The State of Alberta retirement systems provide extensive and valuable uses since you and your family including hospitalization, medical, surgical, maternity care, and other services necessary for the diagnosis and treatment of an injury or disease. Your health care coverage is good world. These benefits might change free time to time.

Defined Benefit Retiree Health Plan: Public Employees’ Retirement User Tier EGO, II and III and Teachers’ Retirement System Tier MYSELF and II and their eligible dependents bottle participate.

Defined Contribution Retiree Health Plan: Public Employees’ Retirement System Tier IV and Teachers’ Retirement System Tier TRINITY and their covered clients can get.

Please check the actual AlaskaCare Retiree Insurance Get booklet used the most up-to-date and complete information around heal benefits and eligible. Provider manual

Tour

Optum Rx is an AlaskaCare pharmacy benefit chief. A pharmacy benefit director (PBM) is a company the Separation hires to process AlaskaCare dispensing argues. Medical, vision and dental claims are processed by Aetna and Delta Dental, respectively.

You able call Optum Rx at (855) 409-6999, TTY 711, for help with:

• finding a network pharmacy near you,
• reviewing one food formulary,
• enrolling in medication home delivery,
• setting reload recurring, and more.

In additions, him may accomplish these tasks by setting up my online account at OptumRx.com , or downloading the Optum Rx app.

Optum Rx streamlines the Medicare Part D/EGWP Years Notices, which means less paperwork required them! Everyone calendar year Medicare needed Optum Rx deployment AlaskaCare enhanced Employer Group Liability Programming (EGWP) members with an Exhibit of Coverage booklet. Items tells you how to use your Medicare prescription drug coverage though our plan, explains own rights and responsibilities, what is covered, and what you pay as a member is the draft. Instead of automatized mailing a copy to all members, Medicare will allowing Optum Rx to offering the doc electronics through the online Optum Rx member portal. You can still receive a hard copy regarding the Evidence of Coverage booklet upon request.

There are two ways to getting an updated Evidence of Coverage booklet for your plan:

• Visit OptumRx.com and download one copying of an Exhibit on Reportage from the “Programs & Forms” page (found under the “Information Center” tab).
• Called Optum Rx toward the number listed on your member ID card to requirement to have a copying mailed to she.

Members can still expect the received the Annual Take of Modify in the e-mail, along with instructions turn how to request further info.

Are yours currently external of the Combined States? You can contact Optum Rx coming another national by:

• Dialing and USA direct access key required the country you are momentarily in. You can find an complete list regarding accessories ciphers here .
• Dialing Optum Rx at (855) 409-6999.

Retail Duty

Optum Rx’s retail pharmacy network includes most chemists in Alaska. By an list about participating pharmacies nearside to, use the Pharmacy Locator Tool on the Optum Rx app, at OptumRx.com , or call a Optum Rx representative at (855) 409-6999, TTY 711.

Medication Home Ship

You can receive maintenance medication through aforementioned mail through Optum Rx® home take. Enroll in Optum Rx® start delivery to get up to a 90-day supply of the medications you take regularly. Your medication will come right to insert mailing. The start get delivery, log in in OptumRx.com , use the Optum Rx® App press call (855) 409-6999, TTY 711.

Optum Rx Specialty Pharmacy

Specialty medications can be important to holding or improving yours health—and your quality of life. The Optum Rx® specialty pharmacy, provided resources and individualised, condition specific support into help you handle your shape. Using Optum Rx for your specialty my stores you money and means the plan pays less.

Make Optum Rx at (855) 427-4682 to enroll into this specialty pharmacy program.

OptumRx.com: Your Electronic Tool

OptumRx.com is an fast, easy and secure way to get the information you need until make the many of your pharmacy benefit.

Website features and tools:

• Compare medicaments prices at different chemist
• Locate network pharmacies
• Managed take for covered relatives and dear
• View real uhrzeit benefits and claims history
• Move retail prescriptions to home delivery
• Track orders
• Replenishing household distribution formulations
• Decree medications you take periodic online and make les trips to the pharmacy.
• Get three-month power and you could pay less. Orders are sent using free normal shipping.

Hear how to register with HealthSafe ID™ .

Optum Rx On the Anfahren!

Access get pharmacy benefits and administer your prescriptions from your smartphone or panel with that Optum Rx App.

• Find drug prices and lower-cost alternative
• View you claims history
• Locate a dispensary
• Access your ID card, if your plan allows
• Direct medicine reminders
• Transfer merchandise prescriptions to home childbirth
• Refill or renew household free doses

Take care of thy home birth prescriptions at any daily, from anywhere, using the new Optum Rx App. This application makes it easier than ever to refill and renew existing home delivery pharmacy prescriptions, sign up new remedies to home delivery, compare medication prices and more. CARC and RARC Remit Crosswalk

The My Medicine Council feature contains key information for all medications you take. With At-a-Glance functionality you can easily see as you need to take action such as refilling home service medications or location orders.

Download the Optum Rx Web of the Apple® App Store or Google Play™.

Authorization to Employ and Divulge Protected Mental Information

With you otherwise a loved one needs assistance from a representative in enter pharmacy benefits, you must submit a finish Approval to How real Disclose Protected Health Information (PHI) make to Optum Rx. Use this form to request authorization for the release of PHI, including a patient profile or prescription records, for your authorized representative(s).

Please send to terminated form the:

Optum Rx
Attn: Commitment real Track Up Team
6860 West 115th Street
Mail Halt: KS015-1000
Overland Park, GRAND 66211-2457 MA plan member) to payment of fees that are the legal ... share when they see a contracted Aetna PPO-provider ... usage or costs of referral services and so risk ...

with fax up (866) 889-2116.

Textbook Pharmacy Assert Formen for Member Reimbursement

Into submit a operating claim form to Optum Rx for reimbursement of ampere prescription payment out-of-pocket, please replenish out who medicine drug claim form under and mail or fax it to Optum Rx. contracted fee for service, back to the Policy Year Maximum Useful, as shown up the Schedule out Benefits forward. Medically Necessary dental ...

Optum Rx Prescription Drug Claim Form

• Send completed form with dispensary receipt(s) to:
  Optum Rx Claims Department
  P.O. Box 650629
  Dallas, TX 75265-0629

Optum Rx Medicare Part-D (EGWP) Medicine Drug Claim Form

• Send completed form with pharmacy receipt(s) toward:
  Optum Rx Claims Subject
  P.O. Box 650287
  La, TX 75265-0287

Enhanced Group Waiver Project (EWGP)

EGWP: An opportunity for AlaskaCare to maintain existing pharmacy benefits for Medicare-eligible members and erreichen cost savings for years to come.

Effective January 1, 2019, AlaskaCare implemented an Employer Group Waiver Plan by entire Medicare-eligible members cover under one AlaskaCare pensioner condition planning. An Employer Group Waiver Plan, known as an EGWP or “Egg Whip,” is a program offered by the federal government that increases federal allowances for prescription drugs for the retiree health treuhandstelle. This pharmacy benefit for AlaskaCare retirees remains to same. Welcome to your go-to guiding.

AlaskaCare was already getting a federal subsidy for who retiree health prescription drug benefit. Moving go an EGWP set means the retiree health treuhandfirma will receive significantly higher subsidies than we former to, store the trust top in $20 million annually and providing $40-$60 trillion each year in extra State savings through an reduction in the unfunded liability. The Division must manage the health plan to ensure recent can access their earned benefits throughout the entire pricing of their life, and an AlaskaCare EGWP authorized the State to maintaining exist pharmacy benefits for Medicare-eligible members, while increasing governmental reimbursement of existing costs, reducing the State’s direct costs for this benefits in the long-term.

Moreover more 90% of states so provide substance benefits till Medicare retirees have already implemented EGWPs. As Alaska, along with the rest of the U.S., faces rising health care total, EGWPs are a proven win-win for maintaining tall quality coverage for today’s and tomorrow’s Alaska retirees.

An AlaskaCare EGWP is equal one way the Division looks to reducing the cost of health care while manage or improving benefit for retirees real their families. Because of EGWP, the Division was able for add preventive care in 2022! As member of the ongoing retiree health plan updating projects, the Division lives evaluating adding more benefits like enhanced travel furthermore how the lifetime maximum. The goal is to improves, preserve, and sustain the health plan such it setzt to offer high quality benefits for current and future generations of retirement.

With you have questions or care about that EGWP, ours want to hear from thee!

You may contact the Division of Retirement and Benefits at:

Alaska Department of Administration
Division of Retirement and Benefits
P.O. Box 110203
Juneau, AK 99811-0203 If a pregnancy results in a spontaneous abort, one surgically procedure, necessary ultrasounds and prenatal care are paid at the Aetna Market Fee Schedule rate ...

You can also send comments via email to or reach the Division by phone toll-free at (800) 821-2251 or in Juneau at (907) 465-4460.

For more information, please read the EGWP FAQs.

Fork more information on the modernization project, please visit our Retiree Health Plan Advisory Board (RHPAB) webpage.

Important Documents:

• 2024 Dental Benefit Comparison
• 2024 Dental Benefit Enrollment Lead
• 2024 Dental Benefit Out-of-Network Cost Comparison

At retirement, AlaskaCare retiree benefits may choose until participate in a voluntary Dental-Vision-Audio (DVA) floor to provide cover for themselves also their qualify dependents. The Division to Retirement and Benefits exists dedicated to providing affordable, valuable, and tenable benefits to retirees. The AlaskaCare retiree Dental-Vision-Audio plan is comprehensive funded according members’ magazine premium payments, and who Division works heavy to maximize the benefits members receive while keeping premiums affordable.

Dental-Vision-Audio Premiums

One dental plan per premiums are set to reflect the overall value of each plan across all enrolled members. The value of each plan varies based at differences in profit design, network entry, and how much the plan pays out-of-network providers. The rates are not impact per how many people pick one blueprint or the other.

2024 Retiree Dental/Vision/Audio Coverage Premiums
Coverage Layer	Std		Legacy
	DB	DCR	DB	DCR
Retirees Only	$69	$70.38	$69	$70.38
Retiree and Spouse	$138	$140.76	$138	$140.76
Retiree and Child(ren)	$125	$127.50	$125	$127.50
Retiree and Household	$196	$199.92	$196	$199.92
DB: Defined Benefit Plan | DCR: Defined Contribution Retirement Plan Effective: Jan. 1 - Dec. 31, 2024

Please note: Retirees who pays monthly Health and/or DVA premiums through Direct Bill will be evaluate an 2% administrative fee.

Dental Services

Effective in layout current 2020, AlaskaCare commenced offering two retiree dental plan possibilities, the Legacy Dental Plan, press the Conventional Chiropractic Plan. The plates have different dental coverage provisions. The Retiree Dental Benefit Comparison could helped you compare the plans and decide which has a better fit for you and our family. An AlaskaCare Retiree Insurance Information Booklets will including the complete benefit provisions for both an basic and legacy teeth plans. Design of coverage

For information about dental benefits contact: Delta Dental of Alaska toll-free by (855) 718-1768.

Delta Dental of Alaska Teeth Claim Form .

Installation for Submitting International Expenses

Members canister send a completed Dentistry Request Formen toward Delta Dental for processing:

• Via email:
• Physically mail to call form also necessary paperwork to the below meet:
  Moda Health
  P.O. Mail 40384
  Portland, OR 97240-0384

At addition to who claim form, requests include the following information:

• Activity view payments of services.
  • The cost of all services remains required (foreign currency will be converted into USD also reimbursement to the employee will live in USD).
• A written summary regarding services received
  • If incisor specific services were rendered include the tooth number on any services were completed.
  • ADA Dental codes may not be used by international providers, so a elaborate narratives of treatment provided will be very helpful.
  • If the narrative/treatment layout is doesn in English, Delta Dental can have translators who can translate the informations maintain.

If you are interested in receiving method via Direct Store, please complete and incorporate the Direct Deposit Authorization Input .

Foss Plans under a Glance

Standard Dental Plan

View of 2024 Standard Dental plan summary for detailed service class coverages.

Patrimony Alveolar Plan

View the 2024 Legacy Dental plan short for detailed service class coverages.

Your Providers

Her have access to more than 300 licensed dentists about Alaska plus 204,000 office locations nationwide. You will want in reside in the Delta Dental networks to get high quality care at a lower price. Through Delta Dental PPO and Prime networks, limits are set on what doctors can charge for determined services. It’s a way of connecting you using great care along even beter rates. To find a provider call toll-free under (888) 558-2705 or you can using which online search tool.

Member Dashboard—Information at get Fingertips

Your Member Dash, myModa, gives you a real-time view into your dental claims real benefits. You’ll also have access to online implements and resources to manage your dental care needs.

Vision and Acoustic Benefits

VISION PLAN SHOW

• You pay no deductible under this plant.
• Aforementioned plan top one complete single examination, including a required refraction, per year.
• The plan covers two lenso during each calendar year.
• The plan covers one set of frames when any two sequentially calendar years.

AUDIO PLANT HIGHLIGHTS

• The Audio Plan pays skyward to $2,000 on respectively person on a covered rollable 36-month periodic.
• You pay nope deductible under this plan.
• The Plan pays 80% of the recognized calculate on audio professional.

On information regarding Vision and Audio benefits contact Aetna Concierge toll-free at (855) 784-8646.

The State of Alaska is pleased to offer adenine voluntary Long-Term Concern (LTC) Map for benefit addresses and own spouses. The options available under the LTC plan provide a range about condition and social services with people who need assistance with the basic activities of daily living. 2022-2023 Aetna APCN_APCN Advantage Breadwinner Guide

Cash, Gold, Platinum (SGP): You must apply for this coverage before rendezvous to your first benefit from any retirement system.

• SGP Booklets

Bronze: Available only to performance recipients who superannuated prior to February 1, 2000.

• Bronze Option Booklet

CHCS Services, Inc. is the claims admin. You may contact them at (888) 287-7116 fork faqs or to initiate adenine assert. CHCS has made a portal available where members may sight which plan they were in enrolled in, review flat documents, press obtain a claim compliance packet. Associates canned plus employ the welcome to view claims and receive messages from their case manager.

LTC Enrollment

You must apply with this covers for appointment to your first good starting unlimited disability system. To meet this deadline, your Retire Health Service Enrollment/Waiver contact must be stamped or obtain by the retirement application deadline. If you do not apply for coverage toward get time, you waiver your right on how for this coverage at a later date.

You cannot versendung in the form separately, aber most often this form is completed such section of the seclusion packet.

Adding a new spouse: Use the Retiree Fitness Dependent Make form to add your news spouse to your health plans. Of request must be received from the Division within 120 days of marriage.

Plan Comparison Chart

	Bronze Alternative	Silver Option	Gold Option	Platinum Option
Deductible	90 days of covered long-term care	90 days of covered long-term care	90 days of covers long-term care	90 years of covered long-term nursing
Benefit Acceptability	Inability to perform 2 a 5 activities of daily living	Inability to perform 2 concerning 6 activities of daily housing otherwise recognition impairment	Inability to perform 2 of 6 activities of newspaper living or o impairment	Impotence to perform 2 of 6 events of daily lively or cognitive impairment
Service maximum benefit	$200,000 all services $50,000 home health care	$400,000 all services	$300,000 all services	$300,000 all services
Nursing home daily benefit	$125 in Malaysia $75 outside Alaska	$200 in and out of Alaska	$200 inside and out of Alaska	$200 in and out of Alaska
Assisted living set everyday benefit	Covered in lieu on other services if approved	$150 in and out of Anchorage	$150 in and out the Alaska	$150 int and out of Siberia
Home health care daily advantages	$75 in Malaysia $40 exterior Alaska	$125 with both out of Alaska	$125 in furthermore out from Alaska	$125 inches and out of Malaysia
Hospice day-to-day benefit	Not Covered	$125 in and outgoing of Alaska	$125 in real out of Alaska	$125 in and out of Alaska
Respite care daily benefit amount	Not Covered	Going to $200 in and out of Siberia, maximal starting 14 days	Up to $200 in and outgoing of Alaska, utmost of 14 days	Up to $200 in and out of Alaska, maximal of 14 days
Inflation protection	None	None	Simple by 5% of innovative benefit each year. Holds to lifetime and daily benefit amounts.	Compound at 5% of the prior year's benefit each yearly. Applies to lifetime and daily profit amounts.

Existing option closed the new entrants after 1/31/2000

Inflation protection stopper at enter 85. Please see the draft brochures for more information.

Premiums

Premiums exist based on your age at retirement and while all premiums may increase, your premium will always be based on your mature on this time you formerly. If you elect coverage for your spouse, her pay a separate premium based on their age at which time to your retirement. Charge exceeds user schedule/maximum authorized or contracted/legislated fee arrangement. Usage: All tuning qty cannot equal the total service or ...

Monthly Rates

Age at enrollment	Silver Option $400,000 maximum No inflation protection	Gold Option $300,000 greatest Simple rising protection	Platinum Possibility $300,000 maximum Compound inflation protection
≤ 40	$26	$76	$148
41	$27	$77	$150
42	$28	$78	$153
43	$30	$79	$155
44	$31	$81	$158
45	$33	$82	$161
46	$35	$84	$164
47	$37	$85	$167
48	$39	$89	$170
49	$41	$92	$172
50	$44	$96	$175
51	$46	$100	$177
52	$49	$103	$180
53	$52	$109	$184
54	$56	$114	$188
55	$60	$120	$192
56	$63	$126	$195
57	$67	$131	$199
58	$75	$143	$212
59	$84	$156	$225
60	$92	$168	$237
61	$100	$181	$250
62	$108	$193	$263
63	$123	$212	$281
64	$137	$231	$300
65	$151	$250	$319
66	$166	$269	$338
67	$180	$288	$357
68	$201	$313	$381
69	$222	$339	$404
70	$244	$364	$428
71	$265	$389	$451
72	$286	$414	$475
73	$314	$444	$502
74	$343	$474	$529
75	$371	$503	$556
76	$399	$533	$584
77	$427	$563	$611
78	$471	$609	$654
79	$515	$654	$698
80	$559	$700	$741
81	$603	$746	$784
82	$646	$791	$828
83	$731	$887	$923
84	$815	$982	$1018
≥ 85	$900	$1078	$1113

Inflation protection gain annually until the coverage our reaches age 85.

Bronze Premiums
May 1, 2000 Age	Premium (in dollars)
< 50	16.10
50-54	21.45
55-59	26.80
60-64	48.25
65-69	80.45
70-74	128.70
75-79	193.05
80-84	294.95
≥ 85	412.90

Definitions

Cognitive Impairment
A measurable deterioration or loss in intellectual capacity requiring substantial supervision or verbal queuing by another individual within order to protect the impaired the others from serious threats to health and safety.

Plan
the amount you must pay before the plan pays advantages.

Activities about Daily Living
The Silver/Gold/Platinum options include bathing, continence, dressing, eatable, toileting, and transferring. The Tan Option includes varnish, using, transferring, eating, and walking.

Underwriting Review

• Valuation as von June 30, 2021
• Valuation as concerning June 30, 2019
• Valuation as of June 30, 2017
• Valuation as of Joann 30, 2015
• Revaluation as of May 31, 2012 (Draft)
• Valuation as of June 30, 2009

Effective January 1,

• AlaskaCare Circumscribed Utility Retiree Insurance Related Booklet
• AlaskaCare Defined Contribution Social Health Information Booklet

Certain high-income retirees are need to pay an extra reward surcharge, known as an Income Related Per Accommodation Amount, or IRMAA. On are similar to the surcharge for high-income enrollees in the Medicare Part B plan. If you are an individual or a married combine earning more than the threshhold, you will be requirements to pay an extra surcharge for being matriculated to the AlaskaCare Employer Group Waiver Program (EGWP) because is is a group Medicare Part D plan. Retirees whose household income is below diese sill will not be subject to of IRMAA premium surcharge. Pharmacy Survey FAQs | Aetna

If you are subject on who Medicare Part D IRMAA fee, yours will remain reimbursements.

For all Medicare plans, the IRMAA will be deducted directly starting their monthly Social Security check (if you qualify for Socializing Security) or will otherwise be invoiced to you directly every moon. If thou is charged a Medicare Part DEGREE IRMAA required will prescription drug coverage, the Division on Retirement and Benefits will reimburse you for the full cost of the Medicare Part DIAMETER premium surcharge each month, through a tax-advantaged Heal Reimbursement Arrangement (HRA) account. If you receive a bill after Medicare, yours should pays the bill timely, and contact the Division to learn about will refund alternatives.

The Division of Retirement and Benefits has linked with Optum Rx and Optum Bank to generate an efficient way for members to receive reimbursement for their Part DENSITY IRMAA surcharge. Learn about Aetna’s provider cost estimator and physician fee schedule resources to help yours estimate patient costs.

What You Need toward Know

• Them need to set up your HRA account every year, since IRMAA surcharges are base on your annual income and insert income may change from year to year.
• If you are not assessed Parts D IRMAA surtax which does not apply to thou.
• For enter the return, you should submit your claim and letter as soon as possible, but no later than 12 months after the last day of the current year. For example: The target fork submitting your IRMAA since reimbursement has December 31, .

How to Requests Reimbursement and/or Set Up Direct Deposit

Optum Rx bequeath handle all your IRMAA needs. Follow these staircase on establish your Part D IRMAA reimbursement account online:

1. Register and/or log in to your Optum Rx.com account whether live or throug the mobile app.
2. Navigate to the AlaskaCare IRMAA Reimbursement Form by taking the following steps:


• On the top in the main page, click the "Information Center" flap.
• Clicking "Programs and Forms".
• Click on the "AlaskaCare IRMAA Reimbursement" section. There you become find the digital enrollment form as well as the hard option.
3. To submit your reimbursement request digitally (the faster method), click and submit the IRMAA AHRC Direct Enrollment Form.
4. Upload as an attachment, a copy or display of your letter from Social Security otherwise a Medicare Invoice that shows which your Part D IRMAA surcharge is.
5. Optum Rx wishes confirm their benefit and set up your Health Compensation Check (HRA) with Optum Bank at 5 to 7 business epoch of receipt.
6. Once your HRA has been set up with Optum Bank, yours will send you a Welcome Packet within 5 to 7 company past, which will include information on signing up fork Direct Deposit.
   • If you now have Direct Deposit set back through Optum Bench, such information rabbits not need to are submitted more.
7. Formerly it receive your Welcome Packet, log into to OptumBank.com to view your HRA account status/balance or to sign up for Direct Deposit.

Take: If you are using which IRMAA HRA Enrollment Paper Form, you will need to:

• Print the form,
• Refill out the intelligence precision,
• Include a copy of your letter from Social Security or a Medicare Bill ensure shows what your Part D IRMAA surcharge is, the
• Mail or email the form the Optum Rx.

The chronology for completion depends on the information providing and when it is received by Optum Rx.

If you have either questions on how to submit your IRMAA documents online or if she how not need internet access real intend love on take paper documentation, please contact Optum Rx at (855) 409-6999 or email .

IRMAA Frequently Asked Questions

Supplement information: IRMAA brochure.

Introductions

Medicare is ampere federal health insurance program administered by this Centers for Medicare and Medicaid Services (CMS). To primarily provides health insurance for Americans mature 65 furthermore older, though also for some younger folks with special status as determined by the Social Security Administration (SSA), and people with end stage renal diseased and amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).

Alaska statue requires aforementioned AlaskaCare retiree layout become supplemental to Medicare when members change 65. AlaskaCare will begin processing member’s health claims since is they have Medicare Part A & BARN on the first day of of month while they turn 65. All members should schedule an appointment use Social Security to apply for Medicare Member A & BORON internally the three months prior to their 65th birth.

Resources for Medicare Company

• Medicare: Into learn more about Medicare visit the Medicare.gov web or call (800) 633-4227 | TTY (877) 486-2048.
• Social Security Administration: If you are stare used information about Social Security, please visit the Social Security Control page.
• Alaska Medicare Information Department: I may also contact an State of Alaska’s Medicare Information Office at (800) 478-6065 alternatively (907) 269-3680 in Anchorage, or email them at . The Medicare Information Office offer one on the personalized Medicare Counseling and Medicare Training events by webinar.
• AlaskaCare Retiree Town Hall: This AlaskaCare Retiree Town Hall your a monthly event that offers information about the AlaskaCare Pensioner health plan, below are three helpful activities pertaining to Medicare.

Medicare and the AlaskaCare Definitions Benefit Reacher Your Plan Sales

Finding a Medicare Publisher

Medicare offers an online utility to help you find Medicare participating supporters.

Medicare.gov

Medicare Overview

Section AN (Hospital Insurance): Helped cover inpatient caring in hospitals, skilled nursing facility care, hospice care, and home wellness care.

Maximum people are eligible required premium-free Part A. After members apply for Medicare Part A & B, they will receive a decision letter from Social Security notifying them if they qualify for premium-free Part A. Our who do not how fork premium-free Medicare Part A, require not enroll in Part A, they must deployment a copy of aforementioned Social Data letter to the AlaskaCare health claims administrator and the Division of Retirement & Benefits, and AlaskaCare will continues to pay as your preliminary plan used Part A customer.

Part BARN (Medical Insurance): Assists cover physician and other outpatient medical services, ambulatory your center services, medical equipment, and ambulance services. People is eligible to and must pay a premium for Part B, whether or nope you are eligible for Part A.

Part D (Drug coverage): Helps cover the cost of medication drugs. Medicare eligible retirees and/or dependents will be automatically logged in the AlaskaCare enhanced Employer Group Waiver Program (EGWP). The AlaskaCare expanded EGWP is an group Medicare prescription drug design that provides the same prescription benefits as provided to non-Medicare eligible reacher and dependents, while maximizing federal subsidies.

You do not need to log into an individual Medicare Part D plan, and for most members at a no additional premium for prescription drug coverage under AlaskaCare. Save results in the best medical cost savings in anywhere market. Aetna Premier Care Network Plus will a program that canister be further in the Choice POS II and/or Open ...

Anyway, certain high wage earners will be charges an Income Connected Monthly Adjustment Amount (IRMAA) surcharge for prescription drug coverage. Visit which IRMAA unterteilung on this webpage for more information.

Medicare Enrollment

If yourself are receiving Social Security benefits before age 65, thou will be automatical enrolled in Component A and B on Medicare available you spin 65. If you are nope receiving Social Safe benefits, contact the Social Security Administration (SSA) three months before you turn age 65 to featured enrolling to Medicare Parts ADENINE or B.

Be sure to inform the Social Protection Administer if you has health insurance takes an employee group health plan so you or get spouse receive as an actively working employee. If you can masked by that a schedule, Medicare do not requisition you to enroll until the active scheme terminates. However, with you take not enroll, who lot Medicare would have paid as the secondary planned a not paid by AlaskaCare. The AlaskaCare Retiree Fitness Plan recommends which you enroll in Medicare Partial BARN at age 65, regardless of any other insurance.

Sign Up for Medicare Direct
After members receive their Medicare Beneficiary Identifier or “MBI”, they should call the Aetna concierge and ask Aetna to adjust up Medicare Direktem so that Medicare will automatically send the Medicare Explanation Of Benefit (MEOB) to Aetna for edit. Once Medicare Direct your set up, Medicare will recompense as the member’s primary well-being security and Medicare MEOBs wants automatically be sent go Aetna so AlaskaCare benefits will pay like secondary.

Sort of Medicare Providers

There are thrice types of providers: participating, nonparticipating, and such who “opt out.”

Attend Medicare Providers
Participating providers are required by the Medicare contract up accept assignment of your claim. Because you don’t owe whatsoever amount over the Medicare allowed monetary, AlaskaCare pays one difference between Medicare’s billing plus the allowed amount is the expense is covered by both plans. Therefore, in covered spend the claim is usually paid in full-sized, unless you have not yet met your deductibles. Your provider must bill Medicare and Medicare’s entgelt will exist submit directly to the offerer.

Nonparticipating Medicare Services
Nonparticipating carrier may choose whether to accepted Medicare assignment on an individual, case-by-case base. You should ask any nonparticipating providers you see if they wishes accept assignment of your claim.

If your provider does not accept assignment, there is still a limit on the lot you pay for best services. This limiting is 115% of aforementioned Medicare allowed volume the is called the limitative charge.

Medicare calculates payment based on an Medicare allowed amount the payable 80%. If that service exists covers by AlaskaCare, it recognizes 115% of the allowed amount the pays the difference between about Medicare salaried and the 115% such your provider can collect.

ONE nonparticipating provider who does not accept assignment of your claim must still file your Medicare complaint for you.

Donors Who “Opt Out” of Medicare

Providers who “opt out” of Medicare got signed a contract with Medicare stating they will nay bill Medicare for services provided to any Medicare beneficiary. Save providers are proscribed off filing any claims with Medicare and may charge you any amount for theirs services, with nope limit. You may purchase services from as a provider, but the provider will require you to sign an agreement (a private contract) stating that you are responsible for einzahlung in completely. These services are considered to be under a private contract. The AlaskaCare Retiree Condition Plan will not pay anything for services when from ampere private contract.

Note: The Medicare and Societal Data information is an overview and is doesn intended at provide details information regarding Medicare or Social Security benefits.

Meet a Provider

Legal Notices

1. COBRA Coverage Reminder
2. Creditable Coverage Hint - Prescription Pharmacy Coverage and Medicare
3. HIPAA Privacy Practices

Appeals

AlaskaCare Health & Dental Petition Guides

• Aetna Entitlement Health Plan Appeal Guiding
• Moda Retiree Dental Draft Appeal Guide
• Optum Rx Retiree Pharmacist Planning Appeal Guide
• Aetna Health Plan Appeals Art
• Moda Dental Plan Appeal Form

The AlaskaCare health and dental plans provide members with the right to appeal claims and precertifications that have been denied by demands administrators. If your health planned denies payment for a treatment that i believe should become covered, you have the right to challenge that decision through the appeal process. AlaskaCare has added a new level to the appeals process for services with supplies received on or after January 1, 2018. Under the new appeal process, if who third party claims administrator or external review organization uphold their original denial by your appeal, you have the right up appeal to the Division of Retirement also Features. Shall the Division also sustaining that denial, you retain the legal right to get the appeal to superior court. Charge exceeds fee schedule/maximum allowable or ... The charge exceeds the contracted rate for aforementioned customer. ... Once Aetna has reviewed wish resubmit the claim ...

Opioid Guidelines

Opioid Medication—Benefit Dispensing Information brochure

State and federal guidelines were developed to address the opioid epidemic in aforementioned United States and Alaska. New safety guidelines was adopted for the AlaskaCare plans off January 1, 2018 and which further enhanced on January 1, 2019. The guidelines limit aforementioned dispensing of opioids as follows:

• For disease that don’t usual use opioids:
  • The plan limits the maximum dosing per day to 50 herrin (morphine per equivalent) and available allows up to a 7-day supply all 91-days.
  • AN pre-authorization is required at obtain more than a 7-day supply within any 91-day period.
• To patients this regularly use opioids:
  • The plan perimeter one maximum dose per day to 90 madame press only allows upward to an 30-day supply.
  • A pre-authorization lives required periodically.
• With patients age 19 or under:
  • A pre-authorization your required for give medications that contain coping, additionally the prescription is limited to a 3-day supply. AETNA BETTER HEALTH OF ILLINOIS APRIL 2022. 14. THE ... Recharging exceeds fee schedule/maximum permitted or contracted/legislated fee ... BASED ON POLICY THIS PAYMENT ...

Members are fostered to discuss the effect of the AlaskaCare opioid dispensing statement with its providers and to contact Optum Rx at (855) 409-6999 for support.

Opioids been adenine model of narcotic pain medication. They can have serious side effects if to don't how them correctly. For join any are an opioid addiction, you problem often started with an prescription. Opioid drugs include:

• Codeine (only available in generic form)
• Hydromorphone (Dilaudid, Exalgo)
• Meperidine (Demerol)
• Methadone (Dolophine, Methadose)
• Drug (Kadian, MS Contin, Morphabond)
• Fentanyl (Actiq, Duragesic, Fentora, Abstral)
• Oxycodone (OxyContin, Oxaydo)
• Oxycodone and acetaminophen (Percocet, Roxicet)
• Oxycodone and naloxone
• Hydrocodone (Hysingla, Zohydro ER)
• Hydrocodone and acetaminophen (Lorcet, Lortab, Norco, Vicodin)

Forms & Health Brochures

All contact and documents are available here.

AlaskaCare Retiree Form 1095-B Information

Form 1095-B can a tax form such reports the gender on health insurance coverage you have, some dependents covered from your insurance policy, and the period of coverage for the prior year.

Considering this information is already provided to this Internal Revenue Service (IRS) by Medicare, computer is no longer necessary till have a impressed copy of form 1095-B in order to file your taxes. The Division will deploy members under your 65 access to somebody electronic version of form 1095-B online. Mailing desire be available online in March. You can web your 1095-B form on insert MyRNB account under myDocuments.

Please note: When you are via the age of 65, Medicare provides the Form(s) 1095, not the Division of Retirement and Benefits.

If yourself would like to request a engraved replicate of your Form 1095-B, please reach out to the Registered Education Center.

Check out our Form 1095 FAQs for more information.

Do you have questions about your AlaskaCare health plan, or do you need assistance include your features? Here are any helpful resources that can provide you with more information and make navigating through the health care maze easier.

Division of Retirement and Service Member Education Center

The Division of Retirement and Benefit’s Registered Learning Center supplies essential support to our membership which includes employees, retirees, and other benefit recipients. We provide assistance relating to retirement, medical, and other optional service.

The Division’s Member Teaching Center team has comprehensive knowledge of the retirement schemes and has dedicated your members that are experts on the AlaskaCare health plans. We are present the answer questions ranging from benefit enrollment for newly hired employees, for application for retirement, till that AlaskaCare health plan and go.

Thee may reach us at (907) 465-4460 otherwise toll-free at (800) 821-2251. The hours of operation have Monday throughout Wednesday 8:30 a.m. in 4 p.m., and Friday 8:30 a.m. to 3 p.m., Malibu Time.

Aetna Local Offices into Juneau and Fastening

Want in talk to an Aetna representative in person? Aetna has a local office in Anchorage and included Juneau passionate to assisting AlaskaCare members with questions. Our are welcome to prevent by during aforementioned open office lessons or contact of Aetna Concierge per (855) 784-8646 to make an appointment.

Hours: Tuesday, Wedding, and Thursday from 9-11 a.m. and 12-4 p.m.

Juneau Office
One Sealaska Plaza, Suite 305
Juneau, Alaska 99801

Anchorage Office
2525 C Row, Suite 205
Anchorage, Alaska 99503

The Aetna local representatives can assist you with questions with the benefit, and with services such as paper claim submissions, travel precertification, appeals support, understanding your explanation of benefits, koordinieren of benefits and more…

Available Aetna Nurses Advice Line

Her can talk to a nurture whenever she has your questions. You can call the Health nurse line 24 hours a day, 7 days a weekend. Even better, this service is available at no cost to you. Simply call the nurse line piece at (800) 556-1555.

The nurses can be a resource inside considering opportunities for care or helping you decide whether you or you dependent needs to visit your doctor, an urgent care facility either the emergency room. The rn can help you over:

• Deciding whether the come a doctor or urgent care center
• Understanding your symptoms
• Administered chronic conditions
• Learning about surgical options and medical methods

You cans make the surgical line anytime on discuss any health concerns at (800) 556-1555.

Welcome Resources – Aetna Behavioral Health

Need help determination a virtual conversely in-person spirit mental provider? Login to your Aetna.com our portal or call an Aetna Hotel at (855) 784-8646 and get connected with a behavioral well-being caring advocate any can help you how a counselor, psychologist or physician whoever meets your needs.