Retiree Benefits

Retirees hired prior to January 1, 2012 and who are vested in WCRC’s pension are eligible for retiree medical and dental benefits.

Deductible Copay Example PPO 4
Deductible Copay Example PPO 7

Deductible Copay Example PPO 4
Deductible Copay Example PPO 7

A retiree electing family coverage is responsible for the cost difference between the monthly premium cost for a 2-person and family options in addition to the 2-person contribution rate.

Single Complementary – Single person on Medicare.
2-Person Complementary – Both spouses on Medicare.
1 Regular + 1 Complementary – 1 spouse pre-65 and 1 spouse on Medicare.

If you have medical coverage elsewhere, you can choose to waive medical insurance and receive a buy-out of $3,000 for the year. Proof of coverage must be provided to receive the buy-out. You are still eligible to participate in dental insurance. Medicare is not considered alternative coverage. If you elect the buy-out, checks are mailed in December.

About Medicare and Engility

Medicare is the federal health insurance program for individuals aged 65 and older, as well as some younger individuals with disabilities. It is managed by the Centers for Medicare and Medicaid Services (CMS).

Eligibility for Medicare begins on the first day of the month you turn 65, or on the first day of the prior month if your birthday falls on the first.

Action Required if You are Eligible for Medicare

Three months before your 65^th birthday, please take the following steps:

• Contact the Social Security office at 1-800-772-1213 or CMS at 1-800-633-4227 to discuss Medicare enrollment.
• Apply for Medicare online at Social Security Administration.

Note: WCRC requires enrollment in Medicare Parts A and B when you or a covered dependent become eligible. At this point, Medicare becomes your primary insurance and WCRC’s medical plan will provide supplemental coverage.

Prescription Drug Coverage

WCRC’s prescription drug coverage is considered “creditable,” meaning it is as good as or better than Medicare Part D. Therefore, you do not need to enroll in Medicare Part D.

Medicare Parts Overview

• Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
• Part B (Medical Insurance): Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
• Part D (Prescription Drug Coverage): Helps with the cost of prescription drugs and recommended vaccines. Do not enroll in Medicare Part D if you are covered under WCRC’s retiree plan.
• Part C (Medicare Advantage): Offered through private insurances, these plans combine Parts A and B and may include additional benefits like vision, dental, or drug coverage.

If you choose a Medicare Advantage plan, you may opt out of WCRC’s supplemental coverage. Please notify HR if you make this decision.

After Enrollment

Once you are enrollment in Medicare, please send a copy of your Medicare card to Alicia Held at [email protected] or mail directly to WCRC.

Coordination of Benefits (COB) is how health care carriers coordinated benefits when members or their dependents are covered by more than one health care plan.  Under COB, carriers work together to make sure members receive the maximum benefits available under their health plan.  If an employee or any of their dependents have more than one health insurance plan it is their responsibility to notify BCBS and to complete the Coordination of Benefits Form.

WCRC’s medical plans include Virtual Care by Teladoc Health®, offering 24/7 remote access to U.S. board-certified doctors, psychiatrists, and licensed therapists through your smartphone, tablet, or computer. This service provides convenient care for both physical and mental health needs.

Medical Care

• Ideal for minor illnesses such as colds, sore throats, urinary tract infections, and pink eye when your primary care provider isn’t available.
• No appointment is needed, with an average wait time of 10 minutes or less.
• Costs are comparable to or lower than in-person office visits.

Mental Health Care

• Appointments are required for mental health services, with evening and weekend availability.
• For urgent mental health needs, additional options are available through your Blue Cross Blue Shield of Michigan or Blue Care Network plan.

How to Access

• Download the Teladoc Health® app on your smartphone or tablet.
• Log in via your computer at https://www.bcbsm.com/find-care/virtual-care/www.bcbsmonlinevisits.com.
• Follow the prompts to set up your account and connect with a healthcare professional.

24/7 Online Health Care

Cost sharing invoices will be mailed in early December for your required retiree contributions. These invoices can be paid in full or quarterly.

Your health plan includes condition management programs through Blue Cross Blue Shield of Michigan, in partnership with Teladoc. These programs are designed to support members in managing chronic health conditions and enhancing overall well-being. By participating, you will gain access to personalized resources and expert guidance tailored to your specific health needs.

• Diabetes Management
  This program offers personalized support for managing Type 1 and Type 2 diabetes, aiming to reduce the risk of complications. It also addresses related conditions such as weight management, hypertension, dyslipidemia, and mental health.
• Diabetes Prevention
  This program assists employees with weight management and related health issues, including hypertension and dyslipidemia. Participants receive unlimited messaging and one-on-one sessions with expert coaches, along with online meetups, health challenges, and strategies for healthy living.
• Hypertension Management
  This program provides personalized support for managing hypertension and dyslipidemia, as well as weight management and mental health. It offers timely assistance to help employees make healthier choices and reduce the risk of complications related to hypertension.
• Weight Management
  This program supports employees in achieving their weight management goals. Participants receive guidance from certified health coaches who help design easy-to-follow, personalized plans focused on improving nutrition, physical activity, and sleep habits.

Diabetes Prevention Program Flyer
Diabetes Management Program Flyer
Hypertension Management Program Flyer

Lifestyle drugs are excluded from the prescription drug plan.  Lifestyle drugs are health habit and reproductive drugs such as those that treat sexual impotency or infertility, help in weight loss or help to stop smoking. They are not designed to treat acute or chronic illnesses or be prescribed for medical conditions that have no demonstrable physical harm if not treated.

BCBS requires review of certain drugs before the plan will cover them, which is called prior authorization.  BCBS will review the member’s medication history to determine whether they’ve tried a preferred alternative first, which is known as step therapy.  Step therapy requires members to try less expensive options before “stepping up” to drugs that cost more.  Prior authorization and step therapy ensure that medically sound and cost-effective medications are prescribed appropriately.  A complete list of medications that require prior authorization or step therapy can be found at bcbsm.com/pharmacy.

Prior Authorization – Step Therapy

Save money and time with fewer refills when you get a 90-day supply of the medication you take regularly.  Please note that not all medications are available in a 90-day supply.  Here’s how to find out if your prescription is eligible:

1. Log in to your account at bcbsm.com
2. Hover over My Coverage in the blue bar at the top of the page
3. Select Prescription Drugs from the drop down
4. Click the link, Price a drug and view additional benefit requirements. It will take you directly to Express Scripts^®. You won’t have to log in again
5. Enter the name of the drug and follow the instructions. You’ll need to know the dosage and how often you’ll be taking it
6. You’ll get an alert if your medication has a quantity limit

BCBS has partnered with PillarRx to help its members save money on specialty and other expensive drugs with a high-cost drug discount program. This co-payment assistance program reduces the out-of-pocket costs members pay for certain medications. If you are eligible to participate in the plan you will receive a letter directly from BCBS and PillarRx on how to enroll in the program.

PillarRx Flyer

Beneficiaries of retirees who retire after January 1, 2003 will receive a $7,500 death benefit.

In the event of a retiree’s passing, the family or the individual handling final arrangements should contact the WCRC Human Resources Department as soon as possible. Once notified, HR will begin processing the necessary information and will initiate the life insurance claim with The Standard.

Additionally, the death must be reported to MERS (Municipal Employees’ Retirement System) by calling 800-767-6377.

You can being using the money in your HCSP account after you have a separation of employment. Once MERS is notified by WCRC of your separation, you’ll receive information on how to begin receiving reimbursements from your account.

You may begin receiving reimbursements for qualified medical expenses after you leave employment. There are three ways you can be reimbursed for purchases using your HCSP:

• Health benefits debit card
• Online/mobile reimbursements
• Reimbursement by mail

Direct deposit payments are made on the 18th of each month. If the 18th falls on a weekend or holiday, the payment will be sent electronically to your financial institution the business day before. Your first payment will be effective the month following the your date of direct deposit authorization.

To make changes to your direct deposit log into your myMERS account, select your Defined Benefit account, and edit your payment method.

You can begin using your account as soon as you leave employment, or you can continue to keep your assets invested. However, you must start receiving payments no later than April 1 of the calendar year following the year you turn 72 or terminate employment, whichever is later.

Withdrawal requests can be submitted online through your myMERS account. To do so, log into your myMERS account and select your 457 Program. Click on the “Distributions” link in the left-hand navigation to make your request.