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Alaska Department of Administration

Division of Retirement and Benefits

Alaska Department of Administration

Division of Retirement and Benefits

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Edited by BC 4/30/24

Retiree Health Plans

Learn more about the AlaskaCare retiree health plan benefits, coverages and monthly premiums. Effective as of January 1,

AlaskaCare Medical Plan Benefits | Aetna

The State of Alaska retirement systems provide extensive and valuable benefits for 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 worldwide. These benefits may change from time to time.

Defined Benefit Retiree Health Plan: Public Employees’ Retirement System Tier I, II and III and Teachers’ Retirement System Tier I and II and their eligible dependents can participate.

Defined Contribution Retiree Health Plan: Public Employees’ Retirement System Tier IV and Teachers’ Retirement System Tier III and their eligible dependents can participate.

Please check the current AlaskaCare Retiree Insurance Information booklet for the most up-to-date and complete information about health benefits and eligibility.

Defined Benefit Retiree Health Plan Premiums

Tier II/III retirees without system-paid medical Coverage Level 2024 Monthly Premium Retiree Only $704 Retiree and Spouse $1,408 Retiree and Child(ren) $995 Retiree and Family $1,699 Effective: Jan. 1 - Dec. 31, 2024

Please note: Retirees who pay monthly Health and/or DVA premiums through Direct Bill will be assessed a 2% administrative fee.

Please note: Retirees who pay monthly Health and/or DVA premiums through Direct Bill will be assessed a 2% administrative fee.

Defined Contribution Retiree Health Plan Premiums

Retiree and Spouse (if applicable) are Medicare Age Eligible Coverage Level 2024 Monthly Premium Retiree Only $320.79 Retiree and Spouse $641.58 Retiree and Child(ren) $849.66 Retiree and Family $1,170.45 Retiree and Spouse (if applicable) are not Medicare Age Eligible Coverage Level 2024 Monthly Premium Retiree Only $1,094.46 Retiree and Spouse $2,188.92 Retiree and Child(ren) $1,623.84 Retiree and Family $2,718.30 When only the Retiree or the Spouse is Medicare Age Eligible Coverage Level 2024 Monthly Premium Retiree and Spouse $1,415.25 Retiree and Family $1,944.12 Effective: Jan. 1 - Dec. 31, 2024

AlaskaCare Pharmacy Benefits | Optum Rx

Introduction

Optum Rx is the AlaskaCare pharmacy benefit manager. A pharmacy benefit manager (PBM) is a company the Division hires to process AlaskaCare pharmacy claims. Medical, vision and dental claims are processed by Aetna and Delta Dental, respectively.

You can call Optum Rx at (855) 409-6999, TTY 711, for help with: finding a network pharmacy near you, reviewing the drug formulary, enrolling in medication home delivery, setting refill reminders, and more.

In addition, you can accomplish these tasks by setting up your online account at OptumRx.com , or downloading the Optum Rx app.

Optum Rx streamlines the Medicare Part D/EGWP Annual Notices, which means less paperwork for you! Each calendar year Medicare requires Optum Rx provide AlaskaCare enhanced Employer Group Waiver Program (EGWP) members with an Evidence of Coverage booklet. It tells you how to use your Medicare prescription drug coverage through our plan, explains your rights and responsibilities, what is covered, and what you pay as a member of the plan. Instead of automatically mailing a copy to all members, Medicare is allowing Optum Rx to provide the document electronically through the online Optum Rx member portal. You can still receive a paper copy of the Evidence of Coverage booklet upon request.

There are two ways to get an updated Evidence of Coverage booklet for your plan: Visit OptumRx.com and download a copy of the Evidence of Coverage from the “Programs & Forms” page (found under the “Information Center” tab). Call Optum Rx at the number listed on your member ID card to request to have a copy mailed to you.

Members can still expect to receive the Annual Notice of Changes in the mail, along with instructions on how to request further information.

Are you currently outside of the United States? You can contact Optum Rx from another country by: Dialing the USA direct access code for the country you are currently in. You can find a complete list of access codes here . Dialing Optum Rx at (855) 409-6999.

AlaskaCare Retiree Plan Formulary

AlaskaCare Defined Benefit Retiree Plan Formulary 2024 AlaskaCare Retiree DB Plan Prescription Drug Formulary 2024 AlaskaCare Retiree DB Plan Medicare Part D and Non-Part D Drug Formulary 2024 AlaskaCare Retiree DB Opt-Out Plan Prescription Drug Formulary 2023 AlaskaCare Retiree DB Plan Prescription Drug Formulary 2023 AlaskaCare Retiree DB Plan Medicare Part D and Non-Part D Drug Formulary 2023 AlaskaCare Retiree DB Opt-Out Plan Prescription Drug Formulary 2022 AlaskaCare Retiree DB Medicare Part D Drug Formulary 2022 AlaskaCare Retiree DB Plan Prescription Drug Formulary AlaskaCare Defined Contribution Retiree Plan Formulary 2024 AlaskaCare Retiree DC Plan Prescription Drug Formulary 2024 AlaskaCare Retiree DC Plan Medicare Part D and Non-Part D Drug Formulary 2023 AlaskaCare Retiree DC Plan Prescription Drug Formulary 2023 AlaskaCare Retiree DC Plan Medicare Part D and Non-Part D Drug Formulary 2022 AlaskaCare Retiree DC Medicare Part D Drug Formulary 2022 AlaskaCare Retiree DC Plan Prescription Drug Formulary

Retail Pharmacies

Optum Rx’s retail pharmacy network includes most pharmacies in Alaska. For a list of participating pharmacies near you, 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 Delivery

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

Optum Rx Specialty Pharmacy

Specialty medications can be important to maintaining or improving your health—and your quality of life. The Optum Rx® specialty pharmacy, provides resources and personalized, condition specific support to help you manage your condition. Using Optum Rx for your specialty needs saves you money and means the plan pays less.

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

OptumRx.com: Your Digital Tool

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

Website features and tools: Compare medication prices at different pharmacies Locate network pharmacies Manage medication for covered dependents and spouses View real time benefits and claims history Transfer retail prescriptions to home delivery Track orders Refill home delivery prescriptions Order medications you take regularly online and make fewer trips to the pharmacy. Get three-month supplies and you could pay less. Orders are sent using free standard shipping.

Learn how to register with HealthSafe ID™ .

Optum Rx On the Go!

Access your pharmacy benefits and manage your prescriptions from your smartphone or tablet with the Optum Rx App. Find drug prices and lower-cost alternatives View your claims history Locate a pharmacy Access your ID card, if your plan allows Manage medication reminders Transfer retail prescriptions to home delivery Refill or renew home delivery prescriptions

Take care of your home delivery prescriptions at any hour, 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 prescriptions for home delivery, compare medication prices and more.

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

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

Authorization to Use and Disclose Protected Health Information

If you or a loved one needs assistance from a representative in receiving pharmacy benefits, you must submit a completed Authorization to Use and Disclose Protected Health Information (PHI) form to Optum Rx. Use this form to request authorization for the release of PHI, including a patient profile or prescription records, to your authorized representative(s).

Please mail the completed form to:

Optum Rx Attn: Commitment and Follow Up Team 6860 West 115th Street Mail Stop: KS015-1000 Overland Park, KS 66211-2457

or fax to (866) 889-2116.

Manual Pharmacy Claim Form for Member Reimbursement

To submit a manual claim form to Optum Rx for reimbursement of a prescription paid out-of-pocket, please fill out the prescription drug claim form below and mail or fax it to Optum Rx.

Optum Rx Prescription Drug Claim Form Send completed form with pharmacy receipt(s) to: Optum Rx Claims Department P.O. Box 650629 Dallas, TX 75265-0629

Optum Rx Medicare Part-D (EGWP) Prescription Drug Claim Form Send completed form with pharmacy receipt(s) to: Optum Rx Claims Department P.O. Box 650287 Dallas, TX 75265-0287

Enhanced Group Waiver Plan (EWGP)

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

Effective January 1, 2019, AlaskaCare implemented an Employer Group Waiver Plan for all Medicare-eligible members covered under the AlaskaCare retiree health plan. An Employer Group Waiver Plan, known as an EGWP or “Egg Whip,” is a program offered by the federal government that increases federal subsidies for prescription drugs for the retiree health trust. The pharmacy benefit for AlaskaCare retirees remains the same.

AlaskaCare was already receiving a federal subsidy for the retiree health prescription drug benefit. Moving to an EGWP plan means the retiree health trust will receive significantly higher subsidies than we used to, saving the trust up to $20 million annually and providing $40-$60 million each year in additional State savings through a reduction in the unfunded liability. The Division must manage the health plan to ensure retirees can access their earned benefits throughout the entire course of their life, and an AlaskaCare EGWP allows the State to keep existing pharmacy benefits for Medicare-eligible members, while increasing federal reimbursement of existing costs, reducing the State’s direct costs for these benefits in the long-term.

More than 90% of states that provide drug benefits to Medicare retirees have already implemented EGWPs. As Alaska, along with the rest of the U.S., faces rising health care costs, EGWPs are a proven win-win for maintaining high quality coverage for today’s and tomorrow’s Alaska retirees.

An AlaskaCare EGWP is just one way the Division looks to reduce the cost of health care while maintaining or improving benefits for retirees and their families. Because of EGWP, the Division was able to add preventive care in 2022! As part of the ongoing retiree health plan modernization project, the Division is evaluating adding more benefits like enhanced travel and removing the lifetime maximum. Our goal is to improve, protect, and sustain the health plan as it continues to offer high quality benefits for current and future generations of retirees.

If you have questions or concerns about the EGWP, we want to hear from you!

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

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

For more information, please read the EGWP FAQs.

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

AlaskaCare Dental-Vision-Audio Benefits

Important Documents:

Upon retirement, AlaskaCare retiree beneficiaries may choose to participate in a voluntary Dental-Vision-Audio (DVA) plan to provide coverage for themselves and their eligible dependents. The Division of Retirement and Benefits is dedicated to providing affordable, valuable, and sustainable benefits to retirees. The AlaskaCare retiree Dental-Vision-Audio plan is fully funded by members’ monthly premium payments, and the Division works hard to maximize the benefits members receive while keeping premiums affordable.

Dental-Vision-Audio Premiums

The dental plan monthly premiums are set to reflect the overall value of each plan across all enrolled members. The value of each plan varies based on differences in benefit design, network access, and how much the plan pays out-of-network providers. The rates are not impacted by how many people elect one plan or the other. 2024 Retiree Dental/Vision/Audio Coverage Premiums Coverage Level Standard Legacy DB DCR DB DCR Retiree 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 Family $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 pay monthly Health and/or DVA premiums through Direct Bill will be assessed a 2% administrative fee.

Please note: Retirees who pay monthly Health and/or DVA premiums through Direct Bill will be assessed a 2% administrative fee.

Dental Benefits

Effective in plan year 2020, AlaskaCare began offering two retiree dental plan options, the Legacy Dental Plan, and the Standard Dental Plan. The plans have different dental coverage provisions. The Retiree Dental Benefit Comparison may help you compare the plans and decide which is a better fit for you and your family. The AlaskaCare Retiree Insurance Information Booklets will contain the complete benefit provisions for both the standard and legacy dental plans.

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

Delta Dental of Alaska Dental Claim Form .

Delta Dental of Alaska Dental Claim Form .

Instructions for Submitting International Claims

Members can send a completed Dental Claim Form to Delta Dental for processing: Via email: Physically mail the claim form and necessary paperwork to the below address: Moda Health P.O. Box 40384 Portland, OR 97240-0384

In addition to the claim form, please include the following information: Receipts showing payments of services. The cost of all services is required (foreign currency will be converted into USD and reimbursement to the member will be in USD). A written summary of services received If tooth specific services were rendered include the tooth number on which services were completed. ADA Dental codes may not be used by international providers, so a detailed narrative of treatment provided will be very helpful. If the narrative/treatment plan is not in English, Delta Dental may have translators who can translate the information received.

If you are interested in receiving reimbursement via Direct Deposit, please complete and include the Direct Deposit Authorization Form .

Standard Dental Plan

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

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

2023 Standard Dental plan summary

Legacy Dental Plan

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

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

2023 Legacy Dental plan summary

You have access to more than 300 licensed dentists across Alaska and 204,000 office locations nationwide. You will want to stay in the Delta Dental networks to get high quality care at a lower price. Through Delta Dental PPO and Premier networks, limits are set on what dentists can charge for certain services. It’s a way of connecting you with great care at even better rates. To find a provider call toll-free at (888) 558-2705 or you can use the online search tool.

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

Vision and Audio Benefits

VISION PLAN HIGHLIGHTS You pay no deductible under this plan. The plan covers one complete eye examination, including a required refraction, per year. The plan covers two lenses during each calendar year. The plan covers one set of frames during every two consecutive calendar years. AUDIO PLAN HIGHLIGHTS The Audio Plan pays up to $2,000 for each person in a covered rolling 36-month period. You pay no deductible under this plan. The Plan pays 80% of the recognized charge for audio services.

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

AlaskaCare Long Term Care Benefits | CHCS

The State of Alaska is pleased to offer a voluntary Long-Term Care (LTC) Plan for benefit recipients and their spouses. The options available under the LTC plan provide a range of health and social services for people who need assistance with the basic activities of daily living.

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

Bronze: Available only to benefit recipients who retired prior to February 1, 2000. Bronze Option Booklet

CHCS Services, Inc. is the claims administrator. You may contact them at (888) 287-7116 for questions or to initiate a claim. CHCS has made a portal available where members may view which plan they are in enrolled in, review plan documents, and obtain a claim submission packet. Members can also use the portal to view claims and receive messages from their case manager.

LTC Enrollment

You must apply for this coverage before appointment to your first benefit from any retirement system. To meet this deadline, your Retiree Health Benefits Enrollment/Waiver form must be postmarked or received by the retirement application deadline. If you do not apply for coverage at this time, you waive your right to apply for this coverage at a later date.

You can send in the form separately, but most often this form is completed as part of the retirement packet.

Adding a new spouse: Use the Retiree Health Dependent Change form to add your new spouse to your health plans. The request must be received by the Division within 120 days of marriage.

Plan Comparison Chart

Bronze Option Silver Option Gold Option Platinum Option Deductible 90 days of covered long-term care 90 days of covered long-term care 90 days of covered long-term care 90 days of covered long-term care Benefit Eligibility Inability to perform 2 of 5 activities of daily living Inability to perform 2 of 6 activities of daily living or cognitive impairment Inability to perform 2 of 6 activities of daily living or cognitive impairment Inability to perform 2 of 6 activities of daily living or cognitive impairment Lifetime 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 Alaska $75 outside Alaska $200 in and out of Alaska $200 in and out of Alaska $200 in and out of Alaska Assisted living facility daily benefit Covered in lieu of other services if approved $150 in and out of Alaska $150 in and out of Alaska $150 in and out of Alaska Home health care daily benefit $75 in Alaska $40 outside Alaska $125 in and out of Alaska $125 in and out of Alaska $125 in and out of Alaska Hospice daily benefit Not Covered $125 in and out of Alaska $125 in and out of Alaska $125 in and out of Alaska Respite care daily benefit amount Not Covered Up to $200 in and out of Alaska, maximum of 14 days Up to $200 in and out of Alaska, maximum of 14 days Up to $200 in and out of Alaska, maximum of 14 days Inflation protection None None Simple at 5% of original benefit each year. Applies to lifetime and daily benefit amounts. Compound at 5% of the prior year's benefit each year. Applies to lifetime and daily benefit amounts.

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

Inflation protection stops at age 85. Please see the plan booklet for more information.

Premiums

Premiums are based on your age at retirement and while all premiums may increase, your premium will always be based on your age on the date you retired. If you elect coverage for your spouse, you pay a separate premium based on their age at the time of your retirement.

Monthly Rates Age at enrollment Silver Option $400,000 maximum No inflation protection Gold Option $300,000 maximum Simple inflation protection Platinum Option $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 increases annually until the covered member reaches age 85.

Bronze Premiums May 1, 2000 Age Premium (in dollars) < 5016.10 50-5421.45 55-5926.80 60-6448.25 65-6980.45 70-74128.70 75-79193.05 80-84294.95 ≥ 85412.90

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

Deductible the amount you must pay before the plan pays benefits.

Activities of Daily Living The Silver/Gold/Platinum options include bathing, continence, dressing, eating, toileting, and transferring. The Bronze Option includes dressing, toileting, transferring, eating, and walking.

Actuarial Valuations

Valuation as of June 30, 2021 Valuation as of June 30, 2019 Valuation as of June 30, 2017 Valuation as of June 30, 2015 Valuation as of May 31, 2012 (Draft) Valuation as of June 30, 2009

Insurance Information Booklets

Effective January 1,

AlaskaCare Defined Benefit Retiree Insurance Information Booklet AlaskaCare Defined Contribution Retiree Insurance Information Booklet

Defined Benefit

Defined Contribution

Income Related Monthly Adjustment Amount (IRMAA) Reimbursement

Certain high-income retirees are required to pay an extra premium surcharge, known as an Income Related Monthly Adjustment Amount, or IRMAA. This is similar to the surcharge for high-income enrollees in the Medicare Part B plan. If you are an individual or a married couple earning more than the threshold, you will be required to pay an extra surcharge for being enrolled in the AlaskaCare Employer Group Waiver Program (EGWP) because it is a group Medicare Part D plan. Retirees whose household income is below this threshold will not be subject to the IRMAA premium surcharge.

If you are subject to the Medicare Part D IRMAA surcharge, you will be reimbursed.

For all Medicare plans, the IRMAA will be deducted directly from your monthly Social Security check (if you qualify for Social Security) or will otherwise be invoiced to you directly each month. If you are charged a Medicare Part D IRMAA for your prescription drug coverage, the Division of Retirement and Benefits will reimburse you for the full cost of the Medicare Part D premium surcharge each month, through a tax-advantaged Health Reimbursement Arrangement (HRA) account. If you receive a bill from Medicare, you should pay the bill timely, and contact the Division to learn about your reimbursement options.

The Division of Retirement and Benefits has partnered with Optum Rx and Optum Bank to create an efficient way for members to receive reimbursement for their Part D IRMAA surcharge.

Optum Rx will handle all your IRMAA needs. Follow these steps to establish your Part D IRMAA reimbursement account online: Register and/or log in to your Optum Rx.com account either online or through the mobile app. Navigate to the AlaskaCare IRMAA Reimbursement Form by taking the following steps: On the top of the main page, click the "Information Center" tab. Click "Programs and Forms". Click on the "AlaskaCare IRMAA Reimbursement" section. There you will find the digital enrollment form as well as the paper version.

Note: If you are using the IRMAA HRA Enrollment Paper Form, you will need to: Print the form, Fill out the information accurately, Include a copy of your letter from Social Security or a Medicare Bill that shows what your Part D IRMAA surcharge is, and Mail or email the form to Optum Rx. The timeline for completion depends on the information provided and when it is received by Optum Rx.

If you have any questions on how to submit your IRMAA documents online or if you do not have internet access and would like to submit paper documentation, please contact Optum Rx at (855) 409-6999 or email .

IRMAA Frequently Asked Questions

Each year, if you are Medicare-eligible, you will be notified by the Social Security Administration about your plan. This includes if you are required to pay an IRMAA and at what amount. The Social Security Administration uses your Modified Adjusted Gross Income (MAGI) to determine if the IRMAA applies to you and, if so, how much you will have to pay. MAGI is the sum of: Adjusted Gross Income (AGI), which can be found on the last line your IRS 1040 tax form (line 37 on form 1040, line 21 on form 1040A, or line 4 on form 1040EZ), plus Any tax-exempt interest income (line 8b on form 1040).

The Social Security Administration requests income information from the IRS for the tax year that is two years prior to the surcharge year. IRMAA is automatically re-determined each year as long as you file an income tax return.

The below table shows the IRMAA for 2024. The MAGI and IRMAA is subject to change from year to year. Please review the table below to see if your income qualifies you to be assessed an IRMAA surcharge based on your Modified Adjusted Gross Income (MAGI) from the 2022 tax year.

Please view the 2024 IRMAA brochure For additional infomation.

Optum Rx will handle all your IRMAA needs. Follow these steps to establish your Part D IRMAA reimbursement account online: Register and/or log in to your Optum Rx.com account either online or through the mobile app. Navigate to the AlaskaCare IRMAA Reimbursement Form by taking the following steps: On the top of the main page, click the "Information Center" tab. Click "Programs and Forms". Click on the "AlaskaCare IRMAA Reimbursement" section. There you will find the digital enrollment form as well as the paper version.

Note: If you are using the IRMAA HRA Enrollment Paper Form, you will need to: Print the form, Fill out the information accurately, Include a copy of your letter from Social Security or a Medicare Bill that shows what your Part D IRMAA surcharge is, and Mail or email the form to Optum Rx. The timeline for completion depends on the information provided and when it is received by Optum Rx.

If you have any questions on how to submit your IRMAA documents online or if you do not have internet access and would like to submit paper documentation, please contact Optum Rx at (855) 409-6999 or email .

If you receive notice that you are required to pay the IRMAA surcharge for the enhanced EGWP, follow the steps listed above to request reimbursement. The Division will fund a tax advantaged HRA account that can be used to reimburse you the Part D IRMAA surcharge amount by paper check or through electronic funds transfer to a bank account of your choosing.

To receive reimbursement for the Part D IRMAA surcharge, you should submit the HRA claim as soon as possible, but not later than 12 months after the date you incurred the expenses. Retroactive reimbursements will not be issued for claims received beyond 12 months. Example: if you are assessed a Part D IRMAA surcharge in 2023, you will have until December 31, 2024 to file the HRA claim for reimbursement.

If you refuse to pay the extra surcharge for your Medicare Part D coverage, Medicare will cancel your enrollment in the AlaskaCare enhanced EGWP plan. This will be treated as an opt-out from the plan, and you will be placed in a prescription drug program that is much different than the plan prescription drug benefits offered today. This alternative plan may result in increased out-of-pocket expenses for you or your Medicare-eligible dependents. Please contact the Division if you have concerns about this surcharge or would like assistance with understanding the options available to you.

For general questions about your pharmacy benefits, contact Optum Rx, the AlaskaCare pharmacy benefits manager at (855) 409-6999. For questions related to your IRMAA surcharge, you may contact Social Security at (800) 772-1213. For more information about the HRA account options, contact the Division at (907) 465-4460 or toll-free at (800) 821-2251.

For assistance or a status on a claim you already submitted, you may contact Optum Rx by email: .

Additional information: IRMAA brochure.

Medicare

Introduction

Medicare is a national health insurance program administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the Social Security Administration (SSA), and people with end stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).

Alaska statute requires the AlaskaCare retiree plan become supplemental to Medicare when members turn 65. AlaskaCare will begin processing member’s health claims as if they have Medicare Part A & B on the first day of the month when they turn 65. All members should schedule an appointment with Social Security to apply for Medicare Part A & B within the three months prior to their 65th birthday.

Resources for Medicare Information

Medicare: To learn more about Medicare visit the Medicare.gov website or call (800) 633-4227 | TTY (877) 486-2048. Social Security Administration: If you are looking for information about Social Security, please visit the Social Security Administration page. Alaska Medicare Information Office: You may also contact the State of Alaska’s Medicare Information Office at (800) 478-6065 or (907) 269-3680 in Anchorage, or email them at . The Medicare Information Office offers one on one personalized Medicare Counseling and Medicare Seminar events by webinar. AlaskaCare Retiree Town Hall: The AlaskaCare Retiree Town Hall is a monthly event that offers information on the AlaskaCare Retiree health plan, below are three helpful events pertaining to Medicare.

Medicare and the AlaskaCare Defined Benefit Retiree Health Plan Brochure

Finding a Medicare Provider

Medicare offers an online tool to help you find Medicare participating providers.

Medicare.gov

Medicare Overview

Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

Most people are eligible for 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. Members who do not qualify for premium-free Medicare Part A, should not enroll in Part A, they must provide a copy of the Social Security letter to the AlaskaCare health claims administrator and the Division of Retirement & Benefits, and AlaskaCare will continue to pay as your primary plan for Part A services.

Part B (Medical Insurance): Helps cover physician and other outpatient medical services, ambulatory surgery center services, medical equipment, and ambulance services. Everyone is eligible for and must pay a premium for Part B, whether or not you are eligible for Part A.

Everyone is eligible for and must pay a premium for Part B, whether or not you are eligible for Part A.

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

You do not need to enroll into an individual Medicare Part D plan, and for most members there is no additional premium for prescription drug coverage under AlaskaCare.

However, certain high wage earners will be charged an Income Related Monthly Adjustment Amount (IRMAA) surcharge for prescription drug coverage. Visit the IRMAA section on this webpage for more information.

Medicare Enrollment

If you are receiving Social Security benefits before age 65, you will be automatically enrolled in Parts A and B of Medicare when you turn 65. If you are not receiving Social Security benefits, contact the Social Security Administration (SSA) three months before you turn age 65 to discuss enrolling in Medicare Parts A and B.

Be sure to inform the Social Security Administration if you have health insurance through an employee group health plan that you or your spouse receive as an actively working employee. If you are covered by such a plan, Medicare does not require you to enroll until the active plan terminates. However, if you do not enroll, the amount Medicare would have paid as the secondary plan is not paid by AlaskaCare. The AlaskaCare Retiree Health Plan recommends that you enroll in Medicare Part B 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 set up Medicare Direct so that Medicare will automatically send the Medicare Explanation Of Benefit (MEOB) to Aetna for processing. Once Medicare Direct is set up, Medicare will pay as the member’s primary health insurance and Medicare MEOBs will automatically be sent to Aetna so AlaskaCare benefits will pay as secondary.

Types of Medicare Providers

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

Participating Medicare Providers Participating providers are required by their Medicare contract to accept assignment of your claims. Because you don’t owe any amount over the Medicare allowed amount, AlaskaCare pays the difference between Medicare’s payment and the allowed amount if the expense is covered by both plans. Therefore, for covered expenses the claim is usually paid in full, unless you have not yet met your deductibles. Your provider must bill Medicare and Medicare’s payment will be sent directly to the provider.

Nonparticipating Medicare Providers Nonparticipating providers may choose whether to accept Medicare assignment on an individual, case-by-case basis. You should ask any nonparticipating providers you see if they will accept assignment of your claim.

If your provider does not accept assignment, there is still a limit on the amount you pay for most services. This limit is 115% of the Medicare allowed amount and is called the limiting charge.

Medicare calculates payment based on the Medicare allowed amount and pays 80%. If the service is covered by AlaskaCare, it recognizes 115% of the allowed amount and pays the difference between what Medicare paid and the 115% that your provider can collect.

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

Providers Who “Opt Out” of Medicare

Providers who “opt out” of Medicare have signed a contract with Medicare stating they will not bill Medicare for services provided to any Medicare beneficiary. These providers are prohibited from filing any claims with Medicare and may charge you any amount for their services, with no limit. You may purchase services from such a provider, but the provider will require you to sign an agreement (a private contract) stating that you are responsible for payment in full. These services are considered to be under a private contract. The AlaskaCare Retiree Health Plan will not pay anything for services provided under a private contract.

Note: This Medicare and Social Security information is an overview and is not intended to provide detailed information regarding Medicare or Social Security benefits.

Network Provider Search and Information

Find a Provider

Find a Provider

Find a Pharmacist

Find a Dentist

Resources and Additional Information

Legal Notices

COBRA Coverage Reminder Creditable Coverage Notice - Prescription Drug Coverage and Medicare HIPAA Privacy Practices

Appeals

The AlaskaCare health and dental plans provide members with the right to appeal claims and precertifications that have been denied by claims administrators. If your health plan denies payment for a treatment that you believe should be 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 or supplies received on or after January 1, 2018. Under the new appeal process, if the third party claims administrator or external review organization uphold their original denial of your appeal, you have the right to appeal to the Division of Retirement and Benefits. Should the Division also uphold the denial, you retain the legal right to take the appeal to superior court.

Opioid Guidelines

Opioid Medication—Benefit Dispensing Information brochure

State and federal guidelines were developed to address the opioid epidemic in the United States and Alaska. New safety guidelines were adopted for the AlaskaCare plans on January 1, 2018 and were further enhanced on January 1, 2019. The guidelines limit the dispensing of opioids as follows: For patients that don’t normally use opioids: The plan limits the maximum dosage per day to 50 mme (morphine milligram equivalent) and only allows up to a 7-day supply every 91-days. A pre-authorization is required to obtain more than a 7-day supply within any 91-day period. For patients that regularly use opioids: The plan limits the maximum dose per day to 90 mme and only allows up to a 30-day supply. A pre-authorization is required periodically. For patients age 19 or under: A pre-authorization is required for cough medications that contain opioids, and the prescription is limited to a 3-day supply.

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

Opioids are a type of narcotic pain medication. They can have serious side effects if you don't use them correctly. For people who have an opioid addiction, their problem often started with a prescription. Opioid drugs include: Codeine (only available in generic form) Hydromorphone (Dilaudid, Exalgo) Meperidine (Demerol) Methadone (Dolophine, Methadose) Morphine (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 forms and documents are available here.

All forms and documents are available here.

Form 1095-B is a tax form that reports the type of health insurance coverage you have, any dependents covered by your insurance policy, and the period of coverage for the prior year.

Since this information is already provided to the Internal Revenue Service (IRS) by Medicare, it is no longer necessary to have a printed copy of form 1095-B in order to file your taxes. The Division will provide members under age 65 access to an electronic version of form 1095-B online. Forms will be available online in March. You can access your 1095-B form in your MyRNB account under myDocuments.

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

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

If you would like to request a printed copy of your Form 1095-B, please reach out to the Member Education Center.

Check out our Form 1095 FAQs for more information.

Check out our Form 1095 FAQs for more information.

Wellbeing and Support Resources

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

Division of Retirement and Benefits Member Education Center

The Division of Retirement and Benefit’s Member Education Center provides essential support to our membership which includes employees, retirees, and other benefit recipients. We provide assistance relating to retirement, medical, and other optional benefits.

The Division’s Member Education Center team has comprehensive knowledge of the retirement systems and has dedicated team members that are experts on the AlaskaCare health plans. We are here to answer questions ranging from benefit enrollment for newly hired employees, to application for retirement, to the AlaskaCare health plan and beyond.

You can reach us at (907) 465-4460 or toll-free at (800) 821-2251. The hours of operation are Monday through Thursday 8:30 a.m. to 4 p.m., and Friday 8:30 a.m. to 3 p.m., Alaska Time.

Aetna Local Offices in Juneau and Anchorage

Want to talk to an Aetna representative in person? Aetna has a local office in Anchorage and in Juneau dedicated to assisting AlaskaCare members with questions. Members are welcome to stop by during the open office hours or contact the Aetna Concierge at (855) 784-8646 to make an appointment.

Hours: Tuesday, Wednesday, 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 Street, Suite 205 Anchorage, Alaska 99503

The Aetna local representatives can assist you with questions about your benefits, and with services such as paper claim submissions, travel precertification, appeals assistance, understanding your explanation of benefits, coordination of benefits and more…

Free Aetna Nurse Advice Line

You can talk to a nurse whenever you have health questions. You can call the Aetna nurse line 24 hours a day, 7 days a week. Even better, this service is provided at no cost to you. Simply call the nurse line number at (800) 556-1555.

The nurses can be a resource in considering options for care or helping you decide whether you or your dependent needs to visit your doctor, an urgent care facility or the emergency room. The nurse can help you with: Deciding whether to visit a doctor or urgent care center Understanding your symptoms Managing chronic conditions Learning about treatment options and medical procedures

You can call the nurse line anytime to discuss any health concerns at (800) 556-1555.

Wellbeing Resources – Aetna Behavioral Health

Need help finding a virtual or in-person mental health provider? Login to your Aetna.com member portal or call the Aetna Concierge at (855) 784-8646 and get connected with a behavioral health care advocate who can help you find a counselor, psychologist or psychiatrist who meets your needs.

Latest DRB News

Workshop: Ready to Retire! Application Review and Submission

Join us May 24, 2024 for an Ready to Retire! Application Review and Submission workshop.

AlaskaCare Retiree Town Hall-May

Please join us for a Town Hall event May 16, 2024, 10 a.m. Alaska Time.

Employer News, Spring 2024, Issue 178

Information on BEARS, annual audits, TRS year-end reporting, and more.

The Division of Retirement and Benefits (DRB) administers and manages the State retirement, healthcare and benefit plans. Our focus is to support the needs of our retirees while additionally providing customer services to current employees.

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AkCare FAQs

You should have a medical ID card from Aetna and a pharmacy ID card from Optum Rx. If you elected the DVA plan you will also have a dental ID card from Delta Dental/Moda and a vision card from Aetna. You can use your ID cards when visiting your health care providers or pharmacy.

You can download a digital copy of your ID card online: Optum Rx Aetna Navigator Delta Dental

To request a new physical ID card via phone, visit our Partner Contacts page.

The definition of retiree dependents limiting coverage to age 19 (or age 23 if a full-time student) comes directly from Alaska statute.

Expanding dependent coverage to age 26 is one of the provisions in the Federal Patient Protection and Affordable Health Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA) that became effective March 2010. This provision affects employee plans and retiree-only health plans differently.

On June 14, 2010, the U.S. Departments of Health and Human Services, Labor, and Treasury issued regulations on Grandfathered Health Plans under PPACA. In the preamble to the Interim Final Rule, the Secretaries clarify that it is not their intent to apply the PPACA coverage to retiree-only health plans. This means the retiree medical plan, is not subject to the expanded dependent coverage provisions of PPACA.

Recognized charge means the negotiated charge contained in an agreement the claims administrator has with the provider either directly or through a third party. If there is no such agreement, the recognized charge is determined in accordance with the provisions of this section. Except for charges related to involuntary out-of-network services, an out-of-network provider has the right to bill the difference between the recognized charge and the actual charge. This difference will be the covered person’s responsibility.

Medical Expenses: As to medical services or supplies, the recognized charge for each service or supply is the lesser of: What the provider bills or submits for that service or supply; Or the 90th percentile of the prevailing charge rate; for the geographic area where the service is furnished as determined by Aetna in accordance with Aetna reimbursement policies.

For more information on recognized charge in the Retiree Plan, see the Retiree Insurance Information Booklet , section 3.1.4 Recognized Charge.

Using "network" providers can provide substantial benefits to members through the elimination of what's known as "balance billing." It can also generate substantial savings to members through negotiated provider discounts.

To find a network provider: Call Aetna's Health Concierge at (855) 784-8646 or select the "Find a Doctor" button on our website, AlaskaCare.gov. Call Moda/Delta Dental at (855) 718-1768 or select the "Find a Dentist" button on our website Call Optum Rx at (855) 718-1768 or select the "Find a Pharmacist" button on our website.

The AlaskaCare plans limit payment of covered services to the recognized charge. The recognized charge is the maximum amount the AlaskaCare plans will pay for a covered service. Aetna and Moda/Delta Dental, and their respective network providers (sometimes referred to as participating providers), agree to a set of discounted negotiated rates for services provided. The recognized charge for network providers is the negotiated rate. For an explanation of how the recognized charge is calculated for out-of-network providers, please see the recognized charge questions under the Network and Dental sections.

An out-of-network provider has the right to bill you for the difference between the recognized charge and the actual charge. This is often referred to as balance billing. Network providers have agreed to accept, as payment in full, the negotiated charge. Therefore, you are not subject to balance billing when you use a network provider.

You may find that not all providers at a "network" facility are part of the Aetna network. For example, if you have a surgical procedure performed at a network hospital, you may find that the hospital and surgeon are in the network, but the anesthesiologist is out-of-network. When you get your bill, you'll see that it reflects the negotiated network rates for your hospital and surgeon. The anesthesiologist, however, may charge what they choose since they have no negotiated contract with Aetna. If the anesthesiologist claim exceeds the recognized charge, you may receive a bill for the balance.

You may prevent balance billing by verifying all medical providers are in the Aetna network and making sure your AlaskaCare Plan covers the services you need. For example, if you're having x-rays, MRIs, CT scans, or PET scans, make sure both the imaging facility and the radiologist who will read your scan are in the network. If you're planning surgery, ask whether the anesthesiologists are in the network. If available, the facility should accommodate your request to use a network provider for your services.

Similarly, for AlaskaCare covered dental services, you may prevent balance billing by verifying the provider is in the Moda/Delta Dental network.

If your provider is not a network provider, you may ask for an estimate of charges, the codes that will be used use for billing, and the provider's zip code. When you receive this information, contact the Aetna Concierge at (855) 784-8646 or Moda/Delta Dental at (855) 718-1768. A member of the Aetna Concierge or Moda Customer Service team can review the estimated charges and will advise you if the charges fall within the recognized charge for your area. If the estimated charges exceed the recognized charge, you may request that your provider accept that amount and not balance bill you, or you may request payment arrangements with their office.

If your current provider is not listed as a network provider, you can ask your provider to contact Aetna at (800) 720-4009 or Moda at (855) 718-1768 for a participation application. Members are also encouraged to nominate their out-of-network providers to join the network. Contact the Aetna Concierge or Moda Customer Service to find out how.

In some cases, unfortunately, there will not be a network provider for the service you need in your area. The Division, Aetna and Moda/Delta Dental are working diligently to improve network access, but please understand that we cannot force providers into the network.

Yes, there is a network of providers for durable medical equipment. For assistance finding a network provider call the Aetna Concierge at (855) 784-8646 or search online using the Aetna DocFind tool .

The AlaskaCare Retiree health plan was created by statute to provide health coverage to eligible retirees and their dependents in 1975. Alaska Statute Sec. 39.35.535(b) requires that the retiree health plan become supplemental to federal old age benefits available at age 65. This statute has been in effect since 1975. The Retiree Insurance Information Booklet section titled, "Effect of Medicare", states: "If you do not enroll in Medicare coverage the estimated amount Medicare would have paid will be deducted from your claim before processing by this plan."

If you are currently eligible for Medicare, or when you become eligible for Medicare, you will be automatically enrolled in the AlaskaCare EGWP plan (a group Medicare Part D plan) by the Division of Retirement and Benefits. You do not need to enroll in an individual Medicare Part D plan.

You are not required to take part in Medicare part C. Part C plans are Medicare Advantage plans provided by private insurers for members who live outside the State of Alaska. They cover the same services as Medicare Part A and B combined as well as some supplemental benefits. The AlaskaCare plan acts as a supplemental plan for Medicare eligible retirees.

Most people are eligible for 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. Members who do not qualify for premium-free Medicare Part A, should not enroll in Part A, they must provide a copy of the Social Security letter to the AlaskaCare health claims administrator and the Division of Retirement & Benefits, and AlaskaCare will continue to pay as your primary plan for Part A services.

Members of the Defined Contribution Retirement plan (Public Employees’ Retirement System Tier IV and Teachers’ Retirement System Tier III) and their eligible dependents can participate. To be eligible for medical coverage you must have: 10 years of service and be Medicare age eligible, or Be any age with 25 years of service for peace officers/firefighters or; Be any age with 30 years of service for all others. Must have worked the prior 12 months and retire directly from the system.

Specific information on your individual tier status can be obtained through the Division of Retirement and Benefits Member Services Contact Center at or by calling (907) 465-4460 in Juneau or (800) 821-2251 toll-free Monday through Thursday from 8:30 a.m. to 4 p.m. or Friday from 8:30 a.m. to 3 p.m.

In general, if you are a member of the Public Employees’ Retirement System (PERS) and first entered service after June 30, 2006, you are Tier IV. If you are a member of the Teachers’ Retirement System (TRS) and first entered the system after June 30, 2006, you are a Tier III.

Your spouse. You may be legally separated but not divorced. Your children from birth (exclusive of hospital nursery charges at birth and newborn care) up to 23 years of age only if they are: your natural children, stepchildren, foster children placed through a State foster child program, legally adopted children, children in your physical custody and for whom bona fide adoption proceedings are underway, or children for whom you are legal, court-appointed guardian (if child is not your natural-born child); unmarried and chiefly dependent upon you for support; AND living with you in a normal parent-child relationship. This provision is waived for natural/adopted children of the benefit recipient who are living with a divorced spouse, assuming all other criteria is met. Stepchildren must live with the retiree 50% or more of the time to be covered under this plan. In addition, if they are between the ages of 19 and 23, they must be attending school regularly on a full-time basis.

Children incapable of employment because of a mental or physical incapacity are covered even if they are past age 23. However, the incapacity must have existed before age 23 and the children must continue to be unmarried, rely chiefly on you for support and living with you in a normal parent-child relationship. You must furnish the claims administrator evidence of the incapacity, proof that the incapacity existed before age 19, and proof of financial dependency. Children are covered as long as the incapacity exists and they meet the definition of children, except for age. Periodic proof of the continued incapacity may be required.

The definition of retiree dependents limiting coverage to age 19 (or age 23 if a full-time student) comes directly from Alaska statute.

Expanding dependent coverage to age 26 is one of the provisions in the Federal Patient Protection and Affordable Health Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA) that became effective March 2010. This provision affects employee plans and retiree-only health plans differently.

On June 14, 2010, the U.S. Departments of Health and Human Services, Labor, and Treasury issued regulations on Grandfathered Health Plans under PPACA. In the preamble to the Interim Final Rule, the Secretaries clarify that it is not their intent to apply the PPACA coverage to retiree-only health plans. This means the retiree medical plan, is not subject to the expanded dependent coverage provisions of PPACA.

You should have a medical ID card from Aetna and a pharmacy ID card from Optum Rx. If you elected the DVA plan you will also have a dental ID card from Delta Dental/Moda and a vision card from Aetna. You can use your ID cards when visiting your health care providers or pharmacy.

Medical/Rx ID Card If your ID card hasn't arrived, you can view and print your Medical/Prescription ID card or download the mobile app that displays the ID card on your smartphone. Note: Aetna Navigator registration required.

You can use your Social Security number to register or call the Aetna health concierge at (855) 784-8646 for assistance.

Dental ID Card To print your Moda Health/Delta Dental of Alaska ID card or download the MyModa mobile app, register on the MyModa website or call Moda at (855) 718-1768.

Employees do not contribute to the DCR health trust while they are actively working.

When the employee retires, the DCR medical plan requires Medicare-eligible participants to pay a percentage of the monthly premium. Prior to Medicare eligibility, retirees pay 100 percent of the DCR medical plan cost. After Medicare eligibility, retirees pay a percentage of the plan cost based on years of service:

A recognized charge is the maximum amount that AlaskaCare's Medical, Vision and Audio plans will pay for a covered service. The term recognized charge is sometimes referred to as the usual, customary and reasonable (UCR) charge or the maximum allowed charge. The recognized charge is determined differently for professional (provider) services, facility services, and pharmacy services.

An out-of-network provider, facility, or pharmacy, has the right to bill you for the difference between the recognized charge and the actual charge. This is sometimes referred to as balance billing.

When you use a network provider, facility, or pharmacy, you are not subject to balance billing for covered services. In other words, the provider, facility, or pharmacy, has agreed to accept, as payment in full, the recognized charge for the service provided. You are only responsible for payment of other applicable charges such as deductibles, co-insurance, and/or non-covered charges. This is an important financial consideration when choosing a provider, facility, or pharmacy.

The facility recognized charge for services or supplies is the lesser of: The amount the facility bills, or The percentage of Medicare fee schedule that most closely reflects the aggregate contracted rate with the preferred hospital (currently 185% of Medicare).

The pharmacy recognized charge for prescription drugs is the lesser of: The amount the provider bills, or 110% of the average wholesale price or other similar resource.

The provider recognized charge for medical, vision, and audio services or supplies is the lesser of: The amount the provider bills, or The 90th percentile of the prevailing charge rate for the geographic area where the service is furnished. The 90th percentile of the prevailing charge rate means the charge that is at or below 90% for all of the charges reported for a service within a specific geographic area.

For assistance with determining a specific recognized charge, call Aetna's Health Concierge at (855) 784-8646 or use the Consumer Cost Lookup tool.

Please see the Dental FAQs for information on the dental recognized charge.

The recognized charge when Medicare is primary and you are receiving a Medicare covered service is assumed to be the Medicare allowed rate and will be determined by Medicare. If you are receiving services that are not covered by Medicare, the provider has the right to bill you for the difference between the recognized charge as determined by the AlaskaCare plan and the actual charge. If you receive services with a provider that has opted out of Medicare, neither Medicare nor the plan will pay benefits for their service.

The recognized charge for out-of-network providers is the 90th percentile of the prevailing charge rate for the geographic area where the service is furnished. The AlaskaCare plans establish the percentile (i.e., 90th percentile) to be applied to the prevailing charge rate; however, the prevailing charge rate is reported by FAIR Health, an independent not-for-profit corporation. FAIR Health collects charge data from claims received by insurance plans and health plan administrators across the country for charges billed by physicians, hospitals, and other healthcare providers. Charges reported are the full fees that healthcare professionals report to insurers as part of the claims process—not the negotiated rates that apply when visiting a network provider. Charges reported are maintained by FAIR Health in its database which is comprised of billions of claims for billed medical procedures from across the United States. New charge data are continually added to the FAIR Health database.

FAIR Health has audit and validation programs in place to ensure the integrity of its data. Part of the validation process entails testing the data with statistical algorithms and examination by FAIR Health's in-house statistical and technology experts. A team of healthcare researchers from leading academic institutions advise FAIR Health on the best methods for analyzing its national claims data. FAIR Health is also advised by an independent Scientific Advisory Board of prominent researchers who review Fair Health's statistical methods and data. FAIR Health also seeks input from other stakeholders such as consumer and patient advocacy groups, healthcare providers, actuaries and federal officials.

Each specific service, procedure or supply in the FAIR Health database has a unique Current Procedural Terminology (CPT) code. CPT codes are numbers assigned to medical services and procedures. CPT codes are part of a uniform system of coding maintained by the American Medical Association and are used by providers, facilities and insurers. Each CPT code is unique. There are currently over 10,000 medical services and procedures classified by CPT code. Most CPT codes are very specific. For example, the CPT code for a 15-minute office visit is different from the CPT code for a 30-minute office visit.

FAIR Health organizes its data by geozip— and a geographical area is usually defined by the first three digits of the U.S. zip codes. Geozips may include areas defined by one three-digit zip code or a group of three-digit zip codes. Geozips generally do not include zip codes in different states. The State of Alaska is currently defined by five geozips: 995—including Anchorage, Bethel, etc. 996—including Homer, Kodiak, etc. 997—including Fairbanks, Kotzebue, etc. 998—including Juneau, Sitka, etc. 999—including Ketchikan, Prince of Wales, Wrangell, etc.

When the volume of claims is insufficient to create a benchmark based on actual data, geozips 995 and 997 and geozips 996 and 998 will be combined. If the volume of claims is still insufficient, the benchmarks will be derived.

If there are fewer than nine occurrences of a procedure in a geographic area, the plan uses FAIR Health's "derived charge data" instead. This data is based on the charges for comparable services, multiplied by a factor that takes into account the relative complexity of the service. If this information cannot be obtained locally, then national data is used.

The following factors can affect the recognized charge: Billing errors: when a provider makes a mistake on either the procedure code or zip code. Multiple procedures: when a provider performs multiple surgical procedures during a single session. The standard practice in such cases is to bill 100% for the primary (largest) procedure, 50% for the secondary procedure and 25% for all others. However, incidental items that require little or no additional time should not have an additional fee. Unbundling: when a provider shows separate codes on the bill for related or incidental services. For example, instead of being billed separately, related blood tests performed at the same time should be billed under a single General Health Panel code.

You can verify whether an out-of-network provider's charges are within the recognized charge by calling the Aetna Concierge and providing the following information: The procedure code, The zip code where the service is to be performed, and The projected cost.

Aetna will use this information to estimate whether the proposed amount is within the recognized charge. Remember, if you use an Aetna network provider, those providers have already contracted with Aetna to offer discounted fees and those discounted fees are deemed to be within the recognized charge.

If the out-of-network provider's claim exceeds the recognized charge, and you have already paid your out-of-network cost-sharing amount, wait for the provider to send you a bill, since the out-of-network provider may adjust their charges after reviewing the claim payment. If not, ask the out-of-network provider to: Consider reducing or waiving their fee to meet the recognized charge amount; Review the bill to ensure the correct procedure code and amount was used (and if not, submit a corrected bill to the plan); Confirm that the out-of-network provider charged their normal fee for the service, or if the out-of-network provider increased the charge due to unusual circumstances. If so, ask the out-of-network provider to either submit a corrected bill to the plan or provide a written explanation so you may file an appeal with the plan.

Aetna's claim reimbursement policies address the appropriate billing of services, taking into account factors that are relevant to the cost of the service such as: The duration and complexity of a service; Whether multiple procedures are billed at the same time, but no additional overhead is required; Whether an assistant surgeon is involved and necessary for the service; Whether follow up care is included in the price of the service; Whether there are any other characteristics that may modify or make a particular service unique; or When a charge includes more than one claim line, whether any service described by a claim line is part of or incidental to the primary service provided.

These claim reimbursement policies are based on: Policies developed for Medicare; Peer-reviewed, published medical journals; Available studies on a particular topic; Evidence-based consensus statements; Expert opinions of health care professionals; Guidelines from nationally recognized health care organizations.

Questions? Call the Aetna Concierge.

If you or your dependent are not Medicare age eligible and use an out-of-network provider, you are responsible for the difference between the recognized charge and the amount charged by the provider in addition to other applicable charges such as deductibles, co-payments, co-insurance, any applicable penalties, and non-covered charges. If you or your dependent is Medicare age eligible, Medicare is the primary payer and AlaskaCare network considerations are not applied, so you should be sure to use a provider who accepts Medicare.

You may appeal a recognized charge determination by providing additional information to indicate why the recognized charge was not correct, such as incorrect procedure codes, an incorrect zip code, etc.

Information on appealing claim decisions is available in the AlaskaCare Defined Contribution Plan Retiree Insurance Information Booklet .

Specific plan language regarding recognized charges is available in the AlaskaCare Retiree Health Insurance Information booklet for DCR Plan Retirees.

See a network provider if one is available. When you receive services from a network provider, the provider has agreed to accept the amount the plan will pay for services, and they may not bill the patient for any amount beyond that (excluding any cost sharing amounts such as deductible, the member’s coinsurance, and any other applicable copayments).

To find out whether your doctor is a member of the Aetna network, call Aetna's Health Concierge at (855) 784-8646. To find out whether your dentist is a member of the Moda/Delta Dental network call Moda/Delta Dental at (855) 718-1768.

Each year, if you are Medicare-eligible, you will be notified by the Social Security Administration about your plan. This includes if you are required to pay an IRMAA and at what amount. The Social Security Administration uses your Modified Adjusted Gross Income (MAGI) to determine if the IRMAA applies to you and, if so, how much you will have to pay. MAGI is the sum of: Adjusted Gross Income (AGI), which can be found on the last line your IRS 1040 tax form (line 37 on form 1040, line 21 on form 1040A, or line 4 on form 1040EZ), plus Any tax-exempt interest income (line 8b on form 1040).

The Social Security Administration requests income information from the IRS for the tax year that is two years prior to the surcharge year. IRMAA is automatically re-determined each year as long as you file an income tax return.

The below table shows the IRMAA for 2024. The MAGI and IRMAA is subject to change from year to year. Please review the table below to see if your income qualifies you to be assessed an IRMAA surcharge based on your Modified Adjusted Gross Income (MAGI) from the 2022 tax year.

Please view the 2024 IRMAA brochure For additional infomation.

Optum Rx will handle all your IRMAA needs. Follow these steps to establish your Part D IRMAA reimbursement account online: Register and/or log in to your Optum Rx.com account either online or through the mobile app. Navigate to the AlaskaCare IRMAA Reimbursement Form by taking the following steps: On the top of the main page, click the "Information Center" tab. Click "Programs and Forms". Click on the "AlaskaCare IRMAA Reimbursement" section. There you will find the digital enrollment form as well as the paper version.

Note: If you are using the IRMAA HRA Enrollment Paper Form, you will need to: Print the form, Fill out the information accurately, Include a copy of your letter from Social Security or a Medicare Bill that shows what your Part D IRMAA surcharge is, and Mail or email the form to Optum Rx. The timeline for completion depends on the information provided and when it is received by Optum Rx.

If you have any questions on how to submit your IRMAA documents online or if you do not have internet access and would like to submit paper documentation, please contact Optum Rx at (855) 409-6999 or email .

If you receive notice that you are required to pay the IRMAA surcharge for the enhanced EGWP, follow the steps listed above to request reimbursement. The Division will fund a tax advantaged HRA account that can be used to reimburse you the Part D IRMAA surcharge amount by paper check or through electronic funds transfer to a bank account of your choosing.

To receive reimbursement for the Part D IRMAA surcharge, you should submit the HRA claim as soon as possible, but not later than 12 months after the date you incurred the expenses. Retroactive reimbursements will not be issued for claims received beyond 12 months. Example: if you are assessed a Part D IRMAA surcharge in 2023, you will have until December 31, 2024 to file the HRA claim for reimbursement.

If you refuse to pay the extra surcharge for your Medicare Part D coverage, Medicare will cancel your enrollment in the AlaskaCare enhanced EGWP plan. This will be treated as an opt-out from the plan, and you will be placed in a prescription drug program that is much different than the plan prescription drug benefits offered today. This alternative plan may result in increased out-of-pocket expenses for you or your Medicare-eligible dependents. Please contact the Division if you have concerns about this surcharge or would like assistance with understanding the options available to you.

For general questions about your pharmacy benefits, contact Optum Rx, the AlaskaCare pharmacy benefits manager at (855) 409-6999. For questions related to your IRMAA surcharge, you may contact Social Security at (800) 772-1213. For more information about the HRA account options, contact the Division at (907) 465-4460 or toll-free at (800) 821-2251.

For assistance or a status on a claim you already submitted, you may contact Optum Rx by email: .

Periodically, the Division competitively bids these contracts through a Request for Proposal (RFP). This gives us an opportunity to seek better service at lower cost for members and the plan.

Effective January 1, 2019, the AlaskaCare plan uses Optum Rx as the PBM to administer pharmacy benefits.

Optum Rx will process claims according to the AlaskaCare plan document. Compounds will continue to be covered under the Defined Benefit Retiree Health plan.

Coverage of compounds differs for the active employee and defined contribution retiree health plans. The AlaskaCare Employee Health Plan and AlaskaCare DCR Benefit Plan only cover compound drugs if: the product contains at least one prescription ingredient; the active ingredient(s) is approved by the FDA for medicinal use in the United States; the product is not a copy of a commercially available FDA approved drug; and the safety and effectiveness for the intended use is supported by FDA approval, or adequate medical and scientific evidence in the medical literature.

Optum Rx maintains a National Compound Credentialing Program (NCCP) to ensure the best compounded medication quality and effectiveness for the patients who need personalized medications. You must fill your compounded medication prescription at a pharmacy which has been credentialed with the Optum Rx National Compound Credentialing Program (NCCP).

Using an NCCP pharmacy ensures that you will not be charged up front for your prescription (and required to submit your own claim for reimbursement), you will not be charged for molding or other non-covered charges, and you will not be charged for shipping if the pharmacy mails your compounded medication to you. You can find a list of NCCP-credentialed pharmacies here. You can also call Optum Rx at (855) 409-6999 (TTY 711) to get help locating NCCP-credentialed pharmacies.

The pharmacy benefit for AlaskaCare retirees remains the same, and Optum Rx will manage all pharmacy benefits. Medicare-eligible retirees and dependents will be enrolled in the AlaskaCare enhanced EGWP. After you enroll in Medicare, you need to provide the Division your Medicare Beneficiary Identifier (MBI - your Medicare Number). You do not need to enroll in an individual Medicare Part D plan.

If you need to fill prescriptions before your Optum RX pharmacy ID card arrives in the mail, you can contact the Division and we can print or email a temporary card. You can also get a printable ID card from the Optum Rx online portal, or view your ID card in the Optum Rx mobile app.

Please select the scenario that best describes you:

Sample card:

Optum Rx coordinates all the layers of coverage for you and your dependents behind the scenes, so in many cases you and your dependents can use each other’s cards at the pharmacy. However, a non-EGWP dependent should not use the card that has a MedicareRx logo in the lower right corner. This card would only work if the pharmacist uses the correct person code (to identify them as a dependent rather than the policy holder). To avoid any confusion at the pharmacy, we recommend you and your dependents only use a card that has your name on it.

You can tell the difference between the cards by looking at the logo on the card. One will say AlaskaCare Employee Pharmacy Plan, and the other will say AlaskaCare Retiree Pharmacy Plan. Your employee plan will typically be the primary payer.

You can contact Optum Rx at (855) 409-6999, TTY711 if you have questions about your prescriptions or any correspondence you have received from them.

The Optum Rx home delivery unit reaches out to members to assist with setting up their home delivery accounts and to verify the prescriptions they want delivered. If you receive a call to this effect, it is not a scam. However, if you are unsure if the call is legitimate, you can always decline the call and then contact Optum Rx at (855) 409-6999 to ensure the call is genuine.

You received this letter because the Centers for Medicare & Medicaid Services (CMS or Medicare) indicated that you have alternative prescription drug coverage under another plan that may be receiving subsidies from Medicare for providing that coverage. We encourage members to confirm enrollment in the AlaskaCare Retiree Medicare Prescription Drug Plan by calling Optum Rx at (855) 235-1405. If you do not confirm your enrollment or choose not to participate in the AlaskaCare Retiree Medicare Prescription Drug Plan, you will be placed into the opt-out prescription drug program. This is highly discouraged, as it will result in higher costs for you and for the health plan.

Yes, members may transfer prescriptions from their local pharmacy to Optum Rx Home Delivery or from Optum Rx Home Delivery to their local pharmacy:

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