Medicare-Eligible Retiree Benefits

Auxiliary, Classified, Confidential, Management

When a retiree or spouse or registered domestic partner of record becomes eligible for Medicare, the eligible person must apply for Medicare Part A and B prior to the month they turn 65. Failure to enroll in Medicare Part A and B and provide Human Resources proof of enrollment prior to the month they turn 65 may be billed a surcharge in the amount of $1,250 per month until proof of enrollment is received.

- Medical Plans
  HMO Medical Plans and Enrollment Forms
  - Kaiser Permanente Sr Advantage $10 (2 pers w/Medicare) Benefits Summary
  - Kaiser Permanente Sr Advantage Enrollment Form (2 pers w/Medicare)
  - Kaiser Permanente Sr Advantage Enrollment Form (1 pers w/Medicare)
  - Kaiser Sr Advantage Benefit Summary
  - Blue Shield 65 Plus Advantage Benefits Summary
  - Enrollment Request For Blue Shield 65 (HMO) Employer Group Enrollment Form
  - SISC III Enrollment Form for Blue Shield HMO Full Network
  PPO Medical Plans and Enrollment Forms
  Prescription Coverage
  - Navitus Medicare Rx Information
  Additional Information
  - HIPAA Notice of Privacy Practices
- Dental Plans (Optional)
  HMO Dental Plan
  - Delta Care HMO Benefits Summary
  PPO Dental Plans
  - - Delta Dental PPO 1500 Benefits Summary
    - Delta Dental PPO Unlimited Benefits Summary
- Vision Plan (Optional)
  - VSP - Vision Care

Gym Discount Programs:

Sliver & Fit Program – Blue Shield Companion Care, Blue Shield Medicare Advantage
Fitness Your Way by Tivity Health – Blue Shield 100A EGWP
Medicare Members One Pass - Kaiser Permanente Senior Advantage 65+

Medicare-Eligible Retiree Benefits

Auxiliary, Classified, Confidential, Management

HMO Medical Plans and Enrollment Forms

PPO Medical Plans and Enrollment Forms

Prescription Coverage

Additional Information

HMO Dental Plan

PPO Dental Plans

Gym Discount Programs: