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Edited by LM 4/12/22 Not Apprvd


Frequently Asked Questions


Frequently Asked Questions about the Division of Retirement and Benefits’ Employee Plans, Retiree Plans, and Employers participating in the Sate of Alaska’s retirement and supplemental benefits systems.

EMPLOYEE FAQs

Frequently Asked Questions about the Division of Retirement and Benefits’ Employee Health plan and programs.

The PERS DB Plan

What type of plan is the PERS Defined Benefit Plan?

For employees who first entered prior to July 1, 2006, the Public Employees' Retirement System (PERS) is a defined benefit (DB) plan which is designed to offer a lifetime monthly benefit once retirement eligibility is reached. Your retirement from the plan, provided you do not refund your contributions, will be determined by a formula defined in statute. Unlike a defined contribution account, your benefit is not based on the amount of money in your contribution account. For anyone who first entered after July 1, 2006, the PERS is a defined contribution retirement plan (DCR Plan).

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What kind of benefits are available through PERS?

PERS provides benefits for active members as well as pension and medical benefits at retirement. Qualifying active members have occupational disability and death benefits available upon entry to PERS. These benefits expand to disability and death benefits resulting from nonoccupational causes once a member is vested.

For members who reach retirement eligibility, PERS provides a lifetime pension benefit with options to provide continuing benefits to a surviving spouse. Along with the pension benefit, PERS also offers a retiree medical plan, Dental-Vision-Audio coverage, and Long-Term Care coverage.

Once retired, eligible members receive a cost of living increase to their PERS benefits once per year if there has been a raise in the cost of living in the previous year.

Retired members who are principally domiciled and physically present in Alaska and receiving a monthly pension may also be eligible for an additional after-retirement increase of 10% of their base pension benefit. This increase is paid on a monthly basis for as long as the member is eligible.

The PERS is administered by the Division of Retirement and Benefits. The division director is the administrator of the plan.

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I have heard about "tiers" in the PERS. How do they affect me and how do I know what tier I am?

PERS is currently a three tiered system with each tier determined by the date a person first became employed with a PERS employer in a PERS-covered position, was receiving compensation and making PERS contributions. This is commonly referred to as your entry or enrollment date.

The tiers establish when a member is eligible for retirement and the after-retirement increases as well as when and if medical premiums are paid by the retirement system or are paid by the member. Tier III members also have a slightly different benefit calculation from Tiers I and II.

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PERS DB Vesting

What does being "vested" mean?

A PERS DB member is vested when they have at least 5 paid-up years of membership service. Once you are vested, you may terminate PERS employment and still receive a monthly retirement benefit when you reach retirement age. However, you must leave your contributions in the PERS to stay vested.

As an active employee in the PERS DB, vesting also expands your death and disability benefits. Prior to vesting, both occupational death and disability monthly benefits are available to apply for in the case of injuries or illnesses arising from occupational causes. Only vested members, however, have monthly benefits upon approval for death or disability resulting from nonoccupational causes.

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Can I claim service to count toward vesting?

Claimed service does not count towards vesting. Members must have 5 years of paid up membership service.

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How do I find out when I will vest?

The PERS does not provide notification of vesting. Since full-time service accrues on a calendar day for day basis, members can determine their vesting date by adding their paid up service periods until a total of five years is obtained. Part-time members can determine their service by dividing their hours worked each year by 1,560 to determine their service for that year (the service earned per year cannot exceed one year). Members needing assistance can contact the PERS.

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PERS DB Service Credit

How do I earn service credit in the PERS?

Full-time members of the PERS earn a day of service credit for each day they are actively employed in a PERS-covered position. This includes holidays or regularly scheduled days off (RDO) as long as you are in pay status the day before and the day after the holiday or RDO.

Part-time members of the PERS, those who work at least 15 hours per week but less than 30 hours per week, receive credit for the number of hours they work. A total of 1,560 hours must be earned to receive a year of service credit. However, service accrued for a stated period of part time service may not exceed the full-time equivalent.

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How do I know how much service I have?

The PERS issues a member statement once each year. The statement includes your total service accrual as of the date of the statement as well as an accounting of all the contributions, indebtedness payments made and interest earned for the year.

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If I think there is an error in my service on the statement, how do I get it corrected?

Your employer reports your service and contributions to the PERS each pay period. If you believe your service is in error, you should contact your employer first. If the employer agrees that there has been an error in reporting, they can correct the error on their next payroll processing or, if they are not able to make the correction that way, they can contact the Division for assistance.

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PERS DB Pension Benefits at Retirement

Does my contribution balance indicate how much I will receive in pension benefits?

This is a common misconception. Your contribution balance does not reflect the true value of your PERS DB pension benefit since it only includes any contributions you have made (as well as any indebtedness payments and interest earned). The employer contributions only become available to members when they qualify and begin to receive a lifetime monthly pension benefit.

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Then how is my pension benefit calculated?

Your pension benefit is calculated using a formula comprised of a multiplier times your average monthly salary (AMS) times the total years of service you have at retirement. PERS is designed to reward longevity, so the multiplier increases at certain key points in a members service.

For "All Other" members, the formula is:

  • 2% x AMS x years of service up to 10 and all years served prior to July 1, 1986; plus
  • 2.25% x AMS x years of service over ten served after July 1, 1986; plus
  • 2.5% x AMS x years of service over twenty.

For "Police/Fire" members, the formula is:

  • 2% x AMS x years of service up to 10; plus
  • 2.5% x AMS x years of service over ten
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What are Excess Salaries?

Highly compensated employees may become subject to the salary limitations under IRS 401(a)(17) if they earn more than the maximum allowed salary for the year. If salaries exceed the limit ($265,000 for 2015) contributions will cease to be taken from their salaries until the start of the next tax year. Any contributions taken in error will be refunded, with interest, to the member and will represent taxable income. Members receiving a refund of contributions under this provision will receive a 1099 at the end of the tax year.

How can I obtain an estimate of what my pension benefit will be?

If you are more than 5 years from retirement eligibility, you can obtain a projection by logging into the myRnB and using the PERS Benefit Estimator.

If you are within 5 years or less from retirement eligibility, you should contact the Member Service Center and order a projection of benefits. Requests are processed in the order they are received. You should allow 15 working days for processing.

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Is there any way to provide continuing benefits to my spouse after retirement if I die first?

Yes. If you are married, you are required to select a joint and survivor option unless your spouse consents to another form of benefit payment. With the election of a joint and survivor option, your benefit is reduced slightly to provide pension and medical benefits for your spouse for the remainder of their lifetime.

PERS provides two levels of survivor payment, 50% of your reduced benefit or 75% of your reduced benefit. If your spouse dies first, your benefit does not change.

Along with the pension benefit, health insurance eligibility will continue.

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What is available to my spouse if survivor benefits are waived and I die first?

With no survivor benefit election, all benefits cease at your death, including the health insurance.

Your spouse would receive your last pension check and the balance of your contribution account, if any, at the time of your death.

Your spouse would also be given an opportunity to purchase health insurance for a limited time under the federal COBRA plan.

Please refer to the PERS Information Handbook on this web site for more detailed information regarding calculation of average monthly salary, survivor options and early retirement reductions.

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PERS DB Medical Benefits at Retirement

Will I have the same health benefits when I retire as I did as an active employee?

Most likely the State of Alaska Retiree Health Plan will differ from the insurance plan you have as an active PERS employee. One of the prime differences is that coverage for medical service and dental, vision and audio services are separate options.

The Medical plan includes coverage for hospitalization, medical, surgical, maternity care and other service necessary for the diagnosis and treatment of an injury or disease for you and your eligible dependents. The health care coverage is good worldwide.

The Dental-Vision-Audio (DVA) plan is an optional plan that all DB retirees have an opportunity to elect.

Another optional plan available to DB retirees is Long-Term Care Insurance (LTC).

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Will I have to pay a premium for the medical insurance?

While all retirees receive the same level of coverage under the Retiree Medical Plan, payment of premiums for this coverage depends on which tier you are in. The PERS is currently a three-tier plan with different requirements for premium payment and eligibility for the medical insurance.

  • Tier I members are eligible for family medical coverage at retirement, whether an early or a normal retirement, with no premium payment.

  • Tier II members have access to medical coverage at retirement, whether an early or a normal retirement.

    "All other" PERS members who retire early, between age 55 and 60, must pay full premium for coverage until age 60. At age 60, medical coverage is provided with no premium payment.

    "All other" PERS members who retire with a normal benefit at any age with 30 years of service or who are vested and at least age 60 are eligible for medical coverage at retirement with no premium payment.

    "Police/Fire" PERS members who retire under age 60 with less than 25 years of service must pay full premium for coverage until age 60. At age 60, medical coverage is provided free with no premium payment.

    "Police/Fire" PERS members who retire with 25 or more years of service are eligible for medical coverage at retirement with no premium payment.

  • Tier III members are eligible for the same benefits as Tier II if they retire with 10 years of credited service. If they retire with less than 10 years of credited service, full premium must be paid for as long as coverage is desired.

All tiers must pay a premium for the optional DVA and LTC plans. Premium rates for these plans are the same for all tiers.

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I am a survivor of a PERS member receiving medical benefits. I plan on remarrying soon. Will my new husband/wife be covered?

No. Only surviving spouses or eligible dependent children of the member can be covered under the medical plan.

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Who is eligible to claim military service for purposes of receiving premium-free retiree medical benefits?

The member must:

  • Have first entered PERS service after June 30, 1986, and before July 1, 1996 (PERS DB Tiers II or III)
  • Be an honorably discharged member of the armed forces of the United States
  • Have at least 20 years of paid- up membership service in the Peace Officer and/or Firefighter occupation classification
  • Not be receiving, or eligible to receive, a federal retirement benefit for the same military service being claimed
  • Have submitted a claim for military service credit for use in the retirement benefit calculation

How does claiming military service to increase the retirement benefit work?

PERS DB members have been able to claim up to five years of military service in the armed forces of the United States for additional credit towards the calculation of retirement benefits since 1960. The basic formula for calculating retirement benefits is: (average monthly salary) x (a benefit multiplier) x (total years of service). Claiming military service allows a member to receive an increased retirement benefit by increasing the total years of service used in the benefit calculation.

How does House Bill 116 provide an additional benefit to qualified members in PERS DB?

HB 116 allows peace officers and firefighters in PERS Tiers II and III who have claimed military service for credit towards the calculation of their retirement benefit to additionally claim up to five years of the same military service to meet the 25-year service requirement necessary to obtain premium-free retiree medical benefits. Claiming military service under HB 116 does not add additional service towards the calculation of the retirement benefit.

What type of military service can be claimed?

The claimed military service must be active-duty service in the armed forces of the United States for which the member received an honorable discharge.

(Members called to active duty directly from PERS employment who return to employment within 90 days of discharge receive PERS service credit. This is not considered “claimed military service” but actual PERS membership service.)

How much military service can I claim towards my eligibility for premium-free retiree medical benefits?

Members may claim up to five years of military service for which they have received an honorable discharge but must first claim military service for use in the retirement benefit calculation. Claiming military service under HB 116 does not add additional service towards the calculation of the retirement benefit. Only need to claim the amount of military claimed service needed to reach the 25-year requirement for premium free medical.

I have already claimed military service in PERS DB. Does this claimed service automatically count towards my eligibility for premium-free retiree medical benefits?

No. The cost to claim military service to meet the 25-year service credit requirement to obtain premium-free retiree medical benefits is separate from the cost to claim military service to increase a retirement benefit. You must file a separate request to claim military service for purposes of obtaining premium-free retiree medical coverage. Claiming military service under HB 116 does not add additional service towards the calculation of the retirement benefit.

How do I pay for claimed military service when used to meet eligibility requirements for premium-free retiree medical benefits?

The cost for the claim will be calculated at the time the member retires. Members may pay all or part of the cost prior to appointment to retirement. Any balance due can be paid for in the form of an actuarially determined reduction to the member’s retirement benefit thereby allowing the member to pay the cost over his/her lifetime after retirement.

Can a Peace Officer or Firefighter who retired with 20 years of service before July 11, 2014, claim military service to obtain premium-free retiree medical benefits?

No. While the legislation was effective immediately upon signature by the Governor, there is no provision for retroactive application. However, a Peace Officer or Firefighter who retired prior to July 11, 2014, and is re-employed as a Peace Officer or Firefighter in PERS may claim military service upon application for an additional retirement benefit.

Can a qualifying member who has a military retirement (20 years or more) purchase up to 5 years of their military time to get medical coverage?

No. A member cannot claim military service for either an increased pension benefit or for premium-free retiree medical benefit if the member is entitled to receive retirement benefits from the United States government for the same service.

Can a qualifying member claim less than five years of military service for the purpose of meeting the 25-year eligibility requirement to qualify for premium-free retiree medical benefits?

Yes, a member may claim only that amount of military service needed to meet the 25-year eligibility requirement for obtaining premium-free retiree medical benefits.

How does a member find out how much claimed military service under HB 116 will cost?

Members who have already claimed military service for use in their retirement benefit calculation may request cost estimates to claim military service for premium-free medical within one year of retirement by calling the Division’s Member Service Center toll-free at (800) 821-2251 or in Juneau at (907) 465-4460, or by email at doa.drb.mscc@alaska.gov. Estimates will typically be provided within 10 days of the member requesting the cost estimate.

What type of documentation does a member need to submit to claim military service?

Once vested, a member can claim up to 5 years of military service to be used in the calculation of their retirement benefit by completing and submitting the Application for Military Service Credit for Benefit Calculation (2-1895) and providing a copy of their DD214 showing the dates of military service being claimed and an honorable discharge. To additionally claim the service under HB 116, the member can complete and submit the Application for Peace Officer/Firefighter Military Service Credit for Medical Eligibility (02-1897) at the time of retirement.

DISCLAIMER

The above information is provided in an effort to give affected members a general overview of recently adopted legislation affecting the benefits of certain PERS DB members. This information does not constitute formal pension, legal or tax advice and is not specific to any individual’s circumstances. Members should consult with a pension counselor before making decisions regarding the claiming of military service. In the event of a conflict between the information contained herein and the plan document, the plan document shall control.

PERS DB Contribution Questions

How can I obtain the contribution account balances for my account and my spouse's account?

Your contribution account balance and any information related to your account is available to you upon proper identification.

Administrative regulations do not allow us to release information regarding personal or financial data to anyone other than the member without the member's prior written authorization unless the inquiring party has a subpoena or a court order to secure the information. We are allowed to release the information to the member's employer, former employer, or other authorized state agency.

A member's spouse or legal counsel is NOT entitled to the member's information without a properly executed release.

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Can I borrow money from my contribution account balance in an emergency?

No! Your account balance is not available to you until you are terminated from employment. Layoff or leave without pay status is not termination for purposes of obtaining a refund.

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What are my options regarding my contribution account balance if I terminate my position?

You always have the option of leaving the money in your account. If you are a vested member intending to retire in the future, or are a nonvested member and intend to become re-employed in a covered position in the future, it may be wise to do so.

If you are nonvested (less than five paid years of service) or single, completing the form is sufficient. If you are a married and vested member, your spouse must consent to the refund on a form provided by the Division of Retirement and Benefits. This form must be notarized. If the rights to your refund are subject to a Qualified Domestic Relations Order (QDRO), you must also provide the notarized consent of each person entitled under the order.

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When can I expect to receive the refund of my account balance?

You should have completed form the Refund Election form which tells us your intentions concerning your refund. If you did not, contact your employer or contact us directly.

There is a minimum waiting period of 60 days from your termination date or 30 days from the receipt of your application, whichever is later, before your refund will be processed. This is to make sure your employer has transmitted all of your contributions and your account can be refunded in full. There would be another week to ten days processing and mailing time once the waiting period has been met.

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What are the tax consequences if I choose to take a refund of my contribution account balance?

First, the Division of Retirement and Benefits and the State of Alaska do not provide tax advice. Each member's tax situation is unique and you must consider the affect on your individual taxes. You should consult with the Internal Revenue Service (IRS) and a consultant as you deem necessary.

Contributions placed in the PERS before July 1, 1986, is "post-tax" contributions. The contributions have already been taxed and you should owe no further tax on them. The interest earnings from these periods are still subject to income taxes.

Contributions and interest placed in the PERS on or after July 1, 1986, is "pretax" contributions. These contributions have not been taxed previously. Therefore, both the contributions and interest earned on these amounts are subject to income tax.

In January following the year in which a refund is made, members will receive a 1099R informational return which indicates the amount of the taxable and nontaxable portions.

For the "pretax" contributions, if you choose to have the refund sent directly to you at your address or to your regular account at a banking institution, the IRS requires that we withhold 20% of the taxable portion of your refund, even if you later choose to do a "rollover" within the 60 day rollover period. You may also be subject to an additional early withdrawal penalty if you receive the refund before age 59½.

You can avoid the withholding tax on the portion of your refund that you have us "Direct Transfer" to another qualified plan that accepts your transfer, such as an IRA. Only the taxable portion of your refund can be transferred. If your refund includes money that has already been taxed, we will refund that portion directly to you without withholding any taxes on it.

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How do I arrange for a direct transfer of my refund?

You must arrange for another qualified plan, such as an Individual Retirement Arrangement / Account (IRA), to accept a direct transfer of your taxable contribution account balance. Once you have arranged for an institution to accept this transfer, you would complete a Notification of Termination/Refund Application form filling in the appropriate information. Be sure to include the plan name, address, plan contact person, and your account number.

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Can a refund be attached by other parties and therefore the account may not be paid to the member directly?

Generally, except for a few exceptions, employee contributions and other amounts held in the system are exempt from levy to enforce the collection of a debt, and are not subject to anticipation, alienation, sale, transfer, assignment, pledge, encumbrance, or charge of any kind, either voluntary or involuntary, without first being received by the person entitled to the amount under the terms of the system.

The exceptions primarily include unpaid state, local, or federal taxes, a Child Support Enforcement Order for unpaid child support, and up to one month's unpaid earnings of an individual employed by a member. In addition, a member's right to receive benefits may be assigned by a Qualified Domestic Relations Order as a result of a divorce or dissolution.

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Can my contribution account balance be attached if I have not terminated my employment?

Until an employee terminates employment or is appointed to retirement, the employee has no right to receive his regular contribution account balance, and therefore, it cannot be distributed at that time. However, while we will not distribute your account balance, we will place a hold on your account. A valid attachment (see the answer to question 10), still in effect when the employee terminates, or is appointed to retirement, will be honored at that time.

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Will I lose my right to retire if I am a terminated, vested member and there is a valid attachment placed on my account?

Yes! If we are forced to honor a valid attachment (see the answer to question 10), a member becomes a former member and loses any rights he or she may have had as a member. Even if the attachment is for a portion of your account balance, we would be forced to refund the balance to you, since there can be no partial refunds from the system. In this instance, an involuntary refund, plus any accumulated accrued interest, may be repaid to the system to reinstate your service without becoming re-employed in a system-covered position. However, if the original attachment is still in effect, any repayments will be forwarded to the appropriate agency to satisfy any amount still due.

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In an emergency, is there any way to obtain a refund of my account prior to the 60-day waiting period?

The Division of Retirement and Benefits takes a critical view of what constitutes an emergency. For any emergency consideration, you must request a waiver in writing, and provide sufficient proof of your emergency. If you have other extenuating circumstances that you feel warrant consideration, you must provide a written detailed description to us along with your request for a waiver. If a waiver is granted in that case, a refund will be processed as soon as your employer has transmitted all of the contributions that were withheld from your pay (generally at least 30 days).

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How can I make payments on my indebtedness?

After receiving verification that your indebtedness has been established, you may make payments on your indebtedness directly to the Division of Retirement and Benefits either in full or with periodic payments over time.

If you intend a payment to pay off your indebtedness balance, you should contact us for the balance. You may also establish a monthly payroll deduction through your employer. We can estimate when your indebtedness would be paid in full based on the amount of deduction you set up. If you have not received verification that your indebtedness has been established, contact us. Interest on your indebtedness will continue to accrue until your indebtedness is paid in full.

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What is the interest rate charged on my indebtedness, and when is it posted?

The interest rate for the PERS is 7%, compounded semiannually. Interest on an indebtedness is posted monthly (see question below regarding interest posting).

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What happens if I have an indebtedness balance left when I retire?

If you have not completely paid your indebtedness by the time you retire, your monthly benefits will be actuarially reduced over your lifetime, unless the reduction causes your benefit to be less than what it would have been without the service related to your indebtedness. If that is the case, your indebtedness payments would be refunded to you.

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When does a payment on my indebtedness have to be received to have it post prior to interest posting?

Interest posts to an account during the last monthly processing cycle during the last week of the month. Your indebtedness payments must be received by the cutoff for input to that processing. Please call the Division for cutoff times.

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Will I lose my tier on July 1, 2006 when the new PERS/TRS DCR Plan becomes effective if I am not vested?

No. Nonvested members whose employer has elected to participate in the conversion option may choose to transfer to the new plan. The decision to elect to convert to the new plan is solely the eligible employee's choice.

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How long will a member have to elect to participate in the defined contribution plan once their employer decides to participate in it?

The window period for election begins on the date the resolution to participate is approved by the PERS Administrator and ends 12 months later or when the member vests, whichever occurs first.

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I am a deferred former member and my former employer is participating in the conversion option. Can I convert my account to the new plan?

Yes and No. Since you are not an active employee with your former employer, you do not have the option to convert to the new plan. However, if you reemploy with your former employer before you vest and before the 12 month conversion period ends, you may elect conversion.

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I worked for two other PERS employers besides my current PERS employer. Will all the PERS employers I worked for have to agree to participate in the conversion option before I can convert?

No. Only the employer you are currently working for must agree to participate in the conversion option. Your current employer is responsible for matching the balance of your employee contribution account up to the allowable limits of the IRC Sec. 415(c) regardless of which PERS employer you may have earned service with in the past.

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PERS DB Death & Disability Benefits

Does the PERS DB Plan provide any benefits to my family if I die?

PERS death benefits are determined by several things--whether the death is from occupational or nonoccupational causes, if the member was vested or not vested (nonoccupational), how much total service the member had, and if they are actively employed or retired at the time of death.

In general, monthly survivor benefits are provided for spouses and dependent children if the death is from occupational causes. These benefits include both pension and medical benefits. If the member is not married and has no dependent children, a lump sum payment is made to the named beneficiary.

If the member dies from nonoccupational causes and is not vested, only a lump sum benefit is available to the beneficiary.

If the member dies from nonoccupational causes and is vested, a surviving spouse has the choice of receiving a monthly survivor benefit, including pension and health, or a lump sum payment. If the member is not married, a lump sum payment is made to the named beneficiary.

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Does the PERS offer me any protection if I become disabled and cannot work?

PERS does not provide short-term disability benefits. It provides disability benefits for occupational and nonoccupational causes for those members who are totally and presumably permanently disabled because of a physical or mental condition.

All PERS members are eligible to apply for occupational disability. Only vested PERS members, however, may apply for nonoccupational disability benefits.

The PERS administrator reviews all applications for disability benefits and the substantiating medical documentation with the assistance of a consulting physician. After a disability application is approved and employment has been terminated, disability benefits will commence.

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The TRS DB Plan

What type of plan is the TRS Defined Benefit (DB) Plan?

For members who first entered the Teachers' Retirement System (TRS) on or before June 30, 2006, the TRS is a Defined Benefit (DB) plan. Your eventual benefit from the plan, if you do not refund your account, is based upon a computation method defined in statute and regulation. It is not based on the amount of money in your refundable account. For anyone hired after July 1, 2006, the TRS is a defined contribution retirement plan (DCR Plan).

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Who is the Plan Administrator?

The TRS is administered by the Division Director, Division of Retirement and Benefits.

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How do I change my address?

You should contact your employer and ask them to submit a change of address for you. If you have trouble getting your address changed through your employer, you should contact the Division of Retirement and Benefits, Accounting Section. If you are retired or no longer working for a TRS employer, you should complete a change of address card and send it to the Division.

TRS DB Vesting

When will I become vested?

You will be vested when you have at least:

  • eight paid-up years of membership service; or
  • five paid-up years of membership service and three paid-up years of Alaska Bureau of Indian Affairs (BIA) service; or
  • fifteen years of paid-up credited service, if the last five years are membership service and you were first hired under the TRS before July 1, 1975; or
  • twelve paid-up years of combined part-time and full-time TRS membership service. You must have at least one-half year of membership service as a part-time teacher or one full year of membership service as a full-time teacher in each of twelve school years.
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How does Leave Without Pay (LWOP) affect my vesting or eligibility for a service based retirement?

Periods of Leave Without Pay (LWOP), whether considered "active" or "inactive," cannot be used to satisfy vesting or retirement eligibility. This would extend the length of time needed to vest or meet eligibility for a service based retirement.

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Can I purchase periods of LWOP?

For "active" LWOP you must pay both the employee and employer contributions to the TRS each month while on LWOP. Contributions should be paid through your payroll office.

For "inactive" LWOP you are not required to pay TRS contributions while on LWOP. When you return to work and claim LWOP, an indebtedness equal to the employee and employer contributions will be established.

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TRS DB Service Credit

What other types of service can I claim in the TRS DB?

You can purchase outside teaching service, Alaska Bureau of Indian Affairs service, or Military service. These are explained in greater detail in other questions and answers.

Part-time members of the PERS, those who work at least 15 hours per week but less than 30 hours per week, receive credit for the number of hours they work. A total of 1,560 hours must be earned to receive a year of service credit. However, service accrued for a stated period of part time service may not exceed the full-time equivalent.

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Can I purchase teaching service from outside Alaska?

You are eligible to claim up to 10 years of full-time service in an out of state school or Alaska private school if you were a:

  • certified elementary or secondary teacher or certified employee in a position which requires a teaching certificate as a condition of employment in an out-of-state public school either inside or outside the United States supported by U.S. funds, or an approved or accredited nonpublic school either inside or outside the United States supported by U.S. funds; or
  • employment in an out-of-state institution of higher learning requiring academic standing and accreditation by a nationally recognized accrediting agency listed in the Education Directory, Colleges and Universities, by the National Center for Education Statistics; or
  • teacher in an approved or accredited nonpublic institution of higher learning in Alaska.

The cost to purchase outside experience will vary depending upon your entry date and entry base salary after the service was performed in the Alaska TRS. Please contact the Division of Retirement and Benefits for cost information.

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Can I purchase teaching service with the Alaska Bureau of Indian Affairs?

You may claim service as a full-time certified teacher in a position which requires a teaching certificate as a condition of employment; or a professional educator. Alaska BIA service may count toward vesting and retirement eligibility. The cost is based on your entry in the Alaska TRS after the service was performed. If your entry was before July 1, 1970, you will be charged 5% of base salary for each year of Alaska BIA. If your entry was after June 30, 1970, you will be charged 7% of base salary for each year of Alaska BIA and if your entry was after June 30, 1990, the charge is 8.65% of base salary.

If you receive a federal benefit based on Alaska BIA, the Alaska TRS will offset their benefits by the amount you receive in federal benefits for that service.

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Can I buy Military time?

You can purchase up to five years of active service including active duty National Guard time. If you were first hired in the TRS after June 30, 1990, and are eligible for a federal benefit based on the same service, you cannot claim the service in the TRS. The cost for eligible service is 7% of your base salary for each year claimed, if you were hired prior to July 1, 1990, or 8.65% of your base salary for each year claimed, if you vested after June 31, 1990.

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Can I receive credit in the PERS at the same time I am receiving TRS credit?

Members cannot receive duplicate credit in PERS except as an elected official. Benefits are payable if you are retired in the TRS and you meet the following:

  • the service occurs while you are a full-time TRS employee;
  • the service is with a municipality or political subdivision that is participating in the PERS at the time the elected service occurs;
  • you are compensated for the elected service; and
  • you pay the mandatory PERS contributions for the elected service (6.75% of salary).
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TRS DB Pension Benefits at Retirement

When can I retire?

If you meet retirement eligibility based on age and you were first hired in a TRS-covered position before July 1, 1990, you can retire with an early reduced benefit at age 50. Normal retirement is age 55. If you were first hired in a TRS-covered position after June 30, 1990, but before July 1, 2006, you can retire with an early reduced benefit at age 55. Normal retirement is age 60.

You may retire from the TRS DB plan at any age with unreduced benefits if you have:

  • 20 paid-up years of TRS membership service;
  • 20 paid-up years of combined TRS membership and Alaska BIA service, if the last five years are membership service;
  • 20 paid-up years of combined years of part-time and full-time TRS membership service (you must have at least one-half year of membership service as a part-time teacher or one full year of membership service as a full-time teacher in each of 20 school years; or
  • 25 paid-up years of credited service, if the last five years are TRS membership service.
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How much will I receive when I retire?

How much depends upon the option you elect at retirement. A member can elect a benefit or elect from three different survivor options. The benefit is calculated based upon the following calculation:

  • 2% * first 20 years * average base salary, plus
  • 2.5% * all years over 20 * average base salary

(All service creditable before July 1, 1990, will be calculated using the 2% multiplier.)

Average base salary is calculated on the three highest salary years during your TRS employment. Salaries that exceed the maximum salary limit under the IRS 401(a)(17) limits cannot be used in the calculation.

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When I retire, am I required to elect a survivor option if I am married?

Yes. State law requires that a married member select a survivor option unless their spouse waives their entitlement to survivor benefits. If survivor benefits are waived, benefits will not continue past the member's death. If health insurance benefits were payable, they will also be discontinued at the retiree's death unless a survivor benefit was elected at retirement.

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What is the 1% Supplemental Option program?

Members who were first hired before July 1, 1982, and have made the additional 1% contribution for one year, may provide survivor's benefits to their spouses and eligible dependent children upon their death. There are two aspects to the benefit. The first is provided if there are dependent children. The monthly benefit is equal to:

  • 35% of base salary at the time of death paid to the surviving spouse
  • 10% for each dependent child, up to a maximum of 4 children
  • 10% for each court-appointed guardian.

When there is no longer any dependent children, the surviving spouse will receive a benefit based on 50% of the retirement benefit the member was receiving at the time of death, or 50% of the benefit the member had accrued at the time of death.

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Will my retirement benefit increase as a result of increases to inflation?

Yes, the TRS provides automatic increases to retiree benefits. The Post Pension Retirement Adjustment (PRPA) is calculated, effective July 1 each year, by multiplying the recipient's base benefit, including past PRPAs, times:

  • 75% of the cost of living increase in the preceding calendar year or 9%, whichever is less, if the recipient is at least age 65 or on TRS disability on July 1; or
  • 50% of the cost of living increase in the preceding calendar year or 6%, whichever is less, if the recipient is at least age 60 on July 1, or under age 60 if the recipient has been receiving TRS benefits for at least 8 years as of July 1.
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What is the Alaska Cost-of-Living Allowance (COLA)?

If you reside in Alaska after you retire, you may receive COLA in addition to your regular monthly benefit. COLA is equal to 10% of your base benefit. "Residing in Alaska" means domiciled and physically present in Alaska. A domicile is that place where you have your true, fixed and permanent home and principal establishment and to which, whenever absent, you intend to return. An absence which exceeds 90 days constitutes a break in residency for COLA purposes.

The following are eligible to receive COLA:

  • Members who were first hired under the TRS before July 1, 1990, and their survivors;
  • members who were hired under the TRS after June 30, 1990, and their survivors if they are at least age 65; and
  • all disabled members.
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If I leave Alaska for a vacation will I still be entitled to COLA?

Yes, if you return to Alaska in less than 91 days. Absences greater than 90 days will result in the removal of COLA beginning the month following your departure for the entire absence. COLA will be reinstated the first of the month following your return and receipt of your application requesting reinstatement. If your absence is required because of illness, you may be out for up to 6 months, however, your absence must be necessary and certified by your physician.

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TRS DB Contribution Questions

How can I obtain the contribution account balances for my account? How can I obtain the same information for my spouse's account?

Your contribution account balance and any information related to your account is available to you upon proper identification.

You can also access your account balance by visiting the myRnB website.

Administrative regulations do not allow us to release information regarding personal or financial data to anyone other than the member without the member's prior written authorization unless the inquiring party has a subpoena or a court order to secure the information. We are allowed to release the information to the member's employer, former employer, or other authorized state agency.

A member's spouse or legal counsel is NOT entitled to the member's information without a properly executed release.

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Excess Salaries

Highly compensated employees may become subject to the salary limitations under IRS 401(a)(17) if they earn more than the maximum allowed salary for the year. If salaries exceed the limit ($265,000 for 2015) contributions will cease to be taken from their salaries until the start of the next tax year. Any contributions taken in error will be refunded, with interest, to the member and will represent taxable income. Members receiving a refund of contributions under this provision will receive a 1099 at the end of the tax year.

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Can I borrow money from my contribution account balance in an emergency?

No! Your account balance is not available to you until you are terminated from employment. Layoff or leave without pay status is not termination for purposes of obtaining a refund.

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What are my options regarding my contribution account balance if I terminate my position?

You always have the option of leaving the money in your account. If you are a vested member intending to retire in the future, or are a non-vested member and intend to become reemployed in a covered position in the future, it may be wise to do so.

If you are non-vested (less than eight paid years of service) or single, completing the form is sufficient. If you are a married member, your spouse must consent to the refund on a form provided by the Retirement and Benefits Division. This form must be notarized. If the rights to your refund are subject to a Qualified Domestic Relations Order (QDRO), you must also provide the notarized consent of each person entitled under the order.

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When can I expect to receive the refund of my account balance?

Complete the Refund Election form (gen008) form to obtain a refund of your contribution account balance.

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What are the tax consequences if I choose to take a refund of my contribution account balance?

First, the Division of Retirement and Benefits and the State of Alaska do not provide tax advice. Each member's tax situation is unique and you must consider the effect on your individual taxes. You should consult with the Internal Revenue Service (IRS) and a consultant as you deem necessary.

Contributions placed in the TRS before January 1, 1991, are "post-tax" contributions. The contributions have already been taxed and you should owe no further tax on them. The interest earnings from these periods are still subject to income taxes. Both interest and contributions taken as a lump sum refund are subject to a penalty for early withdrawal.

Contributions and interest placed in the TRS on or after January 1, 1991, are "pre-tax" contributions. These contributions have not been taxed previously. Therefore, both the contributions and interest earned on these amounts are subject to income tax.

In January following the year in which a refund is made, members will receive a 1099R informational return which indicates the amount of the taxable and nontaxable portions.

For the "pretax" contributions, if you choose to have the refund sent directly to you at your address or to your regular account at a banking institution, the IRS requires that we withhold 20% of the taxable portion of your refund, even if you later choose to do a "rollover" within the 60 day rollover period. You may also be subject to an additional early withdrawal penalty if you receive the refund before age 59½.

You can avoid the withholding tax on the portion of your refund that you have us "Direct Transfer" to another qualified plan that accepts your transfer, such as an IRA. Only the taxable portion of your refund can be transferred. If your refund includes money that has already been taxed, we will refund that portion directly to you without withholding any taxes on it.

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How do I arrange for a direct transfer of my refund?

You must arrange for another qualified plan, such as an Individual Retirement Arrangement / Account (IRA), to accept a direct transfer of your taxable contribution account balance. Once you have arranged for an institution to accept this transfer, you would complete a Notification of Termination/Refund Application form filling in the appropriate information. Be sure to include the plan name, address, plan contact person, and your account number.

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Can a refund be attached by other parties and therefore the account may not be paid to the member directly?

Generally, except for a few exceptions, employee contributions and other amounts held in the system are exempt from levy to enforce the collection of a debt, and are not subject to anticipation, alienation, sale, transfer, assignment, pledge, encumbrance, or charge of any kind, either voluntary or involuntary, without first being received by the person entitled to the amount under the terms of the system.

The exceptions primarily include unpaid state, local, or federal taxes, a Child Support Enforcement Order for unpaid child support, and up to one month's unpaid earnings of an individual employed by a member. In addition, a member's right to receive benefits may be assigned by a Qualified Domestic Relations Order as a result of a divorce or dissolution.

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Can my contribution account balance be attached if I have not terminated my employment?

Until an employee terminates employment or is appointed to retirement, the employee has no right to receive his regular contribution account balance, and therefore, it cannot be distributed at that time. However, while we will not distribute your account balance, we will place a hold on your account. A valid attachment, still in effect when the employee terminates, or is appointed to retirement, will be honored at that time.

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Will I lose my right to retire if I am a terminated, vested member and there is a valid attachment placed on my account?

Yes! If we are forced to honor a valid attachment, a member becomes a former member and loses any rights he or she may have had as a member. Even if the attachment is for a portion of your account balance, we would be forced to refund the balance to you, since there can be no partial refunds from the system. In this instance, an involuntary refund, plus any accumulated accrued interest, may be repaid to the system to reinstate your service without becoming reemployed in a system covered position. However, if the original attachment is still in effect, any repayments will be forwarded to the appropriate agency to satisfy any amount still due.

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In an emergency, is there any way to obtain a refund of my account prior to the 60-day waiting period?

The Division of Retirement and Benefits takes a critical view of what constitutes an emergency. For any emergency consideration, you must request a waiver in writing, and provide sufficient proof of your emergency. If you have other extenuating circumstances that you feel warrant consideration, you must provide a written detailed description to us along with your request for a waiver. If a waiver is granted in that case, a refund will be processed as soon as your employer has transmitted all of the contributions that were withheld from your pay (generally at least 30 days).

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I've just been rehired into a system covered position. Can I reinstate my previously refunded service?

If you hire before July 1, 2010, yes. You may reinstate previously refunded service by repaying your refund amount and any interest that has accrued as required by law. Refunded service does not count toward vesting or retirement eligibility unless the indebtedness is paid in full.

If you hire on or after July 1, 2010, no. You will forfeit your refunded service and tier and will be enrolled in the PERS/TRS DCR Plan.

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How can I make payments on my indebtedness?

After receiving verification that your indebtedness has been established, you may make payments on your indebtedness directly to the Division of Retirement and Benefits either in full or with periodic payments over time.

If you intend a payment to pay off your indebtedness balance, you should contact us for the balance. You may also establish a monthly payroll deduction through your employer. We can estimate when your indebtedness would be paid in full based on the amount of deduction you set up. If you have not received verification that your indebtedness has been established, contact us. Interest on your indebtedness will continue to accrue until your indebtedness is paid in full.

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What is the interest rate charged on my indebtedness, and when is it posted?

The interest rate for the TRS is 7 percent, and it is compounded annually. Interest on an indebtedness is posted monthly (see question below regarding interest posting).

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What happens if I have an indebtedness balance left when I retire?

If you have not completely paid your indebtedness by the time you retire, your monthly benefits will be actuarially reduced over your lifetime, unless the reduction causes your benefit to be less than what it would have been without the service related to your indebtedness. If that is the case, your indebtedness payments would be refunded to you.

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When does a payment on my indebtedness have to be received to have it post prior to interest posting?

Interest posts to an account during the last monthly processing cycle during the last week of the month. Your indebtedness payments must be received by the cutoff for input to that processing. Please call the Division for cutoff times.

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Will I lose my tier on July 1, 2006 when the new PERS/TRS DCR Plan becomes effective if I am not vested?

No. Non-vested members whose employer has elected to participate in the conversion option may choose to transfer to the new plan. The decision to elect to convert to the new plan is solely the eligible employee's choice.

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How long will a member have to elect to participate in the defined contribution plan once their employer decides to participate in it?

The window period for election begins on the date the resolution to participate is approved by the TRS Administrator and ends 12 months later or when the member vests, whichever occurs first.

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I am a deferred former member and my former employer is participating in the conversion option. Can I convert my account to the new plan?

Yes and No. Since you are not an active employee with your former employer, you do not have the option to convert to the new plan. However, if you reemploy with your former employer before you vest and before the 12 month conversion period ends, you may elect conversion.

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I worked for two other TRS employers besides my current TRS employer. Will all the TRS employers I worked for have to agree to participate in the conversion option before I can convert?

No. Only the employer you are currently working for must agree to participate in the conversion option. Your current employer is responsible for matching the balance of your employee contribution account up to the allowable limits of the IRC Sec. 415(c) regardless of which TRS employer you may have earned service with in the past.

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TRS DB Death & Disability Benefits

What happens to my benefits if I die before retirement?

Please visit the Death and Survior Benefits page for details.

Is a completed beneficiary designation a requirement?

Yes, because this is the only record we have of ensuring that death or survivor benefits are paid in accordance with your wishes. If you are married at the time of your death and you were married to the same person during part of your TRS employment, your spouse is automatically your beneficiary, regardless of your written designation, unless:

  • your spouse consents to another beneficiary on the Retiree Beneficiary Designation (gen053) form. However, your spouse's consent to name another beneficiary is not required if the member was married for less than 2 years at the time of his or her death and the member and spouse were not living together when the designation was changed; or
  • another person (such as a former spouse) is eligible for the benefits under a qualified domestic relations order (QDRO) . That person would be entitled to the portion of the benefit that is ordered by the QDRO.
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If I am unable to work because of a disability, can I expect any benefits?

Yes, if you qualify. To qualify for disability, you must have been in a TRS position for 5 years, for which no indebtedness is owing, and be unable to perform the usual duties of your job, or the duties of another job that an employer makes available for which you are qualified by training or education. While disabled, you will receive monthly benefits equal to 50% of your annual base salary immediately before becoming disabled (divided by 12 months). You will receive an additional 10% for each of your dependent children, if any, up to a maximum of four children.

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Account Information

How can I determine my current account balance?

Your account balance, as well as your account activity, is included in your quarterly statement. You may also check your account balance between statements by calling KeyTalk at (800) 232-0859 or by using your PIN to access the information on this site.

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What do I do with my account once I leave PERS or TRS service?

You are not required to remove your funds from the plan once you terminate employment. You may continue managing your account until a future date of your choosing. If you elect to withdraw your account, you may choose between several options. You may elect:

  • to rollover the amount to another qualified plan without tax consequences; or
  • choose a lump sum payout (See "Taxes and Penalties" section); or
  • a monthly annuity for a defined period (5, 10 or 15 years); or
  • a monthly annuity for your lifetime; or
  • a joint and survivor lifetime annuity.
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How do I start benefit payments from my PERS/TRS DCR account?

First, you must be terminated from employment. Then, you must submit an application for payment on the PERS/TRS DCR Distribution Request form. On the form, you can choose to be paid now or to defer payment to a future date.

The date of payment depends on when the Distribution Request is received. Generally, lump-sum payments are paid within 65 to 80 days after termination. Continuing annuity payments usually begin on the first day of the month following the month in which your 60-day waiting period ends.

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Do I have to submit a Distribution Request form if I do not want to be paid now?

If you are age 65 or greater and terminate employment you need to submit a Distribution Request form to defer payment to a later date, not later than April 1 of the year following the year in which you turn 70-1/2 years of age.

If you are under age 65, you do not need to submit a Distribution Request form until you are ready to begin receiving payments.

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Why does my spouse have to submit a waiver when I request payment of my PERS/TRS DCR plan as a lump sum?

Your PERS/TRS DCR plan account is considered marital property subject to equitable division in the event of a divorce or dissolution. Contributions and earning you have accumulated during your marriage are considered to be one-half the property of your spouse.

When you choose any option other than the 50% or 100% joint and survivor option with your spouse as a survivor, your spouse must consent to this choice by signing a Distribution Request form.

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If I have been involved in divorce, dissolution, or legal separation, do I have to submit proof of these circumstances before I can receive payment of my PERS/DCR plan account?

Yes. Because the contributions and earning you have accumulated during your marriage are considered to be one-half the property of your spouse, the plan cannot pay you the funds until the status of your spouse's entitlement is clear. You are required to submit a court-certified copy of the divorce decree or dissolution to the plan for review. If you have been released through the divorce or dissolution, a review of the property settlement will indicate the status of your ex-spouse's share of your account.

If your ex-spouse has retained ownership of his or her share after the divorce or dissolution, the plan requires a domestic relations order (DRO) issued by the court be filed prior to any payments being made from your account. Plan staff will review the DRO to determine if it meets the requirements set out by the statutes governing the plan. If it does, it will then be qualified and the plan will implement the order.

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What additional types of documents might be required before payments can begin?

Depending on the payout form you select, you may be required to provide proof of birth date for yourself as well as your designated spouse and a copy of your marriage certificate.

A birth certificate, baptismal record, military discharge, Alaska driver's license, or a passport are acceptable forms of proof of birth.

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Can I receive payment of my PERS/TRS DCR Plan account if I am laid off?

Yes, if you have been separated from employment.

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Beneficiaries

What is a beneficiary designation?

A beneficiary designation is a form on which you indicate who is to receive any benefits you may be entitled to from the PERS/TRS DCR Plan should you die before drawing your benefits out of the plan.

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I understand my spouse is automatically (50%) my primary designated beneficiary. What do I do if I want to elect someone else as primary?

If you wish to elect another person as your primary beneficiary (50% or greater), your spouse must provide written consent on the PERS/TRS DCR Plan Beneficiary Designation for Active and Deferred Participants form. Consent is not required if you were married for less than one year and you and your spouse were not living together when the designation was changed.

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My spouse and I have divorced. I still wish to have my ex-spouse as my primary beneficiary. Can I do this?

Yes. Since a divorce, dissolution or annulment voids any prior beneficiary designations you have made, you must file a new beneficiary designation after the divorce, dissolution, or annulment specifically affirming in writing that your former spouse is the primary beneficiary.

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I am a single parent and want to leave my account to my minor children. How can I do this?

If your account exceeds $5,000, the plan must make the payment to an adult member of the minor's family who is a court-appointed guardian, a person having custody and care of the minor or a financial institution with a federally insured savings account in the sole name of the minor. A conservatorship must be established for the minor before payments can be made.

If your account is less than $5,000, the plan may make payments without a conservatorship to the court-appointed guardian or person having custody and care of the minor or a financial institution with a federally insured savings account in the sole name of the minor.

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What happens if I don't file a beneficiary designation?

When you fail to designate a beneficiary or, if no designated beneficiary survives you, the death benefit will be paid according to statute in the following order:

  • First to your surviving spouse. If there is no surviving spouse;
  • second to your surviving children in equal parts. If there are no surviving children;
  • third to your surviving parents in equal parts or, if there are no surviving parents;
  • fourth to your estate.
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I want to designate a trust as my beneficiary. Can I do this?

Yes. When an estate or trust is the beneficiary, a copy of the court document naming the personal representative of the estate or trustee of the trust must be filed with the plan along with the beneficiary designation form. The estate or trust must have an Employer Identification Number (EIN) from the federal government before payment may be made.

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How many times may I change my beneficiary?

There is no limit to the number of times you can change who is to receive your benefits in the event of your death. The last beneficiary designation on file is the one the plan will use to determine who should receive your benefits. Please be sure to keep your beneficiary's contact information up-to-date or to change your beneficiary if you have a change in marital status.

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Contributions

How much does my employer contribute to my account?

For PERS members, your employer contributes 5% of your gross eligible PERS salary to your account.

For TRS members, your employer contributes 7% of your gross eligible TRS salary to your account.

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How much do I contribute to my account?

Both PERS and TRS members contribute 8% of gross eligible salary to the defined contribution account.

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Can I make additional contributions to my account?

No. The PERS/TRS DCR Plan does not allow additional voluntary contributions.

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Death and Disability Benefits

Who determines if my death is from occupational causes?

To qualify as an occupational death, the proximate cause of death must be a bodily injury sustained or a hazard undergone while in the performance and within the scope you're your duties and not be the result of negligence on your part. A copy of your death certificate showing cause of death is usually sufficient to show your death was caused by an occupational injury or accident while you were conducting the usual duties of your job. To establish an occupational cause for illness may require additional medical documentation confirming causation.

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What is the difference between benefits that are available to my spouse, if I am married, or to my nonspouse beneficiary, if I am not married, at the time of my death?

Beneficiaries are only eligible to receive the balance of your retirement account, including gains and losses, less expenses.

A surviving spouse is eligible to receive a monthly survivor benefit of 40% of your monthly gross compensation at the time of your death or 50% of your monthly gross compensation if you are a peace officer/firefighter member until the time you would have reached eligibility for normal retirement.

Your employer will also continue to make monthly contributions based on your salary at the time of your death to a survivor account established for your surviving spouse in the occupational death fund. At normal retirement, your survivor may withdraw the balance of this account, including gains and losses, less expenses. This fund is invested by the plan fund managers while the survivor benefit is being paid.

While your surviving spouse is receiving monthly survivor benefits, he or she may not withdraw your DCR retirement account balance. However, your surviving spouse will be able to direct the investment of the account among the ten available options.

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Who determines if I qualify for an occupational disability retirement benefit?

A consulting physician will review your medical documentation and make a recommendation to the PERS/TRS DCR plan Administrator. The Administrator will then review your file and the consulting physician's recommendation to determine if you qualify for a disability retirement benefit. If you are approved for a benefit, you will be notified by phone, followed up by a letter.

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What happens if I'm not approved?

If the Administrator determines you do not qualify for a disability retirement benefit, you may appeal the decision to the Office of Administrative Hearings within 30 days of notification of the denial for benefits. You may also submit additional medical evidence to the Administrator for review.

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Do I have to terminate employment before applying for disability benefits?

No, you do not need to terminate employment before applying for a disability benefit. However, if your disability benefit is approved, you must terminate within 30 days of the Administrator's decision. Your termination of employment must be due to the medical condition causing your disability.

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How do I apply for disability benefits?

You contact the Division of Retirement and Benefits for an application packet. You will receive a booklet that gives you step-by-step information on how to apply and what types of documentation must be submitted. You must submit your application to the division within 90 days after termination of employment if you have already terminated. Remember, you do not have to terminate before you can apply. If you miss the 90-day deadline, please contact the division for assistance.

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How long does it take to find out if you're approved or not?

In general, disability applications take six to eight weeks to process. It can take longer if you do not provide adequate medical documentation or other required information to support your application. It is your responsibility to provide complete information to the division so a determination can be made.

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Will I be eligible for medical coverage while I am receiving disability benefits?

No. Coverage under the retiree medical plan is not available to any participants before eligibility for normal retirement. However, medical coverage can be provided for a limited period by using the federal COBRA entitlement to purchase continuing coverage from your employer health plan as a person losing coverage. Coverage for your disabling condition may be provided by Workers' Compensation. You will be eligible to enroll in the retiree medical plan when you reach normal retirement eligibility.

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What happens if I return to work?

Disability benefits are intended to provide a means of economic survival if you must terminate your employment because of a total and presumably permanent disability. The program is not intended to supplement your income if you should recover from your disability and are able to return to work. If you return to work, you should contact the division immediately.

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Disbursement

When can I receive payment of my PERS/TRS DCR account?

You are eligible to receive payment of your account 60 days after you have been terminated from employment. If you are rehired before the 60-day period has passed, the withdrawal request will be canceled and a new 60-day period will begin at the next termination.

This 60-day period is established in the Alaska Statutes. The only exception is a qualified hardship (see question 50). Actual payment mailing occurs after you have been terminated 60 days.

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Can I receive payment of my PERS/TRS DCR account if I am laid off?

Yes, if you have been separated from service.

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Can I "pay back" money previously paid out from my PERS/TRS DCR plan account?

No. Money previously withdrawn cannot be re-deposited into your account. Once you have requested payment of the account and the 60-day waiting period has passed and the payment has been issued, the account cannot be reinstated.

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How do I start benefit payments from my PERS/TRS DCR account?

First, you must be terminated from employment. Then, you must submit an application for payment on the PERS/TRS DCR Distribution Request form. On the form, you can choose to be paid now or to defer payment to a future date.

The date of payment depends on when the Distribution Request is received. Generally, lump-sum payments are paid within 65 to 80 days after termination. Continuing annuity payments usually begin on the first day of the month following the month in which your 60-day waiting period ends.

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Do I have to submit a Distribution Request form if I do not want to be paid now?

If you are age 65 or greater and terminate employment you need to submit a Distribution Request form to defer payment to a later date, not later than April 1 of the year following the year in which you turn 70 1/2 years of age.

If you are under age 65, you do not need to submit a Distribution Request form until you are ready to begin receiving payments.

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Why does my spouse have to submit a waiver when I request payment of my PERS/TRS DCR plan as a lump sum?

Your PERS/TRS DCR plan account is considered marital property subject to equitable division in the event of a divorce or dissolution. Contributions and earning you have accumulated during your marriage are considered to be one-half the property of your spouse.

When you choose any option other than the 50% or 100% joint and survivor option with your spouse as a survivor, your spouse must consent to this choice by signing a Distribution Request form.

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If I have been involved in divorce, dissolution, or legal separation, do I have to submit proof of these circumstances before I can receive payment of my PERS/DCR plan account?

Yes. Because the contributions and earning you have accumulated during your marriage are considered to be one-half the property of your spouse, the plan cannot pay you the funds until the status of your spouse's entitlement is clear. You are required to submit a court-certified copy of the divorce decree or dissolution to the plan for review. If you have been released through the divorce or dissolution, a review of the property settlement will indicate the status of your ex-spouse's share of your account.

If your ex-spouse has retained ownership of his or her share after the divorce or dissolution, the plan requires a domestic relations order (DRO) issued by the court be filed prior to any payments being made from your account. Plan staff will review the DRO to determine if it meets the requirements set out by the statutes governing the plan. If it does, it will then be qualified and the plan will implement the order.

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What additional types of documents might be required before payments can begin?

Depending on the payout form you select, you may be required to provide proof of birth date for yourself as well as your designated spouse, a copy of your marriage certificate.

A birth certificate, baptismal record, military discharge or a passport are acceptable forms of proof of birth.

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Divorce and Hardship Withdrawl

If I have been involved in divorce, dissolution, or legal separation, do I have to submit proof of these circumstances before I can receive payment of my PERS/DCR plan account?

Yes. Because the contributions and earning you have accumulated during your marriage are considered to be one-half the property of your spouse, the plan cannot pay you the funds until the status of your spouse's entitlement is clear. You are required to submit a court-certified copy of the divorce decree or dissolution to the plan for review. If you have been released through the divorce or dissolution, a review of the property settlement will indicate the status of your ex-spouse's share of your account.

If your ex-spouse has retained ownership of his or her share after the divorce or dissolution, the plan requires a domestic relations order (DRO) issued by the court be filed prior to any payments being made from your account. Plan staff will review the DRO to determine if it meets the requirements set out by the statutes governing the plan. If it does, it will then be qualified and the plan will implement the order.

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Can I receive a hardship withdrawal of my PERS/TRS DCR account while I am still working?

No. You may only withdraw your PERS/TRS DCR Plan account after you have terminated employment.

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Can I receive a hardship withdrawal of PERS/TRS DCR account prior to the 60 days after termination?

Yes. You must be terminated from employment to receive any payment from your account. Only the following reasons are valid to obtain an early eligibility for payment.

  • medical care described in 26 U.S.C. 213(d) incurred by the participant, the participant's spouse, or the participant's dependent, or necessary to obtain medical care;
  • the purchase of a principal residence for the participant;
  • postsecondary education tuition and related educational fees for the next 12-month period for the participant, the participant's spouse, or a dependent of the participant; in this paragraph, "dependent" has the meaning given in 26 U.S.C. 152;
  • prevention of the eviction of the participant from the participant's principal residence or foreclosure on the mortgage of the participant's principal residence; or
  • any need prescribed by the United States Department of the Treasury, Internal Revenue Service, in a revenue ruling, notice, or other document of general applicability that satisfies the safe harbor definition of hardship under regulations adopted under 26 U.S.C. 401(k)
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Investment Services and Fees

I don't know much about investing and don't know how to manage my investment account in the PERS/TRS DCR Plan. What do I do?

Most people do not have the time, the interest or the expertise to manage investments successfully. Keeping this in mind, the PERS/TRS DCR Plan automatically enrolls all new employees into an age based target fund called the Alaska Target Retirement Trust. The target fund provides exposure to a diversified mix of stock, bonds, and money market securities for long-term investors with a higher tolerance for risk. The trust is designed to gradually invest more conservatively as the target year approaches and beyond.

The plan also provides investment advice services offered by Empower Retirement and their subsidiary, Advised Assets Group (AAG).

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I don't want to be enrolled in the Alaska Target Retirement Trust, what do I do?

If you want account management that is tailored to your investment risk tolerance and takes into account other assets you may have or you want to do your own investing, there are three other options available to you. They are:

  • Managed Accounts: Under managed accounts Account you will have your account automatically monitored, rebalanced and reallocated every quarter by AAG based on data resulting from recommendations of an independent financial consultant to respond to market performance. You will receive an account update and forecast statement annually and can update personal information at any time by calling the Plan's toll-free customer service number or visiting the Plan web site.
  • Online Investment Advice: An online tool that provides specific recommendations based upon a participant's financial situation. The recommended investment portfolio is based on information drawn from the Participant's deferred compensation account profile and from the Core Investment Options available in the Plan. The Participant then implements the recommended investment portfolio and manages his or her retirement account online.
  • Online Investment Guidance: An online tool that provides personalized asset allocation assistance without recommending any one specific fund.

You may opt out of the Alaska Target Retirement Trust at any time by calling the Plan's toll-free customer service number or visiting the Plan web site. From there you can enroll in either the managed accounts, advice or guideance features.

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What are the fees for the investment services?

Under Managed Accounts, you will pay 0.5% annually of your assets. The fee is deducted from your account on a quarterly basis.

The fee for Online Investment Advice is $25.00 per year deducted from your account on a quarterly basis.

There is no charge for the Online Investment Guidance tools.

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Do I pay any other fees?

Yes. You will pay a fee to the investment fund managers based on the funds your contributions are invested in. Some of the fees are set while other vary over the course of the year.

You will also pay a recordkeeping and administrative fee of 0.009% of your asset balance monthly as well as a flat fee of $35.00 per year for active participants and $25.00 per year for inactive participants (participants who are not actively employed but still have their contributions managed by the PERS/TRS DCR Plan)

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Health Reimbursement Account

What is the PERS / TRS Defined Contribution Retirement Plan Health Reimbursement Arrangement (HRA) account?

The State of Alaska Public Employees’ (PERS) and Teachers’ (TRS) Defined Contribution Retirement (DCR) Plan Retiree Health Reimbursement Arrangement Plan is established for employees of the state, political subdivisions of the state, and public organizations of the state who first become members of the defined contribution plan of the public employees’ retirement system under AS 39.35.700 —39.35.990 on or after July 1, 2006, and for teachers who first become members of the defined contribution plan of the teachers’ retirement system under AS 14.25.310 —14.25.590 on or after July 1, 2006.

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What is the purpose of the HRA plan?

The purpose of the plan is to allow medical care expenses to be reimbursed from individual savings accounts established for eligible persons.

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How is my HRA funded?

The individual HRA is funded by employer contributions each pay period; no employee contributions are allowed.

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How are my HRA funds invested?

The Alaska Retirement Management Board is the fiduciary of the fund and has the same powers and duties under this section regarding the funds as are provided under AS 37.10.220.

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How is the amount contributed to my HRA account determined?

For each member of the plan, an employer shall contribute to the PERS and TRS retiree HRA trust fund an amount equal to three percent (3%) of the average annual compensation of all employees of all employers in the teachers’ retirement system and public employees’ retirement systems. The annual HRA contribution amount is noticed annually to the ARM Board and then employers and members are noticed via the Employer Rates page.

The amounts contributed annually for each HRA member are shown here:

Fiscal Year Annual
2008 $1,531.27
2009 $1,616.81
2010 $1,699.71
2011 $1,720.70
2012 $1,778.09
2013 $1,848.43
2014 $1,896.60
2015 $1,960.53
2016 $2,004.52
2017 $2,049.36
2018 $2,084.16
2019 $2,102.88
2020 $2,121.60
2021 $2,159.04
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Where is my HRA account balance maintained?

The Division of Retirement & Benefits maintains a separate record for each member to account for the employer contributions on behalf of the member as well as the investment earnings/losses allocated annually to each eligible account balance.

The information is located in two areas: (1) in the member’s myRnB online account (the same place you can find copies of your monthly retiree paystubs) and (2) eligible members will have their HRA account balance reported on their quarterly Empower statement. Additionally, you may contact the Member Services Contact Center.

If you are a retiree that currently uses your HRA account, please contact PayFlex, who administers retiree HRA accounts, for your most current balance.

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Who is eligible for HRA employer contributions?

The following members are eligible for HRA employer contributions: active member currently working for a participating PERS / TRS Defined Contribution Retirement Plan employer per AS 14.25.590(27) and AS 39.35.990(16); those who meet the definition of a PERS/TRS Defined Contribution Retirement Plan member per AS 39.30.495(9); disabled members per AS 14.25.483 and AS 39.35.890; surviving spouse per AS 14.25.487 and AS 39.35.892; and surviving minor children.

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At what age can I start using my HRA?

The normal retirement age is the age set for Medicare eligibility at the time the member retires, currently age 65.

Additionally, a member’s surviving spouse is eligible to elect medical benefits if the member had retired or was eligible for benefits at the time of the member’s death.

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What are the eligibility requirements for the HRA plan?

The requirements are listed below:

  • Age 65 with a minimum of 10 years of defined contribution service
  • At least 30 years of service – TRS and PERS All Other members
  • At least 25 years of service – PERS Peace Officer / Firefighter
  • Does NOT have to retire directly from the plan
  • Or if there is a terminated employer relationship according to AS 39.35.615(a) where the employer terminates from PERS, and an employee/member has service time and HRA contributions from that employer.
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How do I vest in my HRA contributions?

As noted in the FAQ above, you must have at least 10 years of PERS / TRS defined contribution service. However, if you terminate employment before meeting the eligibility requirements noted above, you lose any right to the contributions made on your behalf for the HRA.

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How do I regain any HRA I lost if I don’t meet the eligibility requirements?

If a person returns to employment with a participating employer by December 31 of the year in which the person reaches 65 years of age, the person’s account balance shall be restored in the amount recorded on the date of termination from the trust, adjusted for inflation at the rate of the Consumer Price Index for Anchorage, Alaska. The earlier period of employment with a participating employer shall be credited toward eligibility for medical benefits. You must meet eligibility requirements to begin using the HRA account balance.

However, failure to return to employment before or during the year the member reaches age 65 will result in the irrevocable loss of the HRA account.

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How often is interest posted to a member’s HRA account?

AS 39.30.370 states that “The ARM Board shall establish by regulation the rate of interest applied annually to the amount in a member’s individual account. The regulation established for the annual posting of interest is 115 AAC 112.810 – Health Reimbursement Plan Rate Computation.

The Division has until January 15 of the calendar year following the end of the fiscal year to post interest to an eligible member’s account. Starting with Fiscal Year 2020’s investment income / loss, the Division expects to post investment income / loss by November following a fiscal year. For example, investment income / loss for fiscal year ended June 30, 2020, we expect to be posted to eligible member accounts by November 2020.

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How much interest was posted to eligible member accounts each year?

See the table below for the interest rate applied to eligible member account balances each year:

Fiscal Year PERS TRS
2007 1.0000% 1.0000%
2008 -6.0675% 1.0000%
2009 -11.0290% -11.8556%
2010 1.0000% 1.0000%
2011 20.7688% 21.1813%
2012 2.5555% 2.1560%
2013 14.2995% 14.6413%
2014 22.5315% 23.2874%
2015 4.3376% 4.2197%
2016 0.1549% 0.1109%
2017 17.8758% 17.3789%
2018 10.9103% 10.2339%
2019 8.4785% 8.0819%
2020 6.0265% 5.6086%
2021 41.4117% 39.0786%
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What is involved in the calculation of the interest allocated to eligible member account balances?

The amount to be allocated to eligible accounts is determined by investment earnings (losses) of the fund, reinstatement costs (CPI adjustments), and the fund expenditures for the year.

Before interest is posted, the Division must determine an amount to be transferred to the “Expense and Reinstatement Reserve Account” each year. The reserve account balance equals five times the fiscal year’s expenditures and reinstatement costs (CPI costs for members who reinstated their account balance).

After transfer to the “Expense and Reinstatement Account”, the remaining investment income/loss balance is divided by the eligible member individual account balances as of June 30 to get an interest rate.

Investment income (loss) after transfers divided by Total eligible member balances.

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What is the CPI adjustment?

As noted previously in “Eligibility”, a person who terminates employment before meeting the eligibility requirements of AS 14.25.470 or AS 39.35.870 loses any right to the contributions made on behalf of the person to the TRS DCR and PERS DCR health reimbursement arrangement trust fund.

If a person returns to employment with a participating employer by December 31 of the year in which the person reaches 65 years of age, the person’s account balance shall be restored in the amount recorded on the date of termination from the trust, adjusted for inflation at the rate of the Consumer Price Index for Anchorage, Alaska.

The earlier period of employment with a participating employer shall be credited toward eligibility for medical benefits.

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What is the Consumer Price Index (CPI) adjustment posted to a member’s account if eligible for this adjustment?

See the table below for the CPI rate applied to eligible member account balances each year:

Fiscal Year CPI%
2007 1.422424%
2008 4.625039%
2009 0.408226%
2010 2.708319%
2011 3.003255%
2012 2.237003%
2013 2.698094%
2014 1.979378%
2015 1.070648%
2016 -0.418709%
2017 0.874502%
2018 1.995859%
2019 2.159326%
2020 -0.753937%
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Can I use the HRA if I don't buy the system medical insurance?

If you have at least ten year of service and are Medicare age eligible, yes, you may use the HRA without purchasing the system medical insurance.

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Can the HRA be used for covered expenses my dependents incur?

Yes, in fact, it can be.

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Loans, Pledges, and Attachments

Can I take a loan on my PERS/TRS DCR account?

No. Loans or borrowing of any kind are not permitted.

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Can I assign or pledge my PERS/TRS DCR account?

No. The plan does not recognize any voluntary or involuntary attempt by you to assign, pledge, sell, transfer, or encumber your account. Any attempt to do so is void.

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Can my account be attached in any way?

Yes. Your account can be divided as provided in a qualified domestic relations order with a separate account established for your ex-spouse. Your account can also be attached by a child support order or an IRS levy.

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Taxes, Penalties, and Vesting

What are the taxes and penalties on a PERS/TRS DCR plan payment?

In general, payments you receive will be subject to income taxes. If you choose a lump sum payment to yourself, the plan is required to withhold 20% for payment of federal taxes. In addition, your payments will be subject to an additional 10% penalty if you receive your payment before you reach age 59 1/2. The penalty generally does not apply if:

  • Distributions are paid at your death;
  • You suffer a permanent and total disability and are not eligible for disability benefits from the PERS/TRS DCR plan;
  • You must comply with a Qualified Domestic Relations Order payment [for that portion to be distributed to the alternate payee, however, if an alternate payee transfers the money to an IRA, it is then subject to all the normal tax and penalty rules that apply to an IRA; or
  • You have selected lifetime distribution options.

You are solely responsible for determining how federal tax laws affect your particular situation. You should contact your tax advisor or the Internal Revenue Service if you need additional information. The Division of Retirement and Benefits does not give tax advice.

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When do I vest into my Retirement Savings Account?

You are 100% vested in the contributions you make to the plan and any change in value when they are placed into your account.

You vest in the contributions your employer makes to your account in stages with 100% vesting after 5 years of service. The vesting schedule is:

  • 2 years 25%
  • 3 years 50%
  • 4 years 75%
  • 5 years 100%

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Since I am not vested in the contributions my employer makes to my account until I have five years of credited service, how are the employer contributions invested during that time?

You will be able to invest the employer contributions made on your behalf in any of the fund options you choose when they are placed into your account. The vesting schedule affects how much of the employer contributions and related gains or losses you can refund from the account when you terminate employment.

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Do I have to take my SBS account when I terminate?

No. You do not have to make any decision about your SBS account immediately. Distributions are not required until the later of the first day of April of the calendar year following the calendar year in which you attain age 70 ½ or the date of actual retirement. You can leave your account balance in the plan and continue to control the investments. You can continue to participate in Managed Accounts or Investment Advice.

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Do I have to refund all of my account balance?

No, you can take a partial refund.

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When can I make a withdrawal?

You are first eligible to receive payment of your account 60 days after you have been terminated from employment. If you are re-hired before the 60-day period has passed, the withdrawal request will be canceled and a new 60-day period will begin at the next termination. However, if you terminate, and select an annuity payment, the annuity payment you are receiving will not be affected by subsequent re-employment. Partial lump sum withdrawals will cease upon re-employment. Actual payment mailing occurs after you have been terminated 60 days and the Plan administrator approves your distribution. The only exception to payment eligibility earlier than 60 days after termination is for a qualified hardship. There are very strict criteria that must be met for a hardship distribution.

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What payment options are available?

Payment options include:

  • Do nothing and defer payment until you have obtained the age of Required Minimum Distribution (RMD)
  • Lump-sum payment (full or partial)
  • Five-, 10- and 15-year period certain annuity
  • Single life annuity
  • Single life annuity with 10- or 15-year period certain
  • 50% or 100% joint/survivor annuity
  • Periodic payment
  • Direct rollover to an eligible retirement plan as set forth in the Alaska Supplemental Annuity Plan Document.
Lump-sum payments to participants, former spouse alternate payees, and spouse beneficiaries are eligible for direct transferor rollover to an eligible retirement plan as set forth in the Alaska Supplemental Annuity Plan. A rollover is a payment of your Plan benefits to another eligible plan. A payment from the plan that is eligible for “rollover” can be taken in two ways: You can have your payment paid in a direct rollover or paid to you and rolled over within 60 days of distribution.

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How will a distribution affect my taxes?

You should consult with a qualified tax advisor to determine how the different distribution options will affect your taxes.

This FAQ provides general information regarding the State of Alaska Supplemental Annuity Plan. In the event of a conflict between this FAQ and the plan document, the plan document controls.

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The Deferred Compensation Plan

What is a deferred compensation plan?

The Deferred Compensation Plan allows you to voluntarily set aside a portion of your income either before it is taxed or after it has been taxed. The amount set aside, plus any change in value (interest, gains and losses), is payable to you or your beneficiary at a future date. Upon becoming eligible to participate in the Plan, you may elect to defer your income on a pre-tax or post-tax basis. By doing so, you agree to reduce your salary by an agreed-upon amount. This amount may not exceed certain requirements (outlined below).

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Who is eligible to be in the plan?

Any permanent employee, long-term nonpermanent employee, or elected official of the State of Alaska.

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What type of plan is the DCP and when may a person join the Plan?

The Alaska Deferred Compensation Plan (DCP) is an eligible deferred compensation plan under Internal Revenue Code Section 457. Employees may join any time after they are eligible and complete the necessary enrollment forms.

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How do I enroll?

You may enroll directly on the Empower Retirement site (PIN required), or to request your PIN.

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Where can I find information for Advisory Service Fees, Plan expenses, Plan Payment Options, Tax Information, Account Tracking, and Other Details?
What are the transactions required through Empower Retirement Services?

The following transactions must be conducted through Empower Retirement Services:

  • Inactive and Retired Employees: Changing your address or your name. (Active employees: Contact your employer to change your address or name.)
  • Account Withdrawals: Empower Retirement Services processes all Plan payments. Empower Retirement Services should be contacted for information on how to complete disbursement forms and for the status of pending payments.
  • Hardship withdrawals
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Who is the Plan Administrator?

The Division of Retirement and Benefits is responsible for the overall administration of this plan. To contact the Juneau Division of Retirement and Benefits office, call (800) 821-2251, or (907) 465-4460 from Juneau.

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What happens to my accrued personal leave if I leave state service on or before December 31, 2018?

If you do nothing else, the dollar value of your accrued personal leave will be paid out to you in your final paycheck. The amount paid to you will be subject to applicable taxes.

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How is the dollar value of my accrued personal leave derived?

In accordance with 2 AAC 08.045, personal leave balances are converted monthly to a cash value, by multiplying the hours accrued by the annualized hourly rate of pay for the pay period.

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Is there a way to defer paying taxes on my accrued personal leave?

Yes. If you participate in the State’s deferred compensation plan you can direct some or all of your leave (depending on what you have contributed so far in the tax year) to your deferred compensation account. You must submit a request to the Division of Retirement Benefits, Attention Natalya Khomyakova at . There is a deadline for submitting the request, however.

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What is the deadline for submitting a request to convert leave for deposit into my deferred compensation account?

Under the terms of the Alaska Deferred Compensation Plan, requests must happen in the month prior to termination. Therefore, if you know the month in which you plan to terminate state employment, you must submit the conversion request anytime during the prior month.

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What if I am not currently enrolled in the Deferred Compensation plan?

If you would like to enroll in the Deferred Compensation Plan you can either complete your enrollment online or you can fill out the enrollment form and submit it to Empower Retirement at the fax number listed on the form. If you need a pin number for the website you can contact Empower Retirement at (800) 232-0859.

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When can I access my account?

You can access your account after you have terminated employment or there is an unforeseeable emergency (as defined by the Alaska Deferred Compensation Plan). When you qualify for a distribution, your account value may be applied to the distribution option(s) you choose. These options include:

  • Do nothing and defer payment until you have obtained the age of Required Minimum Distribution
  • Lump-sum payment (full or partial)
  • Five-, 10- and 15-year period certain annuity
  • Single life annuity
  • Single life annuity with 10- or 15-year period certain
  • 50% or 100% joint/survivor annuity
  • Periodic payment
  • Direct rollover to an eligible retirement plan as set forth in the Alaska Deferred Compensation Plan.

You may begin receiving funds immediately or defer receipt until to any date up to April 1 of the year after attaining age 70½. You will be allowed to take partial distributions, and there is no limit on the number of payments that can be taken; however, if you do not receive payment of your entire account, you must maintain a minimum $1,000 account balance.

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What if there is a change of administration?

The Division of Retirement and Benefits will provide information and group seminars on leaving state employment in November. Generally speaking, employees that wish to convert leave to deferred compensation have adequate opportunity to do that in November so long as their last day of service is in December. The Governor is sworn into office at 12 noon on December 3.

If, however, you believe you will terminate state service in December, you should consider converting personal leave in November. Leave cash in requests for the month of November must be submitted to the Division by November 30.

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Contribution & Investment

What is the pre-tax/post-tax contribution option?

Pre-tax contribution option: Contributions to your account made under the pre-tax options reduce your taxable income for the year. These contributions and all associated earnings are then not subject to tax until you terminate employment and withdraw them.

Post-tax contribution option:The Deferred Compensation Plan has a Designated Roth Option that permits contributions to the plan on an after-tax basis. The Roth deferrals and associated earnings can be withdrawn tax-free in the future if the requirements for a qualified distribution are met. You may designate all or a portion of your contributions to the Designated Roth Option.

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What is the minimum and maximum amount I may defer?

The regular contribution limit for those UNDER age 50 is $19,000 in 2019. Members age 50 or older will be able to make additional contributions. The increased contribution amount is $6,000 for 2019.

You may defer a minimum of $50 per month ($25 each pay period).

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What is the “special catch-up” provision?

The catch-up provision is available to employees who are within three years of their normal retirement eligibility. Special catch-up allows you to make up for contributions you could have made during previous years of state employment but didn’t.

The special catch-up limit is double the regular contribution limit. For 2019, this could be up to $38,000.

You may contribute under the special catch-up provision for a maximum of three consecutive years. Once you elect to enroll in the special catch-up provision, if you do not utilize it for all three consecutive years, you cannot make up the amounts not utilized at a later time or with another employer.

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Can I change my contribution amount?

You may increase or decrease your contribution amount once per month.

What if I need to make investment changes?

You may make transfers among existing fund options and allocation changes for future contributions once a day. There is no charge.

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What are my investment options?

The Plan provides for twenty-seven investment alternatives. Once contributions have been allocated among these funds (in whole percentages ranging from 0% to 100%), money may be transferred across funds daily. Investment Options Detail Sheets and Investment Performance Monthly Reports are available on the Empower Retirement website

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How can I get help choosing my investment options?

Your Plan offers access to three different levels of investment advisory tools and services called Reality Investing® Advisory Services. You can have Advised Assets Group, LLC (AAG), a wholly owned subsidiary of Empower Retirement and a federally registered investment adviser, manage your retirement account for you. Or if you prefer to manage your retirement account on your own, you can use online investment guidance and advice tools. These services provide a retirement strategy based on your investment goals, time horizon and tolerance for risk. There is no guarantee that participation in Reality Investing Advisory Services will result in a profit or that your account will outperform a self-managed portfolio.

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Periodic Payments

How do Periodic Payments work?

The Periodic Payment option is one of the many available benefit payment options under the State of Alaska Deferred Compensation Plan. With Periodic Payments, you are able to enjoy benefit payments that are withdrawn directly from your account balance. You elect the amount and frequency of your payments. Your remaining account balance will continue to earn gains or losses associated with the funds your account is invested in.

Unlike life annuity options, Periodic Payment options provide NO guarantee of lifetime income. The benefit payments will continue only until assets are depleted. You should carefully review all your payout options before making a selection.

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What is the minimum amount I must withdraw?

The minimum payment to you must be an amount which meets the distribution requirements of the Internal Revenue Code, but can never be less than $50. Payments will be made at the necessary frequency to ensure the $50 minimum payment is met.

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What is the frequency of payments?

All payments are available on a monthly, quarterly, semi-annual or annual basis, so long as the $50 minimum is met.

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How will payments be made?

When a payment is due, the appropriate number of units will be redeemed to equal the payment amount. Because the unit values will vary from payment date to payment date, the number of units redeemed will vary accordingly.

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In what order are investment options liquidated?

Your investment options automatically will be liquidated on a pro rata basis. However, you may elect specific funds for payments to be drawn from as long as there are sufficient monies available.

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Who controls the assets during the payout phase?

You maintain control of investments of the account balance during Periodic Payment payouts.

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Are there additional expenses associated with Periodic Payments?

There are no additional expenses, but all plan expenses continue to apply (recordkeeping, investment management, etc.).

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May I change the benefit payment level?

Yes. You may change your payment structure at any time. You must always meet any minimum distribution requirements that apply by law.

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Can Periodic Payments be stopped and the balance moved to an IRA or other qualified plan?

Yes. You can decide to do a partial or complete transfer, or rollover, to an IRA or other qualified plan. However, once there, all the tax penalty rules that did not apply to a regular payment from a 457 plan (i.e., the 10% early distribution penalty for payments before 59-½) now apply to payments made from the other plan.

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What are some of the advantages and disadvantages of Periodic Payments?

Advantages:

  • You can transfer among all investment options available under the plan during the payout phase.
  • Payments before 59-½ are not subject to an additional 10% early distribution penalty.
  • You have maximum flexibility in the payment method. You can change the payment method at any time.
  • You can later decide to direct transfer or rollover your account to an IRA or other qualified plan.

Disadvantages:

  • You can outlive assets (unlike life annuity options).
  • Your payments may fluctuate.

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What is the death benefit?

The death benefit is the remaining account balance. No more payments will be made and there will be no death benefit when the account balance is zero.

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Roth 457 Questions

What is the Roth 457 option?

The Roth 457 option for governmental deferred compensation plans was authorized by Congress effective January 1, 2011. A Roth 457 is not a Roth IRA. Neither is a Roth 457 a separate plan; it is simply a way for employees to control the taxation of their deferred wages when they are disbursed in the future. This option allows employees to elect after tax salary deferrals into a Roth option. Roth elective deferrals are accounted for separately from the pre-tax contributions made to the plan. Distributions from the Roth 457 are tax free if the contributions have been in the Roth elective deferral account for at least 5 years and the participant is at least 59 ½.

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Who should consider the Roth 457 option?

For some employees, it might make sense to pay taxes on the DCP contributions now, rather than when money is withdrawn at retirement. Employees who would benefit are:

  • Employees who expect either their pay or tax rate to increase substantially over time. Being taxed at a lower rate today may be a better option.
  • Employees who expect to have relatively higher plan account investment earnings or to otherwise end up with a higher amount of money set aside for retirement, may benefit from paying taxes up front or just having a pool of tax-free money to draw on in the future.
  • Younger employees who have a longer retirement horizon and more time to accumulate tax-free earnings under a Roth 457.
  • Older employees who may want to leave tax-free money to their heirs in the future.
  • Employees may want the option of not taking required withdrawals at age 70 ½ by rolling their Roth 457 to a Roth IRA.

The Roth 457 option gives employees more flexibility to save for retirement and provides control over when contributions, and retirement income, will be subject to federal income tax.

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Can employees contribute to both pre-tax and Roth 457 post-tax basis at the same time?

Yes, but the Roth 457 contributions count towards the IRS limitations on deferred compensation contributions. Roth 457 contributions can either replace or complement traditional pre-tax contributions subject to the IRS limits of $18,000 per year (2015) plus an additional $6,000 in 2015 if the employee is age 50 or older at the end of the year.

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Once contributions are made to the Roth 457, can they be moved to the pre-tax account?

No. There can be no mixing of the two types of contributions.

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Does this affect an employee's ability to contribute to a Roth IRA?

No. Contributions to a Roth 457 have no effect on contributions to a Roth IRA.

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Is there a special fund the Roth 457 contributions are invested?

No. Employees may invest Roth 457 contributions in any of the present fund options available in the Alaska Deferred Compensation Plan.

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Are there special withdrawal options for the Roth 457 contributions?

No. The disbursement options remain the same for Roth 457 contributions. Earnings on the Roth 457 contributions will not be subject to taxation, however, if the employee is at least age 59 ½ and has held the Roth 457 account for 5 years or more.

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How is the 5-year period of participation calculated?

The 5-year period of participation begins on the first day of your taxable year for which you first made designated Roth contributions to the plan. It ends when five consecutive taxable years have passed.

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Does the DCP offer an in-plan Roth 457 rollover?

An in-plan Roth rollover is a rollover from your pre-tax contributions in DCP to the post-tax Roth 457 option. At this time the plan does not allow for this type of rollover.

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A Roth IRA has income restrictions. Do these restrictions apply to the Roth 457?

No, there are no limits on your income in determining if you can make designated Roth 457 contributions. Of course, you have to have sufficient salary from which to make the deferral, and you are subject to the IRS limit on the amount of contributions per year.

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Can I make a designated Roth contribution for my spouse if my spouse has no earned income as permitted with a spousal IRA account?

No, you cannot contribute to a governmental Roth 457 for your spouse.

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Can I make age-50 catch-up contributions to the Roth 457 option?

Yes, provided you are age 50 or older by the end of the year.

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Can I roll my Roth IRA into this new Roth 457 option?

No, the IRS does not allow this type of rollover.

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Are the contributions in my Roth 457 option subject to the IRS required minimum distribution (RMD) rules?

Yes. Designated Roth accounts are subject to the RMD rules. A participant must begin taking annual distributions from the account by either age 70 ½ or retirement, whichever is later.

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General

Why have I received multiple ID cards?

To improve our network and customer service, AlaskaCare selected Aetna to administer all medical and pharmacy claims and Moda Health to administer all dental claims. In the past, these services had been provided by a single company. You should have received a medical ID card from Aetna and a dental ID card from Moda to use when visiting your health care provider or pharmacy.

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How do I obtain a new ID card?

You can download a digital copy of your ID card online:

You can request a new physical ID card by calling:

  • For medical ID cards contact the Aetna Concierge at (855) 784-8646.
  • For pharmacy ID cards contact the OptumRx Service Center at (855) 409-6999.
  • For dental ID cards contact the Delta Dental Service Center at (877) 277-7280.

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How can I get a copy of the Employee Insurance Information booklet?

Plan Booklets are available for all members of the AlaskaCare health plans, they are designed to help you understand your plan and the benefits it provides. You’ll find a benefit summary and information about plan coverage, how benefits are paid, travel coverage, precertification, what expenses are covered, and more.

For your convenience, the Plan Booklets are available on the AlaskaCare website. You can view the booklets online or download them to your computer.

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Will I be taxed on my health benefits?

You are not taxed on premium payments you make for your health benefits, or any contributions you may make to a Health Flexible Spending Account (HFSA). The plan meets the criteria under Internal Revenue Code §125 and its accompanying Treasury Regulations, which govern cafeteria plans as offered under the Select Benefits Health Plan. This allows for premiums that are taken from your pay check to be deducted prior to taxes being calculated.

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Network Providers

How do I find a network vision provider?

To find a network provider:

  • Call Aetna's Health Concierge at (855) 784-8646 or select the "Find a Doctor" button on our website, AlaskaCare.gov.
  • Call Moda/Delta Dental at (855) 718-1768 or select the "Find a Dentist" button on our website
  • Call OptumRx at (855) 718-1768 or select the "Find a Pharmacist" button on our website.

Find a Provider
What if my provider isn't in the network?

If your current provider is not listed as an in-network provider, you can ask your physician to contact AlaskaCare for a participation application. If you would like the provider to receive an application, please complete the Provider Nomination form . When you use a network provider, you can take advantage of the significant discounts negotiated to help lower your out-of-pocket costs for medically necessary care. This can help you get the care you need at a lower price.

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When I use an out-of-network provider, how much of the bill am I responsible for?

If you use an out-of-network provider, you are responsible for the difference between the recognized charge and the amount charged by the provider in addition to other applicable charges such as deductibles, co-payments, co-insurance and non-covered charges.

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What is balance billing?

The AlaskaCare plans limit payment of covered services to the recognized charge. The recognized charge is the maximum amount the AlaskaCare plans will pay for a covered service. Aetna and Moda/Delta Dental, and their respective network providers (sometimes referred to as participating providers), agree to a set of discounted negotiated rates for services provided. The recognized charge for network providers is the negotiated rate. For an explanation of how the recognized charge is calculated for out-of-network providers, please see the recognized charge questions under the Network and Dental sections.

An out-of-network provider has the right to bill you for the difference between the recognized charge and the actual charge. This is often referred to as balance billing. Network providers have agreed to accept, as payment in full, the negotiated charge. Therefore, you are not subject to balance billing when you use a network provider.

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How do I avoid receiving a balance bill?

You may prevent balance billing by verifying all medical providers are in the Aetna network and making sure your AlaskaCare Plan covers the services you need. For example, if you're having x-rays, MRIs, CT scans, or PET scans, make sure both the imaging facility and the radiologist who will read your scan are in the network.

Similarly, for AlaskaCare covered dental services, you may prevent balance billing by verifying the provider is in the Moda/Delta Dental network.

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What if there is no network provider available?

If your provider is not a network provider, you may ask for an estimate of charges, the codes that will be used use for billing, and the provider's zip code. When you receive this information, contact the Aetna Concierge at (855) 784-8646 or Moda/Delta Dental at (855) 718-1768. A member of the Aetna Concierge or Moda Customer Service team can review the estimated charges and will advise you if the charges fall within the recognized charge for your area. If the estimated charges exceed the recognized charge, you may request that your provider accept that amount and not balance bill you, or you may request payment arrangements with their office.

If your current provider is not listed as a network provider, you can ask your provider to contact Aetna at (800) 720-4009 or Moda at (855) 718-1768 for a participation application. Members are also encouraged to nominate their out-of-network providers to join the network. Contact the Aetna Concierge or Moda Customer Service to find out how.

In some cases, unfortunately, there will not be a network provider for the service you need in your area. The Division, Aetna and Moda/Delta Dental are working diligently to improve network access, but please understand that we cannot force providers into the network.

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Is there a "network" for durable medical equipment (DME)?

Yes, there is a network of providers for durable medical equipment. For assistance finding a network provider call the Aetna Concierge at (855) 784-8646 or search online using the Aetna DocFind tool .

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Recognized Charges

What is a recognized charge?

Recognized charge means the negotiated charge contained in an agreement the claims administrator has with the provider either directly or through a third party. If there is no such agreement, the recognized charge is determined in accordance with the provisions of this section. Except for charges related to involuntary out-of-network services, an out-of-network provider has the right to bill the difference between the recognized charge and the actual charge. This difference will be the covered person’s responsibility.

Medical Expenses: As to medical services or supplies, the recognized charge for each service or supply is the lesser of:

  • What the provider bills or submits for that service or supply;
  • Or the 90th percentile of the prevailing charge rate; for the geographic area where the service is furnished as determined by Aetna in accordance with Aetna reimbursement policies.

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Where can I get more information about recognized charges?

For more information on recognized charge in the Employee Plan, see the AlaskaCare Insurance Information Booklet , section 3.3.7 Recognized Charge

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Coordination of Benefits

What is Coordination of Benefits?

Coordination of Benefits (COB) is a method of ensuring that people covered by more than one medical plan will receive the benefits they are entitled to but not more than 100% of their covered expenses. The AlaskaCare health plans coordinate benefits with other group health care plans to which you or your covered dependents belong. Coordination of benefits can be very confusing, even for people who work at a physician's office.

With COB, if you are covered by more than one health care plan, the plans work together to provide benefits. One plan is considered "primary" and pays your covered expenses first. The other plan is "secondary" and pays any remaining covered expenses up to 100%. In some cases, there may be a third or fourth plan, as well.

It is important to remember that not all expenses are covered expenses.

Who sets COB rules?

Most COB rules are set by the National Association of Insurance Commissioners (NAIC). Rules for coordinating with Medicare and Medicaid are set by federal and state law. Most plans follow the NAIC rules, but there is no requirement that they do so. The AlaskaCare health plans follow standard NAIC rules to ensure ease of coordination with other plans.

What are the rules?

Here are examples of common COB situations and rules:

If You Are Covered Under… Here's How the Plans Pay
Active employee plan and retiree plan Primary: Active employee plan
Secondary: Retiree plan
Retiree plan and as dependent under another person's plan through active employment Primary: Retiree plan
Secondary: Other person's plan
Retiree plan and Medicare-eligible Primary: Medicare
Secondary: Retiree plan
Two retiree plans Primary: Plan in force the longest
Secondary: Other plan
Retiree plan, as dependent under another person's plan through active employment, and Medicare-eligible Primary: Other person's plan
Secondary: Medicare
Third: Retiree plan
Active employee plan, retiree plan, as dependent under another person's plan through active employment, and Medicare-eligible Primary: Active employee plan
Secondary: Other person's plan
Third: Medicare
Fourth: Retiree plan

If your dependent children are covered under more than one plan, in most cases, the plan of the parent whose birthday falls earlier in the year (not the oldest) is primary. If both parents have the same birthday, the plan that has covered the children longer is primary. If the parents are separated or divorced, here's how the plans pay:

  • Primary: Plan of the parent whom the court has established as financially responsible for the child's health care (the claims administrator must be informed of the court decree)
  • Secondary: Plan of the parent with custody of the child
  • Pays third: Plan of the spouse of the parent with custody of the child
  • Pays fourth: Plan of the parent who does not have custody of the child
What if none of the rules describe my situation?

If none of the above rules applies, the plan that has covered the patient the longest is primary.

How do the plans coordinate if my AlaskaCare plan is secondary?

When an AlaskaCare plan is secondary, the amount the plan pays after the deductible is met is figured by subtracting the benefits payable by the other plan from 100% of expenses covered by the AlaskaCare plan on that claim.

Will the coverage from two AlaskaCare plans always pay 100% of what the provider charges?

No, you may receive a balance bill if you use an out-of-network provider. In this case, the plan will pay up to the recognized charge for this service in your area.

I am covered under the AlaskaCare Employee Health Plan. Is there anything my spouse should consider when making elections to a State employee union health trust?

The AlaskaCare Employee Health Plan will only pay 30% of the covered charges for your dependents if your spouse, qualified same-sex partner or child(ren) are covered by a state employee health trust and that coverage:

  • Has been waived,
  • Pays less than 70% of covered expenses, or
  • Has an individual out-of-pocket maximum (including deductible) of more than $3,500.

This applies to any dependent covered by the AlaskaCare Employee Health Plan whether the plan pays as primary or secondary.

Example:

  • You incur covered expenses of $1,000. Your spouse elected limited coverage under a union health trust that pays 20% coinsurance, so your AlaskaCare Employee Health Plan will pay 30% after the deductible.
  • Spouse's plan pays: $200 (20% of $1,000)
  • AlaskaCare plan pays: $300 (30% of $1,000)
  • Total paid: $500
  • Potential balance bill amount: $500 ($1,000 - $500)

Dental Plan

Are routine dental cleanings a covered benefit?

Prophylaxis (cleaning) or periodontal maintenance is covered up to two times in any benefit year. Additional cleaning benefits may be available if medically necessary or dentally necessary and when precertified by Moda/Delta Dental.

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What if my health condition makes more frequent cleanings necessary?

If you are diabetic or pregnant in your third trimester, the Oral Health, Total Health program offers more ways to care for your teeth and mouth.

Diabetes increases the risk of cavities, periodontal (gum) disease, tooth loss, dry mouth and infection. If you have been diagnosed with this disease you are eligible for four prophylactic (preventive) cleanings or periodontal maintenance visits per year through our Oral Health, Total Health program. Protect your teeth and gums by enrolling today.

Pregnant women who have periodontal (gum) disease are more likely to have a premature and underweight baby. Bacteria can enter the bloodstream through the mouth, and the body’s response to the infection can trigger early labor. If you are expecting, you can enroll in the Oral Health, Total Health program to help prevent gum disease. If you’ve already had two cleanings for the year, you’ll be eligible for another cleaning or checkup during your third trimester.This added preventive (prophylactic) visit is covered regardless of normal plan frequency limits.

For details on the Oral Health, Total Health program, refer to AlaskaCare Employee Health Plan booklet or call Delta Dental Member Services at (855) 718-1768.

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Prescription Compound Medication

For information on compound medications call OptumRx at (855) 409-6999.

What is a Health Reimbursement Arrangement (HRA)?

The HRA is a tax-free medical reimbursement plan funded by the employer for members enrolled in the Consumer Choice plan. The balance of the HRA is applied towards the Consumer Choice deductible each benefit year until the HRA balance is exhausted. Unused HRA money can be rolled over to be applied towards the next benefit year deductible.

How does an HRA work?

Participants in the Consumer Choice plan will receive a HRA contribution from the state in the amount of $750.00 annually for a single employee, or $1,500.00 for a family. As long as you are enrolled in the Consumer Choice plan with the state, any unused HRA funds can rollover from year to year, for a maximum of up two years (prior benefit year and the current benefit year). Once you are no longer enrolled in the Consumer Choice plan any remaining balance in your HRA will be forfeited.

How does a HRA work for a family?

The family HRA account balance of $1500.00, will be applied towards the deductible before any family member must pay.

Is this a high deductible health plan and does it qualify for a Health Savings Account (HSA)?

No. The Consumer Choice Health Plan does not meet the Internal Revenue Code standards for a High Deductible Health Plan, and it does not have a Health Savings Account (H.S.A.) option. Instead, the Consumer Choice Health Plan has an embedded Health Reimbursement Account (HRA), fully funded by the state, applied to the deductible, to help reduce member costs.

Are preventive services subject to a plan deductible?

No, not when in-network providers are use. The health plan covers eligible preventive services at 100% when received at a network provider, so it's important to make sure you are using a network provider. This means you will you have no out-of-pocket costs (no co-insurance or deductible) for eligible preventive services, including checkups and age-appropriate preventive testing (such as routine blood tests, mammograms or colonoscopies).

Is the HRA part of my health benefits plan?

Yes, the HRA is integrated with the Consumer Choice plan to help offset your annual deductible.

Can I contribute funds to a HRA?

No. IRS regulations do not allow an employee to contribute to an HRA. Only the employer can contribute to your HRA.

Can HRA funds be rolled over from year to year?

Yes. Unused funds from a current year can rollover to the next benefit year if you remain enrolled in the Consumer Choice plan. HRA funds rollover is limited to a maximum of two years, this means that the maximum balance a single employee can have at any time is $1,500. Once you are no longer enrolled in the Consumer Choice plan, any remaining HRA funds will be forfeited.

How do I check my HRA balance?

You can keep track of your account balance by keeping track of your medical claims. You can also get a copy of your claims history from Aetna.

What happens to the money in my HRA if I leave my job or retire?

Any funds left in your HRA when you terminate employment or retire are forfeited. Active employees who elect COBRA have the option of continued enrollment in the Consumer Choice plan with HRA. Remaining HRA funds will remain available if you elect COBRA after leaving state employment. You should contact your health plan administrator for more information on COBRA.

Can I be enrolled in both a HRA and a Health Flexible Spending Account (HFSA)?

Yes. A HRA can work in conjunction with a HFSA, but you can’t be reimbursed from your HFSA for expenses already covered by the HRA.

What if I enroll in the Consumer Choice plan mid-year?

New employees will be entitled to the same HRA contribution at any time during the plan year. HRA contributions will not be pro-rated.

What is SurgeryPlus?

SurgeryPlus is a supplement to your employer’s medical plan that you’re already enrolled in, and is part of your benefits package. It helps you and your covered family members plan and pay for non-emergency surgeries. SurgeryPlus offers access to a top-tier network of specialized surgeons, while providing you with your very own personal assistant to handle the logistics of planning for surgery.

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How do I use SurgeryPlus?

To get started, call SurgeryPlus directly at (855) 715-1680. You will be in contact with a SurgeryPlus Care Advocate who will walk you through the steps to receive the surgery you need. SurgeryPlus will verify if you need any pre-authorizations or precertifications, schedule consultations with you and a Surgeon of Excellence, verify and collect any needed deductible amount, coordinate all the travel logistics, and provide post-surgery follow-up.

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How much does SurgeryPlus cost?

Just by being a member of your health plan, you already have access to these services. There is no additional cost to you to participate. You only need to meet your deductible, just like you would with any surgery, and SurgeryPlus takes care of the rest.

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What expenses are covered if I choose SurgeryPlus for my surgical care?

In addition to covering the cost of travel, there is no additional charge for the concierge service or coordination of care. Within the episode of care, covered expenses include, but are not limited, to the professional fees (surgeon, assistant surgeon, hospitalist, nursing staff, etc.), inpatient pharmacy, anesthesia, facility fees, some diagnostic testing, pre-op consultation and appointment, and post-operative follow-up appointment when appropriate.

Portions of the episode of care that are not covered include, but are not limited, to durable medical equipment (braces, crutches, walkers, etc.), some diagnostic testing, physical therapy, and in-home nursing care. These services vary based on the procedure type and can be covered by your traditional medical insurance, and are subject to standard costs for utilizing your traditional medical insurance.

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Do I have to use SurgeryPlus?

No, SurgeryPlus is a supplemental benefit, and participation isn’t mandatory. You can expect access to world-class surgeons that have been rigorously screened, not only for their education and training, but also for their volume and complication rates. You may also expect financial savings by using SurgeryPlus.

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What surgeries are covered?

SurgeryPlus covers hundreds of non-emergent surgery types within most of the surgical specialties including, but not limited to, the following:

  • Knee
    • Knee Replacement
    • Knee Replacement Revision
    • Knee Arthroscopy
    • ACL/MCL/PCL Repair
  • Hip
    • Hip Replacement
    • Hip Replacement Revision
    • Hip Arthroscopy
  • Shoulder
    • Shoulder Replacement
    • Shoulder Arthroscopy
    • Rotator Cuff Repair
    • Bicep Tendon Repair
  • Foot and Ankle
    • Ankle Replacement
    • Bunionectomy
    • Hammer Toe Repair
    • Ankle Fusion
    • Ankle Arthroscopy
  • Spine
    • Laminectomy/Laminotomy
    • Anterior Lumbar Interbody Fusion
    • Posterior Lumbar Interbody Fusion
    • Anterior Cervical Disk Fusion
    • 360 Spinal Fusion
    • Artificial Disk
  • Wrist and Elbow
    • Elbow Replacement
    • Elbow Fusion
    • Wrist Fusion
    • Wrist Replacement
    • Carpal Tunnel Release
  • General Surgery
    • Gallbladder Removal
    • Hernia Repair
    • Thyroidectomy
  • GI
    • Colonoscopy
    • Endoscopy
  • GYN
    • Hysterectomy
    • Bladder Repair
    • Hysteroscopy
  • Bariatric
    • Gastric Bypass
    • Laparoscopic Gastric Bypass
    • Laparoscopic Sleeve Gastrectomy
  • ENT
    • Ear Tube Insertion (Ear Infection)
    • Septoplasty
    • Thyroidectomy
    • Sinuplasty

This is not an exhaustive list. Contact a Care Advocate today at (855) 715-1680 if you would like more information about a specific procedure type.

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What is a Care Advocate?

When you call SurgeryPlus, a Care Advocate is assigned to your case. Your Care Advocate is your dedicated, personal assistant throughout the process, walking you through education about SurgeryPlus and the surgeons nearest you, medical records transfer, scheduling appointments, coordinating travel, and ensuring your satisfaction throughout the entire process.

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Can I still use SurgeryPlus if I already have a surgery planned?

Yes! Call and speak to a Care Advocate and find out if your surgeon is in our network. Should your surgeon not be a SurgeryPlus surgeon, a Care Advocate can offer you a selection of SurgeryPlus surgeons for you to see for consultation, and can help ensure your records and any workup are referred over so you to be scheduled and proceed through SurgeryPlus, as quickly as possible to accommodate your schedule.

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Do I need to obtain pre-authorization or pre-certification from my referring physician before I contact SurgeryPlus?

SurgeryPlus does not require pre-authorization for procedures beyond surgical clearance for bariatric procedures. Utilizing top surgeons ensures we have an expert review of your surgical case, so additional pre-authorization from a third-party source is not required.

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What can I do if a procedure is not pre-authorized or pre-certified? Can I still use SurgeryPlus?

Your Care Advocate can assist you with any authorization needs; however, it’s not required through the SurgeryPlus program.

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Do I have to use the SurgeryPlus surgeon?

Only participating in-network SurgeryPlus providers can be used with the SurgeryPlus benefit. SurgeryPlus surgeons are rigorously screened, and only a select few are able to pass requirements and are invited to participate, so this helps ensure you are in the "best hands."

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Do I have to travel to use SurgeryPlus?

Depending on the type of surgery you need and where you live, you may have to travel to use SurgeryPlus to access our surgeons, but the benefit covers the cost of travel and lodging for major procedures. Your Care Advocate will make all travel and payment arrangements for you if travel is needed, so that you can focus on your health and recovery.

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If my child needs surgery, does the benefit include coverage of travel costs for both parents/guardians to accompany the child?

No. The benefit will cover the eligible member receiving surgery and one companion only. If additional companions wish to accompany the member, you may coordinate with the SurgeryPlus Care Advocate, but the additional costs (airfare, hotel, etc.) must be paid by the additional companion(s).

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Who is Hinge Health?

Hinge Health is an AlaskaCare Employee health plan benefit that delivers everything you need to conquer pain and recover from injuries. Hinge Health tailors treatment plans to each individual, so you can get the expert help you need from the comfort of your own home.

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How do I apply?

You will be asked about any pain or injuries to help recommend a program for you. Next, you’ll answer a few more questions specific to the program selected for you to ensure a good fit. This entire process only takes about 15 minutes.

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Who is eligible?

Hinge Health’s programs are available to you and your family members age 18+ who are covered by the AlaskaCare Employee Health Plan starting July 1, 2021! If you need help with pain or an injury, then you will go through a clinical questionnaire to make sure our program is the right fit.

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Who is my care team?

You will be matched with your care team based on your needs. Your care team will include a personal physical therapist who will help with your care plan and conduct virtual physical therapy sessions if needed. Care teams for treatments that are longer-term also include a health coach, who will help you stick with the program and make beneficial changes in your daily life. Your coach will be available via email, text, or over the phone to answer your questions and act as an unlimited resource!

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How do I complete remote exercise therapy?

The Hinge Health app will guide you in short exercise therapy sessions. Follow along on screen to see how to do the exercises and stretches. Some treatment plans include a tablet and wearable sensors that give live feedback on your position so that you can adjust your body in real-time. The programs are made up of 15-minute sessions that you work through 3 times per week, are tailored to your abilities, pain, or injury, and adapt as you continue to improve.

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What kind of results can I expect?

On average, participants reduce their pain by over 60%, and they are less interested in surgery as a treatment option.

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What is the science behind the program?

Virtually all major medical bodies, including the CDC and American Orthopedic Association, recommend exhausting non-surgical treatments for chronic pain before considering surgery, as many studies have shown that these can dramatically reduce pain. Hinge Health’s program packages these treatments together, and the results often surpass previous studies.

Hinge Health's 3-year study included over 10,000 participants. The study demonstrates that each Hinge Health remote exercise therapy and coaching session has a direct correlation to pain reduction. Each participant had an average pain reduction of 69%, reduced depression and anxiety 58%, increased productivity 61% and decreased surgery likelihood 67%.

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Why does the Pharmacy Benefit Manager change? What does this mean for me?

Periodically, the Division competitively bids these contracts through a Request for Proposal (RFP). This gives us an opportunity to seek better service at lower cost for members and the plan.

Effective 1/1/2019, the AlaskaCare plan uses OptumRx as the PBM to administer pharmacy benefits.

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How will compound medications be covered with OptumRx?

OptumRx will process claims according to the AlaskaCare plan document. Compounds will continue to be covered under the Defined Benefit Retiree Health plan.

Coverage of compounds differs for the active employee and defined contribution retiree health plans. The AlaskaCare Employee Health Plan and AlaskaCare DCR Benefit Plan only cover compound drugs if:

  1. the product contains at least one prescription ingredient;
  2. the active ingredient(s) is approved by the FDA for medicinal use in the United States;
  3. the product is not a copy of a commercially available FDA approved drug; and
  4. the safety and effectiveness for the intended use is supported by FDA approval, or adequate medical and scientific evidence in the medical literature.

OptumRx maintains a National Compound Credentialing Program (NCCP) to ensure the best compounded medication quality and effectiveness for the patients who need personalized medications. You must fill your compounded medication prescription at a pharmacy which has been credentialed with the OptumRx National Compound Credentialing Program (NCCP).

Using an NCCP pharmacy ensures that you will not be charged up front for your prescription (and required to submit your own claim for reimbursement), you will not be charged for molding or other non-covered charges, and you will not be charged for shipping if the pharmacy mails your compounded medication to you. You can find a list of NCCP-credentialed pharmacies here. You can also call OptumRx at (855) 409-6999 (TTY 711) to get help locating NCCP-credentialed pharmacies.

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How will OptumRx work with the Enhanced Group Waiver Program (EGWP) for retirees?

The pharmacy benefit for AlaskaCare retirees remains the same, and OptumRx will manage all pharmacy benefits. Medicare-eligible retirees and dependents will be automatically enrolled in the enhanced EGWP. Members will not need to do anything to enroll and do not need to enroll in an individual Medicare Part D plan.

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What happens if I don’t receive my prescription drug card in the mail?

If you need to fill prescriptions before your card arrives, you can contact the Division and we will print or email a temporary card. As of January 1, 2019, you can also get a printable ID card from the member portal, or view your card in the mobile app.

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Why did I receive more than one ID card with different ID numbers?

Please select the scenario that best describes you:

  • I am covered under a single AlaskaCare plan, and…
    • I am an active employee:
      ID cards are issued in packs of two to active employees. If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.
    • I am a retiree that is not eligible for Medicare:
      ID cards are issued in packs of two to retirees that are not eligible for Medicare. If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.
    • I am a Medicare-eligible retiree who is not covered under the enhanced Employer Group Waiver Program (EGWP):
      ID cards are issued in packs of two to retirees that are not enrolled in the AlaskaCare enhanced Employer Group Waiver Program (EGWP). If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1st,1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.
    • I am a retiree covered under the enhanced Employer Group Waiver Program (EGWP):
      You should have received only a single ID card with the MedicareRx logo in the lower right corner (see example below). Please contact the Division or OptumRx for additional information on why you may have received a second card.
  • I am covered under my own plan and under my spouse’s AlaskaCare plan, and…
    • Both my spouse and I are either an active employee or a retiree not yet eligible for Medicare:
      You will both receive a two-pack of ID cards with your own name and ID number. You may share one copy of your ID card with your spouse, however, you or your dependents only need to present one of these ID cards to the pharmacy. OptumRx coordinates your coverage behind the scenes.
    • Both my spouse and I are are retirees and eligible for Medicare:
      If you are both eligible for Medicare and are enrolled in the enhanced Employer Group Waiver Program (EGWP), you should each receive a single ID card that has the MedicareRx logo in the lower right (see example below). Each card will have an individual name and ID number. Although you receive only one card, when you present the card at the pharmacy you will receive the benefit of your double coverage under the plan. This means you will not be required to pay a copay at the pharmacy counter.
    • One of us is a Medicare-eligible retiree enrolled in the enhanced Employer Group Waiver Program (EGWP) and the other is either an active employee or a retiree not enrolled in EGWP:
      The retiree who is Medicare-eligible and is enrolled in the enhanced Employer Group Waiver Program (EGWP) will receive a single ID card that has the MedicareRx logo in the lower right (see example below). The card will have their individual name and ID number. Although they receive only one card, when they present the card at the pharmacy, they will receive the benefit of having double coverage under the plan. This means they will not be required to pay a copay at the pharmacy counter.

      The spouse who is not enrolled in the EGWP will receive an ID card two-pack in their own name for each layer of coverage they have (their own coverage and their dependent coverage as the spouse of a Medicare-eligible retiree). The only difference between the two packs of ID cards will be the ID number. The ID number that matches the Medicare-eligible retiree’s MedicareRx ID card will be the dependent coverage card.
  • I am covered under more than one of my own AlaskaCare plans, and…
    • I am eligible for Medicare:
      If you are eligible for Medicare and are enrolled in the enhanced Employer Group Waiver Program (EGWP), you should receive a single ID card that has the MedicareRx logo in the lower right (see example below). Although you receive only one card, when you present the card at the pharmacy you will receive the benefit of your double coverage under the plan. This means you will not be required to pay a copay at the pharmacy counter.
    • I am not eligible for Medicare:
      You will receive an ID card two-pack for each layer of coverage you have. The only difference between the different packs of ID cards will be the ID number. However, you only need to present one of these ID cards to the pharmacy. OptumRx coordinates the coverage behind the scenes.

Sample card:

OptumRx EGWP pharmacy card

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Why did I receive a new ID card from Aetna? I thought my medical benefits weren’t changing?

The transition to OptumRx does not affect your medical benefits—these continue to be administered by Aetna. However, because Aetna and their contractor CVS/Caremark no longer administer AlaskaCare pharmacy claims, all AlaskaCare members will receive updated ID cards from Aetna that reflects their medical benefit coverage. Retirees will receive two new ID cards from Aetna – one for medical coverage, and one for vision/audio coverage. You should use your Aetna ID card at your doctor’s office, and your OptumRx ID card at the pharmacy counter.

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Can my dependent use my card at the pharmacy and vice versa?

OptumRx coordinates all the layers of coverage for you and your dependents behind the scenes, so in many cases you and your dependents can use each other’s cards at the pharmacy. However, a non-EGWP dependent should not use the card that has a MedicareRx logo in the lower right corner. This card would only work if the pharmacist uses the correct person code (to identify them as a dependent rather than the policy holder). To avoid any confusion at the pharmacy, we recommend you and your dependents only use a card that has your name on it.

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I am an active employee AND a retiree. How do I know which card is for my active plan and which one is for my retiree plan?

You can tell the difference between the cards by looking at the logo on the card. One will say AlaskaCare Employee Pharmacy Plan, and the other will say AlaskaCare Retiree Pharmacy Plan. Your employee plan will typically be the primary payer.

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What happens if our new prescription cards are not received by January 1, 2019?

If you need to fill prescriptions before your card arrives, you can contact the Division and we will print or email a temporary card. As of January 1, 2019, you can also get a printable ID card from the member portal, or view your card in the mobile app.

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I received a letter from OptumRx telling me I am taking a medication that will require prior authorization to determine if it is covered. What should I do?

You can contact OptumRx at (855) 409-6999, TTY711 if you have questions about your prescriptions or any correspondence you have received from them.

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How can I tell if the Prior Authorization letter I received is accurate or not?

If you are Medicare-eligible and are taking a medication that requires prior-authorization, you may receive a copy of the letter below. You can contact OptumRx at (855) 409-6999, TTY711 if you have questions about your prescriptions or any correspondence you have received from them.

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I received a phone call from an OptumRx representative, but my caller-ID says the call is coming from United Health Care. Is this a scam?

The OptumRx home delivery unit reaches out to members to assist with setting up their home delivery accounts and to verify the prescriptions they want delivered. If you receive a call to this effect, it is not a scam. However, if you are unsure if the call is legitimate, you can always decline the call and then contact OptumRx at (855) 409-6999 to ensure the call is genuine.

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I received a check in the mail from OptumRx. What is it for?

You may have received a check from OptumRx for a variety of different reasons. To find out what the check was for and what to do next, please contact OptumRx Member Services at (855) 409-6999.

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I received a call from an OptumRx representative who stated my mail-order prescriptions have transferred over and then asked me for personal information. Is this a scam?

The OptumRx home delivery unit reaches out to members to assist with setting up their home delivery accounts and to verify the prescriptions they want delivered. If you receive a call to this effect, it is not a scam. However, if you are unsure if the call is legitimate, you can always decline the call and then contact OptumRx at (855) 409-6999 to ensure the call is genuine.

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I received a letter from OptumRx asking me to confirm my enrollment in the AlaskaCare Retiree Medicare Prescription Drug Plan within 30 days. The bottom of the letter has this document code: S8841_19_EXH-5_AKC. What should I do next?

You received this letter because the Centers for Medicare & Medicaid Services (CMS or Medicare) indicated that you have alternative prescription drug coverage under another plan that may be receiving subsidies from Medicare for providing that coverage. We encourage members to confirm enrollment in the AlaskaCare Retiree Medicare Prescription Drug Plan by calling OptumRx at (855) 235-1405. If you do not confirm your enrollment or choose not to participate in the AlaskaCare Retiree Medicare Prescription Drug Plan, you will be placed into the opt-out prescription drug program. This is highly discouraged, as it will result in higher costs for you and for the health plan.

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Can I transfer my prescriptions from my local pharmacy to the AlaskaCare home delivery service provided by OptumRx?

Yes, members may transfer prescriptions from their local pharmacy to OptumRx Home Delivery or from Home Delivery to their local pharmacy:

  1. Members may call their pharmacy and request they transfer prescriptions from the pharmacy to OptumRx Home Delivery. To start home delivery, log in to OptumRx.com , use the OptumRx app, or call (855) 409-6999.
  2. Members may call OptumRx at (855) 409-6999 and request Home Delivery prescriptions be transferred to their local pharmacy.
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What is Teladoc®?

Teladoc® is the first and largest provider of telehealth medical consults in the United States, giving you 24/7/365 access to quality medical care through phone and video consults.

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Who are the Teladoc® doctors?

Teladoc® doctors are U.S. board certified in Internal Medicine, Family Practice, or Pediatrics. They average 20 years practice experience, are licensed in your state, and incorporate Teladoc® into their day-to-day practice as a way to provide people with convenient access to quality medical care.

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Does Teladoc® replace my doctor?

No. Teladoc does not replace your primary care physician. Teladoc should be used when you need immediate care for non-emergent medical issues. It is an affordable, convenient alternative to urgent care and ER visits.

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What kind of medical care does Teladoc® provide?

Teladoc® provides adult and pediatric general medical care and behavioral health care.

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What kind of medical care does Teladoc® provide?

Teladoc® provides adult and pediatric general medical care.

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What consult methods are available?

You can talk with a Teladoc® doctor via a phone consult, video consult within the secure member portal, or video consult within the Teladoc® mobile app.

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How do I set up my Teladoc® account?

Setting up your account is a quick and easy online process. Visit the Teladoc® website, click “Set Up Account," and follow the online instructions.

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How do I request a consult to talk to a doctor?

Visit the Teladoc® website, log into your account and click “Request a Consult”. You can also call Teladoc at (855) 835-2362 to request a consult by phone.

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How quickly can I talk to the doctor?

The doctor will call you back in minutes. If you miss the doctor’s call—whether you are away from the phone or you have anonymous call blocker on—you will be returned to the bottom of the waiting list. The consult request is cancelled if you miss three calls.

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Is there a time limit when talking with a doctor?

There is no time limit for consults.

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Can Teladoc® doctors write a prescription?

Yes, Teladoc® doctors can prescribe short-term medication for a wide range of conditions when medically appropriate. Teladoc® doctors do not prescribe substances controlled by the DEA, non-therapeutic and/or certain other drugs which may be harmful because of their potential abuse.

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How do I pay for a prescription called in by Teladoc®?

When you go to your pharmacy of choice to pick up the prescription, you may use your health/prescription insurance card to help pay for the medication. You will be responsible for the co-pay based on the type of medication and your plan benefits.

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If the Teladoc® doctor recommends that I see my primary care physician or a specialist, do I still have to pay the Teladoc® consult fee?

Yes. Just like any doctor appointment, you must pay for the consulting doctor’s time.

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Can I provide consult information to my doctor?

Yes. You have access to your electronic medical record at any time. Download a copy online from your account or call Teladoc® and ask to have your medical record mailed or faxed to you.

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When is Open Enrollment?

Open Enrollment for the AlaskaCare Employee Health Plan is typically the first three weeks of November for the benefit year that begins the following January. Visit the Open Enrollment page to find this year's Open Enrollment dates.

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How do I enroll?

The enrollment process will be completed online. Everything you need to make decisions about your benefits and to change your enrollment selection is available in the Open Enrollment Guide . Personalized information will not be sent to members.

Once you are ready to enroll, the web site provides instructions to:

  1. Login to your account – through your myRnB portal. Look for the myRnB button in the left column of any Division Web page.
  2. View your current benefits and change your elections.
  3. Review the dependents under your health plan and add or remove dependents as necessary.
  4. Make sure you have provided your dependent's social security number. Under the individual shared responsibility provision of the Affordable Care Act (ACA), individuals must indicate their enrolled dependents, as well as themselves, have had a full year of qualifying health care coverage (called minimum essential coverage), qualify for an exemption, or pay a penalty when filing their income taxes. By providing your dependent social security numbers, we can report proof of minimum essential health care coverage to help you avoid the hassle of having to prove to the IRS that your dependents had coverage.
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If I am unable to enroll online, can I submit my elections by paper form?

Enrollments must be made online. If you experience technical difficulties while trying to enroll contact the Member Services Contact Center at (800) 821-2251 or in Juneau at (907) 465-4460 Member Services Contact Center Hours: Monday - Thursday 8:30 a.m. - 4 p.m. and Friday 8:30 a.m. - 3 p.m. Alaska Standard Time.

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Will I get new cards?

If you make changes to your health elections or to your beneficiary information, you will be mailed a new medical ID card from Aetna and a new dental ID card from Moda.

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Are there any changes to the health plan?

Yes, there are several important changes to the AlaskaCare health plan that will take effect on the first day of the upcoming benefit year.

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How can I get a current copy of the Health Plan booklet showing all plan changes?

A new Health Plan booklet will be released on or before the first day of the upcoming benefit year.

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Are hearing aids covered under the AlaskaCare health plan?

Coverage for hearing aids is available under the Audio Plan (a sub-plan of Medical). Audio services pay a maximum benefit of $3,000 in a rolling 36-month period. A hearing aid (monaural or binaural) is a covered service if prescribed as a result of an otological (ear) or audiological (hearing) examination. This includes ear mold(s), hearing aid instrument, initial batteries, cords, and other necessary supplementary equipment as well as warranty, and follow-up consultation within 30 days following delivery of the hearing aid.

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Will I be taxed on my health benefits?

The plan meets the criteria under Internal Revenue Code §125 and its accompanying Treasury Regulations, which govern cafeteria plans as offered under the Select Benefits Health Plan. This allows for premiums that are taken from your paycheck to be deducted prior to taxes being calculated.

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Voluntary Supplemental Benefits

Are there changes to the Voluntary Supplemental Benefits (VSB) effective January 1, ?

There no premium changes to the Voluntary Supplemental Benefits (VSB) plan for , but there were some enhancements made to the Critical Illness Plan. 10 new “progressive diseases” were added, coverage for COVID-19 was added, the maximum lifetime benefit was removed, and the pre-existing condition limitation was removed. We are continuously looking for ways to improve and expand benefits to employees, so check back next year for more updates.

Who can enroll in Voluntary Supplemental Benefits?

All employees can enroll, except:

  • members of the bargaining unit Labor, Trades and Crafts (LTC)
  • members of the Teachers’ Retirement System (TRS)
  • on-call Employees
  • employees of the National Guard (including Emergency Guard)
  • short-term non-permanent employees
  • student interns
  • leased employees
  • emergency employees hired for natural disasters, including emergency fire fighters
  • temporary legislative employees

What benefits are available through the Voluntary Supplemental Benefits plan?

  • Life Insurance
  • Accidental Death and Dismemberment
  • Short-Term Disability
  • Long-Term Disability
  • Critical Illness

Are my Voluntary Supplemental Benefit premiums pre-tax?

Yes and no. Premiums for coverage other than life insurance are taken on a pre-tax basis. For the life insurance products, premiums up to $50,000 in total pre-tax or employer paid life insurance, including State-provided Basic Life Insurance are not taxed. Premiums attributable to pre-tax or employer paid life insurance amounts over $50,000 are taxable, will show as imputed income on your pay, and will be taxed. Imputed income is the addition of the value of non-cash compensation to an employee's taxable wages in order to properly withhold income taxes from the wages. Premiums for the Critical Illness plan and Select Life are post-tax and will not result in imputed income.

Do I need to re-enroll if I had a VSB coverage last year?

No. Your current elections will automatically roll over to the next benefit year if you do not participate in Open Enrollment. Occasionally we need to make changes to benefits or administrators that require members to participate in Open Enrollment or a Special Enrollment in order to keep/select benefits. We will always notify members if you are required to make an election.

If MetLife approved me for $200,000 or $300,000 in Life Insurance during this last year, will I need to reapply and provide a new Statement of Health (SOH)?

If you were approved by for life insurance in the amount of $200,000 or $300,000, your approval will continue.

However, if you apply for either $200,000 or $300,000 of coverage for the first time during Open Enrollment, you will be required to provide a Statement of Health (SOH) to MetLife.

Statement of Health (SOH)

What is a Statement of Health (SOH)?

Proof of good health, evidenced by a SOH, is a standard part of the application process to elect higher volumes of life insurance. A SOH is a document that includes a series of questions about your overall health, and is sometimes referred to as Medical Evidence of Insurability (MEOI or EOI).

Why are Statements of Health used?

Statements of health are used to protect an employer's group insurance program from adverse risks and to reduce the likelihood of disproportional claims risk. This helps control the cost of the group insurance program and allows the employer to continue offering the coverage.

Who is required to provide a Statement of Health (SOH)?

Active employees electing life insurance levels at $200,000 or $300,000 will be required to provide an SOH:

  • when electing coverage during open enrollment;
  • when increasing coverage due to qualifying life events; or
  • when electing coverage at initial hire.
If I have questions about evidence of insurability process, who do I contact?

For questions regarding the SOH process or what may result in a denial of coverage, please contact the insurer, MetLife, directly at (800) 638-6420.

If I elect life insurance at $10,000, $50,000, or $100,000 will I need to complete an SOH?

No. Elections of life insurance at these levels do not require proof of good health.

If I elect the $200,000 or $300,000 option will I need to submit an SOH every year?

As long as you don’t change your level of coverage, you will not be required to submit a new SOH form every year. If you elect to increase or decrease your coverage to either $200,000 or $300,000 after a qualified status change or at a subsequent open enrollment, you will have to provide SOH again. If you decrease coverage below $200,000 in the future, no SOH is required.

What level am I covered at until I am approved?

If you elect $200,000 or $300,000 in life insurance you are covered at $100,000 until you are approved. For example, if you apply for $300,000, and you pass away before you are approved for $300,000 your beneficiaries will receive $100,000.

What happens if I am not approved for the $200,000 or $300,000 option?

If you are not approved for $200,000 or $300,000 your coverage will automatically default to $100,000.

How do I submit the SOH form?

During the enrollment process or Open Enrollment, you will be prompted automatically to complete the Statement of Health if you choose the level of life insurance coverage that requires the SOH. Enrollment is through MetLife’s partner, BenefitFocus .

Select AlaskaCare Benefits

What are the premiums for Medical Coverages for this upcoming year?

The new AlaskaCare premiuns effective January 1, are as follows:

2022 ACTIVE EMPLOYEE PREMIUMS
For AVTECTA – AK Vocational Teachers (TA), APEA – Confidential (KK), APEA – Supervisory (SS),
ACOA – Correctional Officers (GC), TEAME – Mt. Edgecumbe Teachers (TM),
Employees not covered by collective bargaining (Exempt)
Plan Employee Only Employee & Family
Standard Medical Plan $125 $303
Economy Medical Plan $63 $167
Consumer Choice Plan $25 $71
Standard Dental Plan $37 $102
Economy Dental Plan $0 $0
Vision $15 $40
For MEBA – Marine Engineers (BB), IBU – Inlandboatman’s (MM) Only
Plan MEBA Employee Only MEBA Employee & Family IBU Employee Only IBU Employee & Family
Standard Medical Plan $125 $303 $125 $303
Economy Medical Plan $0 $0 $35 $95
Consumer Choice Plan $25 $71 $25 $71
Standard Dental Plan $37 $102 $37 $102
Economy Dental Plan $0 $0 $0 $0
Vision Plan $15 $40 $15 $40
Effective: Jan. 1 - Dec. 31, 2022

Will I be taxed on my health benefits?

The plan meets the criteria under Internal Revenue Code §125 and its accompanying Treasury Regulations, which govern cafeteria plans as offered under the Select Benefits Health Plan. This allows for premiums that are taken from your paycheck to be deducted prior to taxes being calculated.

Why do I need to provide my dependent's Social Security number?

Under the individual shared responsibility provision of the Affordable Care Act (ACA), individuals must indicate their enrolled dependents, as well as themselves, have had a full year of qualifying health care coverage (called minimum essential coverage), qualify for an exemption, or pay a penalty when filing their income taxes. By providing your dependent social security numbers, we can report proof of minimum essential health care coverage to help you avoid a tax penalty or the hassle of having to prove to the IRS that your dependents had coverage. Please take a moment to review the dependents listed in the Online Enrollment system and update the information as appropriate.

Are hearing aids covered under the AlaskaCare health plan?

Coverage for hearing aids is available under the audio benefit under the medical plan. Audio services pay a maximum benefit of $3,000 in a rolling 36-month period. A hearing aid (monaural or binaural) is a covered service if prescribed as a result of an otological (ear) or audiological (hearing) examination. This includes ear mold(s), hearing aid instrument, initial batteries, cords, and other necessary supplementary equipment as well as warranty, and follow-up consultation within 30 days following delivery of the hearing aid.

If you elect the optional vision coverage, you or your family member (including your parents or grandparents) can save 30% to 60% on the price of hearing aids through VSP’s partnership with TruHearing. For more information, call TruHearing at (866) 929-5091 Monday – Friday, 8 a.m. - 8 p.m. Alaska time. For TTY, dial 711.

What is the new Consumer Choice health plan?

The AlaskaCare Employee Health Plan is offering a new lower-premium medical plan option this year with a higher deductible than medical plans traditionally offered by AlaskaCare. The new Consumer Choice plan is a consumer driven health plan with an employer sponsored Health Reimbursement Arrangement (HRA).

There are several things you can do to ensure you get the most value from your plan.

Using "network" providers can provide substantial benefits to members through the elimination of what's known as "balance billing." It can also generate substantial savings to members through negotiated provider discounts. To find out whether your doctor is a member of the Aetna network, call Aetna's Health Concierge at (855) 784-8646 or visit the Find a Doctor page .

Get recommended preventive checkups, screenings, vaccines, prenatal care, and contraceptives. You won’t have to pay out-of-pocket for these preventive visits, when provided in network, and getting regular exams and screenings will help you live healthier. For a list of covered preventative services visit the Preventative Care Coverage Information Flyer and the Women’s Preventive Care Coverage Information Flyer .

Use generic drugs when available. Generic drugs offer you a safe and effective alternative to brand name drugs - but at a lesser cost. Choosing a lower tiered drug when it is appropriate can provide access to the necessary medications to stay healthy, at a cost that is more affordable.

What is a Form 1095-C?

The State of Alaska is required to send IRS Form 1095-C to any employee who was offered coverage or enrolled in AlaskaCare or a union trust health insurance plan. If you were eligible for health benefits at any point in the year, then you should receive a 1095-C, which contains detailed information about the health care coverage you were provided or offered by the State of Alaska. It is important to keep the form for your records.

What is a Form 1095-B?

Form 1095-B is an IRS form that reports dependents covered by your union health trust. It also contains similar information to the 1095-C issued by the State of Alaska, including the type of coverage you and your dependents had and the dates you and your dependents were covered in the prior year.

Why did I get a Form 1095?

You received the 1095 form(s) because you were eligible for or were offered employee health benefits in . The IRS will use the information reported on the forms to determine whether a penalty tax is to be assessed. The forms will also be used to determine whether you are eligible for premium tax credits if you purchase coverage on the public insurance marketplace.

Why did I get more than one Form 1095?

A full-time employee who works for more than one employer must receive a separate Form 1095-C from each employer. If you had outside employment, you may receive a 1095-C from both the State of Alaska and your other employer.

If you are covered under a union health trust, you will receive a Form 1095-C from the State of Alaska, and a Form 1095-B from your union health trust that reflects your covered dependents.

When will I get my Form 1095?

Your 1095 for the tax year will be mailed on or before March 2, 2022. If you believe you should have received a 1095-C but did not, please contact the Division of Personnel Employee Call Center at (907) 465-3009 or . If you are covered by a union health trust and believe you should have received a 1095-B but did not, please contact your health trust.

What information is reported on the Form 1095-C?

There are three parts to the form:

  • Part 1 reports information about you and the State of Alaska.
  • Part 2 reports information about the health benefit coverage offered or provided each month, the affordability of the coverage offered, and the reason why you were or were not offered coverage.
  • Part 3 identifies each covered individual, including spouses and dependents, and identifies the months of coverage. Part 3 may not include dependent information if you are covered by a union health trust. You should receive a separate 1095-B to report dependents covered under the trust.

Will the Form 1095 impact my taxes?

If you do not have health care coverage and do not qualify for an exemption, you may be subject to a fine when you file for your 2021 tax return. For more information on whether you may qualify for an exemption, visit IRS.gov

Can I file my taxes before I receive my Form 1095-B and/or 1095-C?

It is not necessary to wait for Forms 1095-B or 1095-C in order to file your taxes. For more questions and answers about health care information forms for individuals from the IRS, see their FAQ page .

Will my dependents receive separate documents to report their coverage under my plan?

The 1095 forms are only received by the employee, or the “responsible individual” as referred to by the IRS. A copy of the form is not provided to the dependents.

What is the difference between a 1095-A, 1095-B, and 1095-C?

These forms report very similar information, and which form you receive will be dependent on who is responsible for issuing the 1095 form.

  • You will receive a 1095-C if you received health care coverage through your employer.
  • You will receive a 1095-B if you were covered by other insurers, such as a union health trust, self-funded retiree plan, or other small self- funded groups or employers.
  • You will receive a 1095-A if you were covered by a federal or state marketplace (also called an exchange.)

I received health coverage through my State of Alaska employment. Is this qualifying healthcare coverage?

Yes, self-insured group health plans for employees, COBRA coverage, and retiree coverage qualify as Minimum Essential Coverage.

What if I have questions?

If you have additional questions about your 1095, please contact your tax consultant. Visit Healthcare.gov to learn more.

1. How often is the Defined Contribution plan (DCR) to Defined Benefit (DB) plan Conversion Process page updated?

The DCR plan to DB plan webpage will be updated on an ongoing basis and will be less frequent from week to week.

2. Where can I find the PERS/TRS participating employers?

You can find information on participating employers on the Payroll Processing Contacts page.

3. Is the conversion election from the DCR Plans to the DB Plans irrevocable?

Yes.

4. If I convert my current DCR service to the Defined Benefit Plan, do I retain my contributions?

The employee contributions and any net market gains or losses of the PERS or TRS DCR account balance will be transferred to pay the cost of conversion. If any PERS or TRS DCR employee balance remains after the outstanding conversion indebtedness balance(s) are paid, the remaining balance will be refunded to the member by Empower Retirement.

Employer match contributions and any attributable gains and losses are not eligible to be utilized by the member to pay the cost of conversion. Employer contributions made on the member’s behalf will be transferred to the defined benefit plan to fund the lifetime future benefit that the member will receive from the fund as well as the system paid medical benefits that the member may be eligible for in retirement.

5. How is my Reinstatement Indebtedness (REI) calculated?

The reinstatement indebtedness (REI) consists of the total refund received plus accrued interest at the rate prescribed by regulation (7%) from the date of refund through June 30, 2010. No further interest will accrue from July 1, 2010, until the previously refunded service is reinstated. Interest will accrue at the rate prescribed by regulation (7%) from the date of conversion until the REI is paid in full or at the time of retirement.

6. How is my conversion indebtedness calculated?

The cost of conversion represents the employee contributions which would have been made and accrued interest (4.5%) had you been a member of the PERS or TRS DB during the years you were enrolled in the PERS or TRS DCR. Interest will accrue on any unpaid balance from the date of conversion until the conversion indebtedness is paid in full or at the time of retirement.

7. If I am a refunded DB member who reemployed in the DCR plan, and have fully refunded my DCR PERS or TRS account, can I still convert?

Yes, but you must first reemploy in a PERS or TRS eligible position. You will have 30 days from the date of Hire to choose whether to convert. If you do not elect to reinstate your previously refunded DB service and return to your original tier status, you will default into the DCR plan. If you elect to reinstate your original tier status, your previous DCR PERS or TRS service must be converted to DB service and an indebtedness will be established on your record for the conversion cost. An indebtedness will also be established for your previously refunded DB service.

8. Can I pay over-time if I do not have enough to pay the full balance upon conversion?

Yes. Members will be able to make payments by pretax transfer, pretax payroll deductions or with post tax monies on any remaining unpaid cost of conversion or Reinstatement Indebtedness that may exist.

9. If I am already vested in the DCR plan, will I be able to take an actuarial reduction for the Reinstatement Indebtedness?

Yes. Indebtedness is not a bill. If at the time of retirement, you elect to cancel any outstanding indebtedness due by accepting an actuarial reduction to your benefit for life, and the election reduces your benefit below what it would have been had the indebtedness not existed, then the claimed service and associated indebtedness will be removed from your final retirement benefit calculation.

10. Will I be able to pay reinstatement indebtedness with pre-tax dollars, such as a pre-tax transfer or payroll deduction?

Yes.

11. Will I be able to pay for the conversion service with pre-tax money?

Yes.

12. Can I use pre-tax qualified accounts to pay if I do not have enough funds in my PERS or TRS DCR account to cover the conversion?

Yes. Remaining balances can be paid with pretax qualified accounts after conversion is complete, including State of Alaska Supplemental Annuity Plans (SBS) and Deferred Compensation Plans (DCP). Once you have been notified that the conversion is complete, you will need to submit a Purchase of Service by Pretax Transfer form to apply any additional pretax qualified payments towards your remaining indebtedness balance(s).

13. If I am already vested in the DCR, will I be able to take an actuarial reduction for the Reinstatement Indebtedness?

Yes.

14. Will there be a conversion estimator available in myRnB?

No.

15. If I choose to convert, will I receive written confirmation?

Yes. The Division of Retirement and Benefits will provide members who convert a notification of pretax transfer payments applied and if there is any remaining indebtedness balance owed.

16. I have submitted the online submission form. How soon will I be contacted?

The DRB will be processing all submissions to convert first in first out. DRB counseling representatives will be contacting the members to provide counseling on the process and costs associated with the conversion. Incorrect information provided by the member will cause a delay in this process.

17. How can I confirm/verify if you received my submission request?

Once you have submitted your online submission form, an auto-generated confirmation will be emailed from surveymonkey@t.outbound.surveymonkey.com confirming your successful submission. A member of the counseling team will contact you to set up a time to discuss the process and costs associated with conversion based on the order that forms are submitted.

18. What is an actuarial reduction and what does it mean to cancel any outstanding indebtedness by accepting an actuarial reduction?

This means, if, as a result of service credit claimed (reinstatement indebtedness or conversion cost not paid in full in this case) for which there is an indebtedness existing at retirement, the benefit is actuarially reduced by a factor spreading the remaining indebtedness balance out over the anticipated lifetime of the benefit. If applying an actuarial reduction reduces your benefit below what it would have been had the claimed service and associated indebtedness not existed, then the claimed service and indebtedness will be removed from your final retirement benefit calculation. Service associated with a Reinstatement indebtedness (REI) or Conversion indebtedness that has an outstanding balance will not count towards vesting or service eligibility (i.e. 20 or 30 years).

19. Can I submit a claim form for the Military/outside service during the conversion process?

Yes. However, each form will need to be submitted according to the directions provided on the specific claim forms. The conversion needs to be completed first, then the military/outside claim will be processed after the conversion has been completed.

20. What does “former member” mean?

A former member means an employee who is terminated and who has received a total refund of the balance of the employee contribution account, or who has requested in writing a refund of the balance in the employee contribution account.

21. What does “accrued interest” mean?

PERS DB members accrue interest on their individual accounts at 4.5% compounded semi-annually. TRS DB members accrue interest on their individual accounts at 4.5% compounded annually on June 30. For the former DB members who have reemployed and are now DCR members, the cost of conversion represents the employee contributions which would have been made including accrued interest (4.5%) had the employee been a member of the PERS or TRS DB plan during the years they were enrolled in the PERS or TRS DCR plan.

22. What does “interest at the rate prescribed by regulation” mean?

Under the PERS DB plan, the prescribed rate of interest that accrues on any indebtedness amount is 7% compounded semi-annually on June 30 and December 31 of each year. Under the TRS DB plan, effective July 1, 1974, the interest rate on arrearage, retroactive and reinstatement contributions is 7% compounded annually on June 30.

23. How long once my conversion election form is received by DRB will the conversion process take?

Once your form is received and approved by the Division, it can take up to 60 days for the pretax transfer from Empower Retirement to be posted to your DB account. All conversion election forms submitted to the Division will be processed on a first in first out basis. Any incomplete forms will be returned to the member for correction and resubmission.

Retiree FAQs

Frequently Asked Questions about the Division of Retirement and Benefits Retiree Health plan and programs.

General

Why have I received multiple ID cards?

You should have a medical ID card from Aetna and a pharmacy ID card from OptumRx. If you elected the DVA plan you will also have a dental ID card from Delta Dental/Moda and a vision card from Aetna. You can use your ID cards when visiting your health care providers or pharmacy.

Aetna

Delta Dental

OptumRx

How do I obtain a new ID card?

You can download a digital copy of your ID card online:

To request a new physical ID card via phone, visit our Partner Contacts page.

Why aren't dependents covered to age 26 under the Retiree health plan?

The rule requiring health plans to extend dependent coverage up to age 26, regardless of financial dependency, student status, employment or marital status, doesn't apply to AlaskaCare retiree health benefits because the plan is exempt from Affordable Care Act requirements. The Division of Retirement and Benefits understands that there is strong interest in adding these benefits to the retiree health plan and is exploring options to do so while remaining cost neutral.

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What is recognized charge?

Recognized charge means the negotiated charge contained in an agreement the claims administrator has with the provider either directly or through a third party. If there is no such agreement, the recognized charge is determined in accordance with the provisions of this section. Except for charges related to involuntary out-of-network services, an out-of-network provider has the right to bill the difference between the recognized charge and the actual charge. This difference will be the covered person’s responsibility.

Medical Expenses: As to medical services or supplies, the recognized charge for each service or supply is the lesser of:

  • What the provider bills or submits for that service or supply;
  • Or the 90th percentile of the prevailing charge rate; for the geographic area where the service is furnished as determined by Aetna in accordance with Aetna reimbursement policies.

Where can I get more information about recognized charges?

For more information on recognized charge in the Retiree Plan, see the Retiree Insurance Information Booklet , section 3.1.4 Recognized Charge.

Network

I'm a retiree; why should I use a network provider?

Using "network" providers can provide substantial benefits to members through the elimination of what's known as "balance billing." It can also generate substantial savings to members through negotiated provider discounts.

To find a network provider:

  • Call Aetna's Health Concierge at (855) 784-8646 or select the "Find a Doctor" button on our website, AlaskaCare.gov.
  • Call Moda/Delta Dental at (855) 718-1768 or select the "Find a Dentist" button on our website
  • Call OptumRx at (855) 718-1768 or select the "Find a Pharmacist" button on our website.

What is balance billing?

The AlaskaCare plans limit payment of covered services to the recognized charge. The recognized charge is the maximum amount the AlaskaCare plans will pay for a covered service. Aetna and Moda/Delta Dental, and their respective network providers (sometimes referred to as participating providers), agree to a set of discounted negotiated rates for services provided. The recognized charge for network providers is the negotiated rate. For an explanation of how the recognized charge is calculated for out-of-network providers, please see the recognized charge questions under the Network and Dental sections.

An out-of-network provider has the right to bill you for the difference between the recognized charge and the actual charge. This is often referred to as balance billing. Network providers have agreed to accept, as payment in full, the negotiated charge. Therefore, you are not subject to balance billing when you use a network provider.

If I have a procedure or service at a network facility, can I be balance billed?

You may find that not all providers at a "network" facility are part of the Aetna network. For example, if you have a surgical procedure performed at a network hospital, you may find that the hospital and surgeon are in the network, but the anesthesiologist is out-of-network. When you get your bill, you'll see that it reflects the negotiated network rates for your hospital and surgeon. The anesthesiologist, however, may charge what they choose since they have no negotiated contract with Aetna. If the anesthesiologist claim exceeds the recognized charge, you may receive a bill for the balance.

How do I avoid receiving a balance bill?

You may prevent balance billing by verifying all medical providers are in the Aetna network and making sure your AlaskaCare Plan covers the services you need. For example, if you're having x-rays, MRIs, CT scans, or PET scans, make sure both the imaging facility and the radiologist who will read your scan are in the network. If you're planning surgery, ask whether the anesthesiologists are in the network. If available, the facility should accommodate your request to use a network provider for your services.

Similarly, for AlaskaCare covered dental services, you may prevent balance billing by verifying the provider is in the Moda/Delta Dental network.

What if there is no network provider available?

If your provider is not a network provider, you may ask for an estimate of charges, the codes that will be used use for billing, and the provider's zip code. When you receive this information, contact the Aetna Concierge at (855) 784-8646 or Moda/Delta Dental at (855) 718-1768. A member of the Aetna Concierge or Moda Customer Service team can review the estimated charges and will advise you if the charges fall within the recognized charge for your area. If the estimated charges exceed the recognized charge, you may request that your provider accept that amount and not balance bill you, or you may request payment arrangements with their office.

If your current provider is not listed as a network provider, you can ask your provider to contact Aetna at (800) 720-4009 or Moda at (855) 718-1768 for a participation application. Members are also encouraged to nominate their out-of-network providers to join the network. Contact the Aetna Concierge or Moda Customer Service to find out how.

In some cases, unfortunately, there will not be a network provider for the service you need in your area. The Division, Aetna and Moda/Delta Dental are working diligently to improve network access, but please understand that we cannot force providers into the network.

Is there a "network" for durable medical equipment (DME)?

Yes, there is a network of providers for durable medical equipment. For assistance finding a network provider call the Aetna Concierge at (855) 784-8646 or search online using the Aetna DocFind tool .

Medicare

Why do I need to purchase Medicare Part B?

The AlaskaCare Retiree health plan was created by statute to provide health coverage to eligible retirees and their dependents in 1975. Alaska Statute Sec. 39.35.535(b) requires that the retiree health plan become supplemental to federal old age benefits available at age 65. This statute has been in effect since 1975. The Retiree Insurance Information Booklet section titled, "Effect of Medicare", states: "If you do not enroll in Medicare coverage the estimated amount Medicare would have paid will be deducted from your claim before processing by this plan."

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Do I need to get Medicare part D?

If you are currently eligible for Medicare, or when you become eligible for Medicare, you will be automatically enrolled in the AlaskaCare EGWP plan (a group Medicare Part D plan) by the Division of Retirement and Benefits. You do not need to enroll in an individual Medicare Part D plan.

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Do I need to get Medicare part C?

You are not required to take part in Medicare part C. Part C plans are Medicare Advantage plans provided by private insurers for members who live outside the State of Alaska. They cover the same services as Medicare Part A and B combined as well as some supplemental benefits. The AlaskaCare plan acts as a supplemental plan for Medicare eligible retirees.

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Do I need to sign up for or purchase Medicare part A?

Most people are eligible for premium-free Part A. After members apply for Medicare Part A & B, they will receive a decision letter from Social Security notifying them if they qualify for premium-free Part A. Members who do not qualify for premium-free Medicare Part A, should not enroll in Part A, they must provide a copy of the Social Security letter to the AlaskaCare health claims administrator and the Division of Retirement & Benefits, and AlaskaCare will continue to pay as your primary plan for Part A services.

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Vision

What should I do if my provider tells me I don't have vision coverage but I know I do?

Providers may receive incorrect information when verifying your vision benefits through Aetna's self-service tool. While Aetna continues to update its systems, you can call the Aetna Concierge at (855) 784-8646 to verify your vision benefits.

How do I find a network vision provider?

The AlaskaCare Retiree Vision Plan does not have a network. This means you may choose to see any provider and receive plan benefits for covered services.

Is my provider required to submit my claims for me?

No, you are responsible for submitting your vision claims to Aetna for processing. Your provider may be willing to file the claim for you, but it is the member's responsibility.

What should I do if I am only enrolled in the AlaskaCare dental-vision-audio plan (but not the medical plan) and do not have an ID card to show my provider?

For the AlaskaCare Retiree Vision and Audio Plans, you may print an ID card that includes your name and Aetna ID number by logging on to Aetna's online Navigator tool and clicking "Get an ID Card." If you are not registered for Aetna Navigator, you may call Aetna Concierge at (855) 784-8646 to obtain your Aetna ID number to give your provider.

For the AlaskaCare Retiree Dental Plan, Moda Health/Delta Dental will send you an ID card for your dental services. If you need assistance with your dental cards, please contact their Customer Service Center at (855) 718-1768.

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Preventive Care

Does the AlaskaCare Retiree plan include preventive service coverage?

Preventive care was not part of the original benefits covered by the AlaskaCare Retiree plan when it was created in 1975. Effective January 1, 2022, the Division of Retirement and Benefits is expanding preventive care coverage to the Retiree Defined Benefit health plan.

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What preventive services will be covered?

Preventive care coverage includes, but is not limited to vaccinations, wellness visits, colorectal cancer screenings, mammograms, pap smears, prostate cancer screenings, and lung cancer screenings. Like other health plans, services covered by the Plan are based on those recommended by the US Preventive Services Task Force (USPSTF) and other governmental advisory groups and may include additional services as outlined in the Third-Party Administrator’s guidelines. These guidelines will change over time as they are updated to reflect the most current research and evidence.

What is the cost for preventive services?

After January 1, 2022, when you visit an in-network provider for preventive services, your AlaskaCare plan will pay 100% coinsurance and your deductible will not apply.

For preventive care received from out-of-network providers, you will first have to meet the $150 deductible, and then the plan would pay 80% coinsurance (up to the recognized charge) for covered services. Your AlaskaCare out-of-pocket maximum will not apply to preventive care services received from out-of-network providers. If you do not have access to an Aetna network provider in your area, you may contact Aetna to pre-certify use of an out-of-network provider, and those services will be paid as though they were received in-network.

Many retiree plan members have other health coverage, such as Medicare, or additional coverage through their spouse. The AlaskaCare plan will continue to coordinate with other plans the way it does today when determining payment for covered services.

Will the Plan cover colorectal cancer screenings, like colonoscopies or an at-home stool test?

Yes, colorectal cancer screenings including colonoscopies and at-home stool tests (such as Cologuard) will be covered in accordance with the standards outlined by the US Preventive Task Force and current clinical guidelines and frequency limitations outlined by the Third-Party Administrator’s (currently Aetna) clinical policy bulletins.

How does the Plan determine which preventive services are covered?

In alignment with the Plan booklet, Section 3.3.1 Medically Necessary Services and Supplies, and mainstream commercial health insurance practices, the Plan will utilize the current Third-Party Administrator’s (currently Aetna) clinical coverage standards for purposes of determining coverage of preventive services under the Plan. These standards must include, at a minimum, those services with an “A” or “B” recommendation by the USPTF but may include additional services or screenings. Clinical coverage standards regarding preventive care are subject to change and are updated periodically based the most current clinical evidence.

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Are there any vaccines included in the preventive coverage?

Yes. Common vaccines included in the proposed preventive care coverage are hepatitis A & B, HPV, influenza (flu shot), measles-mumps-rubella (MMR), meningitis, pneumococcal (pneumonia shot), tetanus, diphtheria, pertussis, polio, chickenpox, rabies, and shingles.

Are shingles vaccinations covered?

Beginning January 1, 2019, all retirees have access to the shingles vaccine, which is covered by AlaskaCare when administered at a pharmacy. The addition of preventive care services means effective January 1, 2022 you can also receive the shingles vaccine at your doctor’s office.

Will the new preventive care coverage include Silver Sneakers?

No, Silver Sneakers is only available to people who are covered by a participating Medicare Advantage or Medicare Supplement Insurance plan. The Division is working to evaluate if any similar programs could be offered to retirees in the future.

Special Medication Prior Authorization

What is prior authorization?

Prior authorization is a pre-approval process guided by rigorous clinical standards for intensive, high-cost medical procedures. Prior authorization for specialty medications:

  • Ensures the therapy meets FDA guidelines for the condition being treated.
  • Ensures providers follow nationally recognized care criteria when prescribing medication.
  • Requires the prescriber to provide documentation in support of the clinical criteria specific to that medication prior to the medication being dispensed.

Prior authorization for specialty drugs is a pharmacy management process that reviews certain medications against clinical, evidence-based standards including those established by the FDA to promote safe and effective use of those medications.

What is a specialty medication?

A specialty medication has at least one of the following characteristics:

  • High Priced: can cost more than $1,000 for a 30-day supply.
  • Complex: drug imitates compounds found in the body or is part of a specialty drug class.
  • High-Touch: special shipping or handling requirements like refrigeration, special steps to follow as you take it, needs a pharmacist or doctor to measure how well it works for you.

How will I know if my drug is a specialty medication?

Only about 1% of covered prescriptions are specialty medications. You can review the OptumRx Specialty Pharmacy Drug List (last updated on 12/02/21) to see if any of your current medications are specialty drugs that may require a prior authorization. If your drug appears on this list, you need to obtain a prior authorization prior to filling your prescription after January 1, 2022. If any of your medications require a prior authorization after January 1, 2022, you will receive a notification letter with detailed information. Please note this list may change over time and is for informational purposes only. If you have any questions, contact OptumRx at (855) 409-6999.

Starting with the 12/02/2021 Specialty Pharmacy Drug List both the brand and generic specialty medication names are included as well as recently released transplant medications.

Can I request a prior authorization for my prescription before January 1, 2022?

While it is not necessary to obtain a prior authorization for your specialty medication prescription before January 1, 2022, you may call OptumRx at (855) 409-6999 and the customer service agents can help you to submit all of the required pieces of information ahead of time. If you do so, OptumRx will initiate your specialty medication prior authorization on your behalf after January 1, 2022.

Will I be notified if my prescription needs a prior authorization?

Yes. Members will receive a notification letter advising their medication requires prior authorization review. Once you have an approved prior authorization in place, when it nears expiration, OptumRx will proactively initiate outreach to your prescriber to obtain the information necessary to extend or renew the authorization.

How long does the prior-authorization process take?

Providers may submit prior authorization requests electronically, over the phone, or by mail. The prior authorization process is designed with expediency in mind. Most prior authorizations are completed within 72 hours. Physicians can use an electronic platform called Pre-Check my script for real-time information and authorizations.

Will my provider be able to help me with prior authorizations?

Yes. This is common in health plans and physicians are already familiar with the prior authorization process. Providers may submit prior authorization requests electronically, over the phone, or by mail.

Why would a prescription need a prior authorization?

Some medications should be reviewed for coverage because:

  • They’re only approved for, and effective in, treating specific illnesses.
  • They may be inappropriately prescribed for conditions for which effectiveness has not been demonstrated.
  • They may have dispensing and prescribing requirements specific to a patient’s age, gender, other medication usage, or clinical condition.

What are the benefits of prior authorization?

Benefits of prior authorization include ensuring the right drug is dispensed at the right time and safety and efficacy standards are adhered to. Members may experience improved quality care when evidence-based criteria are reviewed to promote appropriate use of certain specialty medications.

How long is a prior authorization good for?

Prior authorization approvals are typically valid for 3-36 months, depending on the medication. OptumRx identifies approved prior authorizations for prescriptions expiring within 30 days and will proactively reach out to the prescriber to request any information needed to extend the prior authorization.

Why are you adding prior authorizations for specialty medications?

Specialty medications are a relatively new type of treatment that has grown substantially over the last few years. In 2020, specialty medications accounted for about 1% of all prescriptions covered by the AlaskaCare retiree plan but cost $110 million in covered plan expenses. A single prescription can cost as much as $160K or more annually.

Similar to how the Plan requires precertification for certain intensive, complex, and high-cost medical services, prior authorization is a common tool used by pharmacy plans to ensure appropriate use.

Growth of specialty medication is expected to continue as new medications are developed and the conditions they are used to treat expand. Implementing a prior authorization process for the medications ensures that they are being used for indications approved by the FDA and align with guidelines established by national clinical specialist groups.

Is my drug coverage changing?

There is no change to coverage for prescription medications that are prescribed under the terms outlined in the Plan booklet. The plan will continue to cover medically necessary and clinically appropriate prescription drugs. There is no change to member copayments which will remain $8 for brand medications, $4 for generic medications, and $0 for medications filled through mail order.

What are the qualifications of the persons reviewing the specialty medications?

At OptumRx, prior authorization criteria are reviewed and approved by the OptumRx Pharmacy & Therapeutics (P&T) Committee. The P&T Committee is an independent, multi-specialty and nationally represented group of physicians and pharmacists. The P&T Committee evaluates medications based on scientific evidence to find their place in therapy. Quarterly meetings are held to evaluate, review, and make clinical recommendations. Industry, clinical, and company standards govern the P&T Committee’s review, consideration, and recommendation processes. The committee considers:

  • U.S. Food and Drug Administration (FDA) approved indications
  • Manufacturer’s package labeling instructions
  • Well-accepted and/or published clinical recommendations (ex: American Hospital Formulary Service Drug Information; DRUGDEX; National Comprehensive Cancer Network Drugs and Biologics Compendium; Clinical Pharmacology; major peer reviewed medical journals such as the American Journal of Medicine)

Based on this information, the P&T Committee evaluates whether a drug has a unique therapeutic benefit, comparable safety and efficacy, or whether risk of harm outweighs the benefits. The P&T Committee complies with national quality standards including those provided by the Centers for Medicare & Medicaid Services (CMS), the National Committee for Quality Assurance (NCQA), and the Utilization Review Accreditation Commission (URAC®). After thorough clinical review of prior authorization guidelines is complete, the P&T Committee approves the utilization management criteria.

Is the specialty medication Prior Authorization program a step-therapy program?

No. Prior Authorizations are not step therapy. Step therapy is focused on cost and, has not been implemented in the retiree plan. Prior authorization focuses on clinical indicators, and ensures that a prescription drug is medically necessary, appropriately prescribed, and meets FDA and other clinical guidelines for the condition being treated.

Is there an appeal process for specialty prior authorizations?

The AlaskaCare Retiree Pharmacy Plan provides members with the right to appeal the pharmacy claims and prior authorizations that have been denied by the pharmacy claims administrator, OptumRx. If a claim or prior authorizations is denied, in whole or in part, your letter from OptumRx will explain the reason for the denial. Please refer to your Retiree Insurance Information Booklet located at AlaskaCare.gov for coverage information and if necessary, call OptumRx toll-free at (855) 409-6999 for further clarification.

2022 Benefit Expansion

Is my health plan changing?

The Division of Retirement and Benefit has been working with the Retiree Health Plan Advisory Board (RHPAB) to review proposed updates to the AlaskaCare Defined Benefit Retiree Health Plan (Plan). These updates will add modern coverage provisions to the Plan, including highly desired coverage for preventive care service and prior authorizations for specialty medications.

The Plan Administrator (the Commissioner of Administration) has adopted the proposed updates, and the Plan will be changed to include the expanded coverage beginning on January 1, 2022.

When will any changes take effect?

The proposed changes will take effect on January 1, 2022. This means that the expanded coverage will apply to any dates of service on or after January 1, 2022.

Will the addition of preventive care coverage increase the insurance premiums?

No, the Retiree Plan monthly premiums for 2022 are not changing.

How is this new benefit aligned with preventive care provisions in the Affordable Care Act (ACA)? For instance, if the ACA is changed or no longer offered, does that impact the continued availability of this benefit under our Plan?

As a retiree-only plan, the Plan is exempt from the ACA provisions mandating coverage for preventive care. Though the additional benefits offered do align with the ACA’s preventive care provisions, these provisions do not impact the retiree plan.

In alignment with the Plan booklet, Section 3.3.1 Medically Necessary Services and Supplies, and mainstream commercial health insurance practices, the Plan will utilize the current Third-Party Administrator’s (TPA) clinical coverage standards for purposes of determining coverage of preventive services under the Plan.

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General

Who is eligible to participate in this retiree health plan?

Members of the Defined Contribution Retirement plan (Public Employees’ Retirement System Tier IV and Teachers’ Retirement System Tier III) and their eligible dependents can participate. To be eligible for medical coverage you must have:

  • 10 years of service and be Medicare age eligible, or
  • Be any age with 25 years of service for peace officers/firefighters or;
  • Be any age with 30 years of service for all others.
  • Must have worked the prior 12 months and retire directly from the system.

How do I know if I am PERS Tier IV or TRS Tier III?

Specific information on your individual tier status can be obtained through the Division of Retirement and Benefits Member Services Contact Center at or by calling (907) 465-4460 in Juneau or (800) 821-2251 toll-free Monday through Thursday from 8:30 a.m. to 4 p.m. or Friday from 8:30 a.m. to 3 p.m.

In general, if you are a member of the Public Employees’ Retirement System (PERS) and first entered service after June 30, 2006, you are Tier IV. If you are a member of the Teachers’ Retirement System (TRS) and first entered the system after June 30, 2006, you are a Tier III.

Who is considered an eligible dependent?

  • Your spouse. You may be legally separated but not divorced.
  • Your children from birth (exclusive of hospital nursery charges at birth and newborn care) up to 23 years of age only if they are:
  • your natural children, stepchildren, foster children placed through a State foster child program, legally adopted children, children in your physical custody and for whom bona fide adoption proceedings are underway, or children for whom you are legal, court-appointed guardian (if child is not your natural-born child);
  • unmarried and chiefly dependent upon you for support; AND
  • living with you in a normal parent-child relationship.
    • This provision is waived for natural/adopted children of the benefit recipient who are living with a divorced spouse, assuming all other criteria is met. Stepchildren must live with the retiree 50% or more of the time to be covered under this plan.
  • In addition, if they are between the ages of 19 and 23, they must be attending school regularly on a full-time basis.

Children incapable of employment because of a mental or physical incapacity are covered even if they are past age 23. However, the incapacity must have existed before age 23 and the children must continue to be unmarried, rely chiefly on you for support and living with you in a normal parent-child relationship. You must furnish the claims administrator evidence of the incapacity, proof that the incapacity existed before age 19, and proof of financial dependency. Children are covered as long as the incapacity exists and they meet the definition of children, except for age. Periodic proof of the continued incapacity may be required.

Why aren't dependents covered to age 26 under the Retiree health plan?

The definition of retiree dependents limiting coverage to age 19 (or age 23 if a full-time student) comes directly from Alaska statute.

Expanding dependent coverage to age 26 is one of the provisions in the Federal Patient Protection and Affordable Health Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA) that became effective March 2010. This provision affects employee plans and retiree-only health plans differently.

On June 14, 2010, the U.S. Departments of Health and Human Services, Labor, and Treasury issued regulations on Grandfathered Health Plans under PPACA. In the preamble to the Interim Final Rule, the Secretaries clarify that it is not their intent to apply the PPACA coverage to retiree-only health plans. This means DCR medical plan, is not subject to the expanded dependent coverage provisions of PPACA.

Why have I received three ID cards?

To improve our network and customer service, AlaskaCare selected Aetna to administer all medical, pharmacy, vision, and audio claims, and Moda Health to administer all dental claims. You should have received a medical ID card, and if you elected the Dental-Vision-Audio plan you should have also received a vision/audio ID card from Aetna and a dental ID card from Moda to use when visiting your health care provider or pharmacy.

Aetna

Delta Dental

I am newly retired and my ID card hasn't arrived, what should I do?

Medical/Rx ID Card
If your ID card hasn't arrived, you can view and print your Medical/Prescription ID card or download the mobile app that displays the ID card on your smartphone. Note: Aetna Navigator registration required.

You can use your Social Security number to register or call the Aetna health concierge at (855) 784-8646 for assistance. Aetna

Dental ID Card
To print your Moda Health/Delta Dental of Alaska ID card or download the MyModa mobile app, register on the MyModa website or call Moda at (855) 718-1768.

Delta Dental

Premiums

How much will I need to pay to have major medical and pharmacy coverage?

Employees do not contribute to the DCR health trust while they are actively working.

When the employee retires, the DCR medical plan requires Medicare-eligible participants to pay a percentage of the monthly premium. Prior to Medicare eligibility, retirees pay 100 percent of the DCR medical plan cost. After Medicare eligibility, retirees pay a percentage of the plan cost based on years of service:

Years of Service Retiree Contribution Percentage
10-14 30%
15-19 25%
20-24 20%
25-29 15%
30+ 10%

Recognized Charge

What is recognized charge?

A recognized charge is the maximum amount that AlaskaCare's Medical, Vision and Audio plans will pay for a covered service. The term recognized charge is sometimes referred to as the usual, customary and reasonable (UCR) charge or the maximum allowed charge. The recognized charge is determined differently for professional (provider) services, facility services, and pharmacy services.

An out-of-network provider, facility, or pharmacy, has the right to bill you for the difference between the recognized charge and the actual charge. This is sometimes referred to as balance billing.

When you use a network provider, facility, or pharmacy, you are not subject to balance billing for covered services. In other words, the provider, facility, or pharmacy, has agreed to accept, as payment in full, the recognized charge for the service provided. You are only responsible for payment of other applicable charges such as deductibles, co-insurance, and/or non-covered charges. This is an important financial consideration when choosing a provider, facility, or pharmacy.

The facility recognized charge for services or supplies is the lesser of:

  • The amount the facility bills, or
  • The percentage of Medicare fee schedule that most closely reflects the aggregate contracted rate with the preferred hospital (currently 185% of Medicare).

The pharmacy recognized charge for prescription drugs is the lesser of:

  • The amount the provider bills, or
  • 110% of the average wholesale price or other similar resource.

The provider recognized charge for medical, vision, and audio services or supplies is the lesser of:

  • The amount the provider bills, or
  • The 90th percentile of the prevailing charge rate for the geographic area where the service is furnished. The 90th percentile of the prevailing charge rate means the charge that is at or below 90% for all of the charges reported for a service within a specific geographic area.

For assistance with determining a specific recognized charge, call Aetna's Health Concierge at (855) 784-8646 or use the Consumer Cost Lookup tool.

How does Medicare impact the recognized charge?

The recognized charge when Medicare is primary and you are receiving a Medicare covered service is assumed to be the Medicare allowed rate and will be determined by Medicare. If you are receiving services that are not covered by Medicare, the provider has the right to bill you for the difference between the recognized charge as determined by the AlaskaCare plan and the actual charge. If you receive services with a provider that has opted out of Medicare, neither Medicare nor the plan will pay benefits for their service.

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How is the provider recognized charge amount determined?

The recognized charge for out-of-network providers is the 90th percentile of the prevailing charge rate for the geographic area where the service is furnished. The AlaskaCare plans establish the percentile (i.e., 90th percentile) to be applied to the prevailing charge rate; however, the prevailing charge rate is reported by FAIR Health, an independent not-for-profit corporation. FAIR Health collects charge data from claims received by insurance plans and health plan administrators across the country for charges billed by physicians, hospitals, and other healthcare providers. Charges reported are the full fees that healthcare professionals report to insurers as part of the claims process—not the negotiated rates that apply when visiting a network provider. Charges reported are maintained by FAIR Health in its database which is comprised of billions of claims for billed medical procedures from across the United States. New charge data are continually added to the FAIR Health database.

How does FAIR Health validate their data?

FAIR Health has audit and validation programs in place to ensure the integrity of its data. Part of the validation process entails testing the data with statistical algorithms and examination by FAIR Health's in-house statistical and technology experts. A team of healthcare researchers from leading academic institutions advise FAIR Health on the best methods for analyzing its national claims data. FAIR Health is also advised by an independent Scientific Advisory Board of prominent researchers who review Fair Health's statistical methods and data. FAIR Health also seeks input from other stakeholders such as consumer and patient advocacy groups, healthcare providers, actuaries and federal officials.

How are services identified in the FAIR Health database?

Each specific service, procedure or supply in the FAIR Health database has a unique Current Procedural Terminology (CPT) code. CPT codes are numbers assigned to medical services and procedures. CPT codes are part of a uniform system of coding maintained by the American Medical Association and are used by providers, facilities and insurers. Each CPT code is unique. There are currently over 10,000 medical services and procedures classified by CPT code. Most CPT codes are very specific. For example, the CPT code for a 15-minute office visit is different from the CPT code for a 30-minute office visit.

How are the geographical areas determined?

FAIR Health organizes its data by geozip— and a geographical area is usually defined by the first three digits of the U.S. zip codes. Geozips may include areas defined by one three-digit zip code or a group of three-digit zip codes. Geozips generally do not include zip codes in different states. The State of Alaska is currently defined by five geozips:

  • 995—including Anchorage, Bethel, etc.
  • 996—including Homer, Kodiak, etc.
  • 997—including Fairbanks, Kotzebue, etc.
  • 998—including Juneau, Sitka, etc.
  • 999—including Ketchikan, Prince of Wales, Wrangell, etc.

What if there are not enough occurrences of a procedure in a particular geozip?

When the volume of claims is insufficient to create a benchmark based on actual data, geozips 995 and 997 and geozips 996 and 998 will be combined. If the volume of claims is still insufficient, the benchmarks will be derived.

If there are fewer than nine occurrences of a procedure in a geographic area, the plan uses FAIR Health's "derived charge data" instead. This data is based on the charges for comparable services, multiplied by a factor that takes into account the relative complexity of the service. If this information cannot be obtained locally, then national data is used.

What factors can affect the recognized charge?

The following factors can affect the recognized charge:

  • Billing errors: when a provider makes a mistake on either the procedure code or zip code.
  • Multiple procedures: when a provider performs multiple surgical procedures during a single session. The standard practice in such cases is to bill 100% for the primary (largest) procedure, 50% for the secondary procedure and 25% for all others. However, incidental items that require little or no additional time should not have an additional fee.
  • Unbundling: when a provider shows separate codes on the bill for related or incidental services. For example, instead of being billed separately, related blood tests performed at the same time should be billed under a single General Health Panel code.

How can I make sure an out-of-network provider's rate will be within the recognized charge?

You can verify whether an out-of-network provider's charges are within the recognized charge by calling the Aetna Concierge and providing the following information:

  1. The procedure code,
  2. The zip code where the service is to be performed, and
  3. The projected cost.

Aetna will use this information to estimate whether the proposed amount is within the recognized charge. Remember, if you use an Aetna network provider, those providers have already contracted with Aetna to offer discounted fees and those discounted fees are deemed to be within the recognized charge.

What should I do if my out-of-network provider charges more than the recognized charge?

If the out-of-network provider's claim exceeds the recognized charge, and you have already paid your out-of-network cost-sharing amount, wait for the provider to send you a bill, since the out-of-network provider may adjust their charges after reviewing the claim payment. If not, ask the out-of-network provider to:

  1. Consider reducing or waiving their fee to meet the recognized charge amount;
  2. Review the bill to ensure the correct procedure code and amount was used (and if not, submit a corrected bill to the plan);
  3. Confirm that the out-of-network provider charged their normal fee for the service, or if the out-of-network provider increased the charge due to unusual circumstances. If so, ask the out-of-network provider to either submit a corrected bill to the plan or provide a written explanation so you may file an appeal with the plan.

What are Aetna's policies for claims reimbursement?

Aetna's claim reimbursement policies address the appropriate billing of services, taking into account factors that are relevant to the cost of the service such as:

  • The duration and complexity of a service;
  • Whether multiple procedures are billed at the same time, but no additional overhead is required;
  • Whether an assistant surgeon is involved and necessary for the service;
  • Whether follow up care is included in the price of the service;
  • Whether there are any other characteristics that may modify or make a particular service unique; or
  • When a charge includes more than one claim line, whether any service described by a claim line is part of or incidental to the primary service provided.

These claim reimbursement policies are based on:

  • Policies developed for Medicare;
  • Peer-reviewed, published medical journals;
  • Available studies on a particular topic;
  • Evidence-based consensus statements;
  • Expert opinions of health care professionals;
  • Guidelines from nationally recognized health care organizations.

When I use an out-of-network provider, how much of the bill am I responsible for?

If you or your dependent are not Medicare age eligible and use an out-of-network provider, you are responsible for the difference between the recognized charge and the amount charged by the provider in addition to other applicable charges such as deductibles, co-payments, co-insurance, any applicable penalties, and non-covered charges. If you or your dependent is Medicare age eligible, Medicare is the primary payer and AlaskaCare network considerations are not applied, so you should be sure to use a provider who accepts Medicare.

How can I appeal a recognized charge determination for an out-of-network provider?

You may appeal a recognized charge determination by providing additional information to indicate why the recognized charge was not correct, such as incorrect procedure codes, an incorrect zip code, etc.

Where can I get more information about recognized charges?

Specific plan language regarding recognized charges is available in the AlaskaCare Retiree Health Insurance Information booklet for DCR Plan Retirees.

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How do I avoid recognized charge issues?

See a network provider if one is available. When you receive services from a network provider, the provider has agreed to accept the amount the plan will pay for services, and they may not bill the patient for any amount beyond that (excluding any cost sharing amounts such as deductible, the member’s coinsurance, and any other applicable copayments).

To find out whether your doctor is a member of the Aetna network, call Aetna's Health Concierge at (855) 784-8646. To find out whether your dentist is a member of the Moda/Delta Dental network call Moda/Delta Dental at (855) 718-1768.

Network

I'm a retiree who is not yet Medicare age eligible; why should I use a network provider?

Using network providers can provide substantial benefits to members and their dependent(s) who are not yet Medicare age eligible through the elimination of what's known as "balance billing." It can also generate substantial savings to members through negotiated provider discounts. To find out whether your doctor is a member of the Aetna network, call Aetna's Health Concierge at (855) 784-8646. To find out whether your dentist is a member of the Moda/Delta Dental network call Moda/Delta Dental at (855) 718-1768.

Are all services provided at the preferred hospital or facility considered services provided in network?

Yes, as long as the service is provided (billed) by a preferred hospital or facility. However, you may find that not all providers at a preferred hospital or facility are part of the network. For example, if you have a surgical procedure performed at a preferred hospital, you may find that the hospital and surgeon are in the network, but the anesthesiologist is out-of-network. When you receive your bill, you'll see that it reflects the negotiated network rates for your hospital and surgeon. The anesthesiologist, however, may charge what they chooses since they have no negotiated network contract. If the anesthesiologist claim exceeds the recognized charge, you may receive a bill for the balance. It is wise to talk to your providers before incurring any expenses to see if they are covered in the network. You can also call the Aetna Concierge for additional information at (855) 784-8646 prior to receiving services.

Will I be penalized if I use a preferred hosptial or facility, but the provider is out-of-network?

No. The 20% coinsurance differential that applies to out-of-network facilities only applies to the facility services or supplies, and not to the professional services billed by the provider. Similarly, the increased annual out-of-pocket maximum, and out-of-network facility recognized charge calculation do not apply to the professional services billed by the provider.

Will I face a penalty for using an out-of-network facility?

If you receive care at an out-of-network hospital or other facility either in the Anchorage area or outside of Alaska, including surgery centers, birthing centers, rehabilitative centers, and residential treatment centers, you may be subject to higher out-of-pocket costs. These include a 20% reduction in the coinsurance that the plan pays; and an increase in the individual out-of-pocket maximum. Additionally, the maximum allowable rate for out-of-network facility charges is the lesser of what the facility bills or submits for that service or supply, or the percentage of Medicare that most closely reflects the aggregate contracted rate with the preferred hospital or facility (currently 185% of Medicare).

To avoid incurring a penalty, be sure to use the preferred hospital or facility in your area. There may not be a preferred hospital or facility in some parts of Alaska, and in those instances, members will not incur a penalty. However, it is recommended you contact the Aetna Concierge for additional information at (855) 784-8646 prior to receiving services.

What if there is no network provider in my area?

The DCR medical plan only penalizes use of out-of-network providers for the following services: hospital and facility services, preventive care, and limited circumstances such as transplants or inpatient mental health treatment. If you require these types of services, it is important to contact the Aetna concierge team. They can help you find a network provider or facility in your area, or discuss options with you. The DCR medical plan does provide travel coverage for treatment not provided locally or for surgery or diagnostic procedures that can be obtained more cheaply in another geographic region and members may explore these options with the Aetna Concierge team at (855) 784-8646 prior to receiving services.

Is there a "network" for durable medical equipment (DME)?

Aetna does have a DME national provider listing on their DocFind website. To see the current listing, go to AlaskaCare.gov and select the Find a Doctor tool. In DocFind type “durable medical equipment” in the "Search for:" box and enter the appropriate zip code and plan.

The DME national provider list can be found at the top of the generated list, followed by local DME providers, if any. There is no penalty for using an out of network durable medical equipment provider; but you may save money by using a network provider and a non-network provider may bill you for charges above the allowable.

Medicare

Am I required to enroll in Medicare Parts A and B?

You are not required to enroll in Medicare Parts A and B, but the AlaskaCare Retiree Benefit Plan for DCR Plan Retirees will estimate the portion that Medicare would have covered before paying benefits regardless of your enrollment status. Therefore not enrolling in Medicare Part A & B as soon as you become age eligible may have very significant negative financial impacts for you. Members are strongly urged to consider enrolling in Medicare Part A & B three months prior to their 65th birthday.

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Do I have to pay a premium for Medicare?

For many people, Medicare Part A is premium-free. However, if you are not eligible for premium-free Part A, you may need to pay a monthly premium. Everyone must pay a monthly premium for Medicare Part B.

For information on how you may be reimbursed for Medicare premiums from your Health Reimbursement Arrangement Account, see section 4, Health Reimbursement Arrangement (HRA) of the plan booklet.

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Do I need to get Medicare part D?

Currently, you are not required to enroll in Medicare Part D as the drug coverage benefits you have through your AlaskaCare Retiree plan are at least as good as the required benefits offered under Medicare Part D. By not enrolling in Part D, you can avoid unnecessary premiums and coordination between Medicare and AlaskaCare for your prescription drugs. When the plan incorporates the Employer Group Waiver Program, this will change and you will receive additional instruction and communication in advance of this change.

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Do I need to get Medicare part C?

You are not required, but may opt to take part in Medicare part C. Part C plans are Medicare Advantage plans provided by private insurers for members who live outside the State of Alaska. They cover the same services as Medicare Part A and B combined as well as some supplemental benefits. The AlaskaCare plan acts as a supplemental plan for Medicare eligible retirees, but you may elect to take part in Medicare part C in lieu of the AlaskaCare Retiree Benefit Plan for DCR Plan Retirees.

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Vision

What should I do if my provider tells me I don't have vision coverage but I know I do?

Be sure to use your separate Aetna Vision/Audio ID card to prevent providers from receiving incorrect information when verifying your vision benefits through Aetna's self-service tool. If you believe your provider has incorrect information, you can call the Aetna Concierge at (855) 784-8646 to verify your vision benefits.

How do I find a network vision provider?

The AlaskaCare retiree vision plan does not have a network. This means you may choose to see any provider and receive plan benefits for covered services.

Is my provider required to submit my claims for me?

No, you are responsible for submitting your vision claims to Aetna for processing. Your provider may be willing to file the claim for you, but it is the member's responsibility.

Dental

Is there a dental network if I have Medicare?

Yes, Medicare does not cover most dental services and you have access to the Moda/Delta Dental network of providers through your AlaskaCare coverage if you choose to select the optional dental plan. It is important to choose a dental provider that participates in the network to avoid the potential for unnecessary additional expenses and to fully enjoy the resources and savings available through the network.

What is the dental plan recognized charge?

The AlaskaCare Dental Plans limit payment of covered services to the recognized charge. An out-of-network provider has the right to bill you for the difference between the recognized charge and the actual charge. This is sometimes referred to as balance billing.

When you use a Delta Dental network provider, you are not subject to balance billing for covered services. In other words, the provider has agreed to accept, as payment in full, the recognized charge for the service provided. You are only responsible for payment of applicable deductibles, co-insurance and/or non-covered charges.

The recognized charge is the maximum amount the AlaskaCare Dental Plans will pay for a covered service.

The recognized charge for each service or supply provided by a network provider in Alaska is the lesser of:

  • 100% of the covered expense;
  • 100% of the provider's accepted filed fee with Delta Dental; or
  • 100% of the provider's billed charge.

The recognized charge for out-of-network providers in Alaska is the lesser of:

    The provider's billed charge; or

    75% of the 80th percentile of the prevailing charge rate as determined by Delta Dental; except in the case of services rendered by an endodontist the recognized charge is 100% of the 80th percentile of the prevailing charge rate as determined by Delta Dental.

The recognized charge for out-of-network providers outside Alaska is the lesser of:

  • The provider's billed charge; or
  • The prevailing charge rate as determined by Delta Dental.

How is the prevailing charge determined in Alaska?

Delta Dental of Alaska incorporates a number of factors into the process they use to determine the 80th percentile.

  1. The 80th percentile is determined statewide in order to maximize the statistical significance of the calculation.
  2. Additional data sources are compared to the results of the 80th percentile calculation for consistency purposes. Other data sources reviewed by Delta Dental are:
    • The Delta Dental Submitted Charges Database (DSC): This dataset is maintained by Delta Dental nationally and includes submitted charges from all Delta Plans for services rendered in Alaska.
    • The rates reported by Fair Health, an independent non-profit corporation.
    • Market research on prevailing charges used by other insurance carriers.
  3. For each procedure code, the current prevailing charge is compared to the 80th percentile calculation. Any changes to the current prevailing charge indicated by the 80th percentile calculation must be consistent with the other data sources referenced above. For new procedure codes, or those where there are too few procedures for a statistically valid 80th percentile calculation, additional considerations taken into account are:
    • The complexity of the service or supply;
    • The degree of skill needed; and
    • The cost of any materials required for the service.
  4. When a change in the prevailing charge is indicated, the change is limited to maximum percentage change unless otherwise indicated.

Is this same 80th percentile calculation used for specialists?

If the service provided by the specialist is exactly the same as that provided by the general dentist, the prevailing charge is the same for both (e.g. full mouth X-rays). However, if the services provided are specific to a specialist's training, the specialist will be reimbursed at a higher prevailing charge.

How does the prevailing charge rate determination differ outside of Alaska?

Medical necessity is one factor the AlaskaCare health plans consider in determining whether to provide coverage for a service or supply. The AlaskaCare health plans do not pay for services or supplies that are not medically necessary, such as cosmetic procedures.

When Medicare or another plan is primary to the AlaskaCare Retiree Benefit Plan for DCR Plan Retirees, AlaskaCare will defer to the primary payers determination of medical necessity unless it is a service or supply that is specifically excluded under the plan.

When the AlaskaCare medical plan is primary, the plan uses Aetna's current Medical and Pharmacy Clinical Policy Bulletins to determine medical necessity. The Aetna clinical policy bulletins are available to the public here.

Determinations of medical necessity for dental procedures are made by Moda Health.

Medical Necessity

What is "medical necessity?"

Medical necessity is one factor the AlaskaCare health plans consider in determining whether to provide coverage for a service or supply. The AlaskaCare health plans do not pay for services or supplies that are not medically necessary, such as cosmetic procedures.

When Medicare or another plan is primary to the AlaskaCare Retiree Benefit Plan for DCR Plan Retirees, AlaskaCare will defer to the primary payers determination of medical necessity unless it is a service or supply that is specifically excluded under the plan.

When the AlaskaCare medical plan is primary, the plan uses Aetna's current Medical and Pharmacy Clinical Policy Bulletins to determine medical necessity. The Aetna clinical policy bulletins are available to the public here.

Determinations of medical necessity for dental procedures are made by Moda Health.

How does Aetna determine if a service or supply is medically necessary?

Aetna's clinical policy bulletins are based on:

  • Reports in published, peer-reviewed medical literature
  • Studies on a particular topic
  • Evidence-based consensus statements
  • Expert opinions of health care professionals
  • Guidelines published by nationally recognized health care organizations that include supporting scientific data

Are there any limitations as to what kinds of services and supplies can be considered medically necessary?

Under the AlaskaCare plans, services or supplies are never considered medically necessary if they:

  • Do not require the technical skills of health care professionals who are acting within the scope of their license
  • Are provided mainly for the personal comfort or convenience of you, your family, anyone who cares for you, a health care provider, or a health care facility
  • Are provided only because you are in the hospital on a day when you could safely and adequately be diagnosed or treated elsewhere, or
  • Are provided only because of where you are receiving the service or supply, if it can be provided in a doctor's or dentist's office or other less costly place.

If a service or supply fits the definition of medical necessity, is it always covered by the plan?

No, not all medically necessary services or supplies are covered by a health plan. For example, a medically necessary service or supply is not covered by the AlaskaCare plans when:

  • It is specifically excluded, or
  • The duration of the medically necessary service reaches a plan limitation (for example, some benefits are limited to a certain number of days, services, service per time period, expenses or visits).

Shouldn't medical necessity be defined by the plan document, and not the Third-Party Administrator?

The number of medically necessary procedures and unique circumstances of their application are virtually limitless, and as science progresses and the medical field changes, services that were once considered necessary may be recognized as unsafe or even harmful, or new services may be discovered that are more effective. The Third-Party Administrator (TPA) employs dozens, if not hundreds, of clinical experts who specialize in crafting medical necessity guidelines for multiple plans covering millions of lives across the United States. These guidelines are updated continuously to reflect changes and advances in research and technology.

The Division of Retirement and Benefits has historically relied on the TPA to provide this service as it has never have the breadth of medical personnel, expertise, or experience to establish, maintain, and update clinical guidelines; and determinations of medical necessity are part of the claims processing function. Because AlaskaCare contracts with a TPA to perform this function, it is the TPA who makes determinations of medical necessity as part of the claims processing function.

The clinical policy bulletins provided by Aetna set guidelines that are readily available on-line and transparent to members and their physicians, and clearly show the medical evidence relied upon to make the determination. The evidence basis of the policy bulletins are reviewed regularly and the bulletins are updated as necessary. Medical providers can also request peer-to-peer review with a TPA medical director to present additional medical evidence for consideration.

If my doctor recommended the treatment, isn't that enough to support medical necessity?

The National Institute of Health estimates that nearly 30% of all medical procedures or services performed in the United States are either unnecessary and provide no benefit to the patient, or even worse, are harmful. Additionally, a growing body of research indicates it can take as long as 17 years for medical evidence to move from research reccomendations to clincial practice. In a field driven by constantly evolving research and data, it can be difficult for providers to stay on top of the latest body of evidence for a particular procedure or episode of care. Aetna's clinical policy bulletins rely on carefully reviewed medical evidence to make decisions about coverage that are weighed against clinically accepted standards of medical practice.

We encourage you to have your doctor review the clinical policy bulletins used to guide coverage decisions related to medical necessity. After your provider completes this review, and if they disagree, your provider may request a pre-determination of coverage and present additional medical evidence for consideration during the pre-determination review.

To review your doctor's recommended treatment plan, and verify whether the services or supplies fit the definition of medical necessity, contact Moda Health at (855) 718-1768 for services covered under the dental plan, or contact the Aetna Concierge at (855) 784-8646 for services covered under the medical plan.

If there continues to be a difference in opinion, you or your provider are encouraged to appeal the coverage decision.

What can I do if a claim is denied because the third-party administrator determined my service is not medically necessary?

If a claim is denied based on a medical necessity, you may request an explanation of the scientific or clinical judgment for the determination, free of charge.

If you believe it's warranted, you may also initiate a written appeal to the plan. The AlaskaCare Retiree Benefits Plan for DCR Plan Retirees describe the process and timeline required for submitting an appeal.

The appeals process used by AlaskaCare allows for the use of Independent Review Organizations (IRO) at level 2 of the appeals process. Use of an IRO allows for an impartial review by a third-party medical expert when there is disagreement regarding medical necessity.

Health Reimbursement Arrangement

What is a Health Reimbursement Arrangement?

The Health Reimbursement Arrangement (HRA) is an IRS approved individual savings account, funded by employer contributions, used to reimburse eligible DCR participants tax-free for qualified out-of-pocket medical expenses and individual health insurance premiums.

You or your dependent’s qualified medical expenses that are payable from your HRA include the following:

  • Amounts paid for health insurance premiums.
  • Copays, coinsurance, deductible, services, etc. not covered under AlaskaCare or another health plan.
  • Amounts paid for prescription medication, but not over-the-counter drugs unless prescribed by a licensed health care provider.

How do I know if I am eligible to access my HRA?

To be eligible you must have retired directly from the DCR plan OR be eligible for Medicare and have a minimum of 10 years of service. For purposes of the HRA, to be considered retired directly from the plan, you must:

  • Have at least 30 years of service (other than peace officers and firefighters); or
  • Have at least 25 years of service if you are a peace officer or firefighter; or
  • Be a surviving spouse of a participant who had retired or who was eligible for retirement and medical benefits at the time of the participant’s death; or
  • Be an eligible dependent of a surviving spouse.

Coordination of Benefits

What is Coordination of Benefits?

Coordination of Benefits (COB) is a method of paying claims when you or your covered dependent have more than one health coverage plan. The AlaskaCare health plans coordinate benefits with other group health care plans to which you or your covered dependents belong. Coordination of benefits can be very confusing, even for people who work at a physician's office.

With COB, if you are covered by more than one health care plan, the plans work together to provide benefits. One plan is considered "primary," and pays your covered expenses first. The other plan is "secondary," and depending on the plans COB provisions, may pay a portion or may pay any remaining covered expenses up to 100%. In some cases, there may be a third or fourth plan, as well.

It is important to remember that not all expenses are covered expenses. In addition, each plan may have their own separate deductibles that may have to be satisfied independent of each other. The plans will likely also have independent and different copayments, coinsurance rates and annual out-of-pocket limits.

How do you know who pays as primary, secondary, etc?

Here are examples of common COB situations and rules:

If You Are Covered Under… Here's How the Plans Pay
Active employee plan and retiree plan Primary: Active employee plan
Secondary: Retiree plan
Retiree plan and as dependent under another person's plan through active employment Primary: Retiree plan
Secondary: Other person's plan
Retiree plan and Medicare-eligible Primary: Medicare
Secondary: Retiree plan
Two retiree plans Primary: Plan in force the longest
Secondary: Other plan
Retiree plan, as dependent under another person's plan through active employment, and Medicare-eligible Primary: Other person's plan
Secondary: Medicare
Third: Retiree plan
Active employee plan, retiree plan, as dependent under another person's plan through active employment, and Medicare-eligible Primary: Active employee plan
Secondary: Other person's plan
Third: Medicare
Fourth: Retiree plan

If your dependent children are covered under more than one plan, in most cases, the plan of the parent whose birthday falls earlier in the year (not the oldest) is primary. If both parents have the same birthday, the plan that has covered the children longer is primary. If the parents are separated or divorced, the plans pay as follows:

  • Primary: plan of the parent whom the court has established as financially responsible for the child's health care (the claims administrator must be informed of the court decree)
  • Secondary: plan of the parent with custody of the child
  • Third: plan of the spouse of the parent with custody of the child
  • Fourth: plan of the parent who does not have custody of the child

What if none of the COB rules above describe my situation?

If none of the above rules applies, the plan that has covered the patient the longest is primary.

How do the plans coordinate if my AlaskaCare Dental Vision Audio (DVA) plan is secondary?

The AlaskaCare Retiree Dental, Vision, Audio (DVA) Plan for DCR Plan Retirees coordinates benefits differently than the medical plan does when it is secondary to another plan. For DVA services, the amount the plan pays after the deductible is met is figured by subtracting what the primary plan pays from 100% of expenses covered by the AlaskaCare plan on that claim.

Example:

  • You obtain a filling from a network dentist who charges $200.
  • Both your dental plans pay 80% for class II (restorative) services.
  • You have met your deductibles for the year.
    • Primary plan pays: $160 (80% of $200)
    • Secondary plan pays: $40 (20% of $200)
    • Total paid: $200

For medical services, when the AlaskaCare plan is secondary on a claim the plan will reduce the allowable amount by the amount paid by the primary plan, before applying the deductible, copays and/or coinsurance. The allowable amount is the total amount the AlaskaCare plan is responsible for, before any member cost share provision is applied.

Example:

  • You are Medicare age eligible and obtain a service from a provider who accepts Medicare. The Medicare allowed rate for the service is $1,500.
  • Both Medicare and the AlaskaCare plan pay 80% for the covered service.
  • You have not met either your Medicare or AlaskaCare deductible for the year.
    • Medicare as primary plan pays: $1,067.20 ($1,500-$166 Medicare deductible = $1,334x80% is $1,067.20)
    • AlaskaCare DCR medical plan bases payment on: $432.80 ($1,500-$1,067.20)
    • AlaskaCare DCR medical plan pays as secondary: $106.24 ($432.80 - $300 deductible = $132.80x80% is $106.24)
    • Total paid by both plans: $1,173.44.
    • Unpaid portion ($326.56) applies to the annual individual out-of-pocket maximum.

Will the coverage from two AlaskaCare plans always pay 100% of what the provider charges?

No. Under the medical plan, the allowable amount on the second AlaskaCare plan will be reduced by the amount paid under the primary plan (see above example). You may also receive a balance bill for the amount over the recognized charge allowed under the primary plan if you receive services from an out-of-network provider.

Example:

  • You are not yet Medicare age eligible and obtain a service from an out-of-network provider who charges $500 for a procedure.
  • The recognized charge for the procedure is $425.
  • Both AlaskaCare plans pay 80% for the covered service.
  • You have met your annual deductibles.
    • The primary plan pays: $340 ($425x80% is $340)
    • The secondary plan bases payment on: $85 ($425-$340 paid by primary plan)
    • The plan pays as secondary: $68 ($85x80% is $68)
    • Total paid by both plans: $408.
    • Unpaid portion that you may be responsible for is $92. This is the difference between the billed amount and the allowable recognized charge ($75), plus your coinsurance ($17). Your coinsurance amount ($17) will apply towards the annual individual out-of-pocket maximum.

You may also receive a balance bill if you use an out-of-network provider for dental services. In this case, the plan will pay up to the recognized charge for this service in your area.

Example:

  • You obtain a filling from an out-of-network dentist who charges $250 for a filling.
  • The recognized charge for this service in Alaska is $150.
  • Both your plans pay 80% for class II (restorative) services.
  • You have met your deductibles for the year.
    • Primary plan pays: $120 (80% of $150)
    • Secondary plan pays: $30 (20% of $150)
    • Total paid: $150
    • Potential balance bill amount: $100 ($250 - $150)

You may also receive a balance bill if one of your plans has a lower coinsurance rate (the percentage of the cost you pay for covered expenses once you meet any deductible) or excludes coverage for the service.

Example:

  • You obtain a filling from a dental network provider who charges $200.
  • Your dental plan pays 80% for class II (restorative) services, but your spouse's plan only pays 10%.
  • You have met your deductibles for the year.
    • Primary plan pays: $160 (80% of $200)
    • Secondary plan pays: $20 (10% of $200)
    • Total paid: $180
    • Potential balance bill amount: $20 ($200 - $180)

Are there other benefits to being covered by more than one plan?

If you are covered under two AlaskaCare plans, the annual maximum that the plan pays will double. For example, under the Alaska care retiree dental plan, the annual $2,000 individual maximum would double to $4,000.

Do frequency limits double?

No, the maximum frequency of services per year is not increased due to having other coverage. For example, if you have two plans that each cover up to 20 spinal manipulations each year, the plan will coordinate payment on only 20 manipulations. Manipulations in excess of 20 would not be covered under either plan.

How do the AlaskaCare plans coordinate with Medicare?

If you are covered under AlaskaCare and age eligible for Medicare, your claims will be processed as if Medicare is your primary coverage regardless of whether or not you actually have Medicare coverage. This means that the AlaskaCare plan reduces the allowable amount it will pay by the amount that would have been paid under Medicare Parts A and B, regardless of whether you actually have Medicare. It's your responsibility to enroll in Medicare Parts A and B as soon as you become eligible and to pay applicable Medicare premiums.

I am Medicare-eligible and have multiple insurance coverages; does my enrollment in the AlaskaCare enhanced Employer Group Waiver Program (EGWP) change the coordination between my plans?

Because the AlaskaCare enhanced EGWP is a group Medicare Part D plan, if you have multiple prescription drug coverages the AlaskaCare enhanced EGWP will become the primary payer. If your other coverage previously had been the primary payer, it will move into the secondary payer position. Your total coverage levels will not change. Your medications will still be covered at the same benefit level as they were before.

Please note that you can only receive mail-order prescriptions through your primary prescription drug coverage’s home delivery program. If AlaskaCare is now your primary coverage and you used to receive mail-order prescriptions through an alternate coverage, you will need to enroll in the AlaskaCare prescription home delivery program to continue to receive your medications by mail.

OptumRx provides the mail-order pharmacy for the AlaskaCare plans. Please visit Optumrx.com or contact OptumRx at (855) 409-6999 to enroll in prescription home delivery. If you receive your medication through OptumRx home delivery, your copay is $0, which may be less than the copay assessed by your other coverage.

Please note that you cannot be enrolled in more than one EGWP at a time. We anticipate that this situation will be rare, but if you are already covered under an EGWP through a non-AlaskaCare plan, please provide the Division with a copy of your ID card from the other EGWP plan. We will disenroll you from the AlaskaCare EGWP but will you will continue to receive standard AlaskaCare pharmacy benefits.

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General

What is the AlaskaCare Retiree Dental-Vision-Audio (DVA) Plan?

Upon retirement, AlaskaCare retiree beneficiaries may choose to participate in a voluntary Dental-Vision-Audio (DVA) plan to provide coverage for themselves and their eligible dependents. Unlike the medical and pharmacy plans, the DVA plan benefits are funded entirely by member-paid premiums.

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What is the DVA Open Enrollment?

The DVA open enrollment is the time period during which you can make changes to your dental benefits. If you have questions about this enrollment period please contact the Division at (800) 821-2251, or email to learn about your options. You will be able to change your dental plan each year during an open enrollment period for as long as the State offers two dental plans.

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Why are two dental plans being offered?

Offering two dental plans provides maximum benefit and choice to all members. Each DVA plan has different dental coverage provisions and different monthly premium rates. The vision and audio coverage does not vary between the two DVA plans.

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Where can I get more information about the two DVA plans?

You can find information about the two DVA plans online, including the following:

If you have questions about your options, please contact the Member Service Center or Delta Dental of Alaska at (855) 718-1768.

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What are some of the differences between the standard dental plan and the legacy dental plan?

Standard Dental Plan

  • Features an additional dental network, Delta Dental's PPO network, with deeper discounts that save you more money when you use a network dentist. This allows you to receive coverage for more services before you reach your annual benefit maximum. Standard plan members can also access lower rates from dentists who participate in Delta Dental’s broader Premier dental network.
  • Supports evidence-based coverage limitations, including those developed by the American Dental Association, such as frequency and age limitations for exams, cleanings, and periodontal maintenance.
  • Pays less if you visit an out-of-network dentist.
  • Has lower premiums.
Legacy Dental Plan
  • Does not have pre-determined frequency or age limitations on most services.
  • Features a wide dental network, Delta Dental's Premier dental network, that saves you money when you use a network dentist.
  • Pays out-of-network dentists at a higher rate.
  • Has higher premiums.

Some dental procedures fall into different service classes, depending on which plan you elect. If you would like to know how a specific service would be covered under each plan, call Delta Dental of Alaska at (855) 718-1768.

Please consult the 2022 Dental Benefit Comparison for more details about the differences between the plans. The Defined Benefit Retiree Insurance Information Booklet will contain the complete benefit provisions for both the standard and legacy dental plans.

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What are some of the similarities between the standard dental plan and the legacy dental plan?

  • Both plans have the same annual benefit maximum: $2,000.
  • Both plans provide coverage for dental preventive, restorative, and prosthetic services.
  • Both plans have the same coinsurance levels:
    • Class I (Preventive): 100%
    • Class II (Restorative): 80%
    • Class III (Prosthetic): 50%
  • Both plans have the same annual deductible: $50 per individual (Class II and III Services).
  • Both plans are fully funded by member premiums.
  • Vision and audio benefits are the same.

Please consult the 2022 Dental Benefit Comparison for more details about the differences between the plans. The Defined Benefit Retiree Insurance Information Booklet will contain the complete benefit provisions for both the standard and legacy dental plans.

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Where can I find a copy of the plan booklet?

The plan booklets are available on the AlaskaCare webpage.

You can also call the Division's Member Service Center to request a paper copy.

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Can I see any dentist?

Yes, both the standard plan and the legacy plan let you see any licensed dentist you want. Both plans give you access to a wide network of dental providers that will save you money. If you choose the legacy plan and see an out-of-network provider, the plan will cover a greater portion of the charges so you may pay less for out-of-network services. If you choose the standard plan, you have access to an additional network of providers that offer deeper discounts, saving you more money, but you may pay more if you use out-of-network dentists.

Remember, if you use an out-of-network dentist, you may receive additional bills for charges that the plan will not cover.

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How do I tell the Division of Retirement and Benefits which plan I would like to participate in?

Each year the Division will host an open enrollment period that allows members to change their DVA plan elections for the upcoming plan year. You will find the enrollment link at AlaskaCare.gov/DVA. If you have questions about the enrollment period please contact the Member Service Center at (800) 821-2251, or email . While the Division offers multiple plans, you will have an annual opportunity to select the plan that works best for you. You will only be able to make changes to your plan selection during an open enrollment period unless you have a qualifying status change. You can cancel your DVA election at any time by contacting the Division.

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If I change my DVA plan, when will I receive updated ID cards?

If you updated your plan due to a qualifying status change, you can expect new cards in the mail within 10 to 14 days from when you submitted the change.

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Coverage

Will my DVA coverage change because of the 2022 Supreme Court decision?

You may have heard about a lawsuit related to the AlaskaCare Dental-Vision-Audio (DVA) plan. In 2014, in an effort to protect you from rising premiums and to preserve the value of your benefits, the Division updated the dental portion of the DVA plan to align with best dental practices and reduce the cost of services through an expanded dental network. This sought to preserve the plan’s value while maintaining members’ access to care and averting premium increases.

In January 2016, a lawsuit was filed contesting the Division’s efforts. In April 2019, the Alaska Superior Court ruled in favor of the plaintiff. This decision resulted in two DVA plans being offered, the Standard DVA plan and the Legacy DVA plan. This decision was appealed to the Alaska Supreme Court.

On January 21, 2022, the Alaska Supreme Court vacated the Superior Court’s judgement. The Division is evaluating the decision. There will be no immediate changes to the AlaskaCare Retiree Dental-Vision-Audio benefits.

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Can I decrease my DVA coverage?

Yes, you may decrease your DVA level of coverage at any time. To decrease your coverage, submit a written request to the Division stating the level of coverage you would like.

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Can I have more than one DVA Plan?

Yes. If you have a second retirement (you retire from TRS and then from PERS, for example), you may elect coverage under both plans. Or if you are covered by your spouse’s plan, you may elect to have a second plan for yourself or yourself and your eligible dependents. The benefit to having two DVA plans is they coordinate to pay 100% of covered expenses. For example, a filling is covered at 80% under one plan and the second plan pays the remaining 20%. In addition, any annual dollar limits are doubled. For example, the dental plan has a $2,000 maximum and each plan pays up to $2,000, for a total of $4,000, for covered expenses. Service limits, one eye examination per year for example, are not doubled.

If none of these rules apply, the plan that has covered you longer is the primary plan.

If you have two health plans, any dollar limits are doubled. For example, the dental annual maximum pays up to $2,000 of covered expenses under one plan and another $2,000 under the second plan for a total of $4,000 of covered expenses. Any services that are limited to a maximum number of services in a year are not doubled. For example, if you have two plans that each cover a single vision exam each year, the plans coordinate to cover up to 100% of a single vision exam; they do not pay for two vision exams in a year.

For further information and details on coordination of benefits, please see the Retiree Health Plan Information booklet. It is your responsibility to report the existence of benefits payable under any plan, and to file for those benefits.

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My spouse and I each have DVA coverage and cover each other as dependents. Will our plans continue to coordinate coverage?

Yes. Regardless of which plan each of you selects, your coverage will continue to coordinate.

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I am enrolled in the DVA plan with coverage for myself and my dependent spouse. Can I choose the legacy plan, and can my spouse choose the standard plan?

No. A retiree may only select one plan for themselves and any covered dependents. However, if you and your spouse each have a separate AlaskaCare DVA policy, you may select different plans and cover each other as dependents.

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Benefits

What benefits are included in the two dental plans?

The plans have different dental coverage provisions and different monthly premium rates. The Retiree Dental Benefit Comparison may help you compare the plans and decide which is a better fit for you and your family. The AlaskaCare Retiree Insurance Information Booklets will contain the complete benefit provisions for both the standard and legacy dental plans.

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Are my vision and/or audio benefits impacted?

No. The vision and audio benefits are not affected by which dental plan you choose.

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Premiums and Cost

Why are monthly premiums different for the two plans?

The standard and legacy plan monthly premiums are set to reflect the overall value of each plan across all enrolled members. The value of each plan varies based on differences in benefit design, network access, and how much the plan pays out-of-network providers. The rates are not impacted by how many people elect one plan or the other.

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Network

How do I find an in-network dental provider?

To find a network dental provider, call Delta Dental of Alaska at (855) 718-1768 or use the Find a Dentist search tool. When you need dental care, selecting a provider that is in-network can save both you and the plan money.

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What is the difference between Delta Dental’s Premier dental network and the PPO dental network?

Visiting a dental provider who participates in Delta Dental’s network is one of the best ways to get the most value out of your dental coverage. Network dentists have agreed to provide you services at a discounted rate and will file all claim forms for you.

The Premier network is a broad network of providers who offer savings to members. Both AlaskaCare standard and legacy dental plan members have access to the Premier network and associated discounts.

The PPO network is a narrower network of providers who offer deeper discounts and savings to members. In addition to the Premier network, AlaskaCare standard plan members have access to the PPO network and associated discounts. The PPO network is like a “network within a network” that helps you receive the best prices for the dental care you need.

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Open Enrollment

If I do not make an election during open enrollment, which plan will I have?

If you do not make a plan selection, you will remain in the plan you are currently enrolled in.

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Who is eligible to participate in the DVA open enrollment?

Only members who currently have DVA coverage are eligible to participate in open enrollment.

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Can I switch between the DVA plans?

Yes, you will have an opportunity to change your dental plan selection during the open enrollment period. Outside of the open enrollment period, you will not be able to make changes to your elections unless you have a qualifying status change.

If you miss the open enrollment window and have questions about your next opportunity to make a DVA plan selection, please contact the Division of Retirement and Benefits.

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Can I change DVA plans throughout the year?

You will not be able to make changes to your plan outside the open enrollment period unless you have a qualifying status change. You can change DVA plans during any qualified status change, such as marriage, birth or adoption of a child, or divorce.

If you missed open enrollment and have questions about your next opportunity to make a DVA plan selection, please contact the Division of Retirement and Benefits.

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Who do I contact to open a claim?

CHCS Services, Inc. is the claims administrator. You may contact them at (888) 287-7116 to initiate a claim.

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Where do I submit expenses for processing?

Your receipts for expenses may be submitted to:

CHCS Services, Inc.
P.O. Box 13431
Pensacola, FL 32591-3431

Fax: (866) 383-5821

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Is there a web site that I can find information about the plan and my claims?

Yes, CHCS has made a portal available where members may view which plan they are in enrolled in, review plan documents, and obtain a claim submission packet. Members can also use the portal to view claims and receive messages from their case manager.

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Are there exclusions for pre-existing conditions?

Long-term care required due to a pre-existing condition is excluded.

  • A pre-existing condition is any that was diagnosed or treated during the 3 months before coverage started.
  • If you need care in the first 12 months of coverage due to a pre-existing condition, no benefits will be paid for that period of care.
  • If you need care in the first 12 months of coverage due to something other than a pre-existing condition, benefits are paid as normal.
  • If you need care after 12 months of coverage is covered, regardless of the cause.

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What do I need to do to qualify for benefits?

To qualify for benefits, the Bronze plan requires that you are incapable of performing two of the following five Activities of Daily Living (ADLs):

  • Eating – your ability to feed yourself
  • Dressing – your ability to put on or take of your clothes, fasten buttons or zippers
  • Toileting – your ability to get safely to and from the toilet and perform basic personal hygiene
  • Transferring – your ability to move in and out of a bed or chair
  • Walking – your ability to walk without someone's assistance

The Silver, Gold and Platinum plans require that you be incapable of performing two of the following six ADLs:

  • Eating – your ability to feed yourself
  • Dressing – your ability to put on or take of your clothes, fasten buttons or zippers
  • Toileting – your ability to get safely to and from the toilet and perform basic personal hygiene
  • Transferring – your ability to move in and out of a bed or chair
  • Continence – your ability to maintain control of bowel and bladder functions or if unable, the ability to perform associated personal hygiene (i.e., caring for a catheter or colostomy bag)
  • Bathing – your ability to wash yourself in a tub, shower or by sponge bath

The Silver, Gold, and Platinum plans also provide benefits for cognitive impairment (such as Alzheimer’s), which requires that you be supervised in order to perform the ADLs. Certification of medical necessity from a physician is required under all plans. Prior inpatient care is not required.

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What types of facilities will be covered?

The plans cover licensed nursing care facilities, in-home care provided by a licensed home health care agency, and adult day care. The Silver, Gold and Platinum plans also cover assisted living facilities and respite care. Care provided by family members or outside of the United States is not covered.

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When do benefits begin?

The deductible period is 90 days under all plans. You must receive 90 days of covered care before benefits are paid. You may be in any level of care or multiple levels of care to satisfy the 90 days. For example, you may be in home health care for 60 days and in a nursing home for another 30 days to meet the deductible period.

You do not need to receive care every day during the 90-day period. If you receive care only certain days of the week, you still receive credit for the full week of care toward the 90-day deductible.

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What is excluded under the LTC plan?

The plans do not cover long-term care required due to:

  • Alcohol or drug addiction
  • Acts of war, declared or undeclared
  • Suicide, attempted suicide or intentionally self-inflicted injuries
  • Mental or nervous disorders without demonstrative organic disease
  • Confinement in a government institution unless required to pay
  • Services provided when you are hospitalized
  • Services provided by someone who lives with you, is a member of your family, or who does not normally charge for services
  • Services covered by the retiree medical plan, Medicare or any law or government program, except Medicaid
  • Services provided outside the United States Services because of past or present service in a government armed forces

Note that Alzheimer’s and other forms of dementia are covered.

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Will inflation protection be automatic or may it be elected at periodic intervals?

The Bronze and Silver plans have no inflation protection. The Gold plan has 5% simple inflation protection and the Platinum plan has 5% compound inflation protection. Inflation protection is automatic and associated benefit maximums (both daily and lifetime) will be adjusted annually on the date of your enrollment.

When does inflation protection stop?

Inflation protection stops at age 85. The lifetime and daily benefit amounts reached by that date are locked in for the life of the policy.

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What will be required for proof of good health to buy up or elect LTC for the first time?

A simple health questionnaire asking for information about current health status will be required initially. Based on the questionnaire, you will either be approved or asked to provide more information in writing or in person or have a medical examination.

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Will premiums increase as I age?

No. Premiums are based on your age at retirement and while all premiums may increase, your premium will always be based on your age on the date you retired. If you elect coverage for your spouse, you pay a separate premium based on their age at your retirement.

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How often do the premiums increase?

Premiums are subject to review annually and may increase at any time the fund is insufficient to pay the expected claim costs. Premiums have not changed since the inception of the plan.

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Who insures the LTC plan?

The plans are insured by the retirement systems and claims are paid by the third party administrator.

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Can I use Medicare to cover LTC expenses?

Medicare covers some costs but the coverage is limited and approved only for short term periods. Neither Medicare nor the retiree medical plan cover lengthy nursing home stays or home care services for personal care needs.

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Can I change my LTC coverage?

You may decrease your coverage, from Platinum to Gold for example, or drop coverage for your spouse at any time. You may never increase your level of coverage. You may apply for coverage for a new spouse within 120 days of the date of marriage.

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Why does the Pharmacy Benefit Manager change? What does this mean for me?

Periodically, the Division competitively bids these contracts through a Request for Proposal (RFP). This gives us an opportunity to seek better service at lower cost for members and the plan.

Effective 1/1/2019, the AlaskaCare plan uses OptumRx as the PBM to administer pharmacy benefits.

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How will compound medications be covered with OptumRx?

OptumRx will process claims according to the AlaskaCare plan document. Compounds will continue to be covered under the Defined Benefit Retiree Health plan.

Coverage of compounds differs for the active employee and defined contribution retiree health plans. The AlaskaCare Employee Health Plan and AlaskaCare DCR Benefit Plan only cover compound drugs if:

  1. the product contains at least one prescription ingredient;
  2. the active ingredient(s) is approved by the FDA for medicinal use in the United States;
  3. the product is not a copy of a commercially available FDA approved drug; and
  4. the safety and effectiveness for the intended use is supported by FDA approval, or adequate medical and scientific evidence in the medical literature.

OptumRx maintains a National Compound Credentialing Program (NCCP) to ensure the best compounded medication quality and effectiveness for the patients who need personalized medications. You must fill your compounded medication prescription at a pharmacy which has been credentialed with the OptumRx National Compound Credentialing Program (NCCP).

Using an NCCP pharmacy ensures that you will not be charged up front for your prescription (and required to submit your own claim for reimbursement), you will not be charged for molding or other non-covered charges, and you will not be charged for shipping if the pharmacy mails your compounded medication to you. You can find a list of NCCP-credentialed pharmacies here. You can also call OptumRx at (855) 409-6999 (TTY 711) to get help locating NCCP-credentialed pharmacies.

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How will OptumRx work with the Enhanced Group Waiver Program (EGWP) for retirees?

The pharmacy benefit for AlaskaCare retirees remains the same, and OptumRx will manage all pharmacy benefits. Medicare-eligible retirees and dependents will be automatically enrolled in the enhanced EGWP. Members will not need to do anything to enroll and do not need to enroll in an individual Medicare Part D plan.

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What happens if I don’t receive my prescription drug card in the mail?

If you need to fill prescriptions before your card arrives, you can contact the Division and we will print or email a temporary card. As of January 1, 2019, you can also get a printable ID card from the member portal, or view your card in the mobile app.

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Why did I receive more than one ID card with different ID numbers?

Please select the scenario that best describes you:

  • I am covered under a single AlaskaCare plan, and…
    • I am an active employee:
      ID cards are issued in packs of two to active employees. If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.
    • I am a retiree that is not eligible for Medicare:
      ID cards are issued in packs of two to retirees that are not eligible for Medicare. If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.
    • I am a Medicare-eligible retiree who is not covered under the enhanced Employer Group Waiver Program (EGWP):
      ID cards are issued in packs of two to retirees that are not enrolled in the AlaskaCare enhanced Employer Group Waiver Program (EGWP). If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1st,1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.
    • I am a retiree covered under the enhanced Employer Group Waiver Program (EGWP):
      You should have received only a single ID card with the MedicareRx logo in the lower right corner (see example below). Please contact the Division or OptumRx for additional information on why you may have received a second card.
  • I am covered under my own plan and under my spouse’s AlaskaCare plan, and…
    • Both my spouse and I are either an active employee or a retiree not yet eligible for Medicare:
      You will both receive a two-pack of ID cards with your own name and ID number. You may share one copy of your ID card with your spouse, however, you or your dependents only need to present one of these ID cards to the pharmacy. OptumRx coordinates your coverage behind the scenes.
    • Both my spouse and I are are retirees and eligible for Medicare:
      If you are both eligible for Medicare and are enrolled in the enhanced Employer Group Waiver Program (EGWP), you should each receive a single ID card that has the MedicareRx logo in the lower right (see example below). Each card will have an individual name and ID number. Although you receive only one card, when you present the card at the pharmacy you will receive the benefit of your double coverage under the plan. This means you will not be required to pay a copay at the pharmacy counter.
    • One of us is a Medicare-eligible retiree enrolled in the enhanced Employer Group Waiver Program (EGWP) and the other is either an active employee or a retiree not enrolled in EGWP:
      The retiree who is Medicare-eligible and is enrolled in the enhanced Employer Group Waiver Program (EGWP) will receive a single ID card that has the MedicareRx logo in the lower right (see example below). The card will have their individual name and ID number. Although they receive only one card, when they present the card at the pharmacy, they will receive the benefit of having double coverage under the plan. This means they will not be required to pay a copay at the pharmacy counter.

      The spouse who is not enrolled in the EGWP will receive an ID card two-pack in their own name for each layer of coverage they have (their own coverage and their dependent coverage as the spouse of a Medicare-eligible retiree). The only difference between the two packs of ID cards will be the ID number. The ID number that matches the Medicare-eligible retiree’s MedicareRx ID card will be the dependent coverage card.
  • I am covered under more than one of my own AlaskaCare plans, and…
    • I am eligible for Medicare:
      If you are eligible for Medicare and are enrolled in the enhanced Employer Group Waiver Program (EGWP), you should receive a single ID card that has the MedicareRx logo in the lower right (see example below). Although you receive only one card, when you present the card at the pharmacy you will receive the benefit of your double coverage under the plan. This means you will not be required to pay a copay at the pharmacy counter.
    • I am not eligible for Medicare:
      You will receive an ID card two-pack for each layer of coverage you have. The only difference between the different packs of ID cards will be the ID number. However, you only need to present one of these ID cards to the pharmacy. OptumRx coordinates the coverage behind the scenes.

Sample card:

OptumRx EGWP pharmacy card

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Why did I receive a new ID card from Aetna? I thought my medical benefits weren’t changing?

The transition to OptumRx does not affect your medical benefits—these continue to be administered by Aetna. However, because Aetna and their contractor CVS/Caremark no longer administer AlaskaCare pharmacy claims, all AlaskaCare members will receive updated ID cards from Aetna that reflects their medical benefit coverage. Retirees will receive two new ID cards from Aetna – one for medical coverage, and one for vision/audio coverage. You should use your Aetna ID card at your doctor’s office, and your OptumRx ID card at the pharmacy counter.

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Can my dependent use my card at the pharmacy and vice versa?

OptumRx coordinates all the layers of coverage for you and your dependents behind the scenes, so in many cases you and your dependents can use each other’s cards at the pharmacy. However, a non-EGWP dependent should not use the card that has a MedicareRx logo in the lower right corner. This card would only work if the pharmacist uses the correct person code (to identify them as a dependent rather than the policy holder). To avoid any confusion at the pharmacy, we recommend you and your dependents only use a card that has your name on it.

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I am an active employee AND a retiree. How do I know which card is for my active plan and which one is for my retiree plan?

You can tell the difference between the cards by looking at the logo on the card. One will say AlaskaCare Employee Pharmacy Plan, and the other will say AlaskaCare Retiree Pharmacy Plan. Your employee plan will typically be the primary payer.

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What happens if our new prescription cards are not received by January 1, 2019?

If you need to fill prescriptions before your card arrives, you can contact the Division and we will print or email a temporary card. As of January 1, 2019, you can also get a printable ID card from the OptumRx member portal, or view your card in the mobile app.

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I received a letter from OptumRx telling me I am taking a medication that will require prior authorization to determine if it is covered. What should I do?

You can contact OptumRx at (855) 409-6999, TTY711 if you have questions about your prescriptions or any correspondence you have received from them.

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How can I tell if the Prior Authorization letter I received is accurate or not?

If you are Medicare-eligible and are taking a medication that requires prior-authorization, you may receive a copy of the letter below. You can contact OptumRx at (855) 409-6999, TTY711 if you have questions about your prescriptions or any correspondence you have received from them.

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I received a phone call from an OptumRx representative, but my caller-ID says the call is coming from United Health Care. Is this a scam?

The OptumRx home delivery unit reaches out to members to assist with setting up their home delivery accounts and to verify the prescriptions they want delivered. If you receive a call to this effect, it is not a scam. However, if you are unsure if the call is legitimate, you can always decline the call and then contact OptumRx at (855) 409-6999 to ensure the call is genuine.

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I received a check in the mail from OptumRx. What is it for?

You may have received a check from OptumRx for a variety of different reasons. To find out what the check was for and what to do next, please contact OptumRx Member Services at (855) 409-6999.

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I received a call from an OptumRx representative who stated my mail-order prescriptions have transferred over and then asked me for personal information. Is this a scam?

The OptumRx home delivery unit reaches out to members to assist with setting up their home delivery accounts and to verify the prescriptions they want delivered. If you receive a call to this effect, it is not a scam. However, if you are unsure if the call is legitimate, you can always decline the call and then contact OptumRx at (855) 409-6999 to ensure the call is genuine.

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I received a letter from OptumRx asking me to confirm my enrollment in the AlaskaCare Retiree Medicare Prescription Drug Plan within 30 days. The bottom of the letter has this document code: S8841_19_EXH-5_AKC. What should I do next?

You received this letter because the Centers for Medicare & Medicaid Services (CMS or Medicare) indicated that you have alternative prescription drug coverage under another plan that may be receiving subsidies from Medicare for providing that coverage. We encourage members to confirm enrollment in the AlaskaCare Retiree Medicare Prescription Drug Plan by calling OptumRx at (855) 235-1405. If you do not confirm your enrollment or choose not to participate in the AlaskaCare Retiree Medicare Prescription Drug Plan, you will be placed into the opt-out prescription drug program. This is highly discouraged, as it will result in higher costs for you and for the health plan.

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Can I transfer my prescriptions from my local pharmacy to the AlaskaCare home delivery service provided by OptumRx?

Yes, members may transfer prescriptions from their local pharmacy to OptumRx Home Delivery or from Home Delivery to their local pharmacy:

  1. Members may call their pharmacy and request they transfer prescriptions from the pharmacy to OptumRx Home Delivery. To start home delivery, log in to OptumRx.com , use the OptumRx app, or call (855) 409-6999.
  2. Members may call OptumRx at (855) 409-6999 and request Home Delivery prescriptions be transferred to their local pharmacy.
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Communication Questions

When can I expect to receive my new ID card?

Welcome kits with information and ID cards were mailed the week of December 3, 2018. The welcome kit included ID cards, plan information, and other resources to help members.

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I submit paper claims for my prescription benefits. Who should I send 2018 claims to if they haven’t been filed prior to January 1?

For all prescriptions filled prior to January 1, 2019, you should submit your claim to Aetna/CVS. For any prescription filled on or after January 1, 2019, you should submit your claim to OptumRx. You can find claim forms here.

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I am receiving letters and phone calls from OptumRx, asking for personal information. Is this a scam?

You may receive letters or a phone call from OptumRx or their subcontractor, Convey, asking to confirm certain personal information, including: your name, address, birthday, and Medicare Beneficiary Identifier. Providing this information assists with expedited enrollment and helps avoid any potential issues related to discrepancies or errors between the health plan and Medicare. This is not a scam. If you need to provide updated information, you will receive reminder letters as follows:

  • First letter – upon enrollment in EGWP
  • Second letter – 30 days after enrollment
  • Third letter – 6 months after enrollment
  • Fourth letter – 12 months after enrollment. The fourth letter will be the final request to provide updated information.

To provide this information, you can call the toll-free number provided in the letter, (855) 235-1405 (TTY 711), or mail the return form to:

OptumRx
Attention: Enrollment Services
P.O. Box 269027
Fort Lauderdale, FL 33326

If you have provided updated information but receive an additional reminder letter asking for the information, it is possible that the reminder letter had already been mailed out when Convey received your response to the first letter. To verify that your accurate physical address is on file, you can call Convey toll-free at (855) 235-1405 (TTY 711), or you can contact the Division by phone toll-free at (800) 821-2251 or in Juneau at (907) 465-4460.

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I received an errata sheet from OptumRx in the mail. Do I need to do anything?

If you received an errata sheet from OptumRx, you do not need to take any action; it is intended for informational purposes only. Because the AlaskaCare enhanced EGWP is a Medicare part D prescription drug plan, the Centers for Medicare & Medicaid Services (CMS) requires that we send out errata sheets to inform members of any corrections or clarifications we have made to the plan’s abridged formulary, evidence of coverage, and summary of benefits. If you have any questions about any of the information on the errata sheet, please contact OptumRx member services at (855) 409-6999 (TTY 711).

Please note that the AlaskaCare enhanced EGWP provides enhanced benefits beyond the Medicare Part D covered prescription drugs. Please refer to your AlaskaCare plan booklet to understand your full plan benefits.

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I received a letter from Aetna about home delivery pharmacy services. I thought OptumRx provides home delivery pharmacy services?

Some AlaskaCare members received a letter from Aetna stating that home delivery pharmacy services will be administered by CVS Caremark Mail Service Pharmacy effective next month. This letter was sent in error – please disregard. OptumRx administers pharmacy benefits, including home delivery pharmacy services for all AlaskaCare members.

AlaskaCare members should continue to use OptumRx’s home delivery program to receive medication through the mail and should continue to present their OptumRx pharmacy card to fill prescriptions at a local pharmacy. If you have any questions about home delivery pharmacy services, or your AlaskaCare pharmacy benefits please contact OptumRx at (855) 409-6999.

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Can I opt out of the pharmacy benefit transition to OptumRx and stay with Aetna?

No. You cannot opt out of the transition from Aetna to OptumRx for pharmacy claims administration. All AlaskaCare members were transitioned to OptumRx effective January 1, 2019.

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I received a letter from OptumRx telling me I must opt out within 21 days. What if I need more time to make this decision?

Members received a letter from OptumRx dated November 15, 2018, stating they had 21 days to opt-out of the enhanced Employer Group Waiver Program (EGWP). This was not a hard deadline. Members may elect to opt out of the enhanced EGWP at any time. However, to help ensure you did not experience any disruption in your service on January 1, 2019, members were encouraged to submit their opt-out elections no later than December 26, 2018.

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Can I opt out over the phone?

Yes. Please call the OptumRx member services at (855) 235-1405 to opt out over the phone. This number is only for the opt-out election. Any other questions should be referred to the main OptumRx number at (855) 409-6999.

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Who should I call to confirm if I should have received an opt-out letter?

Please call the OptumRx member services at (855) 409-6999 for additional information on why you were sent an opt-out letter.

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I received a letter from OptumRx asking me to provide a residential address. I use a P.O. box to receive my mail. Why am I being asked to provide a residential address?

You are welcome to use a P.O. box as your mailing address, but in order for you to participate in a Medicare Part D pharmacy plan (i.e. the AlaskaCare enhanced EGWP), federal regulations require OptumRx to confirm you reside within the Medicare service area: the United States, Puerto Rico, or Guam. Providing a residential address will verify your eligibility to be covered under the AlaskaCare enhanced EGWP.

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The letter I received asking me to provide a residential address made it sound like I could lose my prescription drug coverage—is this true?

We apologize for the tone of the letter. The intent of the statement in the letter is to emphasize that in order for AlaskaCare to continue to receive federal subsidies associated with your enrollment in EGWP, you must provide a residential address. You will not lose your coverage—AlaskaCare will always continue to provide you with prescription drug coverage.

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I received a letter from my other Medicare prescription drug plan, saying I have been disenrolled due to my participation in the AlaskaCare enhanced EGWP. What do I do?

You cannot be enrolled in more than one EGWP at a time. If you are already covered under an EGWP through a non-AlaskaCare plan, please contact the Division. We can dis-enroll you from the AlaskaCare EGWP and leave you in the plan available to non-Medicare-eligible members. You will receive a letter from AlaskaCare confirming that you have been removed from the AlaskaCare enhanced EGWP. Please share this letter with your other Medicare prescription drug plan.

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What if I or my spouse are currently enrolled in a Medicare Advantage plan?

You cannot be enrolled in Medicare Advantage plan that includes prescription drug coverage and a separate EGWP plan at the same time. We anticipate that this situation will be rare, but if you are covered under a Medicare Advantage plan that includes prescription drug coverage, please provide the Division with a letter or copy of your Medicare Advantage card and we will disenroll you from the AlaskaCare EGWP. If you are disenrolled from the AlaskaCare EGWP, you will continue to receive pharmacy benefits through the standard AlaskaCare pharmacy benefit.

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Will the Part D Income Related Monthly Adjustment Amount (IRMAA) surcharge deducted in January for my December 2018 benefit be reimbursed by AlaskaCare?

Yes. The Part D surcharge deducted in January 2019 can be reimbursed through the Health Reimbursement Arrangement (HRA) account. Please make sure you have provided a copy of the letter from Social Security that outlines your IRMAA surcharge amount to the Division of Retirement and Benefits. You can mail a copy of the notice to:

Alaska Department of Administration
Division of Retirement and Benefits
P.O. Box 110203
Juneau, AK 99811-0203

You may also send a copy via email to or fax to (907) 465-3086.

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I currently have an individual Part D plan and qualify for low-income subsidies (LIS). Will I need to reapply for the LIS assistance, once I am enrolled in the AlaskaCare enhanced EGWP?

No, you will not need to reapply for the LIS. Your LIS cost sharing/copays will remain the same.

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What is the Late Enrollment Penalty (LEP)?

The Late Enrollment Penalty is an amount added to the Medicare Part D plan premium for a member who meets one or both of the following criteria:

  1. The member did not obtain creditable prescription drug (Rx) coverage when they were first eligible for Medicare Part D
  2. The member had a break in creditable prescription drug (Rx) coverage of at least 63 consecutive days.

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What if I get a Late Enrollment Penalty (LEP) Letter? Will I have to pay the fee?

No, AlaskaCare will pay the Late Enrollment Penalty fee on behalf of the members. You are receiving a LEP letter since you were identified by the Centers for Medicare & Medicaid Services (CMS or Medicare) as having uncovered months prior to their enrollment into the Medicare Part D plan.

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What can be done to remove the LEP?

You can remove a LEP in the following ways:

  1. You can call OptumRx at the phone number on the back of your ID card and speak to an agent who will explain the process to remove the LEP.
  2. You can complete the Declaration of Prior Creditable Coverage form included with the LEP letter and mail it to the following address:
    Convey Health Solutions
    P.O. Box 269027
    Fort Lauderdale, FL 33326

There is a limited amount of time to correct a LEP notice if you feel this has been applied in error. You can contact Convey for up to 90 days after receiving notification to complete an attestation and have the LEP removed.

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I received a check in the mail from OptumRx. What is it for?

You may have received a check from OptumRx for a variety of different reasons. To find out what the check was for and what to do next, please contact OptumRx Member Services at (855) 409-6999.

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I have received an Evidence of Coverage letter from OptumRx. This letter references an Initial Coverage Stage. What does this mean?

Initial Coverage State is a term used by Medicare and is part of the Medicare mandatory information sent to all Medicare prescription drug plan participants. However, due to the additional benefits provided through the AlaskaCare enhanced EGWP, this does not apply and will not impact your benefits. Your copay will not change.

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I received a formulary in the mail from OptumRx and my medication is not listed. Will my medication still be covered?

Yes, medications that were covered in 2018 will continue to be covered after January 1, 2019. The AlaskaCare plan has what is called an “open formulary.” This means the AlaskaCare plan will cover medications, even if those medications would typically not be covered under a Medicare prescription drug plan.

AlaskaCare is required by the federal Center for Medicare and Medicaid Services (CMS) to send a document called an “abridged formulary” to members in the AlaskaCare enhanced EGWP. This formulary provides a list of medications covered under Medicare Part D. Under the AlaskaCare enhanced EGWP, medications that are not typically covered under Medicare Part D will still be covered through the wrap benefit under the AlaskaCare enhanced EGWP. This means that your medication will remain covered even if it is not on the formulary.

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I received a letter from OptumRx telling me I will pay more for my medication. I thought there were no changes to our benefits?

This letter was sent to Defined Benefit retirees in error. There are no changes to your benefit. Your cost will continue to be the $4 copay for generic, $8 copay for brand name medications, and $0 copay for mail order prescriptions. OptumRx sent out a follow up letter to notice you of the error.

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I received a letter from OptumRx telling me there will be a new limit on how much of my medication will be covered. I thought there were no changes to our benefits?

This letter was sent to Defined Benefit retirees in error. There are no changes to your benefit. With the exception of some controlled substances, you will have the ability to fill up to a 90-day supply of your medication. OptumRx sent out a follow-up letter to notify you of the error.

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I received a letter from OptumRx telling me I am taking a medication that will require prior authorization to determine if it is covered. I thought there were no changes to our benefits?

This letter was sent to Defined Benefit retirees in error. There are no changes to your benefit. Although for some Medicare-eligible retirees there are some medications that require prior authorization, these letters reference additional prior authorization or quantity limits that do not apply to the AlaskaCare retiree health plan. OptumRx sent out a follow-up letter to notify you of the error.

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How can I tell if the Prior Authorization letter I received is accurate or not?

If you are Medicare-eligible and are taking a medication that requires prior-authorization, you will receive a copy of the letter below. If you receive a letter referencing prior authorization that does not look like this, you may have received it in error. You can contact OptumRx at (855) 409-6999, TTY711 if you have questions about your prescriptions or any correspondence you have received from them.

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General Questions

Why did the State change to an EGWP?

Moving to an EGWP will have minimal impact to the membership and existing plan, while making providing pharmacy benefits more affordable and sustainable for the health trust and the State. EGWP is estimated to save the health plan approximately $20 million per year and between $40 to $60 million more annually to the State with no diminishment and minimal impact to the membership and existing plan.

EGWP is one method offered by the federal government to provide subsidies to the State of Alaska retiree health trusts. The subsidies help the State keep the health plan funding healthy without impacting most members. We already have a federal reimbursement plan in place called a Retiree Drug Subsidy program (RDS), but EGWP provides greater returns.

Many large employers have made the move from RDS to EGWP because of the significant cost savings and the ability to match existing benefits. Implementing an EGWP means that retirees and beneficiaries who are eligible for Medicare will have the same level and access to pharmacy benefits as they do now, while making more federal funds available to cover those costs. The savings helps the State fulfill its promise to provide retirement benefits to our AlaskaCare retirees.

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What is an “enhanced” EGWP?

An enhanced EGWP, like the AlaskaCare EGWP, is a plan that includes medications covered under Medicare Part D, as well as any medications currently covered under the AlaskaCare retiree health plan that are not typically covered under Medicare. This ensures that all prescription drugs which are covered under the AlaskaCare plan today will be covered under the AlaskaCare EGWP. This enhanced coverage is also called a “wrap.”

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How does an EGWP work?

Much the same way the plan works today. When a member goes to a pharmacy, they will present their AlaskaCare pharmacy ID card. The pharmacy will submit the claim. If the prescription is covered by Medicare, it will be covered by EGWP. Members will pay their normal copay ($0 mail order; $4 generic; $8 brand-name) and collect their medication. If the prescription is not covered by Medicare, it will automatically bill to the “wrap” plan. The member will pay their same copay and collect their medication. Either way, the member shouldn’t notice a difference.

In the beginning, members may need to get prior authorizations for certain medications. A list of those medications is available on the AlaskaCare OptumRx information web page. If you are currently taking a medication that requires prior authorization, you will be contacted with information on what forms you or your doctor need to complete.

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How am I enrolled in EGWP? Will I need to sign up for Medicare Part D?

If you are currently eligible for Medicare, or when you become eligible for Medicare, you will be automatically enrolled in the AlaskaCare EGWP plan (a group Medicare Part D plan) by the Division of Retirement and Benefits. You do not need to enroll in an individual Medicare Part D plan.

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Who is the Pharmacy Benefit Manager for AlaskaCare plans?

Beginning January 1, 2019 OptumRx became the AlaskaCare pharmacy benefits manager. Aetna’s, with their subcontractor CVS/Caremark, pharmacy contract ended December 31, 2018. The Division and the PBM mailed out welcome kits with information, including ID cards, beginning the first week of December 2018.

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Why did the Pharmacy Benefit Manager change?

Periodically, the Division competitively bids these contracts through a Request for Proposal (RFP). This gives the Division an opportunity to seek better service at lower cost for members and the plan. The previous procurement process resulted in OptumRx being selected to provide Pharmacy Benefit Management (PBM) services beginning January 1, 2019. Aetna’s, with their subcontractor CVS/Caremark, contract ended on December 31, 2018.

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Is there a separate Pharmacy Benefit Manager for the AlaskaCare EGWP?

No. There is one Pharmacy Benefit Manager (PBM) for all AlaskaCare prescription drug plans, including the AlaskaCare EGWP, OptumRx.

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Are any other health benefits affected by this change?

No, this transition to an enhanced EGWP only impacts pharmacy benefits for Medicare-eligible retirees and dependents. The pharmacy plan for non-Medicare eligible retirees will remain the same. The transition to OptumRx as the new pharmacy benefit manager will apply to all AlaskaCare members, but only for pharmacy benefits; Aetna will remain the third-party administrator for all medical benefits. The supplemental health benefit plans will also remain the same. Aetna was the pharmacy benefits manager until the transition to OptumRx effective January 1, 2019.

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Why did the State change pharmacy benefits for Medicare-eligible retirees?

Alaska law already requires that for Alaska retirees and beneficiaries, Medicare become the primary coverage for major benefits once they are Medicare-eligible. As a Medicare Part D plan, an EGWP would follow this same statutory requirement. By implementing an enhanced EGWP, like the proposed AlaskaCare EGWP (which covers some medications that are not currently covered under Medicare Part D), the benefits will remain the same as those in place today.

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Are vaccines covered under the AlaskaCare EGWP?

Yes, beginning January 1, 2019. As a group Medicare Part D plan, the AlaskaCare EGWP covers most vaccines if they are administered at a pharmacy. They may also be covered when received in a doctor’s office, but only if the doctor’s office coordinates with a pharmacy to bill the plan for the entire cost of the vaccination, including the injection of the vaccine. This coverage will extend to all retirees as of that date, including retirees who are not Medicare-eligible and are therefore not enrolled in the enhanced EGWP.

Generally, Medicare Part D covers all commercially-available shots needed to prevent illness. Common vaccines include shingles, diphtheria, tetanus, measles-mumps-rubella, polio, hepatitis A & B, and HPV. Please note that flu and pneumococcal shots are typically covered by Medicare Part B, and therefore will not be covered by the AlaskaCare plan. You can find a complete list of covered vaccines in the formulary on the AlaskaCare OptumRx information web page. Each vaccine is listed in the formulary as “viral vaccine” under the therapeutic drug class.

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Are vaccines covered for my dependents that aren’t eligible for Medicare?

Yes. AlaskaCare is extending these same benefits to non-Medicare eligible retiree and dependents.

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I heard EGWP isn’t constitutionally protected. Does that mean this plan isn’t protected either?

No! As an AlaskaCare member, your health benefits are protected, and it’s the Division’s job to ensure those benefits remain protected and sustained. Although the EGWP is not protected under Alaska’’s constitution, your retiree benefits are. Using an enhanced EGWP and covering additional medications that are not covered by a standalone EGWP will ensure that you continue to receive the same level of benefits consistent with the protections in the Alaska Constitution.

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Can the State leave EGWP if it is not performing as expected or if the federal government defunds or significantly changes the program?

Yes. The Division will be closely monitoring the program and will evaluate whether it is in Alaska’s best interest to continue using this type of program. If the Division determines that it is not meeting the needs of our members or the State, the Division can disenroll.

Like all Medicare programs, EGWP could change if federal laws and regulations change. Regardless of what happens in the future, Alaska has an obligation to provide pharmacy benefits and will continue to do so.

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Why is it beneficial to the federal government to subsidize pharmacy benefit for retirees?

The Centers for Medicare and Medicaid Services (CMS) is interested in preserving pharmacy benefits for retirees and in providing an incentive to states or other large employers to continue providing these benefits to retirees. While Alaska will not discontinue retiree pharmacy benefits, this is a concern in many other states and for other large employers with retiree health plans. If retiree drug plans are discontinued, more people will enroll in Medicare Part D, which would mean the federal government shoulders more of the cost. Subsidizing state and employer plans encourages those plans to provide retiree drug benefits and is in everyone’s interest.

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If I am enrolled in an AlaskaCare EGWP will this reduce my prescription drug coverage?

No, the prescription drugs covered under the current plan and the AlaskaCare EGWP will be the same.

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Will my prescriptions cost more because of this change?

No. There will be no change in pharmacy copays.

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Will this change require me to use a different pharmacy or doctor?

No. There will be minimal, if any, impact for our members. Just like today, an AlaskaCare EGWP uses a pharmacy network, which most of Alaska’s pharmacies participate in. OptumRx has been working directly with out-of-network pharmacies utilized by AlaskaCare members to bring them into the network. If your preferred pharmacy declines to join this network, you will be provided information about other options.

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Will my co-pays be higher under the enhanced EGWP?

No. Pharmacy co-payments will not change.

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What are the “Donut Hole” (Coverage Gap) Stage and the Catastrophic Coverage Stage? Will I be subject to this under the enhanced EGWP?

Although these are terms you may hear associated with an EGWP, these stages will not impact your benefits. They are different stages defined by Medicare based on your total drug costs. The “donut hole” policy for coverage of pharmacy benefits is a feature of some Medicare Part D plans, but the design of the AlaskaCare enhanced EGWP ensure that you will not be directly impacted by a coverage gap, because the State covers the pharmacy costs not covered under Medicare Part D. This extra coverage ensures your out-of-pocket costs for drugs will not change.

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I am Medicare-eligible and have multiple insurance coverages; does my enrollment in the AlaskaCare enhanced Employer Group Waiver Program (EGWP) change the coordination between my plans?

Because the AlaskaCare enhanced EGWP is a group Medicare Part D plan, if you have multiple retiree prescription drug coverages the AlaskaCare enhanced EGWP will become the primary payer. If your other retiree coverage previously had been the primary payer, it will move into the secondary payer position. Your total coverage levels will not change. Your medications will still be covered at the same benefit level as they were before.

If you add other health coverage and become covered under an active employee health plan, that coverage will become the primary payer.

Please note that you can only receive mail-order prescriptions through your primary prescription drug coverage’s home delivery program. If AlaskaCare is now your primary coverage and you used to receive mail-order prescriptions through an alternate coverage, you will need to enroll in the AlaskaCare prescription home delivery program to continue to receive your medications by mail.

OptumRx provides the mail-order pharmacy for the AlaskaCare plans. Please visit Optumrx.com or contact OptumRx at (855) 409-6999 to enroll in prescription home delivery. If you receive your medication through OptumRx home delivery, your copay is $0, which may be less than the copay assessed by your other coverage.

Please note that you cannot be enrolled in more than one EGWP at a time. We anticipate that this situation will be rare, but if you are already covered under an EGWP through a non-AlaskaCare plan, please provide the Division with a copy of your ID card from the other EGWP plan. We will disenroll you from the AlaskaCare EGWP but will you will continue to receive standard AlaskaCare pharmacy benefits.

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Eligibility and Enrollment Questions

What if I become eligible for Medicare after January 1, 2019?

You can expect to receive information from Medicare three months prior to turning age 65, and though you should enroll in Medicare Part A and B, you do not need to enroll in an individual Medicare Part D plan. You will be automatically enrolled in the AlaskaCare EGWP by the State.

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Will I be charged a Medicare Part D premium when enrolled in an enhanced EGWP?

In most cases, no. The AlaskaCare retiree plan, through Optum Rx, will enroll eligible retirees into the AlaskaCare EGWP. AlaskaCare will pay a monthly administrative cost to the PBM for each enrolled member, and most retirees and their Medicare-eligible dependents will not be required to pay a premium to Medicare.

CMS does require a premium payment of high-income individuals who are eligible for Medicare. See Question #1 of the high income earners section below for more information about this situation and whether it may impact your household.

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I am not Medicare-eligible, but my spouse is. Will he/she be enrolled in the enhanced EGWP plan?

Yes. If your spouse is eligible for Medicare and you are not, he/she will be enrolled in the AlaskaCare EGWP plan, while your coverage will continue to be provided the same way it is today.

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What if I am eligible for Medicare, but my spouse or other dependents are not yet Medicare-eligible?

If your dependents are not currently Medicare-eligible, they will continue to receive prescription drug benefits the same way they do today. If one of your dependents becomes eligible for Medicare in the future, he or she would be enrolled in the AlaskaCare EGWP at that time.

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OptumRx told me that I won’t be enrolled in the enhanced EGWP until February 1, 2019. Will I still have pharmacy benefits during January 2019?

Some Medicare-eligible AlaskaCare retirees may experience a delayed enrollment in the enhanced EGWP until OptumRx can confirm and reconcile that member’s personal information with Medicare. Affected individuals will not experience a disruption in coverage; they will continue to receive full pharmacy benefits through the standard AlaskaCare pharmacy benefit until their enrollment in the AlaskaCare enhanced EGWP can be properly processed. For more information about your specific situation, please contact OptumRx member services at (855) 409-6999.

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I have more than one AlaskaCare coverage and don’t have a co-pay because my prescription costs are covered at 100 percent. Will this change?

No. If you are covered under two or more AlaskaCare plans and are not required to pay a co-pay today, there will be no change under the AlaskaCare EGWP.

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What if I or my spouse are currently enrolled in an EGWP through another employer?

You cannot be enrolled in more than one EGWP at a time. We anticipate that this situation will be rare, but if you are already covered under an EGWP through a non-AlaskaCare plan, please provide the Division with a copy of your ID card from the other EGWP plan. We will disenroll you from the AlaskaCare EGWP but will you will continue to receive standard AlaskaCare pharmacy benefits.

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What if I have already enrolled in Medicare Part D as an individual?

For most members, the benefit provided through your AlaskaCare retiree plan provides better value than an individual Medicare Part D plan. If you wish to keep your Individual Part D plan, you must opt out of the AlaskaCare EGWP plan. Retirees that opt-out of the AlaskaCare EGWP will be placed in a prescription drug program that is much different than the plan prescription drug benefits offered today. This may result in increased out-of-pocket expenses for you or your Medicare-eligible dependents.

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Why did I receive more than one ID card with different ID numbers?

Please select the scenario that best describes you:

  • I am covered under a single AlaskaCare plan, and…
    • I am a retiree that is not eligible for Medicare:

      ID cards are issued in packs of two to retirees that are not eligible for Medicare. If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.

    • I am a Medicare-eligible retiree who is not covered under the enhanced Employer Group Waiver Program (EGWP):

      ID cards are issued in packs of two to retirees that are not enrolled in the AlaskaCare enhanced Employer Group Waiver Program (EGWP). If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1st,1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.

    • I am a retiree covered under the enhanced Employer Group Waiver Program (EGWP):

      You should have received only a single ID card with the MedicareRx logo in the lower right corner (see example below). Please contact the Division or OptumRx for additional information on why you may have received a second card.

  • I am covered under my own plan and under my spouse’s AlaskaCare plan, and…
    • Both my spouse and I are either an active employee or a retiree not yet eligible for Medicare:

      You will both receive a two-pack of ID cards with your own name and ID number. You may share one copy of your ID card with your spouse, however, you or your dependents only need to present one of these ID cards to the pharmacy. OptumRx coordinates your coverage behind the scenes.

    • Both my spouse and I are are retirees and eligible for Medicare:

      If you are both eligible for Medicare and are enrolled in the enhanced Employer Group Waiver Program (EGWP), you should each receive a single ID card that has the MedicareRx logo in the lower right (see example below). Each card will have an individual name and ID number. Although you receive only one card, when you present the card at the pharmacy you will receive the benefit of your double coverage under the plan. This means you will not be required to pay a copay at the pharmacy counter.

    • One of us is a Medicare-eligible retiree enrolled in the enhanced Employer Group Waiver Program (EGWP) and the other is either an active employee or a retiree not enrolled in EGWP:

      The retiree who is Medicare-eligible and is enrolled in the enhanced Employer Group Waiver Program (EGWP) will receive a single ID card that has the MedicareRx logo in the lower right (see example below). The card will have their individual name and ID number. Although they receive only one card, when they present the card at the pharmacy they will receive the benefit of having double coverage under the plan. This means they will not be required to pay a copay at the pharmacy counter.

      The spouse who is not enrolled in the EGWP will receive an ID card two-pack in their own name for each layer of coverage they have (their own coverage and their dependent coverage as the spouse of a Medicare-eligible retiree). The only difference between the two packs of ID cards will be the ID number. The ID number that matches the Medicare-eligible retiree’s MedicareRx ID card will be the dependent coverage card. However, the spouse or other non-Medicare eligible dependents only need to present one of these ID cards to the pharmacy. OptumRx coordinates the coverage behind the scenes.

  • I am covered under more than one of my own AlaskaCare plans, and…
    • I am eligible for Medicare:

      If you are eligible for Medicare and are enrolled in the enhanced Employer Group Waiver Program (EGWP), you should receive a single ID card that has the MedicareRx logo in the lower right (see example below). Although you receive only one card, when you present the card at the pharmacy you will receive the benefit of your double coverage under the plan. This means you will not be required to pay a copay at the pharmacy counter.

    • I am not eligible for Medicare:

      You will receive an ID card two-pack for each layer of coverage you have. The only difference between the different packs of ID cards will be the ID number. However, you only need to present one of these ID cards to the pharmacy. OptumRx coordinates the coverage behind the scenes.



      Sample card:

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Can my dependent use my card at the pharmacy and vice versa?

OptumRx coordinates all the layers of coverage for you and your dependents behind the scenes, so in many cases you and your dependents can use each other’s cards at the pharmacy. However, a non-EGWP dependent should not use the card that has a MedicareRx logo in the lower right corner. This card would only work if the pharmacist uses the correct person code (to identify them as a dependent rather than the policy holder). To avoid any confusion at the pharmacy, we recommend you and your dependents only use a card that has your name on it.

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I am an active employee AND a retiree. How do I know which card is for my active plan and which one is for my retiree plan?

You can tell the difference between the cards by looking at the logo on the card. One will say AlaskaCare Employee Pharmacy Plan, and the other will say AlaskaCare Retiree Pharmacy Plan. Your employee plan will typically be the primary payer.

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What happens if our new prescription cards are not received by January 1, 2019?

If you need to fill prescriptions before your card arrives, you can contact the Division and we will print or email a temporary card. As of January 1, 2019, you can get a printable ID card from the member portal, or view your card in the mobile app.

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Can I opt out of the enhanced EGWP plan?

You can opt out of the enhanced EGWP, but this is highly discouraged and will result in higher costs for both you and the health plan. Centers for Medicare and Medicaid Services (CMS) require that you be given the opportunity to opt out of EGWP. Retirees that opt out of the AlaskaCare EGWP will be placed in a prescription drug program that is much different than the plan prescription drug benefits offered today. This will result in increased out-of-pocket expenses for you or your Medicare-eligible dependents.

If you are considering opting out because you are covered under another Medicare plan (e.g. Medicare Advantage that includes prescription drug coverage or another EGWP), in lieu of opting out you can provide a copy of your Medicare Advantage or EGWP ID card to the Division and we will remove you from the enhanced EGWP and place you in the AlaskaCare standard pharmacy benefit plan.

You can call the Division Monday through Thursday, 8:30 a.m. to 4 p.m. and Friday from 8:30 a.m. to 3 p.m. AKST toll-free at (800) 821-2251 or in Juneau at (907) 465-4460, or email at .

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What are the opt-out plan benefits?

If you are eligible for the enhanced EGWP and do not opt out, or if you are covered under another Medicare plan and contact the Division with evidence of that coverage, you will retain the Standard Benefit with the following provisions:

Standard Benefit
  Generic Up to 90-Day or 100-Unit Supply Brand Name Up to 90-Day or 100-Unit Supply
Network pharmacy copayment $4 $8
Mail order copayment $0 $0
Supply Limit
Depo-Provera (injectable contraceptive) 5 vials per benefit year

If you are eligible for the enhanced EGWP but choose to opt out, you will receive the opt-out benefit with the following provisions:

Opt-Out Benefit
Retail 30-Day at Network Pharmacy
Prescription Tier Coinsurance Minimum Covered Person Payment Maximum Covered Person Payment
Generic prescription drug 80% $10 $50
Preferred brand-name prescription drug 75% $25 $75
Non-preferred brand-name prescription drug 65% $80 $150
Out-of-Network Pharmacy
Coinsurance for all prescription drugs 60%
Mail Order 1- to 90-Day at Network Pharmacy
Prescription Tier Copayment
Generic prescription drug $20
Preferred brand-name prescription drug $50
Non-preferred brand-name prescription drug $100
Out-of-Pocket-Limit
Annual individual out-of-pocket limit $1,000
Annual family out-of-pocket limit $2,000
Special Note:
Coordination of Benefits The opt-out benefit is exempt from coordination of benefits.
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Pre-Authorization and Appeals Questions

What differences could I expect in the AlaskaCare EGWP?

Here’s what won’t change:

  • Copayments will remain the same at $0 mail order, $4 generic, $8 brand-name.
  • Covered medications will remain the same.
  • Filling prescriptions at the pharmacy will remain the same.
  • The value of your benefit will remain the same.
  • The current plan allows filling a prescription for 90 days or up to 100 units. This will not change.
  • The current appeals process will remain the same. You will not be required to use the federal appeals process.

Here’s what will be different:

  • You will receive several mandatory mailings from OptumRx.
  • You will receive a separate monthly explanation of benefits of your prescription claims.
  • The pharmacy network will change. We don’t believe these changes will substantially impact members, but you will want to check to be sure your preferred pharmacy is in-network.
  • Medicare has a list of drugs that require pre-authorization. These required prior authorizations do not include any “step therapy” requirements. (“Step therapy” is when an insurance plan requires a member to try certain lower-cost medications first before covering a more expensive type of medication.) You may have to get a prior authorization for drugs where it was not previously required or seek prior authorization for drugs that have already been pre‐authorized through Aetna under the current plan.
  • If you have multiple medical conditions and high drug-utilization, you may be enrolled in the Medicare Medication Therapy Management Program by the State. Medicare developed this program as a member protection. This program helps you and your doctor make sure that your medications are working to improve your health and provides a comprehensive review that includes: how your medications are working; if they have side effects; and any interactions between drugs you are taking. You can opt out of this program.

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Will changing to an AlaskaCare EGWP require me to use the federal appeals process instead of the current state appeals process?

The current appeals process will remain the same. You will not be required to use the federal appeals process.

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Will all my current prescriptions be covered in an AlaskaCare EGWP? How and when can I verify this?

Yes. A full list of covered drugs is available on the AlaskaCare OptumRx web page.

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Does EGWP mean the Pharmacy Benefit Manager (PBM) will decide what medication my doctor can prescribe?

No. Your doctors can still prescribe whatever medication they think is most appropriate for you and your co-pay will remain the same as it is today, $0 mail order, $4 generic, and $8 brand-name (or $0 for those covered under more than one AlaskaCare plan). Depending on what they prescribe, the medication may require prior authorization. And just like today, all claims, not just prescription drug claims, must be medically necessary in order to be covered by the health plan. Determinations of medical necessity are part of the claims processing function for all health care plans and can be complex depending on the situation. AlaskaCare has long relied on our Pharmacy Benefit Manager (PBM) to make evidence-based decisions on medical necessity as part of the pharmacy claims processing function, and this process will continue under an AlaskaCare EGWP.

There may be instances in which a member’s doctor will disagree with coverage decisions related to medical necessity. In these cases, we encourage members to appeal the PBM’s decision.

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Information for High Income Earners

CMS charges a higher premium for high wage earners. How will I know if will have to pay extra if I am enrolled in the enhanced EGWP?

Certain high-income retirees will have to pay an extra surcharge, consistent with the extra surcharge applied to Medicare Part B today. Generally, if you are an individual earning more than $85,000 per year or a married couple who earns more than $170,000 per year, you will be charged an extra premium for being enrolled in an AlaskaCare EGWP because it is a group Medicare Part D plan. CMS refers to this as Income Related Monthly Adjustment Amounts (IRMAA). If you are charged an IRMAA for your prescription drug coverage, the Division will cover the full cost of the premium. Contact the Division to learn about your options.

Similar to Medicare Part B, the IRMAA premium amount will be deducted directly from your Social Security check if you qualify for Social Security or will otherwise be invoiced to you directly. The Social Security Administration (SSA) will send you a letter with your IRMAA premium amount and the reason for the determination. If you disagree with the IRMAA premium amount or your income has gone down, you should contact Social Security at (800) 772-1213 to resolve the determination.

The Social Security Administration will use your Modified Adjusted Gross Income (MAGI) to determine if the income-related monthly adjustment amount (IRMAA) applies. MAGI is the sum of:

  • Adjusted Gross Income (AGI), which can be found on the last line your IRS 1040 tax form (line 37 on form 1040, line 21 on form 1040A, or line 4 on form 1040EZ), plus:
  • Any tax-exempt interest income (line 8b on form 1040).

To make this determination, SSA requests income information from the IRS for the tax year that is two years prior to the premium year. For example, Social Security will use your MAGI from 2017 to determine your 2019 IRMAA. IRMAA is automatically re-determined each year as long as you file an income tax return.

The table below shows the anticipated IRMAA for and is for illustrative purposes only. The MAGI and IRMAA are subject to change.

Individual Modified Adjusted Gross Income (MAGI) Household Modified Adjusted Gross Income (MAGI) Monthly Part D IRMAA Surcharge
Less than or equal to $91,000 Less than or equal to $182,000 Not assessed a surcharge
Greater than $91,000 and less than or equal to $114,000 Greater than $182,000 and less than or equal to $228,000 $12.40
Greater than $114,000 and less than or equal to $142,000 Greater than $228,000 and less than or equal to $284,000 $32.10
Greater than $142,000 and less than or equal to $170,000 Greater than $284,000 and less than or equal to $340,000 $51.70
Greater than $170,000 and less than or equal to $500,000 Greater than $340,000 and less than or equal to $750,000 $71.30
Greater than $500,000 Greater than $750,000 $77.90
Learn More
What are my options if I am required to pay the extra surcharge?

The Division is prohibited from paying your Medicare Part D IRMAA premium surcharge directly and will instead reimburse you. If you receive notice that you are required to pay the IRMAA surcharge for the enhanced EGWP, follow the steps outlined in question 74 to request reimbursement. The Division will fund a tax advantaged HRA account that can be used to reimburse you the Part D IRMAA surcharge amount by paper check or through electronic funds transfer to a bank account of your choosing.

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What if I refuse to pay the extra surcharge?

If you refuse to pay the extra surcharge, Medicare will cancel your enrollment in the AlaskaCare enhanced EGWP plan. This will be treated as an opt-out under the plan, and you will be placed in a prescription drug program that is much different than the plan prescription drug benefits offered today. This alternative plan may result in increased out-of-pocket expenses for you or your Medicare-eligible dependents. Please contact the Division if you have concerns about this surcharge or would like to understand the options available.

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What information does the Division need to establish a Health Reimbursement Arrangement (HRA) account to reimburse me for the IRMAA?

Each November you should receive a letter from Social Security that outlines your Medicare premiums, including whether you are subject to the Income-Related Monthly Adjustment Amount (IRMAA) surcharge.

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How does the Health Reimbursement Arrangement (HRA) account work?

The Division has partnered with OptumRx and Optum Bank for easy IRMAA reimbursement through your HRA account. Please allow up to 3 weeks for processing. Members are encouraged to set up reimbursement on an automatic reoccurring basis, but may elect to request reimbursement manually. Reimbursement can be made by check or through electronic funds transfer.

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Are reimbursements from the Health Reimbursement Arrangement (HRA) account taxable?

No. The HRA is a tax-advantaged account and is not taxable income.

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How do I apply for reimbursement from my Health Reimbursement Arrangement (HRA) account?

The Division has partnered with OptumRx and Optum Bank for easy IRMAA reimbursements and will handle all your IRMAA needs. Follow these steps to establish your 2021 Part D IRMAA reimbursement account online:

  • Register and/or log in to your OptumRx.com account either online or through the mobile app.
  • Navigate to forms by clicking on the "Information Center" tab on the Navigation bar at the top, select "Programs and Forms", then click on “IRMAA HRA Enrollment Form”.
  • Complete the online IRMAA HRA Enrollment Form.
  • Upload as an attachment a copy or image of your letter from Social Security or a Medicare Bill that shows what your 2021 Part D IRMAA surcharge will be.
  • OptumRx will confirm your eligibility and set up your Health Reimbursement Account (HRA).
  • Once your HRA has been created, Optum Bank will send you a Welcome Packet.
  • Log in to optumbank.com to view your HRA account status/balance or to sign up for Direct Deposit. Your banking information that may be with PayFlex cannot be transferred on your behalf to Optum Bank.
  • If you have any questions on how to submit your 2021 IRMAA documents online or if you do not have internet access and would like to submit paper documentation, please contact OptumRx at (855) 409-6999 or email .

    Learn More
Can I set up automatic reimbursement?

Yes, by submitting the claim form you will receive a monthly ongoing reimbursement in addition to any eligible reimbursement for previous months.

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I pay my Medicare Part D IRMAA quarterly. Can the ongoing reimbursement be set up to pay on a quarterly basis?

Yes, your quarterly payment will be broken into monthly reimbursement via check or direct deposit when you submit the paper claim form.

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Do I have to go online to set up automatic reimbursement?

No, you can set up automatic reimbursement by submitting the paper claim form.

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How long do I have to submit a claim to the Health Reimbursement Arrangement (HRA) account?

To receive reimbursement for the Part D IRMAA surcharge, you should submit the HRA claim as soon as possible, but not later than 12 months after the date you incurred the expenses. Retroactive reimbursements will not be issued for claims received beyond 12 months. Example: if you are assessed a Part D IRMAA surcharge in 2020, you will have until December 31, 2021 to file the HRA claim for reimbursement.

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What happens to unused funds in the Health Reimbursement Arrangement (HRA) account once the claim deadline is past?

Unclaimed funds will be forfeit and will revert back to the Retiree health trust.

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Can the Health Reimbursement Arrangement (HRA) account be used to pay other medical expenses other than the Medicare Part D IRMAA?

No. The HRA can only be used to reimburse members for the Part D income related monthly adjustment amount (IRMAA).

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Who can I call if I need more help in understanding this new plan?

For general questions about how the plan works or how your drugs are covered under the plan, call OptumRx at (855) 409-6999.

To find out if you will be subject to an extra surcharge because you earn a high income, you may contact Social Security at (800) 772‐1213.

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How will I know if I have to pay an IRMAA, and how much it will be?

Each year, if you are Medicare-eligible, you will be notified by the Social Security Administration about your plan. This includes if you are required to pay an IRMAA and at what amount. The Social Security Administration uses your Modified Adjusted Gross Income (MAGI) to determine if the IRMAA applies to you and, if so, how much you will have to pay. MAGI is the sum of:

  • Adjusted Gross Income (AGI), which can be found on the last line your IRS 1040 tax form (line 37 on form 1040, line 21 on form 1040A, or line 4 on form 1040EZ), plus
  • Any tax-exempt interest income (line 8b on form 1040).

The Social Security Administration requests income information from the IRS for the tax year that is two years prior to the surcharge year. IRMAA is automatically re-determined each year as long as you file an income tax return. The below table shows the IRMAA for . The MAGI and IRMAA is subject to change from year to year.

Please review the table below to see if your income qualifies you to be assessed an IRMAA surcharge based on your Modified Adjusted Gross Income (MAGI) from the 2020 tax year.

Part D IRMAA Amounts

Individual Modified Adjusted Gross Income (MAGI) Household Modified Adjusted Gross Income (MAGI) Monthly Part D IRMAA Surcharge
Less than or equal to $91,000 Less than or equal to $182,000 Not assessed a surcharge
Greater than $91,000 and less than or equal to $114,000 Greater than $182,000 and less than or equal to $228,000 $12.40
Greater than $114,000 and less than or equal to $142,000 Greater than $228,000 and less than or equal to $284,000 $32.10
Greater than $142,000 and less than or equal to $170,000 Greater than $284,000 and less than or equal to $340,000 $51.70
Greater than $170,000 and less than or equal to $500,000 Greater than $340,000 and less than or equal to $750,000 $71.30
Greater than $500,000 Greater than $750,000 $77.90
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How do I establish a HRA account or Setup Direct Deposit?

OptumRx will handle all your IRMAA needs. Follow these steps to establish your Part D IRMAA reimbursement account online:

  • Register and/or log in to your OptumRx.com account either online or through the mobile app.
  • Navigate to forms by clicking on the "Information Center" tab on the Navigation bar at the top, select "Programs and Forms", “AlaskaCare Reimbursement and Exception Forms”, then click “IRMAA HRA Enrollment Form”.
  • Complete the online IRMAA HRA Enrollment Form.
  • Upload as an attachment a copy or image of your letter from Social Security or a Medicare Bill that shows what your Part D IRMAA surcharge will be.
  • OptumRx will confirm your eligibility and set up your Health Reimbursement Account (HRA) with Optum Bank within 5 to 7 business days of receipt.
  • Once your HRA has been set up with Optum Bank, they will send you a Welcome Packet within 5 to 7 business days, which will include information on signing up for Direct Deposit. (If you currently have Direct Deposit set up with OptumBank, that information does not need to be submitted again).
  • Once you receive your Welcome Packet, log in to OptumBank.com to view your HRA account status/balance or to sign up for Direct Deposit.

If you have any questions on how to submit your IRMAA documents online or if you do not have internet access and would like to submit paper documentation, please contact OptumRx at (855) 409-6999 or email

Learn More
What are my options if I am required to pay the extra surcharge?

If you receive notice that you are required to pay the IRMAA surcharge for the enhanced EGWP, follow the steps listed above to request reimbursement. The Division will fund a tax advantaged HRA account that can be used to reimburse you the Part D IRMAA surcharge amount by paper check or through electronic funds transfer to a bank account of your choosing.

Learn More
How long do I have to submit a claim to the Health Reimbursement Arrangement (HRA) account?

To receive reimbursement for the Part D IRMAA surcharge, you should submit the HRA claim as soon as possible, but not later than 12 months after the date you incurred the expenses. Retroactive reimbursements will not be issued for claims received beyond 12 months. Example: if you are assessed a Part D IRMAA surcharge in 2020, you will have until December 31, 2021 to file the HRA claim for reimbursement.

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What if I refuse to pay the extra surcharge?

If you refuse to pay the extra surcharge for your Medicare Part D coverage, Medicare will cancel your enrollment in the AlaskaCare enhanced EGWP plan. This will be treated as an opt-out from the plan, and you will be placed in a prescription drug program that is much different than the plan prescription drug benefits offered today. This alternative plan may result in increased out-of-pocket expenses for you or your Medicare-eligible dependents. Please contact the Division if you have concerns about this surcharge or would like assistance with understanding the options available to you.

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Who can I call if I need assistance understanding the surcharge?

For general questions about your pharmacy benefits, contact OptumRx, the AlaskaCare pharmacy benefits manager at (855) 409-6999. For questions related to your IRMAA surcharge, you may contact Social Security at (800) 772-1213. For more information about the HRA account options, contact the Division at (907) 465-4460 or toll-free at (800) 821-2251.

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What if I was unmarried when I retired?

If you were not married when you retired, you chose one of two options. You chose either a Regular or Level Income Option benefit. The type of retirement you elected is irrevocable.

  1. Regular Retirement: All benefits cease at the time of your death, including health insurance.
    • Beneficiary payment: Your beneficary(s) will receive the balance of your member contribution account, if any, or the last pension check. If you die after you have retired, your beneficiary is entitled to the benefit check for the month in which you died, if it was not already paid to you. Any check payable to you dated after you die, will need to be returned to the Division to be reissued in the name of your beneficiary(s).
  2. Level Income Option (not available for PERS Tier III): If you chose this option you will receive an increased benefit amount prior to age 65, and a decreased amount beginning at age 65. If you chose this benefit option you must anticipate other retirement resources to commence at age 65 in order to provide approximately the same income. All benefits cease at the death of the member, include health insurance.
    • Beneficiary payment: Beneficary(s) receive the balance of your contribution account, if any or the last pension check.

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What if I was not married at retirement, but got married later?

If you were not married at the time of retirement, but marry after appointment to retirement, you cannot change the type of retirement benefit you elected. Payment of your last pension check and the balance of the member contribution account will be paid to the beneficiary(s) as indicated on the most current beneficiary designation on file with the Division of Retirement and Benefits.

While married, you can cover a new spouse for health insurance, but health insurance for your new spouse will stop at the time of your death.

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What if I was married when I retired?

If you elected a joint and survivor option at retirement, at the time of your death your beneficiary will start receiving that benefit. To receive survivor benefits, your surviving spouse or incapacitated child's representative must submit a certified copy of the death certificate and complete and submit the survivor benefit application.

The benefit amount your survivor will receive depends on the irrevocable survivor election you made at retirement. The elections available to you, as the member, were:

  • 50% Joint and Survivor
  • 75% Joint and Survivor
  • 66-2/3rd Last Survivor (Not available for PERS Tier III)

The survivor percentage chosen applies to the gross benefits, before taxes or deductions for supplemental insurance.

Examples:

Member Chose 50% Joint and Survivor
Example Only
Current Monthly Gross BenefitSurvivor Gross Benefit
$2,000 Base Benefit$1,000 Base Survivor Benefit
$800 Post Retirement Pension Adjustment$400 Post Retirement Pension Adjustment
$200 COLA$100 COLA
$3,000 Total Benefit$1,500 Total Survivor Benefit
Member Chose 75% Joint and Survivor
Example Only
Current Monthly Gross BenefitSurvivor Gross Benefit
$2,000 Base Benefit$1,500 Base Survivor Benefit
$800 Post Retirement Pension Adjustment$600 Post Retirement Pension Adjustment
$200 COLA$150 COLA
$3,000 Total Benefit$2,250 Total Survivor Benefit
Member Chose 66-2/3rd Last Survivor Option
Example Only
Current Monthly Gross BenefitSurvivor Gross Benefit
$2,000 Base Benefit$1,333 Base Survivor Benefit
$800 Post Retirement Pension Adjustment$533 Post Retirement Pension Adjustment
$200 COLA$130 COLA
$3,000 Total Benefit$1,996 Total Survivor Benefit

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What if I got divorced after I retired?

If you are divorced after retirement, you will not be able to change your retirement election to a non-survivor option. The retirement election made when you retired is irrevocable. The divorce does not nullify your survivor designation. Upon your death, your spouse at the time of retirement will still be considered the survivor and will receive survivor benefits.

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What if my spouse died after I retired?

If you are the member, death of your spouse does not affect the 50% or the 75% Joint and Survivor options. The retirement election made at the time of retirement is irrevocable. You are not able to change your retirement election to a non-survivor option.

If you chose the 66-2/3rd Last Survivor and your spouse dies, your benefit is reduced to the 66-2/3rd level as you are now the last survivor between the pair.

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What happens if I remarried after divorce, or after the death of a spouse that was named as my survivor when I retired?

If you remarry after divorce or the death of your spouse that was named as the survivor at the time of retirement, your new spouse may be added as a dependent to your retiree health insurance. However, your new spouse will have no rights to survivor benefits. Both pension and retiree health insurance will cease at the time of your death. Your last retirement check will be paid out to your named beneficiary.

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What is a Form 1095-B?

Form 1095-B is an IRS form that reports dependents covered by your union health trust. It also contains similar information to the 1095-C issued by the State of Alaska, including the type of coverage you and your dependents had and the dates you and your dependents were covered in the prior year.

When will I get my Form 1095?

Your 1095 for the tax year will be mailed on or before March 2, 2022. If you believe you should have received a 1095-C but did not, please contact the Division of Personnel Employee Call Center at (907) 465-3009 or . If you are covered by a union health trust and believe you should have received a 1095-B but did not, please contact your health trust.

Will the Form 1095 impact my taxes?

If you do not have health care coverage and do not qualify for an exemption, you may be subject to a fine when you file for your 2021 tax return. For more information on whether you may qualify for an exemption, visit IRS.gov

Can I file my taxes before I receive my Form 1095-B and/or 1095-C?

It is not necessary to wait for Forms 1095-B or 1095-C in order to file your taxes. For more questions and answers about health care information forms for individuals from the IRS, see their FAQ page .

Will my dependents receive separate documents to report their coverage under my plan?

The 1095 forms are only received by the employee, or the “responsible individual” as referred to by the IRS. A copy of the form is not provided to the dependents.

What is the difference between a 1095-A, 1095-B, and 1095-C?

These forms report very similar information, and which form you receive will be dependent on who is responsible for issuing the 1095 form.

  • You will receive a 1095-C if you received health care coverage through your employer.
  • You will receive a 1095-B if you were covered by other insurers, such as a union health trust, self-funded retiree plan, or other small self- funded groups or employers.
  • You will receive a 1095-A if you were covered by a federal or state marketplace (also called an exchange.)

I received health coverage through my State of Alaska employment. Is this qualifying healthcare coverage?

Yes, self-insured group health plans for employees, COBRA coverage, and retiree coverage qualify as Minimum Essential Coverage.

What if I have questions?

If you have additional questions about your 1095, please contact your tax consultant. Visit Healthcare.gov to learn more.

Employer FAQs

Frequently Asked Questions about the Division of Retirement and Benefits’ employers and political subdivisions.

What is Employer eReporting?

Employer eReporting is an application developed for Employers to report payrolls. This application is a web application, meaning you will log in and access it through a link on the Employer Services website. You need a browser tool such as Internet Explorer (version 6.x), Netscape Navigator (version 7.x), or Mozilla Firefox (version 1.x).

Learn More
How do I export from my payroll system?

If you have access to computer programming support, please contact that person and show them the file layouts . If you do not have any technical support, we are working on a second file format that we will support later for payroll systems that can export to Excel or a text file. When this second format is available, we will post more information here as well as in the Employer News newsletter. If you have a technical question regarding your current file export or changes required by the new file layout, please email or (907) 465-5715.

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Who do I contact for questions about Employer eReporting?

You may contact your assigned payroll contact at the email or telephone number listed on the employer contact page.

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Who do I contact for questions about the new Defined Contribution Plan?

Watch the Employer Services home page for information, contact your employer's regional counselor, or email us at .

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What is the "Other ACH" payment option?

A payment option is now available for your use, it is titled "Other ACH." Employers who are currently paying their contributions utilizing an "external ACH" payment method (NOT the eReporting Electronic Payment option) should use the new payment option "Other ACH" and should no longer use the "No Payment" option. The "No Payment" option is now reserved for those transmissions that have no accompanying payment.

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What are the minimum system requirements?

In order to use Employer eReporting effectively, you will need to ensure your workstations and Internet connectivity meet the minimum requirements listed below:

  • A 56K Internet Connection (high-speed or broadband connectivity is recommended but not required)
  • Internet Explorer (version 6.x)
  • Netscape Navigator (version 7.x)
  • Firefox (version 1.x) This is the preferred browser
  • Screen resolution of 1024 x 768
  • Adobe Acrobat Reader version 7.0.8

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What validations are performed by Employer eReporting?

Validations for eReporting are still in progress. Checking ERS Validation Errors before you validate your payroll will let you know what is currently being checked. New validations will be added over time.

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What does the "Status" field mean on the Control tab?

The Status field on the Control tab identifies the “Status” of the payroll selected or the processing stage.

There are four different status types or stages:

  • IN PROCESS = still working on this payroll, it has not yet been validated, has been validated but has had changes since validation OR has been validated but failed with CRITICAL errors that MUST be corrected. CANNOT be and IS NOT submitted.
  • VALIDATING = this payroll is being validated, stand by; other users cannot make/save changes while this payroll is being validated. You can create or work on another payroll while this payroll is being validated.
  • VALIDATED NO ERRORS = this payroll can be submitted. There are no warning or critical errors.
  • VALIDATED WITH WARNING = this payroll can be submitted, however, there are warnings. You should always review these warnings as they may cause critical errors when the Division begins processing this payroll.

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Who does this new policy affect?

The policy affects all members of the Public Employees’, Teachers’, Judicial and Elected Public Officer’s Defined Benefit Retirement Plans who retire or are reemployed effective January 1, 2018.

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What is the reason for the new policy on termination of employment and rehire of employees by the same employer?

In 2016 the Internal Revenue Service and Treasury Department released proposed regulations setting a normal retirement age of 62 years old. Although the proposed regulations have not been finalized, governmental plan sponsors may rely on them until the issuance of final regulations. The Division has conferred with its outside tax counsel and confirmed that to avoid potential early distribution tax penalties for our members and to avoid a risk of disqualification of our plans, retirees must clearly demonstrate a valid severance from employment with the participating employer before returning to any type of employment with the same employer.

While the Division of Retirement and Benefits (DRB) has required a minimum 30-60 day break-in-service period since 2005, the establishment of a federal normal retirement age of 62 to determine when an employee receives an in-service distribution has required a new policy to be adopted. The new policy follows the IRS guidelines for break in service duration and prevents tax penalties from being levied against our retirees.

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What does the IRS require for a valid termination to have occurred?

A valid termination has always been a requirement for retirement benefits to be effective. However, the IRS has issued guidelines for what constitutes a valid termination. For a valid termination of employment to have occurred there must be no prearrangement for reemployment prior to the member’s retirement date. In addition, members under age 62 must observe a six month break in service before reemployment in any capacity can occur with the same employer. Members age 62 or older must observe a 60 day break in service before reemployment in any capacity with the same employer.

Retiring members must certify on their retirement application, under penalty of fraud, that no prearrangement for employment exists.

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For PERS and TRS employees of school districts, does the three-month summer break count towards either the 60-day or 6 month requirements?

Yes. Clarification received from tax counsel indicates the summer break period can be used when calculating the number of months from the member’s retirement date to satisfy the break in service requirements for retirees from school district employers. For example, a teacher retiring on July 1 who is under age 62 would be able to return to non-TRS employment with the same employer on January 1st. A teacher retiring on July 1 who is age 62 or older would be able to return to non-TRS employment with the same employer on September 1st.

What is meant by “reemployment in any capacity”?

Reemployment in any capacity includes but is not limited to employment as a part-time, temporary, contract, or leased employee or as an independent contractor or any fee-for-service arrangement.

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Is the policy effective now?

The requirement for no prearrangement for reemployment has been in effect since 2005. If an employee does not sever the employer-employee relationship by having a break in service of 60 days before returning to employment, their termination of employment date is considered invalid and they are not eligible for retirement benefits.

The extended requirements for a break-in-service equaling six (6) months will become effective when the regulations have been adopted. This is estimated to be by January 1, 2018.

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Will the policy be applied retroactively?

As previously stated, the requirement for a valid termination is currently in effect. The increased break-in-service requirement of six (6) months for members under age 62 will be applied to retirees rehired after January 1, 2018.

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What happens to existing returned retirees when the regulation becomes effective?

The Division will administer the regulations prospectively for retirees rehired after the effective date and no retroactive action will be taken. However, the returned retiree is still subject to the requirement for a bona fide separation from service before receiving a retirement benefit. Should an IRS review of the retiree occur, a facts and circumstances review may be done and a final determination will be made by the IRS.

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If the returning retiree returns to a non-permanent position which does not receive PERS/TRS/JRS/EPORS benefits is the regulation still violated?

A retiree who returns to work with the same employer, without the required separation of service period, would have a violation of the return to work limitation regardless of whether the retiree was returning to work in a full-time, part-time or temporary position, or if the retiree is returning as a leased employer or an independent contractor.

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Does this policy apply to substitute teaching on an incidental basis during the waiting period?

Yes. The policy applies to all employment with the employer and would include substitute teaching on an on-call or incidental basis.

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Can we undo a hire if we accidentally hire someone within the 6-month period?

Yes. There is a “window of correction” period for correcting ineligible hires. The employer must determine if a retiree is eligible for rehire before the hire is made. If it is later discovered the employee is not eligible, the employer may make corrections and back the hire out of their system during the first pay period. Members who are still employed after the first pay period who have not served the break in service requirements will be deemed to be in violation or the rehire policy.

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What is the corrective action?

The Division will first do a facts and circumstances review to determine if a prearrangement for reemployment was made prior to the member’s retirement date. This will require certification from the employer to the facts and circumstances of rehire.

If a prearrangement for rehire was in effect, the member will be deemed to not have had a valid termination of employment and must repay the Division the full amount of retirement benefits received since the effective date of their retirement.

If no prearrangement for rehire was in effect and the member is under age 62, the Division will be required to code the member’s retirement benefits retroactively to date of retirement (or to January 1, 2018 whichever is later) as an early distribution and a 10% tax penalty will be levied by the IRS for an early distribution of retirement benefits. Retirement benefits will be stopped as of the date of re-hire.

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If an employee retires in TRS, can I hire them back in a PERS position?

No. The key to this requirement is whether the employee/employer relationship has been severed, not what retirement plan the member participates in. An employee must still observe the six (6) month break-in-service period before rehire with the same employer. The fact that the employee would be a member of a different retirement system before and after the return to work is irrelevant to the requirement.

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Does the period of absence only apply to the employer from which the employee is retiring, or does it apply to all PERS, TRS or EPORS participating employers? For example, if a State PERS employee retires July 1, can the employee go to work for a city on August 1 without violating the requirements?

Yes. In order for the IRS to consider an employee to be “retired,” the IRS requires an employee to have a bona fide separation from service with the employee’s employer. Therefore, based upon this example, a State PERS employee could retire on July 1 and immediately commence non-covered employment with a local government, even though the local government also is a PERS employer. The requirements refer to employment with the same employer only.

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What if the employee is a State employee working for the Department of Administration? Can the employee immediately return to employment with a different department with the State?

No. A State PERS employee could not retire from one department of the State and then begin work with another department of the State without fulfilling the six (6) month break in service. The reason for this is because all departments and branches of the State are considered to be part of the same employer – e.g. the State of Alaska.

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How does it work for the PERS and TRS Defined Contribution Retirement Plans (PERS/TRS DCR)? Will they not be able to touch their money for six months?

The requirements for bona fide termination apply to both PERS/TRS defined benefit and defined contribution plans. There can be no pre-arrangement for reemployment with the same employer prior to termination of employment. If a PERS/TRS DCR Plan member terminates employment and withdraws their funds, they will automatically pay the 10% early withdrawal penalty if they are under age 59 ½ per the defined contribution plan rules. PERS/TRS DCR Plan members must be terminated from employment for 60 days before their funds can be disbursed as part of the current plan rules.

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How will I know if the person I’m considering hiring is a retiree who has not been retired for six (6) or more months?

To protect the prospective employee, you can tell them that if they are a retiree and have been for less than six months to contact the Division of Retirement and Benefits to be sure they can accept employment without consequence. As the employer, your responsibility is to not have a prearrangement for retirement and to caution prospective employees about the rehire rules. Employers may also contact the division to determine eligibility for rehire. Most employer payroll staff should be aware of their own employees who have recently retired and are now back to work with the same employer.

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The employee is eligible for retirement in the PERS but has moved to a different position with the same employer covered by a different retirement plan. Can they draw their PERS benefits while they are working in this other position?

No. Since they have only changed retirement systems and have not terminated employment with the employer, they will not be able to draw their PERS benefits while continuing employment. They will be eligible to draw your PERS benefits only when they actually terminate employment.

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New DRB Website FAQs

Frequently Asked Questions about the Division of Retirement and Benefits’ new website.

Why is the new DRB website so different from the old one?

The number one concern we heard about the old DRB website was how difficult it was for people to find the information they needed. There were many hidden and buried pages that were only accessible from another page. With the new website, all pages are accessible from the drop-down menus at the top of every page. You can find quick links and tools by accessing the fly-out menu on the right of the page (click the “hamburger” icon ( ) on the upper right side of the page.)

The new website is organized into three main categories based on who our most of our users are—employees, retirees, or employers. You can find the information you need based on your status.

Why is the new web address different from the old one?

We have simplified our web address (URL) so it is easy for our members and participating employers to remember: drb.alaska.gov

Will my old bookmarks still work?

Yes, in most cases, your bookmarks from the old website should still work. However, we recommend you create new bookmarks by clicking the star icon (

How do I find the information I need?

There are a number of ways to find the information you need quickly and easily:

  1. The drop-down menus in the in the light blue strip at the top of every page:
    • Home menu. Click here to find an overview of all the DRB plans, the AlaskaCare home page, latest news, and more.
    • Employee, Retiree, and Employer menus. Check these menus for information based on whether you are an active employee, a retiree, or a participating employer.
    • Events menu. Check here to find information about Open Enrollment and other events.
    • Help menu. Click here to find FAQs, forms and documents, glossary, financial reports, and more. The Help menu also has links to the Can’t Find A Page? and Site Navigation pages, which can provide more guidance on navigating the website.
    • Contact drop-down menu. Check this menu to contact the DRB, find our office locations and hours, make an appointment with a counselor, and more.
  2. Fly-out menu to the right of the page. Access this menu by clicking the “hamburger” icon ( ) on the upper right side of the page. You can find quick links and tools here.
  3. Partner contact information. On the home page, scroll down to the Partner Portals section to find links to our partner websites. You can also find these links at the top of the fly-out menu (click the “hamburger” icon ( ) on the upper right side of the page).
Why hasn’t myRnB changed?

MyRnB is part of another major project we are currently working on to modernize our data system and improve the administration of pension and insurance benefits for our members and participating employers. This system, known as BEARS (Benefits And Retirement System) will allow the Division to provide enhanced customer service to its members, including self-service tools to accommodate on-demand requests. Look for more information in the future about BEARS and how it will affect myRnB.

Page Last Modified: 06/29/22 07:37:07

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