Retirees

Below is information for current FHDA Retirees and Surviving Spouses. Upcoming Deadlines and Events Medicare Part D/CREDITABLE COVERAGE Wellness Program Medical Mail Order Prescriptions Dental Vision COBRA Upcoming Deadlines & Events Important Coverage Notice - SurgiCenter There are no deadlines or events at this time. MEDICARE 2009 General Medicare Information for Retirees HOW TO APPLY FOR MEDICARE REIMBURSEMENT (2009) CREDITABLE COVERAGE DISCLOSURE NOTICE - MEDICARE PART D and Prescription Drugs Program WELLNESS PROGRAM Click here to connect to the District-sponsored wellness program MEDICAL Kaiser Group #: 857 Contact: (800) 464-4000 Website: www.kaiserpermanente.org Summary of Benefits for Kaiser Foundation Medical Plan (HMO) Chiropractic Care providers: ashcompanies.com (self-referral) FORMS AND BILLING Kaiser Senior Advantage Application Form (for Medicare eligible Kaiser members) Kaiser Senior Advantage Disenrollment Form UnitedHealthcare (UHC) Group #: 708611 Contact: (800) 510-4846 Nurse Hotline: (866) 805-8310 Website: www.MyUHC.com United HealthCare List of Providers PPO**: Summary of Benefits for District Combined Coverage Health Plan EPO**: Summary of Benefits for District Network Only Plan District Network Only Medical Plan (now known as EPO) MUST choose providers contracted with the UnitedHealthcare Choice Health Plan. The District Combined Coverage Medical Plan (now known as PPO) offers access to both providers contracted with the United Healthcare Choice Plus Health Plan and non-network providers. FORMS AND BILLING Retirees with Dependents on the PPO** Medical Plan: BILLING INFORMATION PY 09/10 UHC Benefit Services (billing service for PPO** Premium): www.uhcservices.com (866) 747-0048 UHCDirectBill-Direct Deposit (ACH) Authorization Agreement United HealthCare Domestic Medical Claim Form (For non-PPO service claims - PPO**) United HealthCare International Medical Claim Form **The UnitedHealthcare "PPO+" plan is now known as the "PPO" plan **The UnitedHealthcare "PPO Network Only/PPO" plan is now known as the "EPO" plan DISEASE MANAGEMENT PROGRAM FOR PPO NETWORK ONLY AND PPO+ PLAN - Effective July 1, 2006 UnitedHealth FOCUS General Information UHC Optum Connect24 UHC NurseLine 7/24 Brochure UHC CHOICE Health Plan General Information UHC CHOICE PLUS Health Plan General Information UHC Health Discount Program UHC Healthy Pregnancy Program HOW TO REPLACE OR REQUEST ADDITIONAL ID CARDS (employees or dependents): First, access the web page: www.MyUHC.com. Under the section on the right, "Need a username and password?", you must register on-line by entering the newly assigned ID number (listed on your ID card), or your SSN to register. Then, set your own LOGIN and PASSWORD to access personalized health care, benefits information and order ID cards. Once logged in, go to the "Manage my Account" menu at the top, and then choose, "Request ID cards". Please Note: Individuals can only place one ID card request per individual per day. If you need to request more cards for the same person, please try again tomorrow. Otherwise, you can print a temporary ID card immediately. If you are experiencing technical difficulties, while accessing myuhc.com, please contact UHC Technical Support at (877) 844-4999. If you don't have access to a computer, you can always contact UHC customer care at 1-800-510-4846. MAIL ORDER PRESCRIPTIONS Medco Mail Order Group #: UHEALTH Contact: Retail: (877) 842-1424 Mail order: (800) 473-3455 MEDCO - Rx Mail Order Brochure Maintence Drug List FORMS AND BILLING MEDCO - Retail Claim Form MEDCO - Mail Order Form DENTAL Delta Dental PPO Group #: 603 Contact: (888) 335-8227 Website: www.deltadental.com Delta Dental Premier Plan/Delta Preferred Option PPO Delta Dental Benefit Highlights Delta Dental Summary Plan Description FORMS AND BILLING Delta Dental Claim Form VISION Vision Services Plan (VSP) Group #: 12075742 Contact: (800) 877-7195 Website: www.vsp.com/ Vision Service Plan (VSP) - Summary Plan Description FORMS AND BILLING COBRA COBRA and HIPAA rights Click here for the current COBRA rates and HIPAA regulations.