2021-2022 ST. LOUIS COUNTY RETIREE BENEFITS
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ST. LOUIS COUNTY RETIREE BENEFITS 2021-2022
St. Louis County 2021-2022 Retiree Benefits 2
CONTENTS WELCOME TO YOUR BENEFITS GUIDE 3
LETTER FROM DIRECTOR OF ADMINISTRATION 4
WHO’S ELIGIBLE FOR BENEFITS? 5
CHANGING YOUR BENEFITS 6
ENROLLING FOR BENEFITS 7
MEDICAL, DENTAL & VISION 8
WHICH PLAN IS RIGHT FOR YOU? 9
MEDICAL PLANS 10
MEDICARE ADVANTAGE PLANS 11
MEDICAL PLAN COSTS 12
PREVENTIVE CARE SCREENING BENEFITS 13
ARE PRESCRIPTION DRUGS BREAKING YOUR 14
BUDGET?
DENTAL PLANS 15
VISION PLANS 16
IMPORTANT PLAN INFORMATION 17
PLAN CONTACTS, PLAN DOCUMENTS
ENROLLMENT FORMS 23
PAPER ENROLLMENT ALTERNATIVES
MEDICARE PART D NOTICE
If you (and/or your
dependents) have Medicare
or will become eligible for
Medicare in the next 12
months, a federal law gives
you more choices about your
prescription drug coverage.
Please see the Important
Notices section for more
details.
St. Louis County 2021-2022 Retiree Benefits 3
WELCOME TO
YOUR BENEFITS This guide is about your benefits, but it’s also
about you and how to protect your health,
GUIDE your lifestyle, your future, and the people who
are important to you.
You’ll find details about your healthcare and
retirement benefits and tips on how to use
your benefits.
This guide is an overview
The benefits in this summary are effective
October 1, 2021
through
September 30, 2022.
This guide is an overview and does not provide a complete
description of all benefit provisions. For more detailed
information, please refer to your plan benefit booklets or
summary plan descriptions (SPDs). The plan benefit booklets
determine how all benefits are paid.
Open Enrollment is from
Monday, Aug 16 to
Wednesday, Sept 1.
Join Meetings by Phone or Computer. Meetings will be held on:
• Aug 18 @ 9:30am
Dial by Phone at 346-248-7799 -or- Join by Meeting URL
Meeting URL – https://alliantinsurance.zoom.us/j/91386328304?pwd=Rm83OFQ4d0dQZ2lPazNydFhFR3Z5QT09
Meeting ID – 913 8632 8304
Meeting Passcode – 526309
• Aug 23 @ 12:00pm
Dial by Phone at 346-248-7799 -or- Join by Meeting URL
Meeting URL – https://alliantinsurance.zoom.us/j/99689110785?pwd=c1YybEQvUkRSNFM4a3gyVnFaZGpZQT09
Meeting ID – 996 8911 0785
Meeting Passcode – 052915
St. Louis County 2021-2022 Retiree Benefits 4
Letter from the Director
Dear St. Louis County Retirees,
Welcome to the 2021–2022 benefits plan year. We recognize that having continued access to comprehensive
group medical plans is a great residual benefit in honor of your valued service with St. Louis County
Government. We continue to offer multiple medical plan options to allow retirees to select the best fit for their
individual household needs.
As we continue to navigate this pandemic, we are taking all necessary measures to be mindful of the safety
of our community. We continue to monitor the impact of COVID-19 on the County’s overall health benefits. As a
result of continued high claims in the retiree group, some changes have been made to the medical plans. By
making changes to the deductible and out-of-pocket maximums, premiums will increase by a smaller amount
than would have been necessary without the changes. The County continues to work with our consultant and
medical plan providers to keep retiree insurance as affordable as possible.
Anthem will remain the network provider for the County’s retirement medical plan and Express Scripts will
continue as the pharmacy provider. Retirees who have maintained dental coverage can choose one of the same
two dental plans with DHMO by CIGNA and DPPO by Delta Dental. Vision benefits will continue through VBA.
Please review the following pages to learn more about these group benefit plans.
The Aetna and UHC Medicare Advantage Plans will continue to be offered and those currently enrolled do
not have to take any actions to remain enrolled. Medicare Advantage Plan information will be available in late
October – November for the January 1, 2022 Medicare Plan effective date. Only those who wish to make
changes to their current coverage are required to submit those elections. Retirees can take advantage of online
enrollment through Employee Self Service or use the paper enrollment forms provided in the Retiree Benefits
Guide.
Additionally, if you are researching options available outside the County offerings, consider visiting
www.healthcare.gov to review the opportunities available as part of the Affordable Care Act. Please keep in
mind that as a retiree of St. Louis County you have the option to remain on the group medical plan as long as
you would like and choose to pay the premiums. At your convenience, take a moment to review the benefits
listed in the guide as you make choices that are ideal for you and your family.
Sincerely,
Jennifer J. Keating
Acting Director of Administration
St. Louis County 2021-2022 Retiree Benefits 5
WHO’S ELIGIBLE Retired employees
FOR BENEFITS? Any employee that is retiring would be eligible to carry on
their current benefits. If you are Medicare eligible, you would
be able to select from one of the Medicare plans offered by
Aetna or UnitedHealthcare.
If you opt out of your benefits as a retiree, you will not be
eligible to return for enrollment under that plan offered by the
County.
Eligible dependents
• Legally married spouse or domestic partner*
• Natural, adopted, step children, or domestic partner’s
children up to age 26
• Children over age 26 who are disabled and depend on you
for support.
• Children named in a Qualified Medical Child Support Order
(QMCSO).
For additional information, please refer to the benefit
booklets for each benefit.
*Domestic partners will need to complete and notarize a
form. This form can be requested from the County Benefits
Office.
When you can enroll
You are eligible to change your plans during open enrollment.
If you would like to drop your coverage, please complete the
cancellation form included at the end of this guide.
If you miss the enrollment deadline, you'll need to wait until
the next open enrollment period (the one time each year that
you can make changes to your benefits for any reason).
St. Louis County 2021-2022 Employee Benefits 6
CHANGING Outside of open enrollment, you may be able to make
changes to your benefit elections if you have a big change in
YOUR BENEFITS your life, including:
• Change in legal marital status
• Change in number of dependents or dependent eligibility
status
• Change in employment status that affects eligibility for you,
your spouse, or dependent child(ren)
• Change in residence that affects access to network
providers
• Change in your health coverage or your spouse’s coverage
due to your spouse’s employment
• Change in an individual’s eligibility for Medicare or
Medicaid
• Court order requiring coverage for your child
• “Special enrollment event” under the Health Insurance
Portability and Accountability Act (HIPAA), including a new
dependent by marriage, birth or adoption, or loss of
coverage under another health insurance plan
• Event allowed under the Children’s Health Insurance
Program (CHIP) Reauthorization Act (you have 60 days to
request enrollment due to events allowed under CHIP).
You must submit your change within 31 days after the event.
St. Louis County 2021-2022 Retiree Benefits 7
ENROLLING FOR St. Louis County Employee Self-Service
BENEFITS Employee Self-Service is an online system that enables you to
make all your benefit decisions in one place. This year you do
not have to make any elections if you do not want to change
anything, but it is highly encourage that you visit ESS and
ensure everything is accurate.
Before you enroll
• Know the date of birth, social security number, and address
for each dependent you will cover. ACA has made it a
requirement for Medical plans to list a Social Security
numbers for all dependents.
• Review your enrollment materials to understand your
benefit options and costs for the coming year.
• Attend a Virtual Open Enrollment Meeting. The schedule of
meetings is listed on Page 3 of this guide. Attendance is not
required but strongly encouraged.
Getting started
• LOG IN to Employee Self-Service on or before September 1st.
If you have any issues accessing our ESS, please contact
County Help Desk at 314-615-4357.
https://stlouisco.munisselfservice.com/default.aspx
Username: Your Retiree EIN
DO I NEED TO ENROLL? Password: Your last saved password or, if this is your first
If you do not want to make changes or time logging in, the last 4 digits of your Social Security
check on your current elections, you number.
do not need to take any action. • ADD or VERIFY your personal and dependent information.
• SELECT your benefit plans for the coming year.
You have the option to use paper • REVIEW your choices and costs before finalizing.
enrollment forms located in the back
of this guide if you prefer not to use
the ESS system.
St. Louis County 2021-2022 Employee Benefits 8
HEALTHCARE MAKE TIME FOR HEALTH
OUR COMMITMENT Medical
We believe that our retirees We offer 4 comprehensive medical plans, as well as 4
Medicare Advantage supplemental plans. Preventive care is
should have access to healthcare fully covered under all plans if obtained in-network. Your costs
coverage that promotes for other services will depend on which plan you choose.
preventive care and helps cover Review the network provider information and out-of-pocket
the cost of illness. costs such as deductible, coinsurance and prescription drugs
so you can choose the best fit for your health concerns and
Eligible retirees and their eligible budget and understand how the plan works.
dependents can enroll in
medical, dental, and vision Dental
coverage through the St. Louis Some people don’t like going to the dentist, but no one likes
County benefits program. big dental bills. Regular checkups and cleanings are fully
covered and can identify issues before they become serious.
And if you do need dental services, insurance helps cover the
cost for fillings, root canals, gum disease, orthodontia, and
more.
Vision
An eye exam can uncover health conditions you may not know
you have, such as glaucoma, or even high blood pressure. Our
vision plan help cover the cost of eye exams, eyeglasses, and
contact lenses to ensure you’re seeing and feeling your best.
St. Louis County 2021-2022 Retiree Benefits 9
WHICH PLAN IS Consider a PPO (Preferred Provider Organization) if:
RIGHT FOR
• You want to be able to see any provider, even a specialist,
without a referral
YOU?
• You are willing to pay more to see out-of-network providers
Plans To Consider
• Anthem PPO Access Option 1
• Anthem PPO Access Option 2
• Anthem PPO Select Option 1
*Access Plans include BJC network, Select Plans exclude BJC network
Consider a High Deductible Health Plan (HDHP) if:
• You want to be able to see any provider, even a specialist,
without a referral
• You are willing to pay more to see out-of-network providers
• You want tax-free savings on your healthcare costs
• You want an extra way to add to your retirement savings
Plans To Consider
• Anthem HSA Access Plan
Consider a Medicare Advantage Plan if:
• You want an all-inclusive alternative to Original Medicare
• You want a plan that includes hospital, medical and
prescription drug coverage
• You want lower out-of-pocket costs than Original Medicare
Plans To Consider
• Aetna PPO Plan
• Aetna Street HMO Plan
• Aetna Enhanced HMO Plan
• UnitedHealthcare Group Medicare Advantage PPO Plan
*Aetna Advantra Plan will no longer be available after
12/31/2021.
St. Louis County 2021-2022 Retiree Benefits 10ANTHEM MEDICAL PLANS
You always pay the deductible and copayment ($). The coinsurance (%) shows what you pay after the deductible. The County
offers medical coverage through Anthem and pharmacy coverage through Express Scripts.
Out of Out of Access 2/ Out of
HSA Access Access 1
Network Network Select 1 Network
Annual Deductible
Individual $4,000 $4,000 $8,500 $17,000 $3,500 $7,500
+ One Dependent $8,000 $8,000 $8,500 $34,000 $7,000 $15,000
Family $8,000 $8,000 $8,500 $34,000 $7,000 $15,000
Annual Out-of-Pocket
Maximum
Individual $6,650 $12,000 $8,500 $21,250 $8,500 $12,000
+ One Dependent $13,300 $24,000 $8,500 $42,500 $17,000 $24,000
Family $13,300 $24,000 $8,500 $42,500 $17,000 $24,000
Office Visit
Primary 20% 40% 0% 50% $30 50%
Specialist 20% 40% 0% 50% $60 50%
Chiropractic
Lab and X-ray 20% 40% 0% 50% 25% 50%
Urgent Care 20% 20% 0% 50% $75 $75
Emergency Room 20% 20% 0% 50% $450 $450
Hospitalization 20% 40% 0% 50% 25% 50%
Outpatient Surgery 20% 40% 0% 50% 25% 50%
PRESCRIPTION DRUGS HSA Access Access 1 Access 2/Select 1
Retail (30 day supply)
Generic 20% $10 $10
Brand Name 20% $30 $40
Specialty 20% $60 $75
Mail Order (90 day supply)
Generic 10% $10 $10
Brand Preferred 10% $75 $100
Brand Non-Preferred 10% $180 $225
Specialty 10% $150* $150*
• PPO Access Option 1 plan shows 0% in-network, which indicates that all eligible medical expenses are 100% covered in
full once the deductible and out of pocket maximums have been met.
• Deductible and Out of Pocket Maximum are based on plan year of October 1 – September 30.
• Immunizations up to age 5 are 100% covered.
• Only 30-day supply allowed for mail order specialty drugs and only through a specialty pharmacy.
*Specialty is a 25% coinsurance up to a $150 maximum.
St. Louis County 2021-2022 Retiree Benefits 11AETNA/UHC MEDICARE ADVANTAGE PLANS
You always pay the deductible and copayment ($). The coinsurance (%) shows what you pay after the deductible. The plan
summaries below are for 2021.
UHC Medicare
UHC Medicare
Aetna Street Aetna Enhanced Advantage
Aetna PPO Plan Advantage PPO
HMO Plan HMO Plan Nationwide PPO
Plan
Plan
*Tier 1 - $45
2021 Monthly
$0 $0 $224.45 $0 *Tier 2 - $75
Premium
*Tier 3 - $150
Aetna Medicare Aetna Medicare
Network Aetna National PPO LPPO NPPO
HMO (CVTY) HMO (CVTY)
Deductible $500 None None None None
Annual Out-of-
$3,400 $2,800 $1,200 $4,000 $3,400
Pocket Maximum
Office Visit
Primary $0 per visit $5 per visit $10 per visit $10 per visit $20 per visit
Specialist $25 per visit $40 per visit $20 per visit $35 per visit $50 per visit
Routine Vision $0 per visit $0 per visit $20 per visit $35 per visit $50 per visit
$275/day (days 1-5) $150/day (days 1-3) $350/day (days 1-6)
$200/day (days 1-5) $200/day (days 1-8)
Inpatient Treatment $0 unlimited addtl $0 unlimited addtl $170/day (days 7-10)
$0 unlimited addtl days $0 copay (9+ days)
days days $0 copay (11+ days)
Emergency Room $120 $90 $50 $90 $120
Urgent Care $25 $65 $25 $35 $65
$20/day (days 1-20) $0/day (days 1-20) $0/day (days 1-20) $0/day (days 1-20)
Skilled Nursing $20/day (days 1-20)
$178/day (days 21- $25/day (days 21-40) $100/day (days 21- $184/day (days 21-39)
Facility $178/day (days 21-100)
100) $0/day (days 41-100) 100) $0/day (days 40-100)
Outpatient Surgery $150 per visit $275 per visit $250 per visit $200 per visit $500 per visit
Diagnostic Lab $0 per visit $0 per visit $0 per visit 5% $0 per visit
Diagnostic X-
20% 20% 20% 5% $65 per visit
Rays/Tests
Durable Medical
20% 20% 20% 5% $65
Equipment
PRESCRIPTION DRUGS
Retail (30 day supply)
Preferred Generic $15 $15 N/A $15 $15
Generic $20 $20 $0 $15 $15
Preferred Brand $47 $47 $25 $47 $47
Non-Preferred $100 $100 $55 $100 $100
Specialty 33% 33% 25% $100 $100
*UHC NPPO Plan – Tier 1 states include: Al, AR, AZ, CO, FL, HI, ID, IN, KS, LA, MI, MO, MS, NC, OH, OK, PA, RI, SC, TN, TX, UT, WI
*UHC NPPO Plan – Tier 2 states include: GA, KY, ME, NE, NJ, NM, NV, OR, VA, WA, D.C., WV
*UHC NPPO Plan – Tier 3 states include: AK, CA, CT, DE, IA, IL, MA, MD, MN, MT, ND, NH, NY, SD, VT, WY
St. Louis County 2021-2022 Retiree Benefits 12YOUR MONTHLY BENEFIT COSTS
The total amount that you pay for your benefits coverage depends on the plans you choose and how many
dependents you cover.
ANTHEM MEDICAL – Non-Medicare Eligible
HSA Access PPO Access 1 PPO Access 2 PPO Select 1
RETIREE ONLY $1,100.19 $720.51 $1,418.49 $1,213.71
RETIREE + 1 DEP. $2,156.46 $1,412.27 $2,779.70 $2,377.86
RETIREE + FAMILY $3,080.38 $2,017.35 $3,970.88 $3,397.06
ANTHEM MEDICAL – Medicare Eligible
HSA Access PPO Access 1 PPO Access 2 PPO Select 1
1 MEDICARE
$834.95 $546.81 $1,136.24 $962.65
ELIGIBLE
2 MEDICARE
$1,491.34 $976.68 $2,237.13 $1,911.64
ELIGIBLE
1 MEDICARE + 1
$1,888.39 $1,236.70 $2,655.08 $2,269.42
NON-MEDICARE
1 MEDICARE + 2+
$2,333.31 $1,528.08 $3,148.56 $2,691.89
NON-MEDICARE
2 MEDICARE + 1+
$1,846.02 $1,208.95 $2,691.45 $2,300.44
NON-MEDICARE
St. Louis County 2021-2022 Retiree Benefits 13Preventive care You take your car in for maintenance. Why not do
the same for yourself?
screening Annual preventive checkups can help you and your doctor
identify your baseline level of health and detect issues before
benefits they become serious.
What is Preventive Care?
The Affordable Care Act (ACA) requires health insurers to
cover a set of preventive services at no cost to you, even if
you haven’t met your yearly deductible. The preventive care
services you’ll need to stay healthy vary by age, gender and
medical history. Visit cdc.gov/prevention for recommended
guidelines. Preventive care is covered in full only when
obtained from an IN-NETWORK provider.
Not all exams and tests are considered preventive
Exams performed by specialists are not generally considered
preventive and may not be covered at 100 percent.
Additionally, certain screenings may be considered diagnostic,
not preventive, based on your current medical condition. You
may be responsible for paying all or a share of the cost for
those services. If you have a question about whether a service
TYPICAL SCREENINGS FOR will be covered as preventive care, contact your medical plan.
ADULTS
• Blood pressure Should I skip my checkup due
• Cholesterol
• Diabetes to COVID-19?
• Colorectal cancer Staying safe from the coronavirus
• Depression doesn’t necessarily mean skipping
• STIs preventive healthcare. Talk to your
doctor about whether you need a checkup right away or
can delay until there is a lower risk of being exposed to
Preventive care for women COVID-19. Depending on your medical needs, you may
should include breast and be treated with a combination of telehealth and in-
gynecological exams
person care.
Consider scheduling a flu shot when they’re available to
For men, preventive care avoid a potential combined infection of COVID-19 and
should include prostate the flu. And, of course, seek medical care right away if
cancer screening and a you have symptoms that need immediate attention.
testicular exam Nearly every doctor's office has added new practices to
ensure the safety of patients, providers and other
retirees.
St. Louis County 2021-2022 Retiree Benefits 14Are prescription Understanding the formulary can save you money
If your doctor prescribes medicine, especially for an ongoing
drugs breaking condition, don’t forget to check your health plan’s drug
formulary. It’s a powerful tool that can help you make
your budget? informed decisions about your medication options and
identify the lowest cost selection.
What is a formulary?
A drug formulary is a list of prescription drugs covered by your
medical plan. Most prescription drug formularies separate the
medications they cover into four or five drug categories, or
“tiers”. These groupings range from least expensive to most
expensive cost to you. “Preferred” drugs generally cost you
less than “non-preferred” drugs.
Get the most from your coverage
To get the most out of your prescription drug coverage, note
where your prescriptions fall within your plan’s drug
formulary tiers and ask your doctor for advice. Generic drugs
are usually the lowest cost option. Generics are required by
the Food and Drug Administration (FDA) to perform the same
as brand-name drug counterparts.
THE FORMULARY DRUG TIERS
DETERMINE YOUR COST To find out if a drug is on your plan’s formulary, visit the
plan’s website or call the customer service number on your
Preferred Generic ID card.
$ Drug
Non-Preferred
$$ Generic Drug
Preferred Brand
$$$ Name Drug
Non-Preferred
$$$$ Brand Name Drug
$$$$$ Specialty Drug
St. Louis County 2021-2022 Retiree Benefits 15DELTA DENTAL PPO & CIGNA DENTAL HMO PLANS
You always pay the deductible and copayment ($). The coinsurance (%) shows what you pay after the deductible.
Delta Dental PPO Cigna Dental HMO
Annual Deductible
Individual $50 None
Family $150 None
Annual Plan Maximum $1,500* None
Diagnostic & Preventive 0%, Deductible not applicable $5 copay
Basic Services 20% after deductible Copays listed on Patient Charge Schedule
(PCS)
Major Services 50% after deductible Copays listed on Patient Charge Schedule
(PCS)
Orthodontia
Child (under 19) 50%, Deductible not applicable $2,040 copay**
Adult 50%, Deductible not applicable $2,376 copay**
Ortho Lifetime Max $2,000 None
*Delta Dental Max Rollover allows you to rollover up to $350 per year to your Annual Maximum, up to $1,500, as long as you
do not exceed $500 in claims. If claims are filed with a PPO provider, you will receive an additional $100 rollover.
**Copayment amount may change and other copayments may apply, depending on the services received.
DENTAL MONTHLY COSTS
Cigna DHMO Delta Dental DPPO
RETIREE ONLY $19.80 $37.74
RETIREE + 1 DEP. $37.20 $75.46
RETIREE + FAMILY $48.30 $113.20
St. Louis County 2021-2022 Retiree Benefits 16VBA VISION PLAN
Your vision checkup is fully covered after your Exam copay. After any Materials copay, the plan covers frames, lenses, and contacts
as described below.
In-Network Out-of-Network
(Amount Covered) (Amount Reimbursed)
Copay 100% $42
Frames 100% (within $50 wholesale allowance) $45
Lenses
Single Vision 100% $40
Bifocal 100% $60
Blended Bifocal 100% $60
Trifocal 100% $80
Progressives Controlled Cost* $80
Lenticular 100% $120
Polycarbonate 100% (for child up to age 19) N/A
Transitions 100% N/A
Solid or Gradient Tints 100% N/A
Scratch Coat (1 Year) 100% N/A
Contacts (Elective) $110 material allowance $110 material allowance
15% off UCR fitting fee No discount on fitting fee
Medically Necessary Contacts 100% $450
Lasik Surgery (once every 8 years) N/A $125
Frequency
Exams Every 12 months Every 12 months
Standard Corrective Lenses Every 12 months Every 12 months
Contact Lenses Every 12 months Every 12 months
Frames Every 12 months Every 12 months
*Progressive lenses typically retail from $150 to $400. VBA’s controlled costs generally range from $45 to $175.
VISION MONTHLY COSTS
VBA Vision
RETIREE ONLY $5.18
RETIREE + 1 DEP. $10.38
RETIREE + FAMILY $14.52
St. Louis County 2021-2022 Retiree Benefits 17IMPORTANT PLAN
INFORMATION
In this section, you’ll find important plan information,
including:
• Contact information for our benefit carriers and vendors
• A summary of the health plan notices you are entitled to
receive annually, and where to find them.
• A Benefits Glossary to help you understand important
insurance terms.
St. Louis County 2021-2022 Retiree Benefits 18PLAN CONTACTS
Plan Carrier Phone # Website
Medical Anthem 833-600-4760 www.anthem.com
www.express-
Pharmacy Express Scripts 844-516-3316
scripts.com/stlouiscounty
Medicare Aetna 800-533-0367 www.aetnaretireeplans.com
Medicare UnitedHealthcare 877-714-0178 www.UHCretiree.com
Dental Delta Dental 800-335-8266 www.deltadentalmo.com
Dental Cigna Dental 800-244-6224 www.mycigna.com
Vision Benefits of
Vision 800-432-4966 www.vbaplans.com
America (VBA)
Legal Hyatt Legal 800-821-6400 www.legalplans.com
Auto & Home Travelers 636-733-0030 www.whoisyourbroker.com
St. Louis County 2021-2022 Retiree Benefits 19GLOSSARY
-A- Claim
A request for payment that you or your
Excluded Service
A service that your health plan doesn’t pay
AD&D Insurance health care provider submits to your for or cover.
An insurance plan that pays a benefit to healthcare plan after you receive services
you or your beneficiary if you suffer from that may be covered. -F-
loss of a limb, speech, sight, or hearing, or Formulary
if you have a fatal accident. Coinsurance A list of prescription drugs covered by your
Your share of the cost of a healthcare visit medical plan or prescription drug plan. Also
Allowed Amount or service. Coinsurance is expressed as a called a drug list.
The maximum amount your plan will pay percentage and always adds up to 100%.
for a covered healthcare service. For example, if the plan pays 70%, your -G-
coinsurance responsibility is 30% of the Generic Drug
Ambulatory Surgery Center (ASC) cost. If your plan has a deductible, you pay A drug that has the same active ingredients
A healthcare facility that specializes in 100% of the cost until you meet your as a brand name drug, but is sold under a
same-day surgical procedures such as deductible amount. different name. For example, Atorvastatin
cataracts, colonoscopies, upper GI is the generic name for medicines with the
endoscopy, orthopedic surgery, and more. Copayment same formula as Lipitor.
A flat fee you pay for some healthcare
Annual Limit services, for example, a doctor's office Grandfathered
A cap on the benefits your plan will pay in a visit. You pay the copayment (sometimes A medical plan that is exempt from certain
year. Limits may be placed on particular called a copay) at the time you receive provisions of the Affordable Care Act
services such as prescriptions or care. In most cases, copays do not count (ACA).
hospitalizations. Annual limits may be toward the deductible.
placed on the dollar amount of covered -H-
services or on the number of visits that will -D- Health Reimbursement Account (HRA) An
be covered for a particular service. Deductible account funded by an employer that
After an annual limit is reached, you must The amount of healthcare expenses you reimburses employees, tax-free, for
pay all associated health care costs for the have to pay for with your own money qualified medical expenses up to a
rest of the plan year. before your health plan will pay. The maximum amount per year. Sometimes
called Health Reimbursement
-B- deductible does not apply to preventive
care and certain other services. Arrangements.
Balance Billing
In-network providers are not allowed to Dental Basic Services Healthcare Flexible Spending Account
bill you for more than the plan's allowable Services such as fillings, routine extractions (FSA)
charge, but out-of-network providers are. and some oral surgery procedures. A health account through your employer
This is called balance billing. For example, that lets you pay for many out-of-pocket
if the provider's fee is $100 but the plan's Dental Diagnostic & Preventive Generally medical expenses with tax-free dollars.
allowable charge is only $70, an out-of- includes routine cleanings, oral exams, x- Eligible expenses include insurance
network provider may bill YOU for the $30 rays, and fluoride treatments. copayments and deductibles, qualified
difference. Most plans limit preventive exams and prescription drugs, insulin, and medical
cleanings to two times a year. devices, and some over-the-counter items.
Beneficiary
The person (or persons) that you name to Dental Major Services High Deductible Health Plan (HDHP) A
be paid a benefit should you die. Complex or restorative dental work such as medical plan with a higher deductible than
Beneficiaries are requested for life, AD&D, crowns, bridges, dentures, inlays and a traditional insurance plan. The monthly
and retirement plans. You must name your onlays. premium is usually lower, but you pay
beneficiary in advance. more health care costs (the deductible)
Dependent Care Flexible Spending before the insurance company starts to pay
Brand Name Drug Account (FSA) its share. A high deductible plan (HDHP)
A drug sold under its trademarked name. An arrangement through your employer may make you eligible for a health savings
For example, Lipitor is the brand name of a that lets you pay for eligible child and elder account (HSA) that allows you to pay for
common cholesterol medicine. care expenses with tax-free dollars. Eligible certain medical expenses with money free
from federal taxes.
-C- expenses include day care, before and
after-school programs, preschool, and
COBRA
summer day camp for children under age -I-
A federal law that may allow you to In-Network
13. Also included is care for a spouse or
temporarily continue healthcare coverage In-network providers and services contract
other dependent who lives with you and is
after your employment ends, based on with your healthcare plan and will usually
physically incapable of self-care.
certain qualifying events. If you elect be the lowest cost option. Out-of-network
COBRA (Consolidated Omnibus Budget -E- services will cost more, or may not be
Reconciliation Act) coverage, you pay 100% Eligible Expense covered. Check your plan's website to find
of the premiums, including any share your A service or product that is covered by doctors, hospitals, labs, and pharmacies
employer used to pay, plus a small your plan. Your plan will not cover any of that belong to the network.
administrative fee. the cost if the expense is not eligible.
St. Louis County 2021-2022 Retiree Benefits 20GLOSSARY
-L- -P- -T-
Life Insurance Participating Pharmacy Telehealth / Telemedicine / Teledoc
An insurance plan that pays your A pharmacy that contracts with your A virtual visit to a doctor using video chat
beneficiary a lump sum if you die. medical or drug plan and will usually result on a computer, tablet or smartphone.
in the lowest cost for prescription Telehealth visits can be used for many
Long Term Disability Insurance medications. common, non-serious illnesses and injuries
Insurance that replaces a portion of your and are available 24/7. Many health plans
income if you are unable to work due to a Plan Year and medical groups provide telehealth
debilitating illness, serious injury, or A 12-month period of benefits coverage. services at no cost or for much less than an
mental disorder. Long term disability The 12-month period may or may not be office visit.
generally starts after a 90-day waiting the same as the calendar year.
period. -U-
Preferred Drug UCR (Usual, Customary, and Reasonable)
-M- Each health plan has a preferred drug list The amount paid for a medical service in a
Mail Order that includes prescription medicines based geographic area based on what providers
A feature of a medical or prescription drug on an evaluation of effectiveness and cost. in the area usually charge for the same or
plan where medicines you take routinely Another name for this list is a “formulary.” similar medical service. The UCR amount
can be delivered by mail in a 90-day The plan may charge more for non- sometimes is used to determine the
supply. preferred drugs or for brand name drugs allowed amount.
that have generic versions. Drugs that are
-O- not on the preferred drug list may not be Urgent Care
Open Enrollment covered. Care for an illness, injury or condition
The time of year when you can change the serious enough that care is needed right
benefit plans you are enrolled in and the Preventive Care Services away, but not so severe it requires
dependents you cover. Open enrollment is Routine healthcare visits that may include emergency room care. Treatment at an
held one time each year. Outside of open screenings, tests, check-ups, urgent care center generally costs much
enrollment, you can only make changes if immunizations, and patient counseling to less than an emergency room visit.
you have certain events in your life, like prevent illnesses, disease, or other health
getting married or adding a new baby or problems. Many preventive care services -V-
child in the family. are fully covered. Check with your health Vaccinations
plan in advance if you have questions Treatment to prevent common illnesses
Out-of-Network about whether a preventive service is such as flu, pneumonia, measles, polio,
Out-of-network providers (doctors, covered. meningitis, shingles, and other diseases.
hospitals, labs, etc.) cost you more because Also called immunizations.
they are not contracted with your plan and Primary Care Provider (PCP)
are not obligated to limit their maximum The main doctor you consult for healthcare Voluntary Benefit
fees. Some plans, such as HMOs and EPOs, issues. Some medical plans require An optional benefit plan offered by your
do not cover out-of- network services at members to name a specific doctor as their employer for which you pay the entire
all. PCP, and require care and referrals to be premium, usually through payroll
directed or approved by that provider. deduction.
Out-of-Pocket Cost
A healthcare expense you are responsible -S-
for paying with your own money, whether Short Term Disability Insurance Insurance
from your bank account, credit card, or that replaces a portion of your income if
from a health account such as an HSA, FSA you are temporarily unable to work due to
or HRA. surgery and recovery time, a prolonged
illness or injury, or pregnancy issues and
Out-of-Pocket Maximum childbirth recovery.
Protects you from big medical bills. Once
costs "out of your own pocket" reach this
amount, the plan pays 100% of most
remaining eligible expenses for the rest of
the plan year.
Outpatient Care
Care from a hospital that doesn’t require
you to stay overnight.
St. Louis County 2021-2022 Retiree Benefits 21REQUIRED PLAN NOTICES HEALTH PLAN NOTICES These notices must be provided to plan participants on an annual basis and are available in the Annual Notices document, located in the County’s site at https://stlouiscountymo.gov/st-louis-county- departments/administration/personnel/retirees/. • HIPAA Notice of Privacy Practices: Describes how health information about you may be used and disclosed • Health Insurance Exchange • Premium Assistance Under Medicaid and the Children's Health Insurance Program (CHIP): Describes availability of premium assistance for Medicaid eligible dependents • Notice of Patient Protections • HIPAA Notice of Special Enrollment Rights: Describes when you can enroll yourself and/or dependents in health coverage outside of open enrollment • Women's Health and Cancer Rights Act: Describes benefits available to those that will or have undergone a mastectomy • Mental Health Parity and Addiction Equity Act • Newborns' and Mothers' Health Protection Act: Describes the rights of mother and newborn to stay in the hospital 48-96 hours after delivery • Medicare Part D Notice: Describes options to access prescription drug coverage for Medicare eligible individuals • GINA Disclosure • General Notice of COBRA Rights • General FMLA Notice • USSERA Notice COBRA CONTINUATION COVERAGE You and/or your dependents may have the right to continue coverage after you lose eligibility under the terms of our health plan. Upon enrollment, you and your dependents receive a COBRA Initial Notice that outlines the circumstances under which continued coverage is available and your obligations to notify the plan when you or your dependents experience a qualifying event. Please review this notice carefully to make sure you understand your rights and obligations. St. Louis County 2021-2022 Retiree Benefits 22
PLAN DOCUMENTS Important documents for our health plan and retirement plan are available in the County’s site. Paper copies of these documents and notices are available if requested. If you would like a paper copy, please contact the Plan Administrator. SUMMARY OF BENEFITS AND COVERAGE (SBC) A document required by the Affordable Care Act (ACA) that presents benefit plan features in a standardized format. SBC documents are available in the County’s site. • Anthem HSA Access Plan • Anthem PPO Access Option 1 Plan • Anthem PPO Access Option 2 Plan • Anthem PPO Select Option 1 Plan • Aetna PPO Plan • Aetna Street HMO Plan • Aetna Enhanced HMO Plan • UHC Medicare Group Advantage PPO Plan • UHC Nationwide PPO Plan STATEMENT OF MATERIAL MODIFICATIONS This enrollment guide constitutes a Summary of Material Modifications (SMM) to the St. Louis County 2021-2022 Benefits. It is meant to supplement and/or replace certain information in the SPD, so retain it for future reference along with your SPD. Please share these materials with your covered family members. St. Louis County 2021-2022 Retiree Benefits 23
Retiree Enrollment Form
Name: ________________________
Plan Year 10/01/2021 – 09/30/2022 EIN: _____________
MEDICAL COVERAGE CHOICES
If you are currently enrolled in the Retiree Group Medical Plan
Please indicate your choice of medical plan and select the coverage level you wish to enroll for by checking
the appropriate box.
NON-MEDICARE ELIGIBLE
Access 1 PLAN (Anthem Blue Access Choice)
Retiree Only $720.51
Retiree and 1 Dependent $1,412.27
Retiree and Family $2,017.35
HSA PLAN (Anthem Blue Access Choice)
Retiree Only $1.100.19
Retiree and 1 Dependent $2,156.46
Retiree and Family $3,080.38
Select 1 (Anthem Preferred Select -BJC)
Retiree Only $1,213.71
Retiree and 1 Dependent $2,377.86
Retiree and Family $3,397.06
Access 2 (Anthem Blue Access Choice + BJC)
Retiree Only $1,418.49
Retiree and 1 Dependent $2,779.70
Retiree and Family $3,970.80
DENTAL CHOICES
(Available if you are currently enrolled in the Retiree Group Dental Plan)
Please indicate your choice of dental plan and select the coverage level you wish to enroll for by checking the appropriate box.
Plan Names Description Cost/Month
CIGNA DENTAL CARE DHMO
Retiree Only $19.80
Retiree and 1 Dependent $37.20
Retiree and Family $48.30
DELTA DENTAL PPO
Retiree Only $37.74
Retiree and 1 Dependent $75.46
Retiree and Family $113.20
VISION CHOICES
(Available If you are currently enrolled in the Retiree Group Vision Plan)
Please select the coverage level you wish to enroll for by checking the appropriate box.
VBA VISION
Retiree Only $5.18
Retiree and 1 Dependent $10.38
Retiree and Family $14.52
Hyatt Legal/CyberScout
Prepaid Services $16.50
Prepaid Services + Identity Theft Protection $19.00
Saint Louis County Retirement Police Headquarters Bldg. 5th Floor 41 S. Central Ave. Clayton, MO 63105 314-615-8110
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