Full Text
COMMONWEALTH OF MASSACHUSETTS MUNICIPAL EMPLOYEES, RETIREES & SURVIVORS 2024–2025 BENEFITS GUIDE For benefits and rates effective JULY 1, 2024 – JUNE 30, 2025 View this Benefits Guide on the MyGICLink member benefits portal or mass.gov/GIC ---PAGE BREAK--- 2 TABLE OF CONTENTS 3 Enrolling In or Updating GIC Benefits 4 Health Insurance Plan Rates Employees & Non-Medicare Retirees 5 Health Insurance Plan Locator Map 6 Benefits-at-a-Glance Medicare Retirees 8 Health Insurance Plan Locator Map 9 Benefits-at-a-Glance 10 Prescription Drug Benefits 11 Mass4YOU: Employee Assistance Program (EAP) 12 GIC Retiree Dental Plan 13 Resources & Contact Information IMPORTANT REMINDERS 1. Contact your health and other insurance plans about tier changes, network coverage, providers, drug tiers, wellness benefits, and more. 2. Which tier are your doctors and hospitals in? When checking provider coverage and tiers, be sure to specify the health insurance plan’s full name, such as “Harvard Pilgrim Explorer” or “Harvard Pilgrim Quality,” not just the health carrier name such as “Harvard Pilgrim Health Care.” Your health insurance plan is the best source for this information. 3. Are your doctors and hospitals in the health plan’s network? If your provider is no longer available, your health insurance carrier will help you find a new one. Note: Doctors and hospitals within any health plan’s network may change during the year. 4. TURNING 65? Visit bit.ly/gicmedicare for a video to guide you through the next steps, whether you’re retiring or not. You may only enroll in or change your health plan during GIC’s spring annual enrollment or within 60 days of a qualifying event. For information about annual enrollment and a complete list of qualifying events, visit mass.gov/gic. The GIC encourages members to actively shop and evaluate different coverage options. Please carefully review this guide as well as detailed benefits information for each GIC benefit carrier available at mass.gov/lists/contact-gic-benefit-plans, to make informed decisions about your coverage. Existing members, after reviewing your options, if you wish to keep your current GIC benefits, no action is required and your benefits will remain in place at the new rates effective July 1, 2024. REVIEW THIS GUIDE TO IDENTIFY WHICH BENEFITS YOU’RE ELIGIBLE FOR AND WHICH OPTIONS ARE BEST FOR YOU. FY2025 Health Insurance Plan News: Effective July 1, 2024, UniCare is changing its name to Wellpoint to reflect their mission of supporting GIC members’ whole health. View FAQs on UniCare’s new website, wellpointmass.com, to learn more. ---PAGE BREAK--- 3 When You Can Enroll In or Update GIC Benefits Save time and paper by managing your benefits on MyGICLink, GIC’s secure member benefits portal. l Enroll in/update your benefits during Annual Enrollment or within 60 days of experiencing a qualifying event l Securely update your personal information, chat with us, and more! Register & Log in mygiclink.my.site.com l Marriage l Address change l Birth or adoption of a child l Legal guardianship of a child l Legal separation, divorce or remarriage of you or your former spouse l Death of a covered spouse or dependent l You have GIC COBRA coverage and become eligible for other coverage If you have or will experience any of these qualifying events, you must notify the GIC within 60 days of the event. Failure to do so can result in financial liability to you. WITHIN 60 DAYS OF EXPERIENCING A QUALIFYING EVENT DURING GIC’S SPRING ANNUAL ENROLLMENT 2024 Annual Enrollment dates: April 3, 2024 - May 1, 2024 As a GIC member, Annual Enrollment is your opportunity to review benefit options and better understand the upcoming plan year changes to make coverage updates for benefits effective July 1, 2024. Reminder: Submit all changes no later than May 1, 2024. View a complete list of Qualifying Events bit.ly/gicqualifyingevent New employees have a period of 21 days to enroll in GIC benefits from their date of hire. Please visit GIC’s website for information regarding the effective date of GIC benefits as a new hire. Note: this does not apply to employees who transfer agencies. WHEN YOU’RE A NEW HIRE OF A PARTICIPATING MUNICIPALITY Learn more at bit.ly/gicnewhire Learn more about Annual Enrollment bit.ly/gicannualenrollment GIC’s Member Benefits Portal ---PAGE BREAK--- 4 Effective July 1, 2024 Full cost rates include the 0.30% administrative fee. You do not pay the full cost rate. Your share of the cost depends on your city or town cost-sharing arrangement. Contact your local benefit coordinator for information on your premiums. EMPLOYEE AND NON-MEDICARE RETIREE/SURVIVOR HEALTH INSURANCE PLANS HEALTH INSURANCE PLANS PLAN NETWORK INDIVIDUAL COVERAGE FAMILY COVERAGE Harvard Pilgrim Access America PPO National $1,259.39 $2,809.26 Wellpoint Total Choice INDEMNITY Broad $1,501.35 $3,331.72 Wellpoint PLUS PPO-TYPE $958.62 $2,284.05 Harvard Pilgrim Explorer POS $1,067.87 $2,645.90 Mass General Brigham Health Plan Complete HMO $977.66 $2,585.42 Harvard Pilgrim Quality HMO Limited $788.04 $2,005.81 Wellpoint Community Choice PPO-TYPE $744.97 $1,849.09 Health New England HMO Regional $778.25 $1,866.96 MEDICARE HEALTH INSURANCE PLANS HEALTH INSURANCE PLANS PLAN NETWORK PER PERSON Tufts Medicare Preferred MEDICARE ADVANTAGE Limited $363.84 Harvard Pilgrim Medicare Enhance MEDICARE SUPPLEMENT National $436.13 Health New England Medicare Supplement Plus MEDICARE SUPPLEMENT $438.79 Wellpoint Medicare Extension MEDICARE SUPPLEMENT $444.68 Health Insurance Plan Rates Full Cost) ---PAGE BREAK--- 5 Health Insurance Plan Locator Map (Employees & Non-Medicare Retirees) BERKSHIRE FRANKLIN HAMPSHIRE HAMPDEN WORCESTER MIDDLESEX ESSEX NORFOLK SUFFOLK BRISTOL PLYMOUTH BARNSTABLE NANTUCKET CONNECTICUT RHODE ISLAND NEW HAMPSHIRE VERMONT MAINE NEW YORK DUKES OUTSIDE OF MASSACHUSETTS Wellpoint Total Choice is the only health insurance plan offered by the GIC that is available for members living outside of the US. Harvard Pilgrim Access America is the only plan offered by the GIC that is available for members living outside of New England (CT, ME, MA, NH, RI, and VT). CONNECTICUT* Total, Explorer, Plus MAINE Total, Explorer, Plus NEW HAMPSHIRE Total, Explorer, Plus NEW YORK Access RHODE ISLAND Total, Explorer, Plus VERMONT Total, Explorer, Plus ACCESS – Harvard Pilgrim Access America TOTAL – Wellpoint Total Choice EXPLORER – Harvard Pilgrim Explorer PLUS – Wellpoint Plus COMPLETE – Mass General Brigham Health Plan Complete QUALITY – Harvard Pilgrim Quality COMMUNITY – Wellpoint Community Choice HNE – Health New England The BOLD text is a shortened version of the full plan name. These names are used to indicate which plan is available in each county. Where you live determines which health insurance plan you may enroll in. Please review the map and information below to determine which plan you are eligible to enroll in. Ensure your plan’s provider network includes your area of residence prior to enrollment. BARNSTABLE Total, Explorer, Plus, Complete, Community BERKSHIRE Total, Explorer, Plus, Complete, Quality, Community, HNE BRISTOL Total, Explorer, Plus, Complete, Quality, Community DUKES Total, Explorer, Plus, Complete ESSEX Total, Explorer, Plus, Complete, Quality, Community FRANKLIN Total, Explorer, Plus, Complete, Quality, Community, HNE HAMPDEN Total, Explorer, Plus, Complete, Quality, Community, HNE HAMPSHIRE Total, Explorer, Plus, Complete, Quality, Community, HNE MIDDLESEX Total, Explorer, Plus, Complete, Quality, Community NANTUCKET Total, Explorer, Plus, Complete NORFOLK Total, Explorer, Plus, Complete, Quality, Community PLYMOUTH Total, Explorer, Plus, Complete, Quality, Community SUFFOLK Total, Explorer, Plus, Complete, Quality, Community WORCESTER Total, Explorer, Plus, Complete, Quality, Community, HNE * For residents of CT, members residing near the MA border may enroll in HNE (review HNE’s website for provider and network information). Note: If you are a New England resident who covers dependent family member(s) who live in a state outside of New England, you may select the Total, Explorer and Plus health insurance plans – contact the plans for details regarding their national networks/out of area coverage. For all other health insurance plans, your dependents may only have emergency coverage while out of the plan’s service area. You should contact the health insurance plans directly for details. Please view page 13 for health insurance plan contact information. ---PAGE BREAK--- 6 Benefits-at-a-Glance (Employees & Non-Medicare Retirees) NATIONAL NETWORK BROAD NETWORK HEALTH INSURANCE PLANS HARVARD PILGRIM ACCESS AMERICA WELLPOINT TOTAL CHOICE WELLPOINT PLUS HARVARD PILGRIM EXPLORER GEOGRAPHIC ELIGIBILITY (See Health Insurance Plan Locator Map, page 5) U.S. Outside New England New England New England New England PLAN TYPE PPO INDEMNITY PPO-TYPE POS PCP Designation Required? No No No Yes PCP Referral to Specialist Required? No No No Yes Out-of-pocket Maximum Individual coverage Family coverage $5,000 $10,000 $5,000 $10,000 $5,000 $10,000 $5,000 $10,000 Fiscal Year Deductible Individual / Family $500 / $1,000 $500 / $1,000 $500 / $1,000 $500 / $1,000 Primary Care Provider Office Visit $20 / visit $20 / visit Tier 1: $10 / visit Tier 2: $20 / visit Tier 3: $40 / visit Tier 1: $10 / visit Tier 2: $20 / visit Tier 3: $40 / visit Preventive Services Most covered at 100% – no copay Most covered at 100% – no copay Most covered at 100% – no copay Most covered at 100% – no copay Specialist Physician Office Visit Tier 1 / Tier 2 / Tier 3 $45 / visit (no tiering) $45 / visit (no tiering) $30 / $60 / $75 / visit $30 / $60 / $75 / visit Retail Clinic and Urgent Care Center $20 / visit $20 / visit $20 / visit $20 / visit Outpatient Behavioral Health/ Substance Use Disorder Care $20 / visit $20 / visit $10 / visit $10 / visit Emergency Room Care $100 / visit (waived if admitted) $100 / visit (waived if admitted) $100 / visit (waived if admitted) $100 / visit (waived if admitted) Inpatient Hospital Care – Medical Maximum one copay per person per calendar year quarter. Waived if readmitted within 30 days in the same calendar year. Tier 1 / Tier 2 / Tier 3 $275 / admission no tiering $275 / admission no tiering $275 / $500 / $1,500 / admission $275 / $500 / $1,500 / admission Outpatient Surgery Eye & GI procedures at freestanding facilities in Massachusetts $150 $150 $150 $150 All other in Massachusetts $250 $250 $250 $250 High-Tech Imaging Maximum one copay per day. Contact the carrier for details. MRI, CT & PET scans) $100 / scan $100 / scan $100 / scan $100 / scan Prescription Drugs Prescription Drug Deductible: $100 Individual / $200 Family Retail (up to a 30-day supply) Tier 1 / Tier 2 / Tier 3 $10 / $30 / $65 $10 / $30 / $65 $10 / $30 / $65 $10 / $30 / $65 Mail Order Maintenance Drugs (up to a 90-day supply) Tier 1 / Tier 2 / Tier 3 $25 / $75 / $165 $25 / $75 / $165 $25 / $75 / $165 $25 / $75 / $165 If you participate in a non-Medicare plan, GIC protects you from balance billing under Massachusetts General Law Chapter 32A, §20. If you receive covered, medically necessary medical care in Massachusetts, doctors, hospitals, and other medical providers may only collect the amount covered by your GIC plan. You are still responsible for your share of the plan’s copays, deductibles, and any other eligible medical out-of-pocket costs, but not any excess. Always compare bills to the Explanation of Benefits (EOB) statement provided by your GIC health carrier. If you are not sure your invoice is a balance bill, call your health carrier. If it is a balance bill, advise your provider that as a GIC member, you are not liable for their excess compensation. If your provider persists in efforts to collect, contact the Group Insurance Commission. ---PAGE BREAK--- 7 Benefits-at-a-Glance (Employees & Non-Medicare Retirees) Out-of-pocket maximums apply to medical and behavioral health benefits across all health insurance plans. Prescription drug (Rx) benefits are included in the out-of-pocket maximums for all health insurance plans. BROAD NETWORK LIMITED NETWORK REGIONAL NETWORK MASS GENERAL BRIGHAM HEALTH PLAN COMPLETE HARVARD PILGRIM QUALITY WELLPOINT COMMUNITY CHOICE HEALTH NEW ENGLAND All of Mass Most of Mass Most of Mass Western Mass HMO HMO PPO-TYPE HMO Yes Yes No Yes Yes Yes No No $5,000 $10,000 $5,000 $10,000 $5,000 $10,000 $5,000 $10,000 $500 / $1,000 $400 / $800 $400 / $800 $400 / $800 Tier 1: $10 / visit Tier 2: $20 / visit Tier 3: $40 / visit $20 / visit $20 / visit $20 / visit Most covered at 100% – no copay Most covered at 100% – no copay Most covered at 100% – no copay Most covered at 100% – no copay $30 / $60 / $75 / visit $30 / $60 / visit (no Tier 3) $30 / $60 / $75 / visit $30 / $60 / visit (no Tier 3) $20 / visit $20 / visit $20 / visit $20 / visit $10 / visit $20 / visit $20 / visit $20 / visit $100 / visit (waived if admitted) $100 / visit (waived if admitted) $100 / visit (waived if admitted) $100 / visit (waived if admitted) Maximum one copay per person per calendar year quarter. Waived if readmitted within 30 days in the same calendar year. $275 / $500 / $1,500 / admission $275 / $500 / admission (no Tier 3) $275 / admission no tiering $275 / admission no tiering $150 $150 $150 $150 $250 $250 $250 $250 Maximum one copay per day. Contact the carrier for details. $100 / scan $100 / scan $100 / scan $100 / scan Prescription Drug Deductible: $100 Individual / $200 Family $10 / $30 / $65 $10 / $30 / $65 $10 / $30 / $65 $10 / $30 / $65 $25 / $75 / $165 $25 / $75 / $165 $25 / $75 / $165 $25 / $75 / $165 You pay both a copay and a deductible for some services. For details, see your plan’s schedule of benefits at mass.gov/GIC. ---PAGE BREAK--- 8 Health Insurance Plan Locator Map (Medicare) BERKSHIRE FRANKLIN HAMPSHIRE HAMPDEN WORCESTER MIDDLESEX ESSEX NORFOLK SUFFOLK BRISTOL PLYMOUTH BARNSTABLE NANTUCKET CONNECTICUT RHODE ISLAND NEW HAMPSHIRE VERMONT MAINE NEW YORK DUKES BARNSTABLE HPME, HNEMSP, TMP, OME BERKSHIRE HPME, HNEMSP, OME BRISTOL HPME, HNEMSP, TMP, OME DUKES HPME, HNEMSP, OME ESSEX HPME, HNEMSP, TMP, OME FRANKLIN HPME, HNEMSP, OME HAMPDEN HPME, HNEMSP, TMP, OME HAMPSHIRE HPME, HNEMSP, TMP, OME MIDDLESEX HPME, HNEMSP, TMP, OME NANTUCKET HPME, HNEMSP, OME NORFOLK HPME, HNEMSP, TMP, OME PLYMOUTH HPME, HNEMSP, TMP, OME SUFFOLK HPME, HNEMSP, TMP, OME WORCESTER HPME, HNEMSP, TMP, OME HPME – Harvard Pilgrim Medicare Enhance HNEMSP – Health New England Medicare Supplement Plus TMP – Tufts Health Plan Medicare Preferred OME – Wellpoint Medicare Extension The BOLD text is a shortened version of the full plan name. These names are used to indicate which plan is available in each county. OUTSIDE OF MASSACHUSETTS Harvard Pilgrim Medicare Enhance, Health New England Medicare Supplement Plus, and Wellpoint Medicare Extension are available throughout the country. CONNECTICUT HPME, HNEMSP, OME MAINE HPME, HNEMSP, OME NEW HAMPSHIRE HPME, HNEMSP, OME NEW YORK HPME, HNEMSP, OME RHODE ISLAND HPME, HNEMSP, OME VERMONT HPME, HNEMSP, OME Where you live determines which health insurance plan you may enroll in. Please review the map and information below to determine which plan you are eligible to enroll in. Ensure your plan’s provider network includes your area of residence prior to enrollment. ---PAGE BREAK--- 9 MEDICARE ADVANTAGE MEDICARE SUPPLEMENT HEALTH INSURANCE PLANS TUFTS HEALTH PLAN MEDICARE PREFERRED HARVARD PILGRIM MEDICARE ENHANCE HEALTH NEW ENGLAND MEDICARE SUPPLEMENT PLUS WELLPOINT MEDICARE EXTENSION GEOGRAPHIC ELIGIBILITY (See Health Insurance Plan Locator Map, page 8) Most of Mass National National National PLAN TYPE HMO INDEMNITY INDEMNITY INDEMNITY PCP Designation Required? Yes No No No PCP Referral to Specialist Required? Yes No No No Calendar Year Deductible None None None None Preventive Care Office visits according to health plan’s schedule No Copay No Copay No Copay No Copay Physician’s Office Visit (except behavioral health) $15 per visit $15 per visit $15 per visit $10 per visit Retail Clinic $15 per visit $15 per visit $15 per visit $10 per visit Outpatient Behavioral Health / Substance Abuse Disorder Care $15 per visit $15 per visit $15 per visit First 4 visits: no copay; visits 5 and over: $10 / visit Inpatient Hospital Care No Copay No Copay No Copay No Copay Hospice Care No Copay No Copay No Copay No Copay Diagnostic Laboratory Tests and X-Rays No Copay No Copay No Copay No Copay Surgery Inpatient and Outpatient No Copay No Copay No Copay No copay in MA and for out-of-state providers that accept Medicare; call the plan for details if using out-of-state providers that do not accept Medicare Emergency Room Care (includes out-of-area) $50 per visit (waived if admitted) $50 per visit (waived if admitted) $50 per visit (waived if admitted) $50 per visit (waived if admitted) Hearing Aids First $500 covered at 100%, 80% coverage of the next $1,500 per ear, per two-year period First $1,700 per ear, per two-year period PRESCRIPTION DRUGS Retail (up to a 30-day supply) Tier 1 / Tier 2 / Tier 3 $10 / $30 / $65 $10 / $30 / $65 $10 / $30 / $65 $10 / $30 / $65 Mail Order Maintenance Drugs (up to a 90-day supply) Tier 1 / Tier 2 / Tier 3 $25 / $75 / $165 $25 / $75 / $165 $25 / $75 / $165 $25 / $75 / $165 Here is an overview of health insurance benefits offered through each of the GIC’s Medicare plans. Benefits are subject to definitions, conditions, limitations and exclusions as spelled out in the respective health insurance plans’ documents. With the exception of emergency care, out-of-network benefits are not covered through the Tufts Medicare Advantage Plan. Benefits-at-a-Glance (Medicare) ---PAGE BREAK--- 10 Employees & Non-Medicare Retirees CVS Caremark is the GIC’s prescription drug benefit administrator for non-Medicare health insurance plans. Use your CVS Caremark ID card when filling prescriptions. Prescription Drug Deductible You pay an annual prescription drug deductible of $100/ individual and $200/family, separate from your health plan deductible. Once you have paid your prescription drug deductible, your covered prescriptions are subject to a copay. Prescription Drug Copays All GIC health plans feature a three-tier copay structure. Contact CVS Caremark with questions about your specific medications. l Tier 1: You pay the lowest copay. Most generic prescription drugs fall into this tier. l Tier 2: You pay the mid-level copay. Many brand- name prescription drugs fall into this tier. l Tier 3: You pay the highest copay. This tier includes brand-name and generic prescription drugs that don’t fall into Tiers 1 or 2. Covered prescription drugs may change when CVS Caremark updates its drug formulary during the plan year. Avoid the Prescription Retail Refill Penalty l If you or a family member is taking a long-term medication—such as high cholesterol or high blood pressure medicine—you will receive a communication from CVS Caremark asking you how you wish to receive your future refills—by mail or at your local CVS pharmacy. For these maintenance medications, you must fill a 90-day supply at either a CVS Retail Pharmacy, or you may utilize CVS Caremark Mail Service Pharmacy, and you will pay one mail order copay. l All acute 30-day retail medications, or any non- maintenance medications—such as antibiotics or painkillers—can be filled at any in-network Retail Pharmacy for one 30-day retail copay. Make sure you take action before your third refill, otherwise you will pay the full cost of the medication. GIC Rx: Prescription Drug Benefits Medicare Eligible Retirees CVS SilverScript administers the prescription drug benefit for all GIC Medicare health insurance plans. Your prescrip- tion drug benefit is called an Employer Group Waiver Plan (EGWP). It combines a standard Medicare Part D drug plan with additional coverage provided by the GIC. Prescription Drug Copays All GIC health plans feature a three-tier copay structure. Contact CVS SilverScript with questions about your specific medications. l Tier 1: You pay the lowest copay. Most generic prescription drugs fall into this tier. l Tier 2: You pay the mid-level copay. Many brand- name prescription drugs fall into this tier. l Tier 3: You pay the highest copay. This tier includes brand-name and generic prescription drugs that don’t fall into Tiers 1 or 2. l Do not enroll in a non-GIC Medicare Part D plan. All GIC Medicare plans include Medicare Part D coverage. If you enroll in another Part D plan, the Centers for Medicare and Medicaid Services will disenroll you from your GIC coverage. This means that you will lose your GIC health, behavioral health and prescription drug benefits. l A “Notice of Creditable Coverage” is located in your plan handbook. It provides proof that you have com- parable or better coverage than Medicare Part D. If you should later enroll in an individual Medicare drug plan because of changed circumstances, you must show the Notice of Creditable Coverage to the Social Security Administration to avoid paying a penalty. l If you have extremely limited income and assets, contact the Social Security Administration to find out about subsidized Part D coverage. l If your adjusted gross income, as reported on your federal tax return, exceeds a certain amount, Social Security will impose a additional fee called IRMAA (Income-Related Adjustment Amount). Visit medicare.gov for more information. Social Security will notify you if this applies to you. Medicare Part D Prescription Drug Coverage QUESTIONS? CONTACT CVS SILVERSCRIPT gic.silverscript.com 1.[PHONE REDACTED] QUESTIONS? CONTACT CVS CAREMARK info.caremark.com/oe/gic 1.[PHONE REDACTED] IMPORTANT ---PAGE BREAK--- 11 Mass4YOU is a free Employee Assistance Program available to all state and municipal employees and their families who are eligible for GIC benefits administered through Optum health. GIC health insurance coverage is not required to access the many Mass4YOU work/life and other support services. Through Mass4YOU, GIC benefits-eligible employees and their families can find easy access to a comprehensive suite of free, confidential support available 24/7, including: l Three in-person virtual, telephone, or in-person therapy visits per issue, per year l 30-minute telephone or in-person legal or mediation consultation per issue per year l Guidance from a financial advisor to help with debt, foreclosure, financial planning, and more l Referrals for a variety of Work-Life convenience services: child care, elder care and more l Access to Mass4YOU’s 24/7 confidential substance abuse treatment helpline and a licensed clinician No formal enrollment is required. Stay up-to-date on all Mass4YOU benefits by providing the GIC with your email at bit.ly/MyGICLinkOnlineForms. Mass4YOU: Employee Assistance Program (Employees) QUESTIONS? CONTACT MASS4YOU liveandworkwell.com; Enter access code mass4you 1.[PHONE REDACTED] I TTY Support: 711 +1.[PHONE REDACTED] Substance Use Treatment Helpline: 1.[PHONE REDACTED] ---PAGE BREAK--- 12 1.[PHONE REDACTED] metlife.com/gicbenefits QUESTIONS? CONTACT METLIFE The GIC Retiree Dental Plan is provided through MetLife. You can get reimbursed up to $1,250 a year for cleanings, fillings, crowns and other dental services. You pay less if you receive care from one of 370,000 participating dentists nationwide. You pay more if you receive care from a non-participating dentist. You pay the full cost of this voluntary coverage. Eligibility Retirees and survivors from the following municipalities that have elected to offer the plan are eligible: l City of Melrose l Town of Ashland l Town of Bedford l Town of Brookline l Town of Holbrook l Town of Marblehead l Town of Middleborough l Town of Millis l Town of North Andover l Town of Randolph l Town of Swampscott l Town of Weston l Town of Westwood l Northeast Metropolitan Regional Vocational School District If your municipality is not listed, you are not eligible for GIC Retiree Dental benefits. Contact your municipal benefits office for additional information. Enrollment Eligible retirees and survivors may join during Annual Enrollment, or within 60 days of a qualifying status change, such as when COBRA dental coverage ends, when you become a survivor of a GIC member, or at retirement. If you drop GIC Retiree Dental coverage, you may never re-enroll. GIC PLAN RATES – EFFECTIVE JULY 1, 2024 Includes 0.30% Administrative Fee $1,250 Maximum Annual Benefit per Member COVERAGE TYPE RETIREE PAYS Single $29.36 Family $70.75 GIC Retiree Dental Plan ---PAGE BREAK--- CONTACT YOUR HEALTH INSURANCE CARRIERS FOR: l Requesting Member ID card(s) l Finding a provider l Tiered doctor & hospital lists l Tele-health options that are offered l Fitness and wellness programs offered 13 Resources & Contact Information HEALTH INSURANCE PLAN CARRIERS PHONE WEBSITE Mass General Brigham Health Plan 1.[PHONE REDACTED] gic-members Harvard Pilgrim Health Care 1.[PHONE REDACTED] harvardpilgrim.org/gic Health New England 1.[PHONE REDACTED] healthnewengland.org/gic Tufts Health Plan (Medicare Only) 1.[PHONE REDACTED] Wellpoint (Formerly UniCare) Non-Medicare plans Medicare plan 1.[PHONE REDACTED] 1.[PHONE REDACTED] wellpointmass.com PHARMACY BENEFITS CVS Caremark 1.[PHONE REDACTED] info.caremark.com/oe/gic CVS SilverScript 1.[PHONE REDACTED] gic.silverscript.com DENTAL BENEFITS GIC Retiree MetLife Dental Plan 1.[PHONE REDACTED] metlife.com/gicbenefits ADDITIONAL RESOURCES (NOT ADMINISTERED BY THE GIC) Social Security Administration 1.[PHONE REDACTED] or your local Social Security Office ssa.gov Medicare 1.[PHONE REDACTED] medicare.gov ---PAGE BREAK--- 14 Notes ---PAGE BREAK--- 15 Notes ---PAGE BREAK--- STD. U.S. POSTAGE PAID PERMIT #860 GREEN BAY, WI 1 Ashburton Place, Suite 1619 Boston, MA 02108 COMMONWEALTH OF MASSACHUSETTS GROUP INSURANCE COMMISSION Website: mass.gov/GIC Telephone: 1.[PHONE REDACTED] TDD/TTY: 711 Mailing Address: Group Insurance Commission P.O. Box 556 Randolph, MA 02368 Maura Healey, Governor Kim Driscoll, Lieutenant Governor Matthew Veno, Executive Director Group Insurance Commission Commissioners *Current as of March 2024. Valerie Sullivan (Public Member), Chair Bobbi Kaplan (NAGE), Vice Chair Matthew Gorzkowicz, Secretary for Administration and Finance, ex officio Gary Anderson, Commissioner of Insurance, ex officio Elizabeth Chabot (NAGE) Edward Tobey Choate (Public Member) Tamara P. Davis (Public Member) Jane Edmonds (Retiree Member) Joseph Gentile (AFL-CIO, Public Safety Member) Gerzino Guirand (Council 93, AFSCME, AFL-CIO) Patricia Jennings (Public Member) Eileen P. McAnneny (Public Member) Melissa Murphy-Rodrigues (Massachusetts Municipal Association) Jason Silva (Massachusetts Municipal Association) Anna Sinaiko (Health Economist) Timothy D. Sullivan, Ed. D. (Massachusetts Teachers Association)