Fresno Unified School District
Retiree Health Benefits
Hello prospective FUSD retirees!
This is intended for employee’s that have submitted their retirement notification to the Human Resources Department. On behalf of the District, we thank you for your service.
As you may be nearing your retirement date, we understand you may have questions on how your health benefits will look after retirement. We hope the information below is helpful.
Criteria for Retiree Lifetime Medical Benefits
If you do not qualify for retiree lifetime benefits, you will be mailed a COBRA continuation of coverage letter to the address on file approximately one month before your health and welfare benefits terminate through the District. The criteria to qualify for lifetime benefits is summarized below.
- 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.
File your Retirement with CalSTRS/CalPERS
Given that you have submitted your retirement form to HR you want to ensure that you also file your retirement with your pension provider; either CalSTRS or CalPERS. On your CalSTRS/CalPERS application, you want to enter your retirement date for a date after the date you entered in the form submitted to HR. Please thoroughly review your retirement application with both CalSTRS/CalPERS, 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.
Retiree Appointments with the Benefits Department
Once HR processes your retirement, you will be contacted by a Retiree Technician.
For employees retiring at the end of the school year, at some point in May or early June, you will be contacted by a Retiree Technician, either via phone or email, with meeting location, options and dates. During this meeting we will review the District’s retiree health benefits agreement and answer any questions you might have.
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.
Ongoing Retiree Events:
Ensure Eligibility for Your Retiree Benefits
Upon Medicare eligibility, whether it is at age 65 or disability status, you and/or your dependent(s) must enroll in Medicare Part A and B in alignment with the retiree health plan agreement to avoid service interruption and/or cost share responsibilities. You will notified by mail 3 months prior to your eligibility date.
You're required to:
- Enroll in Medicare Part A and B.
- Provide Fresno Unified School District Benefits Department with a copy of your Medicare ID card, including your MBI.
- Have a U.S. residential address on file with CMS and the Fresno Unified School District Benefits Department at the contact number below.
You may have to pay a higher Part A and/or Part B premium for late enrollment if you had missed your enrollment window. When you sign up during the General Enrollment Period, your coverage starts the first day of the month after you sign up. Therefore, we encourage you to sign up in a timely manner.
Medicare Advantage
Mandatory changes to your current Medicare retiree health benefits, provided by the Joint Health Management Board and Fresno Unified School District.
After an extensive review of various market options in addition to Kaiser Senior Advantage, the Aetna Medicare Advantage PPO plan has been identified as a program that meets the JHMB’s high standards. The new plan(s) goes into effect for eligible members on July 1, 2023. We are pleased to present a program that provides a balance of quality, access, and affordability for our members.
The Aetna Medicare Advantage PPO plan offers:
- Provider access on a national scale
- Customer service at a high level
- Broad coverage with low to zero out-of-pocket expenses for members, in many cases
- Additional services, including:
- Transportation services
- Meal delivery services
- Audiology hearing aid benefits
- Virtual behavioral health support from MDLIVE® through Aetna®
The JHMB is committed to ensuring quality benefits for all its members, and to that end, the Board regularly reviews health programs that will deliver on that expectation. Great care is taken to ensure that provider access, customer service, and benefit levels all meet the high standard of quality that our members deserve.
The Aetna Medicare Advantage PPO plan will provide you with medical and prescription drug coverage with a provider network available in Fresno County and throughout most of the United States. All Medicare-eligible retirees currently enrolled in PPO Plans A and B and their Medicare-eligible dependents will be transferred to the Aetna Medicare Advantage PPO plan. Dependents who are not eligible for Medicare will be covered by the Aetna Open Choice PPO plan, the non-Medicare option, which resembles PPO Plan A.
You and your Medicare dependents will be given the opportunity to transfer to a Medicare Advantage plan or to opt out of these plans entirely during your Medicare special enrollment event. However, PPO Plan A and PPO Plan B will no longer be available to Medicare-eligible retirees and their dependents.
For more information regarding the plans, click the links below.
Aetna Medicare Group Schedule of Cost Sharing
Aetna OpenChoice PPO Non-Medicare Spouse/Dependents - SBC
Kaiser Permanente Senior Advantage - SBC
Kaiser Permanente Senior Advantage - EOC
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.
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