OUC 2025 Defined Contribution (DC) / Hybrid Retiree Benefits Guide
WELCOME
OUC knows that benefits are important to you and your family. OUC offers a comprehensive benefits package focused on your total wellbeing that provides peace of mind. 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 on December 31.
Retirees can enroll via paper enrollment form, provided to you with this Benefits Guide. If you do not need to make changes to your benefits for 2025, you do not need to fill out the form. If you become Medicare eligible in 2025, you will need to complete and send the enrollment form to HR/Benefits along with your Medicare card.
WHAT’S NEW FOR 2025
• Payflex is now called Inspira Financial.
• A dedicated phone number for Aetna Insurance Services – (866) 253-0659
WELLBEING IN 2025
• Retirees on our Aetna medical plan can participate in the wellness program and earn monetary incentives
• Minimum Wellness Watts to reach is 100, maximum is 400
• There are over 1,200+ ways to earn Wellness Watts for completing health-related goals
• A new platform will be implemented in 2025 with enhanced capabilities and resources.
Reminders
• OUC Retiree Life Insurance is $10,000 for eligible retirees.
• Keep your address, phone number and email up to date to receive benefits info, retiree news and the Update! newsletter. Contact HR/Benefits to provide updated contact information.
• To update your retiree life insurance beneficiary designation, reach out to HR/Benefits.
• Death notification: When a retiree and/or beneficiary passes, it’s important to inform HR/Benefits as soon as possible. This will help to avoid any issues with pension and health benefits.
ELIGIBILITY AND ENROLLMENT
Eligible Dependents
Your legal spouse
Your child(ren) up to age 26
§ 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)
§ Legally adopted child(ren) or child(ren) who have been placed for adoption
§ Other children for whom the employee is the legal guardian or has legal responsibility for providing medical coverage as defined by a court order.
Your child with a disability
Grandchild(ren)
§ 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 a under-26 dependent under this plan, or while covered as a under-26 dependent under a prior plan with no break in coverage.
§ Child(ren) of covered dependent child(ren) – grandchild(ren) can be covered through the end of the month the child(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
§ Between ages 26 to 30
Over age dependent (under their own coverage)
§ 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
Qualifying Life Event
Benefit elections and their related payroll deductions can only be changed during the 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 HR/Benefits at benefits@ouc.com. Supporting documentations must be provided in a timely manner to complete 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 retiree during the plan year before the insurance shares the cost. This excludes copayments 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 innetwork 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, copays 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 dependent become Medicare eligible, you should do the following:
1. At least two (2) months before you become Medicare eligible, please contact 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. a. If choosing Medicare Advantage, contact HR/Benefits (benefits@ouc.com or (407) 434-2284) to receive the Medicare Advantage enrollment form.
4. If you choose the Core Plan or HRA Plan as your supplemental coverage you must: a. Contact Medicare (800) 633-4227) and Aetna (855) 281-8858 to inform them that Medicare is primary and Aetna is secondary coverage. Enroll in the Aetna Medicare Direct Program (Aetna’s electronic filing system with Medicare).
5. Dental coverage ends when you become Medicare eligible. You must enroll to continue coverage.
When you aren’t feeling well and need to be seen by a medical professional, there are a variety of care options available to you through OUC’s Aetna medical plan. Some healthcare facilities have a higher copay cost associated with them, so it may save you some money to review your options before you go.
Aetna’s website (aetna.com) provides cost of care estimates for in-network providers and facilities. Aetna’s 24-Hour Nurse Line may also be helpful: (800) 556-1555.
illnesses and rashes not requiring in-person care.
DENTAL BENEFITS
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 aetnadental.com.
For more information visit the OUC360 Retirees resource site at ouc360.com/retiree
PPO DENTAL PLAN
Services
Preventive Care (two visits per plan year); Oral exams, cleanings, routine x-rays, fluoride Plan pays 100%; deductible waived Plan pays 100%; deductible waived
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 Pearle 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 aetnavision.com.
For more information visit the OUC360 Retirees resource site at ouc360.com/retiree.
Standard progressive vision lenses
Any frames, including frames for prescription sunglasses
Contact lenses in lieu of glasses
Frequency of Services
copay
$140 allowance, additional 20% off balance over the allowance
$140 allowance, additional 20% off balance over the allowance
Unused funds forfeited if employee does not directly retire from OUC.
WELLNESS INCENTIVE PROGRAM
OUC is proud to offer a comprehensive and award-winning wellness program! Participating in the wellness program will help increase overall wellbeing by helping you create or enhance healthy habits.
Questions? Email wellbeing@ouc.com
Who Can Participate?
Registration & Tracking Your Watts
Timeframe
• All OUC employees
• OUC retirees, spouses and dependents (ages 18 – 26) on an OUC health plan
• Scan the QR code or go to oucwellbeing.com.
• Earnable Wellness Watts are found under the “Tracking Your Watts” tab.
• Make sure to self-report activities and check your Watts periodically.
• New opportunities to earn Watts will be communicated throughout the Commission, OUC360 and the Wellbeing portal calendar.
• Medicare Advantage participants need to submit an affidavit for preventive care exams (contact HR/Benefits for a copy)
• Complete health-related goals between January 1 through December 31.
• Incentive rewards are distributed the following plan year
• Earn a minimum payout of 100 Wellness Watts
REQUIRED NOTICES
Wellness Program – Reasonable Alternative Standard
Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness program are available to all retirees. If you think you may be unable to meet a standard for a reward under this wellness program, you may qualify for an opportunity to earn the same reward through different means.
Email wellbeing@ouc.com to find a solution that will work for you.
Notice Regarding Wellness Program
The Wellbeing Program is a voluntary wellness program available to all employees, spouses and dependents (ages 18 - 26) on the OUC medical plan. The program is administered according to federal rules permitting employersponsored 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 medical plans who choose to participate in the Wellbeing program will have the opportunity to earn up to $400. If you are unable to participate in any of the health-related activities, you may be entitled to reasonable accommodation or an alternative standard. You may request a reasonable accommodation or an alternative standard by emailing wellbeing@ouc.com
Creditable Coverage Notice About Your OUC
Prescription Drug Coverage and Medicare
Notice for employees, retirees, eligible dependents and COBRA participants who may be approaching 65 years of age or have 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 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 15 to December 7. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two-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 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. However, reentry is subject to the underlying terms of the plan.
PRESCRIPTION PLAN COPAYS
$200/script
$200/script
WHEN WILL YOU PAY A HIGHER PREMIUM (PENALTY) TO JOIN A MEDICARE DRUG PLAN?
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 coverage. For example, if you go 19 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
For further information, contact the HR/Benefits team. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, or 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 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
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.ssa.gov, or call them at (800) 772-1213 (TTY (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: HR Benefits, 100 W Anderson Street, Orlando, Florida 32801 10/1/2024
IMPORTANT CONTACT INFORMATION
Human Resources/Benefits
100 W. Anderson Street Orlando, FL 32801 (407) 434-2284 (407) 434-5003 fax benefits@ouc.com
RETIREE OR SURVIVING DEPENDENT print clearly LAST NAME FIRST NAME
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
• 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:
o The Aetna Medicare Advantage PPO Plan Employer Group Enrollment Form for each enrollee.
o Contact HR/Benefits to receive the Medicare Advantage Enrollment Form.
o 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.
• If adding dependent(s), a copy of the dependent’s Social Security card(s) and birth certificate(s) must be provided.
• If adding a spouse, a marriage certificate must also be provided.
• If adding a dependent during the year, a qualifying event document must be provided.
• To DROP a dependent, write a “D”, the reason for dropping, and the dependent’s information.
• If dropping a 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 lives 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 before 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.
• 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 the change date.
• Fax (407) 434-5003, scan email (benefits@ouc.com) or mail (OUC HR/Benefits, PO BOX 3193, Orlando, FL 32802) required form(s) to HR/Benefits.
• If you have any questions, contact HR/Benefits via e-mail (benefits@ouc.com) or phone (407) 434-2284.
Turn Page to Complete
RETIREE HEALTH INSURANCE
COVERAGE ENROLLMENT
OPTION Check Applicable Box
DENTAL ENROLLMENT OPTION MEDICARE RETIREE and/or DEPENDENT(S) q Retiree Drop Dental CORE PLAN
MEDICARE ADVANTAGE
AETNA VISION PREFERRED
DEPENDENT OR SURVIVING DEPENDENT COVERAGE
Check Applicable Box
RETIREE NOT MEDICARE RETIREE MEDICARE
DEPENDENT OR SURVIVING DEPENDENT NOT MEDICARE
Dental
Dental
Retiree & Dependent Dental
& Family Dental
DEPENDENT OR SURVIVING DEPENDENT MEDICARE FAMILY NOT MEDICARE
ENROLLMENT OF ELIGIBLE DEPENDENT(S) print clearly
RELATIONSHIP CODE: SP=Spouse, S=Son, D=Daughter, SS=Step-Son, SD=Step-Daughter, GS=Grandson, GD=Granddaughter 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 election 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 contributions 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:
Surviving Dependent Signature:
Date:
Date: DECLINATION OF AETNA MEDICARE ADVANTAGE for RETIREE and/or DEPENDENT(S)
q 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 open enrollment. DECLINATION OF OUC HEALTH PLANS
q 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. Sign and date below.
