RETIREES

"Below is information for Retirees" Medicare Part D/CREDITABLE COVERAGE Wellness Program Medical Prescription Drugs (Rx) Dental Vision COBRA Upcoming Deadlines & Events RETIREE BILLING INFO Click here to get information and forms for retiree billing and premium payments. MEDICARE 2011 General Medicare Fact Sheet HOW TO APPLY FOR MEDICARE REIMBURSEMENT (2011) 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 Kaiser Summary Plan Description (SPD) - Retirees (HMO) Chiropractic Care providers (self-referral): Kaiser Chiropractic Care Benefits ashcompanies.com FORMS AND BILLING Kaiser Permanente Senior Advantage Enrollment Form Retiree Billing and Payment Information 2010-2011 UHC Benefit Services (billing service for your Monthly Premium): www.uhcservices.com Phone: (866) 747-0048 Fax: (866) 525-1740 Group #: 708611 UHCDirectBill-Direct Deposit (ACH) Authorization Agreement UnitedHealthcare (UHC) EPO/PPO Group #: 708611 Contact: (800) 510-4846 Nurse Hotline: (866) 805-8310 Website: www.MyUHC.com Find UnitedHealthcare Facilities and Providers PPO (UnitedHealthcare CHOICE PLUS health plan) : Summary Plan Description (SPD) for PPO PPO (UHC Choice Plus) Plan Highlights EPO (UnitedHealthcare CHOICE health plan): Summary Plan Description (SPD) for EPO EPO (UHC Choice) Plan Highlights OOA (UnitedHealthcare OPTIONS PPO health plan - restricted to Plan Administrator's Designation only) : Summary Plan Description (SPD) for OOA Out-of-Area (OOA) Highlights EPO MUST choose providers contracted with the UnitedHealthcare Choice Health Plan. PPO offers access to both providers contracted with the UnitedHealthcare Choice Plus Health Plan and non-network providers. FORMS AND BILLING Retiree Billing and Payment Information 2010-2011 UHC Benefit Services (billing service for your Monthly Premium): www.uhcservices.com Phone: (866) 747-0048 Fax: (866) 525-1740 Group #: 708611 UHCDirectBill-Direct Deposit (ACH) Authorization Agreement UnitedHealthcare Domestic Medical Claim Form (For non-PPO service claims - PPO**) UnitedHealthcare International Medical Claim Form 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 Healthy Pregnancy Program HOW TO REPLACE OR REQUEST ADDITIONAL ID CARDS (employees or dependents): Option 1) Access http://www.uhc.com/live/uhc_com/Assets/Documents/myuhcTempID.htm Option 2) 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. PRESCRIPTION DRUGS (Rx) Please click here for prescription drugs information. DENTAL Delta Dental PPO Group #: 603 Contact: (888) 335-8227 Website: www.deltadental.com Delta Dental Premier Plan/Delta Preferred Option PPO Delta Dental Highlights Delta Dental Summary Plan Description (SPD) FORMS AND BILLING Delta Dental Claim Form VISION Vision Services Plan (VSP) Group #: 12075742 Contact: (800) 877-7195 Website: www.vsp.com/ VSP (Vision) Plan Highlights Summary Plan Description (SPD) for VSP Vision FORMS AND BILLING COBRA COBRA and HIPAA rights Click here for the current COBRA rates and HIPAA regulations.