Coverage for Retirees Under Age 65
The Retiree Medical Plan would be a medical plan option if you retire from the University before you are Medicare eligible, or if you are a covered dependent under age 65 of a University retiree. This coverage may continue until you become eligible for Medicare, at which time your coverage under the Retiree Medical Plan becomes a supplement to your Medicare coverage.
Medical Coverage with the Retiree Medical Plan
The Retiree Medical Plan provides medical and hospital coverage through the BlueCross BlueShield (BCBS) Preferred Provider Option (PPO). This plan offers a wide range of benefits and the flexibility to choose any licensed doctor or hospital provider across the country and around the world when you need care.
You receive special advantages if you visit certain physicians. If you visit a BCBS PPO provider, your care is considered "in-network," and the plan will cover a higher percentage of your costs. If you do not visit a BCBS PPO provider, coverage is still provided, but your care is considered to be "out-of-network," and your out-of-pocket costs will be significantly higher. You should check with BCBS before receiving care from a provider who is not part of the Plan's network.
Select key Features
The following represents a partial list of the features the Retiree Medical Plan medical and hospital coverage. Please refer to the Retiree Medical Plan Information brochure for detailed information.
- Annual deductible of $300 per individual.
- The out-of-pocket limit is $1,750 per family. The plan covers 100% after you reach the out-of-pocket limit.
- In-Network Benefits (after you meet the annual deductible)
- Generally, the plan covers 80% of the cost of covered services based on the prevailing fee schedule, and you pay the rest.
- Out-of-Network Benefits (after you meet the annual deductible)
- A separate $200 copay per hospital admission
- Generally, the plan pays 65% of the covered charges based on the BCBS prevailing fee schedule, and you pay the rest.
- Certain limits apply, meaning you are responsible for any amount that exceeds the BCBS's prevailing fee schedule.
- Overnight hospitalization requires advance BCBS approval. If you do not obtain advance approval, your benefits for that admission will be reduced by $200. In case of an emergency, you or your family member must call BCBS within two days.
Prescription Drug Coverage with the Retiree Medical Plan
The Retiree Medical Plan provides prescription drug coverage through Express Scripts. All retirees, spouses/partners and dependents under age 65 (not enrolled in Medicare) will be enrolled into an under 65 prescription drug program.
Select key Features
The following represents a partial list of the features the Retiree Medical Plan prescription coverage. Please refer to the Retiree Medical Plan Information brochure for detailed information.
- You pay a copayment at the time of purchase depending upon:
- The type of drug - generic, preferred brand, or non-preferred brand
- Which pharmacy the drug is purchased at - in-network or out-of-network
- Where the drug is purchased - a retail pharmacy or through the home delivery/mail order service.
- Prescription drugs are not subject to the medical/hospital $300 annual deductible and do not count towards the $1,750 out-of-pocket limit.