Edited by LM 8/18/22Not Apprvd

Retiree Health Plans

Learn more about the AlaskaCare retiree health plan benefits, coverages and monthly premiums.
Effective as of January 1,

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.

Defined Benefit Retiree Health Plan Premiums

Tier II/III retirees without system-paid medical
Coverage Level 2021 Monthly Premium 2022 Monthly Premium
Retiree Only $704 $704
Retiree and Spouse $1,408 $1,408
Retiree and Child(ren) $995 $995
Retiree and Family $1,699 $1,699
Effective: Jan. 1 - Dec. 31, 2022

Defined Contribution Retiree Health Plan Premiums

Retiree and Spouse (if applicable) are Medicare Age Eligible
Coverage Level 2021 Monthly Premium 2022 Monthly Premium
Retiree Only $320.79 $320.79
Retiree and Spouse $641.58 $641.58
Retiree and Child(ren) $849.66 $849.66
Retiree and Family $1,170.45 $1,170.45
Retiree and Spouse (if applicable) are not Medicare Age Eligible
Coverage Level 2021 Monthly Premium 2022 Monthly Premium
Retiree Only $1,094.46 $1,094.46
Retiree and Spouse $2,188.92 $2,188.92
Retiree and Child(ren) $1,623.84 $1,623.84
Retiree and Family $2,718.30 $2,718.30
When only the Retiree or the Spouse is Medicare Age Eligible
Coverage Level 2021 Monthly Premium 2022 Monthly Premium
Retiree and Spouse $1,415.25 $1,415.25
Retiree and Family $1,944.12 $1,944.12
Effective: Jan. 1 - Dec. 31, 2022


OptumRx 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 OptumRx 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 OptumRx app.

OptumRx streamlines the Medicare Part D/EGWP Annual Notices, which means less paperwork for you! Each calendar year Medicare requires OptumRx 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 OptumRx to provide the document electronically through the online OptumRx 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 OptumRx 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 OptumRx 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 OptumRx at (855) 409-6999.

AlaskaCare Retiree Plan Formulary

AlaskaCare Defined Benefit Retiree Plan Formulary

AlaskaCare Defined Contribution Retiree Plan Formulary

Retail Pharmacies

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

Medication Home Delivery

You can receive maintenance medication through the mail through OptumRx® home delivery. Enroll in OptumRx® 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 OptumRx® App or call (855) 409-6999, TTY 711.

OptumRx Specialty Pharmacy

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

Call OptumRx 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™ .

OptumRx On the Go!

Access your pharmacy benefits and manage your prescriptions from your smartphone or tablet with the OptumRx 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 OptumRx 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 OptumRx 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 OptumRx. 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:

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

OptumRx Prescription Drug Claim Form

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

OptumRx Medicare Part-D (EGWP) Prescription Drug Claim Form

  • Send completed form with pharmacy receipt(s) to:
    OptumRx 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.

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
Coverage Level Standard Legacy
Retiree Only $66 $67.32 $73 $74.46
Retiree and Spouse $131 $133.62 $145 $147.90
Retiree and Child(ren) $119 $121.38 $132 $134.64
Retiree and Family $187 $190.74 $207 $211.14
DB: Defined Benefit Plan | DCR: Defined Contribution Retirement Plan
Effective: Jan. 1 - Dec. 31, 2022

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 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.

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

Instructions for Submitting International Claims

  1. 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
  2. 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.
  3. If you are interested in receiving reimbursement via Direct Deposit, please complete and include the Direct Deposit Authorization Form .

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


  • 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.
  • 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.

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

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 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
≥ 85$900$1078$1113

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

Bronze Premiums
May 1, 2000 Age Premium (in dollars)
< 5016.10
≥ 85412.90


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.

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

Archived Booklets

Defined Benefit

Defined Contribution

Notice of Proposed Changes to the AlaskaCare Retiree Health Plans

The State of Alaska Division of Retirement and Benefits proposes to adopt changes to the AlaskaCare Defined Benefit Retiree Health Plan effective for the 2023 plan year. The public comment period scheduled to open on September 2, 2022 has been postponed. Please check back for additional information and the updated public comment period dates.

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 OptumRx and Optum Bank to create an efficient way for members to receive reimbursement for their Part D IRMAA surcharge.

How to establish an 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 .

What do 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, .

Medicare Overview

Medicare is a health insurance program for:

  • People age 65 or older
  • People under age 65 with certain disabilities
  • People of all ages with end-stage renal disease

The AlaskaCare Retiree Health Plan assumes that you and your eligible dependents are enrolled in both Parts A and B of Medicare at age 65. Once enrolled, AlaskaCare coordinates with Medicare to pay most of your medical expenses. Medicare coverage includes different categories: Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and Medicare Part D (prescription drugs).

State of Alaska Medicare Information Office

The Medicare Information Office offers one on one personalized Medicare Counseling and Medicare Seminar events by webinar. Please call for more information and to schedule.

(907) 269-3680 | Toll-free (800) 770-8973 | TTY: (800) 770-8973

550 W 7th Ave., Suite 1230
Anchorage, AK 99501


AlaskaCare Health & Dental Appeal Guides

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

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 OptumRx 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

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.

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

Page Last Modified: 09/20/22 15:28:30