65+ Health Benefits

SVUSD sponsors a Medicare Supplement plan for retirees who are age 65 and over. Click through the below tabs for more information.

General Info

Beginning January 1, 2017, the District will offer a Medicare Supplement plan through The Hartford for retirees and their spouse/domestic partner age 65 and older. The plan includes coverage for medical, prescription, hearing, vision, chiropractic, and acupuncture services. While this is a District sponsored plan, enrollment, billing questions, etc. should be directed to Benistar Admin Services (see "Contact" tab below). In addition, retirees are responsible for 100% of the benefit premium.

Who is eligible?

In order to be eligible for The Hartford plan, applicants must meet all of the following criteria:

  • Age 65 or Older
  • Enrolled in Medicare Part A and B
  • Currently enrolled in SVUSD's active group health plan, retiree group health plan, or COBRA medical coverage.

Please be advised that applicants are only eligible if moving directly from a SVUSD medical plan to The Hartford. Spouses looking to enroll must meet all the same requirements.

What is the cost?

Rates for The Hartford are broken down by age. The rates below include coverage for medical, prescription, hearing, vision, chiropractic, and acupuncture. These rates do not include the cost of Medicare enrollment.

2017 Rates:

  • Age 65-69 $370.35
  • Age 70-74 $402.34
  • Age 75-79 $433.81
  • Age 80+ $444.07

2018 Rates:

  • Age 65-69 $377.35
  • Age 70-74 $409.34
  • Age 75-79 $440.81
  • Age 80+ $451.07

2019 Rates:

  • Age 65-69 $383.35
  • Age 70-74 $415.34
  • Age 75-79 $446.81
  • Age 80+ 457.07

Please note, applicants may only enroll in the full package, and cannot enroll in just prescription or just medical.

What services and doctors are covered?

The Hartford network consists of all doctors who accept Medicare. Information on covered services, copays, etc. can be found by navigating the tabs below.

How do I enroll?

Applicants will need to submit a Medical enrollment form and a Prescription enrollment form directly to Benistar at least 30 days prior to your eligibility date. Please contact the Benefits Department for copies of these enrollment forms.

My spouse and I are enrolling in the Hartford. What coverage options do my dependent children have?

Dependent children are not eligible to enroll in the Hartford. All dependents will be offered the opportunity to enroll in COBRA once their coverage on an SVUSD active or retiree plan ends. SVUSD does not offer any additional coverage options for dependent children, however, they may wish to explore coverage options through the insurance market place by visiting Covered California.

My spouse is under 65, but already enrolled in Medicare. Is he/she eligible?

No, all plan participants must be both 65+ and enrolled in Medicare part A and B.

Contact

For Enrollment, Eligibility, and Billing, contact:

BENISTAR Admin Services

  • 10 Tower Lane, First Floor, Avon, CT 06001
  • 800-236-4782, Press 1
  • 5:30 am-3:00 pm

For Customer Service/Claims, contact:

The Hartford

  • PO Box 1928, Grapevine, TX 76099
  • 844-380-4577

For Prescription Drug Customer Service/Claims, contact:

Express Scripts

  • Attn: Med-D Accounts, PO BOX 66752, St Louis, MO 63196-6752
  • 888-345-2560

For Mail Order Prescription:

Express Scripts

  • PO Box 66773, St Louis, MO 63166-6773
  • Physician: 888-327-9791
  • Fax: 800-357-9577
  • Prior Authorization: 800-935-6103

Below are summaries of the benefits and coverages for the Hartford plan. Accessible Alternative Version (AAV) of the available medical plans can be viewed utilizing the accordion navigation below.

Medical Benefit Summary

Calendar Year Deductible: $0

Lifetime Maximum: Unlimited

Part A Services - Hospitalization
  • Semi-private room and board, general nursing, and miscellaneous services and supplies.
ServicesMedicare PaysPlan PaysYou Pay
First 60 daysAll but $1,288100% of Medicare Part A Deductible$0
61st through 90th dayAll but $322 per day100% of Medicare Part A Coinsurance$0
91st through 150th day (60 day Lifetime Reserve Period)All by $644 per day100% of Medicare Part A Coinsurance$0
Once Lifetime Reserve days are used (or would have ended if used) additional 365 days of confinement per person per lifetime$0100%$0
Part A Services - Skilled Nursing Facility Care
  • Semi-private room and board, skilled nursing and rehabilitative services and other services and supplies. You must meet Medicare's requirement which includes hospitalization of at least 3 days. You must enter a Medicare-approved facility within 30 days after leaving the hospital.
ServicesMedicare Pays Plan PaysYou Pay
First 20 daysAll approved amounts$0$0
21st through 100th dayAll but $161 per dayUp to 100% of Medicare SNF coinsurance$0
101st through 365 day$0$0All other charges
Part A Services - Blood Deductible - Hospital Confinement and Out-Patient Medical Expenses
  • When furnished by a hospital or skilled nursing facility during a covered stay.
ServicesMedicare PaysPlan PaysYou Pay
First 3 pints$0100%$0
Additional amounts100%$0$0
Part A Services - Hospice Care
  • Pain relief, symptom management and support services for terminally ill.
ServicesMedicare PaysPlan PaysYou Pay
As long as the Physician certifies the needAll costs, but limited to costs for out-patient drug and in-patient respite careCo-insurancecharges for in-patient respite care, drugs and biologicals approved by medicareAll other charges
Part B Services - Out-Patient Medical Expenses

The Policy may cover the following Medicare Pare B Benefits:

  • Physician Services benefit
  • Specialist Services benefit
  • Outpatient Hospital Services and Ambulatory Surgical Care benefit
  • Outpatient Diagnostic and Radiology Services benefit
  • Outpatient Mental Health and Substance Abuse Services benefit
  • Outpatient Rehabilitative and Cardiac Rehabilitative Services benefit
  • Emergency Care benefit
  • Urgent Care benefit
  • Ambulance Services benefit
  • Durable Medical Equipment and Prosthetics benefit

All Medicare Part B Benefits are based on per visit, except Ambulance Services Benefit, which is based on per trip, and Durable Medical Equipment and Prosthetics Benefit, which is based on per device.

ServicesMedicare PaysPlan PaysYou Pay

Medicare Part B Deductible

First $166 of Medicare-approved amounts

$0100% of Medicare Part B Deductible$0
Remainder of Medicare-approved amounts80%100% of the remaining Medicare Part B Coinsurance$0
Part B Excess Charges for Non-Participating Medicare providers covers the difference between the 115% Medicare limiting fee and the Medicare-approved Part B charge$0100%$0
Preventive Medical Care & Cancer Screenings
  • Coverage for expenses incurred by a covered person for physical exams, preventative screening tests and services, cancer screenings, and any other tests or preventive measures determined to be appropriate by the attending Physician. Refer to your Medicare and You handbook for more information on Preventive services.
ServicesMedicare PaysPlan PaysYou Pay
"Welcome to Medicare" Physical exam within first 12 months of Part B enrollment100%$0$0
Annual Wellness Visit100%$0$0
Vaccinations100%$0$0
Preventive Care Cancer Screening BenefitsGenerally 100% for most preventive screenings. Some screenings subject to Medicare Part B Deductible and Coinsurance100% of remaining covered expenses incurred not covered by Medicare$0
Foreign Travel Emergency
  • Medically necessary emergency care services
ServicesMedicare PaysPlan PaysYou Pay
Emergency services needed due to injury or sickness of sudden and unexpected onset during the first 60 days while traveling outside the United States.$080% after $250 Deductible (to a lifetime maximum of $50,000)$250 Deductible and then 20% of expenses incurred (to a lifetime maximum of $50,000 then 100% thereafter)
Private Duty Nursing
  • Service provided to a person while covered under this benefit and charged directly to the covered person by the nurse and not the hospital.
ServicesMedicare PaysPlan PaysYou Pay
Up to a maximum of 3 shifts per day consisting of at least 3 consecutive hours of nursing care per shift$0100% of remaining covered expenses incurred after the copayment for 30 shifts per calendar year up to the benefit maximum of $500 per calendar year$20 copay per shift (to a calendar year maximum of $500, then 100% thereafter)
Hearing Services
ServicesMedicare PaysPlan PaysYou Pay
  • one routine hearing and balance exam every 12 months
  • two hearing aids every 3 years
  • one hearing aid fitting evaluation every 3 years
$0100% of remaining covered expenses incurred, after the copayment, up to the benefit maximum of $1,000 per calendar year

$25 copay per exam

$50 copay for two hearing aids, including fitting and evaluation (to a calendar year maximum of $1,000, then 100% thereafter)

Vision Services
ServicesMedicare PaysPlan PaysYou Pay
  • one supplemental routine eye exam every 12 months
  • one pair of glasses every 12 months or 12 month supply of contact lenses
$0100% of remaining covered expenses incurred, after the copayment, up to the benefit maximum of $500 per calendar year

$25 copay per exam

$50 copay per pair of glasses or supply of contact lenses (to a calendar year maximum of $500, then 100% thereafter)

Chiropractic Services
ServicesMedicare PaysPlan PaysYou Pay
Services performed by a licensed chiropractor to correct structural alignment$0100% of remaining covered expenses incurred, after the copayment, up to the benefit maximum of $500 per calendar year$25 copay per exam (to a calendar year maximum of $500, then 100% thereafter)
Acupuncture Services
ServicesMedicare Pays Plan PaysYou Pay
Services performed by a licensed acupuncturist to treat pain$0100% of remaining covered expenses incurred, after the copayment, up to the benefit maximum of $500 per calendar year$25 copay per exam (to a calendar year maximum of $500, then 100% thereafter)
Annual Physical Exam
ServicesMedicare PaysPlan PaysYou Pay
The exam may include a review of medical history and a discussion of risk factor reductions and other services performed as part of an annual exam which are not covered by Medicare or under another benefit in the policy.After the "Welcome to Medicare Physical Exam" $0100% of remaining covered expenses incurred, after the copayment, up to the benefit maximum of $500 per calendar year$25 copay per exam (to a calendar year maximum of $500, then 100% thereafter)


Limitations & Exclusions: The Hartford's Insurance Plan does not cover any expense that is not a Medicare Eligible Expense or beyond the limits imposed by Medicare for such expenses or excluded by name or specific description by Medicare, except as specifically provided in the policy. The plan does not cover: Any part of a covered expense to the extent paid by Medicare; benefits payable under one benefit of the policy to the extent covered under another benefit of the policy; or expense incurred after coverage terminates, except as stated in the Extension-of-Benefits provision of the policy.

Prescription Benefit Summary

You do not pay a yearly deductible.

Initial Coverage Stage:
  • You will pay the following until your total yearly drug costs (what you and the plan pay) reach $3,700
TierRetail One-Month (31-day) SupplyRetail Three-Month (90-day) SupplyMail Three-Month (90-day) Supply
Tier 1: Generic Drugs$0 copayment$0 copayment$0 copayment
Tier 2: Preferred Brand Drugs$30 copayment$90 copayment$60 copayment
Tier 3: Non-Preferred Drugs$60 copayment$180 copayment$120 copayment
Tier 4: Specialty Drugs33% coinsurance33% coinsurance33% coinsurance

Not all drugs are available at a 90-day supply, and not all retail pharmacies offer a 90-day supply.

You may receive up to a 90-day supply of certain maintenance drugs (medications taken on a long-term basis) through home delivery from Express Scripts Pharmacy. There is no charge for standard shipping.

Additional Coverage Stages:
StageCoverage
Coverage Gap Stage

After your total yearly drug costs reach $3,700, you will pay the following until you qualify for the Catastrophic Coverage Stage:

  • Brand-name drugs: You pay 40% of the total cost (plus a portion of the dispensing fee)
  • Generic drugs: You will continue to pay the same cost-sharing amount as in the Initial Coverage stage
Non-Part D DrugsCovered, excluding lifestyle
Compound SolutionCompound Management Solution applies. Compound Management Solution is in place to mitigate compound drug abuse by means of inclusion and exclusion lists
Catastrophic Coverage Stage

After your yearly out-of-pocket drug costs reach $4950, you will pay the greater of 5% coinsurance or:

  • a $3.30 copayment for covered generic drugs (including brand drugs treated as generics) with a maximum of Initial Coverage Stage member cost share
  • a $8.25 copayment for all other covered drugs