Fresno Unified School District
Retiree Health Benefits
Retiree Lifetime Medical Benefits - Eligibility
Hello prospective FUSD retirees!
As you may be nearing your retirement, we understand you may have questions on how your health benefits will look after retirement. We hope the information below is helpful.
Retirement Orientation with the Benefits Department
Once HR processes your retirement, you will be contacted by the Benefits Department if you meet the eligibility requirement of Retiree Lifetime Benefits.
For employees retiring at the end of the school year, you will be contacted by the Benefits Department, either via phone, mail or email, with meeting location and dates. During this orientation, we will review the importance of the District’s retiree health benefits agreement and answer any questions you might have.
If you do not meet the minimum requirements for retiree lifetime benefits, you will be mailed a COBRA/EdCode7000 continuation of coverage letter to the address on file approximately one month before your health and welfare benefits terminate through the District.
Please ensure your contact information such as, phone number and address, in the HR system (Lawson) is correct and up to date. If you need assistance with updating your phone number, please contact the Employee Service Center at 559-457-3514, or email them at EmployeeServiceCenter@fresnounified.org.
If you have any questions, feel free to contact our retiree technicians.
Criteria for Retiree Lifetime Medical Benefits
- You need to have been hired permanently before 7/1/2005
- You need to be at least 57.5 years of age
- If you are at least 50 years old, but not quite 57.5 yet, you can still qualify for lifetime medical benefits, but will be required to pay the COBRA premium until the month you turn 57.5.
- You need to have at least 16 years of service with the District
- Some of you might have 15 years of service, with the current school year counting as your 16th.
- You must have filed for retirement with Human Resources and *CalSTRS/CalPERS.
OR
- You need to have been hired permanently on/after 7/1/2005
- You need to be at 57.5 years of age
- If you are at least 50 years old, but not quite 57.5 yet, you can still qualify for lifetime medical benefits, but will be required to pay the COBRA premium until the month you turn 57.5.
- You need to have at least 20 years of service with the District
- Some of you might have 19 years of service, with the current school year counting as your 20th.
- You must have filed for retirement with Human Resources and CalSTRS/CalPERS.
If you wish to enroll in retiree health benefits at a later date, please contact the Benefits Department at 559.457.3520 and provide proof of your retirement status with CalSTRS/CalPERS when you've become eligible.
Ineligible for Retiree Lifetime Medical Benefits
If you do not meet the minimum requirements for retiree lifetime benefits, you will be mailed a COBRA/EdCode7000 continuation of coverage letter to the address on file approximately one month before your health and welfare benefits terminate through the District. Rates are as shown below and is subject to change.
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Regular 18 Month COBRA Coverage |
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| Coverage for you and your dependents under COBRA for a maximum period of 18 months starting the month after your official retirement date. | |||
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2026 |
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|
Single |
Two Party |
Family |
|
|
Option A - Medical/Rx Only |
$864.00 |
$1,729.00 |
$2,522.00 |
|
Option B - Medical/Rx Only |
$772.00 |
$1,546.00 |
$2,254.00 |
|
Option C - Kaiser |
$1,461.00 |
$1,461.00 |
$1,461.00 |
|
Delta Dental Plan |
$55.00 |
$114.00 |
$170.00 |
|
United Healthcare Dental |
$55.00 | $55.00 | $55.00 |
|
VSP Vision Plan |
$18.00 | $18.00 | $18.00 |
OR
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Ed Code 7000 Rates (For Certificated Retirees and all Non-Certificated Retirees who Retired after 1/1/2009) |
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Coverage for you and your spouse under Ed Code 7000 starting the month after your official retirement date or after your COBRA coverage has ended. This option does not provide coverage for dependent children. |
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|
2026 |
||
| Retiree Only | Retiree + Spouse/DP | |
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Option A - Medical/Rx Only - Non-Medicare Retiree <65 |
$1,719.00 |
$3,439.00 |
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Option B - Medical/Rx Only - Non-Medicare Retiree <65 |
$1,530.00 |
$3,064.00 |
|
Option C - Kaiser - Non-Medicare Retiree <65 |
$1,029.16 |
$2,058.32 |
|
Option A - Medical/Rx Only - Retiree 65+ w/out Medicare |
$1,322.00 |
$2,641.00 |
|
Option B - Medical/Rx Only - Retiree 65+ w/out Medicare |
$1,187.00 |
$2,370.00 |
|
Medicare Advantage PPO - Medicare Retiree |
$534.48 |
$1,068.96 |
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Medicare Advantage PPO - Over/Under 65 Combo |
|
$1,987.82 |
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Kaiser Senior Advantage - Medicare Retiree |
$323.52 |
$647.04 |
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Kaiser Senior Advantage - Over/Under 65 Combo |
|
$1,352.68 |
|
Delta Dental Plan |
$55.00 |
$114.00 |
|
United Healthcare Dental |
$55.00 |
$55.00 |
|
VSP Vision Plan |
$18.00 |
$18.00 |
How to apply for Service Retirement
Step 1: File your Retirement with CalSTRS/CalPERS
It is necessary to plan ahead as the retirement process can be overwhelming. First thing first, is to file your retirement with your pension provider; either CalSTRS or CalPERS. On your CalSTRS/CalPERS application, you will want to enter your official retirement date after your last day of work with FUSD. In example, you've selected 12/31 as your last day of work with FUSD. Therefore, your retirement date with CalSTRS/CalPERS would be a date after your last day of work.
You cannot be working and retiring on the same day. Please thoroughly review your retirement application with your pension providers, as any mistakes can delay your retirement through these pension providers.
If you have not already done so, you can visit the CalSTRS/CalPERS website by clicking on the links referenced below and apply for service retirement.
Additional question regarding retirement should be directed to the appropriate pension provider, CalSTRS @ 800-228-5453 or CalPERS @ 888-225-7377.
Step 2: File your Retirement with Human Resources
After finalizing your retirement with your appropriate pension provider CalSTRS/CalPERS, next step is to file for retirement via Resignation Form with FUSD Human Resources. On your resignation form, you will want to enter your last day of work, reasoning Service Retirement. However, if you are retiring with PARS, this step may be skipped.
If you have not already done so, you may apply by clicking on the link referenced below to submit your resignation.
Any question regarding your last day of work and/or sick and vacation hours, should be directed to FUSD Human Resources @ 559-457-3500.
Once you've completed the 2 steps above, you're on your way into retirement! We thank you for your service!
Ongoing Retiree Benefit Announcement
About your Upcoming Retiree Medical Plan Options
You can now review medical plan options in advance of Open Enrollment. We’re sharing this information on the coverage options that will be available, so you can begin comparing benefits and understanding how each plan works.
By clicking this link, Medicare Plan Comparison, you will find a comparison of the medical plans that will be available, including two new options—Commercial PPO Plan A and Commercial PPO Plan B—along with the Kaiser Permanente Senior Advantage HMO Plan and the Medicare Advantage PPO Plan.
Understanding How Your Coverage Works
If you are a retiree eligible for Medicare, then Medicare will serve as your primary option for coverage. Commercial PPO Plans A and B will be available to then act as secondary coverage, helping cover additional eligible healthcare costs after Medicare pays its portion.
For the Medicare Advantage and Kaiser Senior Advantage plans, the plan functions as both your primary and secondary coverage.
Please note that for Commercial Plan A and Plan B, the prescription drug coverage and plan design are not yet determined, pending information to be released by the Centers for Medicare Services. More information on prescription drug coverage is expected to be available by July 2026.
Review Your Options
Each plan offers different structures for deductibles, copays, provider access, and covered services. The enclosed comparison chart is designed to help you review these differences and begin considering which option may best meet your healthcare needs.
You Must be Enrolled in Medicare
As a Medicare-eligible retiree of Fresno Unified School District, you have the opportunity to take advantage of various healthcare benefits, as provided by the District and the Joint Health Management Board. To maintain enrollment in a Fresno Unified Medicare Advantage plan, you must be enrolled in both Medicare Part A and Medicare Part B. You must also keep up with your Medicare premiums and IRMAA fees, if applicable, to maintain coverage.
If you enroll in another Medicare Advantage or Medicare Part D plan later, you will be disenrolled from the Fresno Unified School District Employee Healthcare Plan. If you are disenrolled, you may not be able to re-enroll until the next annual open enrollment period or during a HIPAA special enrollment event.
You can only enroll in one Medicare Advantage plan and/or one Medicare Part D plan at once.
What if I see an ad telling me to enroll in another plan?
Fresno Unified offers two Medicare Advantage retiree health plans (a PPO option and an HMO option), and you can only be in one Medicare Advantage plan at a time. Talk to the Fresno Unified Benefits Department about the rules before you consider enrolling in another Medicare Advantage plan. Joining another Medicare Advantage plan will cause you to lose coverage for yourself, your spouse, and your dependents, and again, you may not be able to get it back until the next annual open enrollment period or upon a HIPAA special enrollment event.
What if I don’t pay my premiums and fees?
As previously stated, you must keep up with your Medicare premiums and IRMAA fees to maintain your coverage. The Income-Related Monthly Adjustment Amount (IRMAA) is an amount you may pay in addition to your Part B or Part D premium if your income is above a certain level.
What if I lost my coverage or want to change plans?
If you lost your other coverage, you may be able to re-enroll into the Fresno Unified Medicare Advantage Plan since that would fall under a HIPAA special enrollment event. If you want to change plans between the Medicare Advantage retiree health plans with Fresno Unified, you will need to wait until the open enrollment period, which is October through November.
Will I get Part A and Part B automatically, or will I have to sign up?
If you’re already getting benefits from Social Security, you’ll automatically get Part A and Part B starting the first day of the month you turn 65. If you automatically get Medicare, you’ll get your red, white, and blue Medicare card in the mail three months before your 65th birthday, and you won’t need to pay a premium for Part A (sometimes called “premium-free Part A”), although you will need to pay a premium for Part B.
If you’re close to 65, but NOT getting Social Security, you’ll need to sign up for Medicare. You can also contact Social Security three months before you turn 65 to set up an appointment.
How do I sign up for Medicare or check my Medicare enrollment status?
To sign up for Part A and/or B, visit SSA.gov/Medicare or contact Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. The current Medicare General Enrollment Period (to enroll in Part A and B) ends on March 31, 2024. You may have to pay a late enrollment penalty if you don’t sign up during general enrollment or your initial enrollment eligibility period.
IRMAA Reimbursement
You May Be Eligible for Medicare Part D Financial Assistance
As a Medicare-eligible retiree (or Medicare-eligible dependent of a retiree) currently enrolled in the Aetna Medicare Advantage PPO Plan or Kaiser Permanente Senior Advantage Plan, you may be eligible for financial assistance from the District’s Joint Health Management Board (JHMB) for your Medicare Part D prescription drug premiums.
How It Works: As a result of a federal regulation that went into effect in 2012, certain higher-income Medicare beneficiaries are subject to additional Medicare prescription drug premiums. This additional premium is known as the Part D Income-related Monthly Adjustment Amount (IRMAA). The amount is calculated based on your federal income taxes filed two years prior to the plan year. You may be subject to the IRMAA premium if you are a Medicare beneficiary whose modified adjusted gross income (AGI) on your most recent Federal tax return fell into either of the following categories:
- AGI of $103,000 or more—Individuals
- AGI of $206,000 or more—Married Couples Filing Jointly
Though the Joint Health Management Board has agreed to assist with your IRMAA premiums, it is still up to you to pay the premiums to Medicare. Please note that the JHMB does not reimburse Part B IRMAA.
What You Need to Do: If you received a notice or bill from the Social Security Administration or Medicare indicating that your monthly Medicare premiums include a Part D prescription drug IRMAA, simply follow the instructions below:
Instructions
1. Please scan or email, fax, or mail a copy of your statement or bill from the Social Security Administration or Medicare to Delta Fund Administrators. Contact information is below:
Delta Fund Administrators
FUSD IRMAA Reimbursement
PO Box 2330
Stockton CA 95201
Fax: (209) 940-5147
Email: IRMAAReimb@deltafund.com
2. Make sure the statement or bill clearly indicates your monthly Part D or prescription drug IRMAA premium. Delta Fund Administrators will annualize your IRMAA premium based on the monthly amount and provide you with financial assistance for the entire plan year.
3. Be sure to include your phone number or email address, so they may follow up with you for additional information if necessary. You are not required to submit this information monthly—only one time during the plan year.
Pay Your Premiums: Though the Joint Health Management Board has agreed to provide financial assistance for your Part D IRMAA premiums, it is still up to you to pay the premiums to Medicare. Delta Fund Administrators is not sending the money to Medicare on your behalf. If you fail to pay the premiums, you may lose your Medicare eligibility. So, be sure to continue to make your payments throughout the year.
IRMAA Reimbursements: You may still submit documentation to receive your previous year reimbursement, please follow the instructions provided in the “What You Need to Do” section above and send the required information to Delta Fund Administrators by the end of the calendar year.
If You Have Questions: Please contact Delta Fund Administrators if you have any additional questions. You may reach them by calling the following phone numbers:
Delta Fund Administrators
P: (209) 940-5100 or (866) 358-1711