BENEFITS LINE FOR RETIREES - City of St. Petersburg

BENEFITS LINE FOR RETIREES
Effective April 1, 2012
Group Health Plan Changes for 2012 - 2013
UnitedHealthcare will continue to administer the City’s group health insurance with
premium rates increasing at a rate lower than the national average. The provisions of
each plan have been reviewed and some benefits will be changed effective 4/1/12.
United Healthcare EPO Plan
Annual Deductibles
Hospital
2011 - 2012
United Healthcare EPO
$200 Individual
$400 Family
$200 co-pay/day
(1st 3 days per admission)
and plan year deductible
2012 - 2013
United Healthcare EPO
$400 Individual
$800 Family
$300 co-pay/day
(1st 3 days per admission) and plan year
deductible
Emergency Room $100 co-pay + deductible $200 co-pay + deductible
Physician: Specialist
$30 co-pay per visit
$30 co-pay per visit (for Two Star)
$40 for all other Specialists
Preventive Care Applicable co-pays Covered 100%
United Healthcare PPO Plan
Annual Deductibles
Hospital
2011 - 2012
United Healthcare PPO
$200 Individual
$400 Family
$200 co-pay/day
(1st 3 days per admission)
+ 10% co-ins after deductible
2012 - 2013
United Healthcare PPO – In network
$400 Individual
$800 Family
$300 co-pay/day
(1st 3 days per admission)
+ 10% co-ins after deductible
Emergency Room $100 co-pay + deductible $200 co-pay + deductible
Physician: Specialist
$35 co-pay per visit
$35 co-pay per visit (for Two Star)
$45 for all other Specialists
Preventive Care Applicable co-pays Covered 100%
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Section 1: HUMANA Comp Benefits
Dental and Vision Plans and Retiree Rates
No changes in Carriers, Coverage or Rates 2012 - 2013
Monthly Cost Dental DHMO Dental PPO Vision Basic Vision High Option
Single $15.25 $22.31 $ .95 $ 5.92
Two person $26.59 $47.30 $1.43 $11.80
Family $37.11 $73.01 $2.38 $15.78
Refer to your Benefit Summary for more complete information and for out of network benefit provisions.
Section 2: Basic Life - Standard Life Insurance Company
Life Insurance is offered by The Standard Life Insurance Company. There is no change
in the rate for basic life insurance in 2012- 2013 it remains at $4.58 per thousand dollars
of coverage. Your coverage was determined at the time you retired. Your beneficiary
designation can be changed at any time.
It is recommended retirees contact the benefit office
prior to making changes in their benefits.
Page 2 of 8

Section 3: Retiree Questions and Answers
General information
• Changes in coverage become effective the first of
the month following the change.
• Medicare Part A & B coverage is required in
order to be eligible for the City of St. Petersburg
UHC Base Option Plan, Humana HMO or Humana
PPO plans.
• Medicare Part D is not needed when retiree is
covered by the UHC or Humana plans since the
City’s coverage is equal to or better than Part D.
• Insurance companies will not pay what
Medicare would have. Once a retiree is Medicare
eligible, Medicare becomes the primary payor and
the City of St. Petersburg plans become secondary
payors.
• If you become eligible for Social Security
disability, enroll in Medicare Parts A & B coverage.
Once you have both Medicare Parts A & B submit a
copy of your card to the Benefits division as you will
be eligible for the UHC Base Option Plan, Humana
HMO or Humana PPO plans.
Spouses who are covered
under the retiree health insurance
when the retiree dies
are eligible for
health insurance benefits
as follows:
o Retired prior to March 1 1978 - until the end
of the period for which the spouse receives
pension benefits, with the City's contribution to
the premium.
o Retired from March 1, 1978 - March 31, 1988
- the earlier of 12 months or the end of the
pension benefit period with the City's
contribution. COBRA coverage is available for
the balance of a 36 month period.
o Retired after April 1, 1988 - COBRA
coverage for up to 36 months at the full cost of
the premium plus a 2% administrative fee.
Frequently asked Questions
What are the Retiree Benefit Options? Changes
to your benefits are available when you or your
spouse experience a qualifying life event or you
want to decrease your coverage. Once you elect to
decrease or drop your coverage you will NOT have
the option to re-enroll in that coverage again.
What is a qualifying life event? Qualifying life
events are: turning age 65, approved social security
disability, marriage, birth of a child, adoption,
divorce, spouse’s loss of insurance coverage, death.
How long does a retiree have to report a
qualifying life event to the Benefits office?
Retirees have only 31 days from the qualifying life
event effective date to contact the City of St.
Petersburg Benefits office and complete the
required forms and provide certified documentation.
What happens if a retiree signs up for an outside
supplemental Medicare plan while enrolled in a
Humana plan offered by the City? Your Humana
plan with the City of St. Petersburg will be cancelled
by your new carrier and you will not have the option
of going back on the City of St. Petersburg plan.
How long does someone turning 65 have to
change to a Medicare plan with the City of St
Petersburg? Retirees can make this selection of
benefit at any time. Retirees must be enrolled in
Medicare Parts A & B. Enrollment is not retroactive.
Can a life insurance/AD&D beneficiary be
changed? Retirees are allowed to change their life
insurance/AD&D beneficiary at any time.
What is the difference between the UHC PPO
and UHC Base PPO Option? As a Medicare
supplement plan UHC Base Option Plan has a
lifetime maximum benefit of $100,000. UHC PPO
has no lifetime max.
What happens if a retiree is traveling and has an
emergency? All plans cover emergency services.
Contact your insurance provider as soon as
possible.
What happens if I move out of the service area
and am on a Humana Plan? You will not be able to
remain on the plan. A onetime only opportunity to
transfer to the UHC Base Option plan will be offered
to you.
Page 3 of 8

Section 4: Group Health Plans and Rates for Retirees
Healthcare plans for Retirees under the age of 65 and those still employed:
• UnitedHealthcare Choice Plan (EPO) – Open Access network plan
• UnitedHealthcare Choice Plus Plan (PPO) – Open Access network and out of network services
Healthcare plans for Retirees 65 years and older:
• UnitedHealthcare Choice Plan (EPO) – Open Access network plan
• UnitedHealthcare Choice Plus Plan (PPO) – Open Access network and out of network services
• UnitedHealthcare Choice Plus Plan (PPO) – Base Option
(Medicare is primary and UHC Choice Plus plan base option is secondary)
• Humana Gold (HMO) – In-Network plan
• Humana Choice (PPO) – In and Out of Network plan
2012 - 2013 RETIREE GROUP HEALTH PLAN COMPARISON
Plan
UHC Choice
(EPO)
In-network
UHC Choice
Plus (PPO)
In-network
UHC Choice
Plus Base
(PPO)
In-network
Humana Gold
(HMO)
Humana
Choice (PPO)
In-network
Annual
Deductibles
$400
Individual
$800 Family
$400
Individual
$800 Family
$400
Individual
$800 Family
N/A
N/A
Hospital
$300 copay/day
(1st 3
days per
admission) and
plan year
deductible
$300 copay/day
(1st 3
days per
admission) +
10% co-ins
after
deductible
$300 copay/day
(1st 3
days per
admission) +
10% co-ins
after
deductible
$250 copay/day
(1st 5
days per
admission then
100% coverage
$150 copay/day
(1st 5
days per
admission then
100% coverage
Emergency
Room
$200 co-pay
plus deductible
$200 co-pay
plus deductible
$200 co-pay
plus deductible
$65 co-pay per
visit
$65 co-pay per
visit
Ambulance
Deductible
does not apply
10% co-ins
after
deductible
10% co-ins
after
deductible
$75 co-pay per
date of service
$50 co-pay per
date of service
Physician:
Primary
$20 co-pay per
visit
$25 co-pay per
visit
$25 co-pay per
visit
$10 co-pay per
visit
$10 co-pay per
visit
Physician:
Specialist
$30-$40 copay
per visit
$35-$45 copay
per visit
$35-$45 copay
per visit
$25 co-pay per
visit
$20 co-pay per
visit
Urgent Care
Center
$50 after
deductible
$50 after
deductible
$50 after
deductible
$25 co-pay per
visit
$20 co-pay per
visit
Preventative
Care
100%
Coverage
100%
Coverage
100%
Coverage
100%
Coverage
100%
Coverage
Page 4 of 8

Plan
UHC Choice
(EPO)
In-network
UHC Choice
Plus (PPO)
In-network
UHC Choice
Plus Base
(PPO)
In-network
Humana Gold
(HMO)
Humana
Choice (PPO)
In-network
Skilled nursing
facility
100% coverage
after
deductible
(Limited to 60
days per plan
year)
10%
co-ins after
deductible
(Limited to 60
days per plan
year)
10%
co-ins after
deductible
(Limited to 60
days per plan
year)
100% coverage
days 1 - 20.
$75 co-pay per
day (days 21-
100 per benefit
period)
100% coverage
days 1 - 20.
$75 co-pay per
day (days 21-
100 per benefit
period)
Rehabilitation
Services
$30 co-pay per
visit (limit 60
visits each type
of service,
multiple visits
per day)
$35 co-pay per
visit (limit 60
visits each type
of service,
multiple visits
per day)
$35 co-pay per
visit (limit 60
visits each type
of service,
multiple visits
per day)
$25 - $100 copay
based on
services
received
$20 co-pay per
visit
Outpatient
Surgery -
hospital
100% coverage
after
deductible
10% co-ins
after
deductible
10% co-ins
after
deductible
$200 co-pay
per visit
$50 co-pay per
visit
Annual Out of
Pocket Limit
Lifetime
Maximum
Benefit
Generic
Prescriptions
(Tier 1)
Preferred
Brand
(Tier 2)
Non-preferred
Brand
(Tier 3)
Specialty
(Tier 4)
$2,000
individual,
$4,000 Family;
excludes
deductible,
co-pays
No lifetime
maximum
benefit
$1,000
individual,
$2,000 Family;
excludes
deductible,
co-pays
No lifetime
maximum
benefit
$1,000
individual,
$2,000 Family;
excludes
deductible,
co-pays
Combined
Network and
Non-network
maximum of
$100,000 per
covered
person.
$2,500 per
plan year
Benefits apply
to Medicare
covered
services.
$4,000 per
plan year
Benefits apply
to Medicare
covered
services.
$15.00 $15.00 $15.00 $4.00 $4.00
$30.00 $30.00 $30.00 $25.00 $25.00
$45.00 $45.00 $45.00 $40.00 $40.00
N/A N/A N/A 33% 33%
NOTE: This is general information only. Benefit plan provisions are governed by the
applicable plan agreement. All questions and concerns regarding specific coverage and
benefits should be directed to the insurance company.
Page 5 of 8

Group Health Insurance Rates - Retirees
Effective April 1, 2012
TOTAL
COST
CITY
CONTRIBUTION
RETIREE
COST
Benefit Plan Monthly Monthly Monthly
UnitedHealthcare CHOICE (EPO)
Single $466.79 $204.74 $262.05
Two person $1,003.62 $413.55 $590.07
Family $1,321.04 $573.23 $747.81
UnitedHealthcare CHOICE PLUS (PPO)
Single $560.24 $204.74 $355.50
Two person $1,131.72 $413.55 $718.17
Family $1,568.73 $573.23 $995.50
UnitedHealthcare CHOICE PLUS - BASE OPTION (PPO)
Single $272.98 $204.74 $68.24
Two person $551.40 $413.55 $137.85
Family $764.31 $573.23 $191.08
HUMANA GOLD (HMO) * effective 1/1/2012
Single $49.00 $49.00 0
Two Person $98.00 $98.00 0
HUMANA CHOICE (PPO) *effective 1/1/2012
Single $149.00 $149.00 0
Two Person $298.00 $298.00 0
Page 6 of 8

INSURANCE COVERAGE
FOR CHILDREN AGE 19 OR OVER
I. HEALTH INSURANCE
Under Florida State Law, retirees covered by one of the City’s health insurance plans have the
option of covering children (who meet the requirements for eligibility) up to age 30.
The City requires that each employee electing to continue coverage or add coverage for
a child age 19 or over complete the ‘Children age 19 or over – Verification for Coverage’
form. The completed form must be returned to the City of St. Petersburg – Benefits Division
Office by March 17, 2012.
The payment of insurance premiums for children age 19 or over will continue to be deducted
from the monthly Retiree Pension check (or included on monthly invoices.)
From calendar year after child attains age 26 through end of calendar year in which child
attains age 30 – Child may be covered for Health Insurance only if the child is:
a) Unmarried,
b) Has no dependents of his/her own,
c) Is a resident of Florida,
d) Is not covered or offered coverage under any other health plan or under Title
XVIII of the Social Security Act;
OR IS:
a) Unmarried,
b) Has no dependents of his/her own,
c) Is a full or part-time student,
d) Is not covered or offered coverage under any other health plan or under Title
XVIII of the Social Security Act
NOTE: The City of St Petersburg reserves the right to require additional documentation to
confirm eligibility of a child age 19 or over at any time.
II. DENTAL AND VISION INSURANCE
Children are eligible for dental and vision insurance coverage until the attainment of age 19. If
the child is a full time student, coverage may be continued until age 25. In order to initially cover
or continue dental and vision coverage for a child age 19 and over, you must complete the form
‘Children age 19 or over – Verification for Coverage’ and return the completed form to the
City of St. Petersburg – Benefits Division Office by March 17, 2012.
Page 7 of 8

City of St. Petersburg Retiree Benefits 727-893-7819 benefits@stpete.org
UnitedHealthcare on site representative 727-893-7911 lauren_gibson@uhc.com
UnitedHealthcare customer service 1-800-377-5154 www.myuhc.com
com
Humana on site representative (Fridays 1:00pm to 4:00pm)
727-793-2116 jpaolillo@humana.com
Humana customer service 1-866-396-8810 www.humana.com
compbenefits.com
Humana CompBenefits (Dental) 1-800-342-5209 www.compbenefits.com
Humana CompBenefits (Vision) 1-800-865-3676 www.compbenefits.com
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