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New Participant Portal
You can enroll for the new Participant Portal experience. Click here for instructions on how to access the new Participant Portal.
Register for New Participant PortalRetiree Health Summary Plan Description
As of February 1, 2018
En Español (PDF)
2.1 Benefit Options
2.1.1 Retirees Under Age 65 and not eligible or enrolled in Medicare
This section modified by: Amendment 5. View Previous Language.
Southern California residents may choose one of the options if you reside in the geographical jurisdiction as defined by the HMO you select.
Benefit Options |
Prescription Drug Benefits |
|
Option 1 |
Kaiser Permanente HMO |
Kaiser Permanente Prescription Drug Plan |
Option 2 |
UnitedHealthcare HMO |
Mandatory Generic Prescription Drug Program |
Southern California residents may choose one of the options if you reside in the geographical jurisdiction as definedy by the HMO you select.
Benefit Options |
Prescription Drug Benefits |
|
Option 1 |
Kaiser Permanente HMO |
Kaiser Permanente Prescription Drug Plan |
Option 2 |
UnitedHealthCare HMO |
UnitedHealthcare Prescription Drug Program |
Summary of Benefits
Early Retirees (Under Age 62 and not eligible or enrolled in Medicare)
Prescription Drugs |
||
|---|---|---|
|
Kaiser HMO |
UnitedHealthcare HMO * |
Retail Pharmacy: Generic |
$0 co-payment |
$0 co-payment |
Retail Pharmacy: Brand - Formulary |
$10 co-payment |
$10 co-payment |
Retail Pharmacy — Brand - Non-Formulary |
N/A |
N/A |
|
|
|
Mail Order: Generic |
$0 co-payment |
$0 co-payment |
Mail Order: Brand - Formulary |
$20 co-payment |
$20 co-payment |
Mail Order — Brand — Non-Formulary |
N/A |
N/A |
2.1.2 Retirees Age 65 and Over (Enrolled in Medicare Parts A and B)
This section modified by: Amendment 8. View Previous Language.
Southern California residents may choose one of these options if you reside in the geographical jurisdiction as defined by the HMO you select.
| Benefit Options | Prescription Drug Benefits | |
|---|---|---|
| Option 1 | Kaiser Permanente Senior Advantage HMO | Kaiser Permanente Senior Advantage Prescription Drug Plan |
| Option 2 | UnitedHealthcare® Group Medicare Advantage (HMO) | UnitedHealthcare® Group Medicare Advantage Prescription Drug Program |
The only option available to participants residing outside the service area of the HMOs listed (For example: residents of Northern California or out-of-state) is:
| Benefit Options | Prescription Drug Benefits |
|---|---|
| Out of Area Plan (through UnitedHealthcare® Group Medicare Advantage) | Out of Area - UnitedHealthcare® Group Medicare Advantage |
Participants that were covered under the Medicare Supplement Plan effective January 1, 2016, when Medicare Supplement coverage was eliminated, were allowed to continue such coverage. For more information, please refer to Article 7: Medicare Supplement Plan on page 37.
Southern California residents may choose Kaiser Permanente HMO or Anthem Blue Cross PPO. You must reside in the geographical jurisdiction as defined by the HMO to select Kaiser Permanente HMO. The only option available to participants who reside outside of Southern California area (for example: residents of Northern California or out-of-state) is Anthem Blue Cross Medicare Preferred PPO as listed below.
| Benefit Options | Prescription Drug Benefits | |
|---|---|---|
| Option 1 | Kaiser Permanente Senior Advantage HMO | Kaiser Permanente Senior Advantage Prescription Drug Plan |
| Option 2 | Anthem Blue Cross Medicare Preferred PPO | Anthem Blue Cross Medicare Preferred PPO Prescription Drug Program |