The State of Alaska retirement systems provide extensive and valuable benefits for you and your family including hospitalization, medical, surgical, maternity care, and other services necessary for the diagnosis and treatment of an injury or disease. Your health care coverage is good worldwide. These benefits may change from time to time.

Defined Benefit Retiree Health Plan: Public Employees’ Retirement System Tier I, II and III and Teachers’ Retirement System Tier I and II and their eligible dependents can participate.

Defined Contribution Retiree Health Plan: Public Employees’ Retirement System Tier IV and Teachers’ Retirement System Tier III and their eligible dependents can participate.

Please check the current AlaskaCare Retiree Insurance Information booklet for the most up-to-date and complete information about health benefits and eligibility.

Introduction

Optum Rx is the AlaskaCare pharmacy benefit manager. A pharmacy benefit manager (PBM) is a company the Division hires to process AlaskaCare pharmacy claims. Medical, vision and dental claims are processed by Aetna and Delta Dental, respectively.

You can call Optum Rx at (855) 409-6999, TTY 711, for help with:

• finding a network pharmacy near you,
• reviewing the drug formulary,
• enrolling in medication home delivery,
• setting refill reminders, and more.

In addition, you can accomplish these tasks by setting up your online account at OptumRx.com , or downloading the Optum Rx app.

Optum Rx streamlines the Medicare Part D/EGWP Annual Notices, which means less paperwork for you! Each calendar year Medicare requires Optum Rx provide AlaskaCare enhanced Employer Group Waiver Program (EGWP) members with an Evidence of Coverage booklet. It tells you how to use your Medicare prescription drug coverage through our plan, explains your rights and responsibilities, what is covered, and what you pay as a member of the plan. Instead of automatically mailing a copy to all members, Medicare is allowing Optum Rx to provide the document electronically through the online Optum Rx member portal. You can still receive a paper copy of the Evidence of Coverage booklet upon request.

There are two ways to get an updated Evidence of Coverage booklet for your plan:

• Visit OptumRx.com and download a copy of the Evidence of Coverage from the “Programs & Forms” page (found under the “Information Center” tab).
• Call Optum Rx at the number listed on your member ID card to request to have a copy mailed to you.

Members can still expect to receive the Annual Notice of Changes in the mail, along with instructions on how to request further information.

Are you currently outside of the United States? You can contact Optum Rx from another country by:

• Dialing the USA direct access code for the country you are currently in. You can find a complete list of access codes here .
• Dialing Optum Rx at (855) 409-6999.

Retail Pharmacies

Optum Rx’s retail pharmacy network includes most pharmacies in Alaska. For a list of participating pharmacies near you, use the Pharmacy Locator Tool on the Optum Rx app, at OptumRx.com , or call a Optum Rx representative at (855) 409-6999, TTY 711.

Medication Home Delivery

You can receive maintenance medication through the mail through Optum Rx® home delivery. Enroll in Optum Rx® home delivery to get up to a 90-day supply of the medications you take regularly. Your medication will come right to your mailbox. To start home delivery, log in to OptumRx.com , use the Optum Rx® App or call (855) 409-6999, TTY 711.

Optum Rx Specialty Pharmacy

Specialty medications can be important to maintaining or improving your health—and your quality of life. The Optum Rx® specialty pharmacy, provides resources and personalized, condition specific support to help you manage your condition. Using Optum Rx for your specialty needs saves you money and means the plan pays less.

Call Optum Rx at (855) 427-4682 to enroll in this specialty pharmacy program.

OptumRx.com: Your Digital Tool

OptumRx.com is a fast, easy and secure way to get the information you need to make the most of your pharmacy benefit.

Website features and tools:

• Compare medication prices at different pharmacies
• Locate network pharmacies
• Manage medication for covered dependents and spouses
• View real time benefits and claims history
• Transfer retail prescriptions to home delivery
• Track orders
• Refill home delivery prescriptions
• Order medications you take regularly online and make fewer trips to the pharmacy.
• Get three-month supplies and you could pay less. Orders are sent using free standard shipping.

Learn how to register with HealthSafe ID™ .

Optum Rx On the Go!

Access your pharmacy benefits and manage your prescriptions from your smartphone or tablet with the Optum Rx App.

• Find drug prices and lower-cost alternatives
• View your claims history
• Locate a pharmacy
• Access your ID card, if your plan allows
• Manage medication reminders
• Transfer retail prescriptions to home delivery
• Refill or renew home delivery prescriptions

Take care of your home delivery prescriptions at any hour, from anywhere, using the new Optum Rx App. This application makes it easier than ever to refill and renew existing home delivery pharmacy prescriptions, sign up new prescriptions for home delivery, compare medication prices and more.

The My Medicine Cabinet feature contains key information for all medications you take. With At-a-Glance functionality you can easily see when you need to take action such as refilling home delivery medications or tracking orders.

Download the Optum Rx App from the Apple® App Store or Google Play™.

Authorization to Use and Disclose Protected Health Information

If you or a loved one needs assistance from a representative in receiving pharmacy benefits, you must submit a completed Authorization to Use and Disclose Protected Health Information (PHI) form to Optum Rx. Use this form to request authorization for the release of PHI, including a patient profile or prescription records, to your authorized representative(s).

Please mail the completed form to:

Optum Rx
Attn: Commitment and Follow Up Team
6860 West 115th Street
Mail Stop: KS015-1000
Overland Park, KS 66211-2457

or fax to (866) 889-2116.

Manual Pharmacy Claim Form for Member Reimbursement

To submit a manual claim form to Optum Rx for reimbursement of a prescription paid out-of-pocket, please fill out the prescription drug claim form below and mail or fax it to Optum Rx.

Optum Rx Prescription Drug Claim Form

• Send completed form with pharmacy receipt(s) to:
  Optum Rx Claims Department
  P.O. Box 650629
  Dallas, TX 75265-0629

Optum Rx Medicare Part-D (EGWP) Prescription Drug Claim Form

• Send completed form with pharmacy receipt(s) to:
  Optum Rx Claims Department
  P.O. Box 650287
  Dallas, TX 75265-0287

Enhanced Group Waiver Plan (EWGP)

EGWP: An opportunity for AlaskaCare to maintain existing pharmacy benefits for Medicare-eligible members and achieve cost savings for years to come.

Effective January 1, 2019, AlaskaCare implemented an Employer Group Waiver Plan for all Medicare-eligible members covered under the AlaskaCare retiree health plan. An Employer Group Waiver Plan, known as an EGWP or “Egg Whip,” is a program offered by the federal government that increases federal subsidies for prescription drugs for the retiree health trust. The pharmacy benefit for AlaskaCare retirees remains the same.

AlaskaCare was already receiving a federal subsidy for the retiree health prescription drug benefit. Moving to an EGWP plan means the retiree health trust will receive significantly higher subsidies than we used to, saving the trust up to $20 million annually and providing $40-$60 million each year in additional State savings through a reduction in the unfunded liability. The Division must manage the health plan to ensure retirees can access their earned benefits throughout the entire course of their life, and an AlaskaCare EGWP allows the State to keep existing pharmacy benefits for Medicare-eligible members, while increasing federal reimbursement of existing costs, reducing the State’s direct costs for these benefits in the long-term.

More than 90% of states that provide drug benefits to Medicare retirees have already implemented EGWPs. As Alaska, along with the rest of the U.S., faces rising health care costs, EGWPs are a proven win-win for maintaining high quality coverage for today’s and tomorrow’s Alaska retirees.

An AlaskaCare EGWP is just one way the Division looks to reduce the cost of health care while maintaining or improving benefits for retirees and their families. Because of EGWP, the Division was able to add preventive care in 2022! As part of the ongoing retiree health plan modernization project, the Division is evaluating adding more benefits like enhanced travel and removing the lifetime maximum. Our goal is to improve, protect, and sustain the health plan as it continues to offer high quality benefits for current and future generations of retirees.

If you have questions or concerns about the EGWP, we want to hear from you!

You may contact the Division of Retirement and Benefits at:

Alaska Department of Administration
Division of Retirement and Benefits
P.O. Box 110203
Juneau, AK 99811-0203

You can also send comments via email to or reach the Division by phone toll-free at (800) 821-2251 or in Juneau at (907) 465-4460.

For more information, please read the EGWP FAQs.

For more information on the modernization project, please visit our Retiree Health Plan Advisory Board (RHPAB) webpage.

Important Documents:

• 2025 DVA Benefit Enrollment and Comparison Guide

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. The Division of Retirement and Benefits is dedicated to providing affordable, valuable, and sustainable benefits to retirees. The AlaskaCare retiree Dental-Vision-Audio plan is fully funded by members’ monthly premium payments, and the Division works hard to maximize the benefits members receive while keeping premiums affordable.

Dental-Vision-Audio Premiums

The dental 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.

Retiree Dental/Vision/Audio Coverage Premiums
	2024				2025
Coverage Level	Standard		Legacy		Standard		Legacy
	DB	DCR	DB	DCR	DB	DCR	DB	DCR
Retiree Only	$69	$70.38	$69	$70.38	$71	$72.42	$75	$76.50
Retiree and Spouse	$138	$140.76	$138	$140.76	$142	$144.84	$149	$151.98
Retiree and Child(ren)	$125	$127.50	$125	$127.50	$129	$131.58	$135	$137.70
Retiree and Family	$196	$199.92	$196	$199.92	$202	$206.04	$212	$216.24
DB: Defined Benefit Plan | DCR: Defined Contribution Retirement Plan Effective: Jan. 1 - Dec. 31, 2025

Please note: Retirees who pay monthly Health and/or DVA premiums through Direct Bill will be assessed a 2% administrative fee.

Dental Benefits

Effective in plan year 2020, AlaskaCare began offering two retiree dental plan options, the Legacy Dental Plan, and the Standard Dental Plan. The plans have different dental coverage provisions. 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.

For information about dental benefits contact: Delta Dental of Alaska toll-free at (855) 718-1768.

Delta Dental of Alaska Dental Claim Form .

Instructions for Submitting International Claims

Members can send a completed Dental Claim Form to Delta Dental for processing:

• Via email:
• Physically mail the claim form and necessary paperwork to the below address:
  Moda Health
  P.O. Box 40384
  Portland, OR 97240-0384

In addition to the claim form, please include the following information:

• Receipts showing payments of services.
  • The cost of all services is required (foreign currency will be converted into USD and reimbursement to the member will be in USD).
• A written summary of services received
  • If tooth specific services were rendered include the tooth number on which services were completed.
  • ADA Dental codes may not be used by international providers, so a detailed narrative of treatment provided will be very helpful.
  • If the narrative/treatment plan is not in English, Delta Dental may have translators who can translate the information received.

If you are interested in receiving reimbursement via Direct Deposit, please complete and include the Direct Deposit Authorization Form .

Dental Plans at a Glance

Standard Dental Plan

View the 2025 Standard Dental plan summary for detailed service class coverages.

Legacy Dental Plan

View the 2025 Legacy Dental plan summary for detailed service class coverages.

Network Providers

You have access to more than 300 licensed dentists across Alaska and 204,000 office locations nationwide. You will want to stay in the Delta Dental networks to get high quality care at a lower price. Through Delta Dental PPO and Premier networks, limits are set on what dentists can charge for certain services. It’s a way of connecting you with great care at even better rates. To find a provider call toll-free at (888) 558-2705 or you can use the online search tool.

Member Dashboard—Information at your Fingertips

Your Member Dashboard, myModa, gives you a real-time view into your dental claims and benefits. You’ll also have access to online tools and resources to manage your dental care needs.

Vision and Audio Benefits

VISION PLAN HIGHLIGHTS

• You pay no deductible under this plan.
• The plan covers one complete eye examination, including a required refraction, per year.
• The plan covers two lenses during each calendar year.
• The plan covers one set of frames during every two consecutive calendar years.

AUDIO PLAN HIGHLIGHTS

• The Audio Plan pays up to $2,000 for each person in a covered rolling 36-month period.
• You pay no deductible under this plan.
• The Plan pays 80% of the recognized charge for audio services.

For information about Vision and Audio benefits contact Aetna Concierge toll-free at (855) 784-8646.

The State of Alaska is pleased to offer a voluntary Long-Term Care (LTC) Plan for benefit recipients and their spouses. The options available under the LTC plan provide a range of health and social services for people who need assistance with the basic activities of daily living.

Silver, Gold, Platinum (SGP): You must apply for this coverage before appointment to your first benefit from any retirement system.

• SGP Booklet

Bronze: Available only to benefit recipients who retired prior to February 1, 2000.

• Bronze Option Booklet

CHCS Services, Inc. is the claims administrator. You may contact them at (888) 287-7116 for questions or to initiate a claim. 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.

LTC Enrollment

You must apply for this coverage before appointment to your first benefit from any retirement system. To meet this deadline, your Retiree Health Benefits Enrollment/Waiver form must be postmarked or received by the retirement application deadline. If you do not apply for coverage at this time, you waive your right to apply for this coverage at a later date.

You can send in the form separately, but most often this form is completed as part of the retirement packet.

Adding a new spouse: Use the Retiree Health Dependent Change form to add your new spouse to your health plans. The request must be received by the Division within 120 days of marriage.

Plan Comparison Chart

	Bronze Option	Silver Option	Gold Option	Platinum Option
Deductible	90 days of covered long-term care	90 days of covered long-term care	90 days of covered long-term care	90 days of covered long-term care
Benefit Eligibility	Inability to perform 2 of 5 activities of daily living	Inability to perform 2 of 6 activities of daily living or cognitive impairment	Inability to perform 2 of 6 activities of daily living or cognitive impairment	Inability to perform 2 of 6 activities of daily living or cognitive impairment
Lifetime maximum benefit	$200,000 all services $50,000 home health care	$400,000 all services	$300,000 all services	$300,000 all services
Nursing home daily benefit	$125 in Alaska $75 outside Alaska	$200 in and out of Alaska	$200 in and out of Alaska	$200 in and out of Alaska
Assisted living facility daily benefit	Covered in lieu of other services if approved	$150 in and out of Alaska	$150 in and out of Alaska	$150 in and out of Alaska
Home health care daily benefit	$75 in Alaska $40 outside Alaska	$125 in and out of Alaska	$125 in and out of Alaska	$125 in and out of Alaska
Hospice daily benefit	Not Covered	$125 in and out of Alaska	$125 in and out of Alaska	$125 in and out of Alaska
Respite care daily benefit amount	Not Covered	Up to $200 in and out of Alaska, maximum of 14 days	Up to $200 in and out of Alaska, maximum of 14 days	Up to $200 in and out of Alaska, maximum of 14 days
Inflation protection	None	None	Simple at 5% of original benefit each year. Applies to lifetime and daily benefit amounts.	Compound at 5% of the prior year's benefit each year. Applies to lifetime and daily benefit amounts.

Existing option closed to new entrants after 1/31/2000

Inflation protection stops at age 85. Please see the plan booklet for more information.

Premiums

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 the time of your retirement.

Monthly Rates

Age at enrollment	Silver Option $400,000 maximum No inflation protection	Gold Option $300,000 maximum Simple inflation protection	Platinum Option $300,000 maximum Compound inflation protection
≤ 40	$26	$76	$148
41	$27	$77	$150
42	$28	$78	$153
43	$30	$79	$155
44	$31	$81	$158
45	$33	$82	$161
46	$35	$84	$164
47	$37	$85	$167
48	$39	$89	$170
49	$41	$92	$172
50	$44	$96	$175
51	$46	$100	$177
52	$49	$103	$180
53	$52	$109	$184
54	$56	$114	$188
55	$60	$120	$192
56	$63	$126	$195
57	$67	$131	$199
58	$75	$143	$212
59	$84	$156	$225
60	$92	$168	$237
61	$100	$181	$250
62	$108	$193	$263
63	$123	$212	$281
64	$137	$231	$300
65	$151	$250	$319
66	$166	$269	$338
67	$180	$288	$357
68	$201	$313	$381
69	$222	$339	$404
70	$244	$364	$428
71	$265	$389	$451
72	$286	$414	$475
73	$314	$444	$502
74	$343	$474	$529
75	$371	$503	$556
76	$399	$533	$584
77	$427	$563	$611
78	$471	$609	$654
79	$515	$654	$698
80	$559	$700	$741
81	$603	$746	$784
82	$646	$791	$828
83	$731	$887	$923
84	$815	$982	$1018
≥ 85	$900	$1078	$1113

Inflation protection increases annually until the covered member reaches age 85.

Bronze Premiums
May 1, 2000 Age	Premium (in dollars)
< 50	16.10
50-54	21.45
55-59	26.80
60-64	48.25
65-69	80.45
70-74	128.70
75-79	193.05
80-84	294.95
≥ 85	412.90

Definitions

Cognitive Impairment
A measurable deterioration or loss in intellectual capacity requiring substantial supervision or verbal cueing by another individual in order to protect the impaired and others from serious threats to health and safety.

Deductible
the amount you must pay before the plan pays benefits.

Activities of Daily Living
The Silver/Gold/Platinum options include bathing, continence, dressing, eating, toileting, and transferring. The Bronze Option includes dressing, toileting, transferring, eating, and walking.

Actuarial Valuations

• Valuation as of June 30, 2021
• Valuation as of June 30, 2019
• Valuation as of June 30, 2017
• Valuation as of June 30, 2015
• Valuation as of May 31, 2012 (Draft)
• Valuation as of June 30, 2009

Effective January 1,

• AlaskaCare Defined Benefit Retiree Insurance Information Booklet
• AlaskaCare Defined Contribution Retiree Insurance Information Booklet

Certain high-income retirees are required to pay an extra premium surcharge, known as an Income Related Monthly Adjustment Amount, or IRMAA. This is similar to the surcharge for high-income enrollees in the Medicare Part B plan. If you are an individual or a married couple earning more than the threshold, you will be required to pay an extra surcharge for being enrolled in the AlaskaCare Employer Group Waiver Program (EGWP) because it is a group Medicare Part D plan. Retirees whose household income is below this threshold will not be subject to the IRMAA premium surcharge.

If you are subject to the Medicare Part D IRMAA surcharge, you will be reimbursed.

For all Medicare plans, the IRMAA will be deducted directly from your monthly Social Security check (if you qualify for Social Security) or will otherwise be invoiced to you directly each month. If you are charged a Medicare Part D IRMAA for your prescription drug coverage, the Division of Retirement and Benefits will reimburse you for the full cost of the Medicare Part D premium surcharge each month, through a tax-advantaged Health Reimbursement Arrangement (HRA) account. If you receive a bill from Medicare, you should pay the bill timely, and contact the Division to learn about your reimbursement options.

The Division of Retirement and Benefits has partnered with Optum Rx and Optum Bank to create an efficient way for members to receive reimbursement for their Part D IRMAA surcharge.

What You Need to Know

• You need to set up your HRA account every year, since IRMAA surcharges are based on your annual income and your income may change from year to year.
• If you are not assessed Part D IRMAA surcharge this does not apply to you.
• To receive the reimbursement, you should submit your claim and letter as soon as possible, but no later than 12 months after the last day of the current year. For example: The deadline for submitting your IRMAA for reimbursement is December 31, .

How to Request Reimbursement and/or Set Up Direct Deposit

Optum Rx will handle all your IRMAA needs. Follow these steps to establish your Part D IRMAA reimbursement account online:

1. Register and/or log in to your Optum Rx.com account either online or through the mobile app.
2. Navigate to the AlaskaCare IRMAA Reimbursement Form by taking the following steps:


• On the top of the main page, click the "Information Center" tab.
• Click "Programs and Forms".
• Click on the "AlaskaCare IRMAA Reimbursement" section. There you will find the digital enrollment form as well as the paper version.
3. To submit your reimbursement request digitally (the faster method), click and submit the IRMAA HRA Digital Enrollment Form.
4. 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 is.
5. Optum Rx will confirm your eligibility and set up your Health Reimbursement Account (HRA) with Optum Bank within 5 to 7 business days of receipt.
6. 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 Optum Bank, that information does not need to be submitted again.
7. 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.

Note: If you are using the IRMAA HRA Enrollment Paper Form, you will need to:

• Print the form,
• Fill out the information accurately,
• Include a copy of your letter from Social Security or a Medicare Bill that shows what your Part D IRMAA surcharge is, and
• Mail or email the form to Optum Rx.

The timeline for completion depends on the information provided and when it is received by Optum Rx.

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 Optum Rx at (855) 409-6999 or email .

IRMAA Frequently Asked Questions

Additional information: IRMAA brochure.

Introduction

Medicare is a national health insurance program administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the Social Security Administration (SSA), and people with end stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).

Alaska statute requires the AlaskaCare retiree plan become supplemental to Medicare when members turn 65. AlaskaCare will begin processing member’s health claims as if they have Medicare Part A & B on the first day of the month when they turn 65. All members should schedule an appointment with Social Security to apply for Medicare Part A & B within the three months prior to their 65th birthday.

Resources for Medicare Information

• Medicare: To learn more about Medicare visit the Medicare.gov website or call (800) 633-4227 | TTY (877) 486-2048.
• Social Security Administration: If you are looking for information about Social Security, please visit the Social Security Administration page.
• Alaska Medicare Information Office: You may also contact the State of Alaska’s Medicare Information Office at (800) 478-6065 or (907) 269-3680 in Anchorage, or email them at . The Medicare Information Office offers one on one personalized Medicare Counseling and Medicare Seminar events by webinar.
• AlaskaCare Retiree Town Hall: The AlaskaCare Retiree Town Hall is a monthly event that offers information on the AlaskaCare Retiree health plan, below are three helpful events pertaining to Medicare.

Medicare and the AlaskaCare Defined Benefit Retiree Health Plan Brochure

Finding a Medicare Provider

Alaska Department of Health offers a Resource Directory to assist in finding Medicare provider information. You can also go to the Medicare website, which offers an online tool to help you find Medicare participating providers.

Medicare.gov

Medicare Overview

Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

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.

Part B (Medical Insurance): Helps cover physician and other outpatient medical services, ambulatory surgery center services, medical equipment, and ambulance services. Everyone is eligible for and must pay a premium for Part B, whether or not you are eligible for Part A.

Part D (Drug coverage): Helps cover the cost of prescription drugs. Medicare eligible retirees and/or dependents will be automatically enrolled in the AlaskaCare enhanced Employer Group Waiver Program (EGWP). The AlaskaCare enhanced EGWP is a group Medicare prescription drug plan that provides the same prescription benefits as provided to non-Medicare eligible retirees and dependents, while maximizing federal subsidies.

You do not need to enroll into an individual Medicare Part D plan, and for most members there is no additional premium for prescription drug coverage under AlaskaCare.

However, certain high wage earners will be charged an Income Related Monthly Adjustment Amount (IRMAA) surcharge for prescription drug coverage. Visit the IRMAA section on this webpage for more information.

For more information on EGWP, please visit the Employer Group Waiver Plan webpage.

Medicare Enrollment

If you are receiving Social Security benefits before age 65, you will be automatically enrolled in Parts A and B of Medicare when you turn 65. If you are not receiving Social Security benefits, contact the Social Security Administration (SSA) three months before you turn age 65 to discuss enrolling in Medicare Parts A and B.

Be sure to inform the Social Security Administration if you have health insurance through an employee group health plan that you or your spouse receive as an actively working employee. If you are covered by such a plan, Medicare does not require you to enroll until the active plan terminates. However, if you do not enroll, the amount Medicare would have paid as the secondary plan is not paid by AlaskaCare. The AlaskaCare Retiree Health Plan recommends that you enroll in Medicare Part B at age 65, regardless of any other insurance.

Sign Up for Medicare Direct
After members receive their Medicare Beneficiary Identifier or “MBI”, they should call the Aetna concierge and ask Aetna to set up Medicare Direct so that Medicare will automatically send the Medicare Explanation Of Benefit (MEOB) to Aetna for processing. Once Medicare Direct is set up, Medicare will pay as the member’s primary health insurance and Medicare MEOBs will automatically be sent to Aetna so AlaskaCare benefits will pay as secondary.

Types of Medicare Providers

There are three types of providers: participating, nonparticipating, and those who “opt out.”

Participating Medicare Providers
Participating providers are required by their Medicare contract to accept assignment of your claims. Because you don’t owe any amount over the Medicare allowed amount, AlaskaCare pays the difference between Medicare’s payment and the allowed amount if the expense is covered by both plans. Therefore, for covered expenses the claim is usually paid in full, unless you have not yet met your deductibles. Your provider must bill Medicare and Medicare’s payment will be sent directly to the provider.

Nonparticipating Medicare Providers
Nonparticipating providers may choose whether to accept Medicare assignment on an individual, case-by-case basis. You should ask any nonparticipating providers you see if they will accept assignment of your claim.

If your provider does not accept assignment, there is still a limit on the amount you pay for most services. This limit is 115% of the Medicare allowed amount and is called the limiting charge.

Medicare calculates payment based on the Medicare allowed amount and pays 80%. If the service is covered by AlaskaCare, it recognizes 115% of the allowed amount and pays the difference between what Medicare paid and the 115% that your provider can collect.

A nonparticipating provider who does not accept assignment of your claim must still file your Medicare claim for you.

Providers Who “Opt Out” of Medicare

Providers who “opt out” of Medicare have signed a contract with Medicare stating they will not bill Medicare for services provided to any Medicare beneficiary. These providers are prohibited from filing any claims with Medicare and may charge you any amount for their services, with no limit. You may purchase services from such a provider, but the provider will require you to sign an agreement (a private contract) stating that you are responsible for payment in full. These services are considered to be under a private contract. The AlaskaCare Retiree Health Plan will not pay anything for services provided under a private contract.

Note: This Medicare and Social Security information is an overview and is not intended to provide detailed information regarding Medicare or Social Security benefits.

Find a Provider

Legal Notices

1. COBRA Coverage Reminder
2. Creditable Coverage Notice - Prescription Drug Coverage and Medicare
3. HIPAA Privacy Practices

Appeals

AlaskaCare Health & Dental Appeal Guides

• Aetna Retiree Health Plan Appeal Guide
• Moda Retiree Dental Plan Appeal Guide
• Optum Rx Retiree Pharmacy Plan Appeal Guide
• Aetna Health Plan Appeal Form
• Moda Dental Plan Appeal Form

The AlaskaCare health and dental plans provide members with the right to appeal claims and precertifications that have been denied by claims administrators. If your health plan denies payment for a treatment that you believe should be covered, you have the right to challenge that decision through the appeal process. AlaskaCare has added a new level to the appeals process for services or supplies received on or after January 1, 2018. Under the new appeal process, if the third party claims administrator or external review organization uphold their original denial of your appeal, you have the right to appeal to the Division of Retirement and Benefits. Should the Division also uphold the denial, you retain the legal right to take the appeal to superior court.

Opioid Guidelines

Opioid Medication—Benefit Dispensing Information brochure

State and federal guidelines were developed to address the opioid epidemic in the United States and Alaska. New safety guidelines were adopted for the AlaskaCare plans on January 1, 2018 and were further enhanced on January 1, 2019. The guidelines limit the dispensing of opioids as follows:

• For patients that don’t normally use opioids:
  • The plan limits the maximum dosage per day to 50 mme (morphine milligram equivalent) and only allows up to a 7-day supply every 91-days.
  • A pre-authorization is required to obtain more than a 7-day supply within any 91-day period.
• For patients that regularly use opioids:
  • The plan limits the maximum dose per day to 90 mme and only allows up to a 30-day supply.
  • A pre-authorization is required periodically.
• For patients age 19 or under:
  • A pre-authorization is required for cough medications that contain opioids, and the prescription is limited to a 3-day supply.

Members are encouraged to discuss the effect of the AlaskaCare opioid dispensing policy with their providers and to contact Optum Rx at (855) 409-6999 for support.

Opioids are a type of narcotic pain medication. They can have serious side effects if you don't use them correctly. For people who have an opioid addiction, their problem often started with a prescription. Opioid drugs include:

• Codeine (only available in generic form)
• Hydromorphone (Dilaudid, Exalgo)
• Meperidine (Demerol)
• Methadone (Dolophine, Methadose)
• Morphine (Kadian, MS Contin, Morphabond)
• Fentanyl (Actiq, Duragesic, Fentora, Abstral)
• Oxycodone (OxyContin, Oxaydo)
• Oxycodone and acetaminophen (Percocet, Roxicet)
• Oxycodone and naloxone
• Hydrocodone (Hysingla, Zohydro ER)
• Hydrocodone and acetaminophen (Lorcet, Lortab, Norco, Vicodin)

Forms & Health Brochures

All forms and documents are available here.

AlaskaCare Retiree Form 1095-B Information

Form 1095-B is a tax form that reports the type of health insurance coverage you have, any dependents covered by your insurance policy, and the period of coverage for the prior year.

Since this information is already provided to the Internal Revenue Service (IRS) by Medicare, it is no longer necessary to have a printed copy of form 1095-B in order to file your taxes. The Division will provide members under age 65 access to an electronic version of form 1095-B online. Forms will be available online in March. You can access your 1095-B form in your MyRNB account under myDocuments.

Please note: If you are over the age of 65, Medicare provides the Form(s) 1095, not the Division of Retirement and Benefits.

If you would like to request a printed copy of your Form 1095-B, please reach out to the Member Education Center.

Check out our Form 1095 FAQs for more information.

Do you have questions about your AlaskaCare health plan, or do you need assistance with your benefits? Here are some helpful resources that can provide you with more information and make navigating through the health care maze easier.

Division of Retirement and Benefits Member Education Center

The Division of Retirement and Benefit’s Member Education Center provides essential support to our membership which includes employees, retirees, and other benefit recipients. We provide assistance relating to retirement, medical, and other optional benefits.

The Division’s Member Education Center team has comprehensive knowledge of the retirement systems and has dedicated team members that are experts on the AlaskaCare health plans. We are here to answer questions ranging from benefit enrollment for newly hired employees, to application for retirement, to the AlaskaCare health plan and beyond.

You can reach us at (907) 465-4460 or toll-free at (800) 821-2251. The hours of operation are Monday through Thursday 8:30 a.m. to 4 p.m., and Friday 8:30 a.m. to 3 p.m., Alaska Time.

Aetna Local Offices in Juneau and Anchorage

Want to talk to an Aetna representative in person? Aetna has a local office in Anchorage and in Juneau dedicated to assisting AlaskaCare members with questions. Members are welcome to stop by during the open office hours or contact the Aetna Concierge at (855) 784-8646 to make an appointment.

Hours: Tuesday, Wednesday, and Thursday from 9-11 a.m. and 12-4 p.m.

Juneau Office
One Sealaska Plaza, Suite 305
Juneau, Alaska 99801

Anchorage Office
2525 C Street, Suite 205
Anchorage, Alaska 99503

The Aetna local representatives can assist you with questions about your benefits, and with services such as paper claim submissions, travel precertification, appeals assistance, understanding your explanation of benefits, coordination of benefits and more…

Free Aetna Nurse Advice Line

You can talk to a nurse whenever you have health questions. You can call the Aetna nurse line 24 hours a day, 7 days a week. Even better, this service is provided at no cost to you. Simply call the nurse line number at (800) 556-1555.

The nurses can be a resource in considering options for care or helping you decide whether you or your dependent needs to visit your doctor, an urgent care facility or the emergency room. The nurse can help you with:

• Deciding whether to visit a doctor or urgent care center
• Understanding your symptoms
• Managing chronic conditions
• Learning about treatment options and medical procedures

You can call the nurse line anytime to discuss any health concerns at (800) 556-1555.

Wellbeing Resources – Aetna Behavioral Health

Need help finding a virtual or in-person mental health provider? Login to your Aetna.com member portal or call the Aetna Concierge at (855) 784-8646 and get connected with a behavioral health care advocate who can help you find a counselor, psychologist or psychiatrist who meets your needs.