals; repairs to dentures, bridges and crowns
This coverage is a great way to save money on contact lenses, frames, lenses and even LASIK surgery. The Aetna network includes chains such as Pearl Vision, LensCrafters, JCPenney Optical, Target Optical and Sears Optical, along with many other neighborhood eye doctors and optical shops. Discover what the plan covers and find an eye care provider by visiting www.aetnavision.com For more information visit our OUC360 at www.ouc360.com/retiree
VISION PLAN
SERVICES In-Network
Single, Bifocal, Trifocal & Lenticular Lenses
Standard Progressive Vision Lenses
Any Frames, including frames for prescription sunglasses
Contact Lenses in lieu of glasses
Frequency of Services
§ Exams
§ Lenses or Contacts
§ Frames
$25 copay
$90 copay
$145 allowance, additional 20% off balance over the allowance
$145 allowance, additional 20% off balance over the allowance
Once every 12 months
Once every 12 months
Once every 24 months
Your plan is committed to helping you achieve your best health. The WELLbeing program is administered according to federal rules permitting employer-sponsored wellness programs seeking to improve population health and prevent disease. This includes the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008 and the Health Insurance Portability and Accountability Act, among others.
Eligible members of the health plans who choose to participant in the WELLbeing program will have the opportunity to earn up to $400 at the highest level. Rewards for participating in a wellness program are available to all employees and retirees If you think you may be unable to meet a standard for a reward under this wellness program, you may be entitled to a reasonable accommodation or an alternative standard. You may request a reasonable accommodation or an alternative standard by emailing wellbeing@ouc.com.
WELLBEING: THE POWER TO THRIVE
OUC is proud to offer its employees, retirees, and dependents a comprehensive and award-winning workplace wellness program! Participating in the wellness program will help increase overall wellbeing by helping you create or enhance healthy habits.
W h o c a n
p a r t i c i p a t e ?
R e g i s t r a t i o n
OUC employees, retirees, spouses, and dependents (ages 18 – 26) on an OUC health plan are eligible to participate in the WELLbeing program.
§ Scan the QR code or go to www.myoucwellbeing.com to register now to start earning wellness watts.
§ Click “LOG IN” on the upper right corner of the website to register.
§ Members earn points from 1/1/2024 through 12/31/2024
T i m e l i n e
E a r n W a t t s
S e l f - R e p o r t & E a r n R e w a r d s
§ Incentive rewards are distributed the following plan year.
§ Earnable wellness watts are found at www.myoucwellbeing.com under the “Watts” tab
§ New opportunities to earn watts will be communicated throughout the Commission.
§ Make sure to self-report activities and check your watts accumulated periodically.
§ Earn a minimum payout of $75/watts and a maximum of $400/watts I
Q u e s t i o n s ?
Visit Frequently Asked Questions (https://www.myoucwellbeing.com/en/help/help/) or for additional questions, email wellbeing@ouc.com.
Notice for employees, retirees, eligible dependents and COBRA participants whom may be approaching 65 years of age or has just become disabled and will be eligible for Medicare enrollment.
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with OUC and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
THERE ARE TWO IMPORTANT THINGS YOU NEED TO KNOW ABOUT YOUR CURRENT COVERAGE AND MEDICARE’S PRESCRIPTION DRUG COVERAGE:
• Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
• OUC has determined that the prescription drug coverage offered by the OUC Group Health Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.
WHEN CAN YOU JOIN A MEDICARE DRUG PLAN?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current OUC coverage will not be affected. You can keep this coverage if you elect Part D, and this plan will coordinate with Part D coverage. See pages 7- 9 of the CMS Disclosure of Creditable Coverage To Medicare Part D Eligible Individuals Guidance (available at http://www.cms.hhs.gov/CreditableCoverage/), which outlines the prescription drug plan provisions/options that Medicare eligible individuals may have available to them when they become eligible for Medicare Part D.If you do decide to join a Medicare drug plan and drop your current group health coverage through OUC, be aware that you and your dependents will be able to get this coverage back. If you are able to get this coverage back, reentry into the plan is subject to the underlying terms of the Plan.
90-Day Supply – Home Delivery Generic/Formulary/Non-Formulary
$0/$100/$150
$0/$100/$150
WHEN WILL YOU PAY A HIGHER PREMIUM (PENALTY) TO JOIN A MEDICARE DRUG PLAN?
Specialty Pharmacy
20% co-insurance, max co-insurance $200/script
20% co-insurance, max co-insurance $200/script
You should also know that if you drop or lose your coverage with OUC and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that cover- age. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.
FOR MORE INFORMATION ABOUT THIS NOTICE OR YOUR CURRENT PRESCRIPTION DRUG COVERAGE
Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through OUC changes. You also may request a copy of this notice at any time.
FOR MORE INFORMATION ABOUT YOUR OPTIONS UNDER MEDICARE PRESCRIPTION DRUG COVERAGE
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.
FOR MORE INFORMATION ABOUT MEDICARE PRESCRIPTION DRUG COVERAGE:
• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help
• Call 1.800.MEDICARE (1.800.633.4227). TTY users should call 1.877.486.2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1.800.772.1213 (TTY 1.800.325.0778).
REMEMBER: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Contact-Position/Office: OUC HR/Benefits
Phone Number: 407.434.2284
Name of Entity/Sender & Address: Orlando Utilities Commission, 100 W Anderson Street, Orlando, Florida 32801 10/1/2023
Human Resources/Benefits
100 W. Anderson Street Orlando FL 32802 (407) 434-2284 benefits@ouc.com
Fidelity Investments Defined Contribution (DC) Plan, Deferred Compensation 457 (b) Plan, Supplemental Retirement Plan (800) 430-2363 Fidelity.com/atwork
Voya Financial Partners (407) 252-3151
Principal (Defined Benefit-DC Pension Plan) (877) 877-1207
Pat Tierney pat@gaboragency.com Voyaretirement.voya.com
The Pines at Windermere (407) 434-4030 pines@ouc.com
Apollo Campground or Intake Area (407) 434-4030
Medicare (800) 633-4227 Medicare.gov
Social Security Administration (800) 633-4227 Ssa.gov
OUC Retiree Health Insurance Enrollment/Change Form
RETIREE OR SURVIVING DEPENDENT print clearly
HOME ADDRESS (APT. #)
HEALTH INSURANCE COVERAGE ENROLLMENT INFORMATION
➢ You have the choice to elect or decline OUC’s Health Insurance Coverage.
➢ If you are making changes, ADD/DROP dependent(s) or change health coverage (CORE, HRA, Medicare Advantage) options or DROP dental, complete and return this Form to HR/Benefits by Saturday, 10/21/23
➢ If a Medicare eligible Retiree and/or a Medicare eligible dependent enroll in the Aetna Medicare Advantage Plan, the following forms must be completed and sent to HR/Benefits:
1. The Aetna Medicare Advantage PPO Plan Employer Group Enrollment Form for each enrollee.
a. Contact HR/Benefits to receive the Medicare Advantage Enrollment form.
2. This Enrollment Form electing your medical and prescription and/or dental option(s).
➢ If you decline any of the OUC’s Health Insurance Coverage, complete and return this form.
➢ The Plan Option the retiree chooses is the same Plan for eligible dependent(s) except for the Aetna Medicare Advantage Plan.
➢ To ADD a dependent, type an “A”, dependent information.
o If adding dependent(s): copy of social security card(s) and birth certificate(s) must be provided.
o If adding spouse marriage certificate must also be provided.
o If adding dependent during the year, a qualifying event document must be provided.
➢ To DROP a dependent, write a “D”, reason for dropping, and the dependent information.
o If dropping dependent during the year, a qualifying event document must be provided.
➢ Eligible dependents include:
o Your legal spouse (opposite-sex or same-sex)
o Children under age 26 who are your biological children; or are your stepchildren; or are your legally adopted children; or are your foster children; or is a child for whom the retiree is the court ordered legal guardian; or live with you and whose parent is your child and the parent is covered as a dependent under the plan; or is fully handicapped and the child is not able to earn his/her own living because of mental retardation or a physical handicap which started prior to the date he/she reaches the maximum age for dependent children under your plan and he/she depends chiefly on you for support and maintenance and must live with you.
➢ On an annual basis, the retiree must complete and return to HR/Benefits the Dependent Eligibility Questionnaire Form for a child who lives with you and whose parent is your child and is covered as a dependent under the plan.
➢ When you become Medicare eligible you must enroll in Medicare Part A and Part B. OUC medical insurance coverage will become secondary and dental insurance coverage will become optional.
➢ If you and/or your dependent become Medicare eligible and want to enroll in dental coverage for a premium cost, please complete this form and check the Dental box that applies to you. Dental coverage must remain in effect for a minimum of two (2) years.
➢ During the rest of the plan year, a change to your enrollment can only be made if the change falls into the definition of a qualifying status change. It is the retiree’s responsibility to inform HR/Benefits of a qualifying status change within 30 days of change date.
➢ Fax (407.434.5003) or scan e-mail (benefits@ouc.com) or mail (OUC HR/Benefits, PO BOX 3193, Orlando, FL 32802) required form(s) to HR/Benefits.
➢ If any questions, contact HR/Benefits via e-mail (benefits@ouc.com) or phone (407.434.2284). Turn Page To Complete
ADD/DROP RELATIONSHIP LAST NAME FIRST NAME MI SSN DATE OF BIRTH
RETIREE AUTHORIZATION FOR ENROLLMENT AND OR CHANGES IN THE OUC HEALTH PLAN
I hereby elect the plan(s) indicated above. I understand that this electi on applies to the retiree and/or any covered dependent. I authorize OUC to adjust the monthly health deduction in my pension benefit or if applicable OUC will invoice for the monthly amount necessary to cover my contributi ons for medical and/or dental coverage. I understand that if I cease to make the required monthly payments, coverage will be dropped. This authorization will remain in effect for Plan Year. My signature below affirms that all information and statements provided on this form are full, complete and true to the best of my knowledge. Sign and date below.
Retiree Signature: Date:
Surviving Dependent Signature: Date:
DECLINATION OF AETNA MEDICARE ADVANTAGE for RETIREE and/or eligible DEPENDENT(S)
I do not want to enroll myself in the Aetna Medicare Advantage Plan. I have elected one of the other options. I understand I will not have the opportunity to enroll again until the next OUC Annual Enrollment. Sign and date below.
Medicare Retiree Signature: Date:
Medicare Spouse Signature: Date:
Medicare Surviving Dependent Signature: Date:
DECLINATION OF OUC HEALTH PLAN
I do not want to enroll myself and (if applicable) dependents in any of the three (3) OUC Health Insurance
Coverage options. I understand I will not have the opportunity to enroll again unless I have a qualifying event during the Plan Year or at annual enrollment and I must provide proof of other health insurance coverage.
