2021 Retiree Benefits Book - DEPARTMENT OF HUMAN RESOURCES - Gwinnett County
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DEPARTMENT OF HUMAN RESOURCES 2021 Retiree Benefits Book
Gwinnett County
Board of Commissioners
2021 Retiree Benefits Plans
This book provides 2021 benefits options available to Gwinnett County retirees who are eligible to participate
in Gwinnett County Benefits Plans.
Gwinnett County Board of Commissioners reserves the right to revise benefits offered at any time and the right
to charge appropriate premiums for these benefits.
The premiums listed in this book are effective as of January 1, 2021, and are not guaranteed to remain the
same in future years.
Please note: Fraudulent statements on benefits application forms or website (My GCHub, formerly known
as ESS) enrollment will invalidate any payment of claims for services and will be grounds for canceling the
retiree’s benefit coverage.
2021 Retiree Benefit Plans | 2
1 Health Plan Eligibility Information
4 Summary 2021 Benefit Changes
5 2021 Benefit Plans
6 Kaiser HMO
9 Aetna Traditional PPO
13 Aetna Bronze, Silver, and Gold Max Choice HSA
17 Aetna Medicare Advantage
19 Dental Plan
21 Vision Plan
22 GC Retiree Website
23 My GCHub (Formerly ESS) Instructions
24 Important Information for Gwinnett County Retirees
29 Gwinnett County Human Resources Contact Information
30 Vendor Contact Information
2021 Retiree Benefit Plans | 3
HEALTH PLAN
ELIGIBILITY INFORMATION
Medical Levels of Coverage
• Retiree only: No dependent coverage
• Retiree + spouse: No dependent children
• Retiree + child(ren): Employee + one or more children, no spouse
• Family: Retiree, spouse, and child(ren)
Coverage for the retiree
This document describes the benefits an eligible retiree may receive through health plans (medical, dental, and vision) offered by Gwinnett County.
The retiree is also referred to as the participant. Employees approved for a medical disability while employed by Gwinnett County are eligible to
continue health, dental, or vision benefits at retiree rates for a maximum of two years. Benefits can continue past two years if the disability is total
and permanent, as defined by the Social Security Administration, and if the employee is receiving approved disability benefits provided by Gwinnett
County. Refer to CA OPEB policy for additional details concerning continued benefit eligibility. Employees approved for a medical disability are also
referred to as the participant.
Coverage for the retiree’s dependents
If the retiree is covered by Gwinnett County health plans, eligible dependents of the retiree may also enroll. Eligible dependents are also called
participants. Only dependents who were eligible for benefits on the participant’s retirement date can be covered by any of the Gwinnett County
benefits plans. Refer to the CA OPEB policy located on the GC Retiree website.
For details regarding potential eligible dependents, refer to the Gwinnett County Summary Plan Document and CA OPEB Policy located on the GC
Retiree website.
Retirees adding dependents during Annual Enrollment, or adding dependents as a result of a qualified life status change, will be required to substantiate
the eligibility of all dependents for whom enrollment is being requested in Gwinnett County medical, dental, and/or vision benefits. Gwinnett County’s
eligibility requirements are included in this book. If documentation for your dependent(s) is not received and validated by the date specified, your level of
coverage for elected benefits will be “retiree only” as of your effective date.
The Gwinnett County Department of Human Resources will verify all retiree and dependent eligibility. For a list of documentation required for each
potentially benefit-eligible dependent (spouse, child, or stepchild) please refer to the Gwinnett County Summary Plan Document located on the GC
Retiree website.
2021 Retiree Benefit Plans | 4
Important information about eligibility for Medicare: retirees and covered dependents
Important Notice: You are required to contact the Gwinnett County Benefits Division 60 days prior to the date you or your covered dependent(s) become
Medicare-eligible. As soon as you become Medicare eligible you must immediately enroll in Medicare Part A and Part B in order to continue participation
in Gwinnett County health plans.
The Gwinnett County health plan option for retirees and eligible dependent(s) who are Medicare-eligible is the Aetna Medicare Advantage Plan.
If there is a non-Medicare participant and a Medicare eligible participant on the same coverage, the non-Medicare participant will be linked to a non-
Medicare plan of your choice as provided by Gwinnett County. If there is a non-Medicare eligible retiree/dependent, coverage for the dependent will be
linked to a non-Medicare plan of your choice as provided by Gwinnett County.
Retiree procedures for submission of documentation
Upon final completion of the website enrollment process, print and review a confirmation statement to ensure accuracy of the enrollment. Supporting
documentation must be received by the Department of Human Resources, Benefits Division, by the date specified. Clear photocopies of the documents
will be adequate. The documents submitted will not be returned.
Enrollment must be completed within 30 days of retirement. Documents must be received in the Department of Human Resources within 30 calendar
days of retirement or life status change for the benefits to become effective for the retiree and any eligible dependents.
Document review procedures
Documents will be reviewed by the Department of Human Resources staff. If the documentation is found to be adequate, no further action will be necessary.
If documentation is deemed inadequate, a Department of Human Resources staff member will request additional documentation or clarification from the
retiree. If the documentation does not support dependent eligibility for benefits, enrollment of the dependent will be denied. Medical, dental, and/or vision
coverage for dependents ruled ineligible will be rescinded unless an appeal of this decision is processed and approved.
Immediately upon denial of a dependent’s eligibility, the employee will be contacted by Human Resources.
Life status change
At any time other than the annual enrollment period, retirees are unable to add
or delete coverage for themselves or their dependents unless the
retiree experiences a life status change, as defined by the IRS.
For details of life status change, refer to the Gwinnett
County Summary Plan Document located on the
GC Retiree website.
Important information: If a retiree
experiences a qualified life status
change that results in a request
2020 Retiree Benefit Plans | 5
to add a dependent to any of his/her benefits plans, the request will be considered only if the dependent was eligible for benefits at the time of retirement. Only dependents who were eligible for benefits on the retiree’s retirement date can be covered by any of the Gwinnett County benefits plans at that time or in the future. See CA OPEB policy. The Department of Human Resources must be notified – in writing, with required documentation – within 30 calendar days of a qualified life status change if the retiree wants to apply for a change in coverage as a result of the change in status. If approved, the requested change will be effective on the date of the qualifying event. Opting out of benefits offered by Gwinnett County Retirees are given the opportunity to elect to continue receiving group health benefits at the time of retirement. If the option to continue group health benefits is not elected within 30 days of retirement, and the retiree does not have comparable group health coverage elsewhere, coverage will not be offered again and the retiree will have waived the option to participate in Gwinnett County’s health plan for life. If at any time a retiree waives health coverage because he/she has other group health coverage that is comparable to the coverage offered to retirees by Gwinnett County, the retiree may subsequently elect Gwinnett County retiree health benefits only in the event of the involuntary loss of the other coverage (e.g., through loss of employment or loss of coverage due to a spouse’s retirement/termination). The retiree must make this election within 30 days of this involuntary loss of coverage and must provide satisfactory documentation of continuous group health coverage since the date of retirement. Plan requirements will not allow a break in coverage. In the event of such an election, the Gwinnett County health plan effective date will be the day following the loss of prior health coverage. Fraudulent statements on a retiree’s benefits application form or website enrollment will invalidate any payment of claims for services and are grounds for canceling the retiree’s coverage.
SUMMARY OF 2021
BENEFITS UPDATES
Medical Insurance
• Aetna and Kaiser remain health insurance providers for pre-Medicare
retirees. Medicare-eligible retirees will be able to enroll in the Aetna
Medicare Advantage Plan.
Pre-Medicare Aetna Plans
Refer to page 12 for complete details.
• Gwinnett has added telemedicine and video appointment services for Aetna
members in 2021. Telehealth visits will be treated the same as your in-per-
son appointments and subject to applicable deductibles and co-insurances.
• US Imaging, the advanced imaging service, will no longer be a feature of the
Aetna plan. However, you can still find the best pricing for tests and imaging by
searching the Find Care and Pricing Tool at Aetna.com.
• Premiums will have slight increases.
Pre-Medicare Kaiser HMO Plans
Refer to page 9.
• Kaiser members have many options for safe, convenient medical care: video, phone, in person, e-visit, or chat
online. Receive advice via email or phone, and manage appointments, refill most prescriptions, and see test results on
the app or at kp.org.
• Kaiser introduces new diabetes prevention program, Omada, for their qualifying members.
• Premiums will have slight increases.
Medicare-Eligible Retirees
Refer to page 20 for complete details.
• Aetna Medicare Advantage Plan will continue to be the only plan for Medicare eligible retirees.
• No changes to medical copays, deductibles, or out of pocket maximum.
• Decrease in premiums.
Cigna Dental Insurance
• There are no changes to plan designs.
• Premiums will have slight increases.
VSP Vision Coverage
• There are no changes to premiums or plan designs.
2021 Retiree Benefit Plans | 7
2021 Benefits Plans
• Kaiser Permanente Gold and Silver HMO Plans • Aetna Medicare Advantage Plan
• Aetna Traditional PPO Plan • Cigna Dental Plans
• Aetna Maximum Choice HSA • VSP Vision Plans
Gold, Silver, and Bronze Plans
2021 Retiree Benefit Plans | 8
Kaiser HMO
Cost to You
What’s Covered
Silver HMO Gold HMO
In-Network In-Network
$2,150 per person $1,200 per person
Annual Deductible
$4,300 per family $2,400 per family
Out-of-Pocket Maximum
Deductible, coinsurance, and copay accumulate toward the Out-of- $6,100 per person $3,700 per person
Pocket Maximum $12,200 per family $7,400 per family
Primary Care Office Visit $65 copay $35 copay
Preventive Care No cost No cost
Affordable Care Act Guidelines Varies, based on type Varies, based on type
Non-ACA Services and place of service and place of service
Specialty Care Office Visit $85 copay $55 copay
Emergency Care
Urgent Care Facility $70 copay $50 copay
Ambulance $100 copay per trip $100 copay per trip
Hospital Emergency Room 30% coinsurance after deductible 20% coinsurance after deductible
Inpatient Hospital
30% coinsurance after deductible 20% coinsurance after deductible
Including Mental Health and Chemical Dependency
Inpatient/Outpatient Surgery 30% coinsurance after deductible 20% coinsurance after deductible
Lab and Imaging
Inpatient and Outpatient No cost with office visit; No cost with office visit;
Lab, Diagnostic Clinic, or Facility 30% coinsurance outpatient 20% coinsurance outpatient
Outpatient Visit
$65 copay $30 copay
Mental Health and Chemical Dependency
2021 Retiree Benefit Plans | 9Kaiser HMO
Cost to You
What’s Covered Silver HMO Gold HMO
In-Network In-Network
Rehabilitation
Physical Therapy
Occupational Therapy
30% coinsurance after deductible 20% coinsurance after deductible
(PT and OT: combined 20 visit limit per calendar year)
Speech Therapy
(20 visit limit per calendar year)
Chiropractic Visit
$85 copay $50 copay
(30 visit limit per calendar year)
Maternity Services
Specialty Office Visit $85 copay $50 copay
Pre and Post Maternity Care 30% coinsurance after deductible 20% coinsurance after deductible
Delivery and Hospital Care
Family Planning
Specialty Office Visit $85 copay $85 copay
Diagnostic Infertility Services (to diagnose condition) 30% coinsurance after deductible 20% coinsurance after deductible
(Artificial Insemination and In-Vitro Fertilization are not covered)
Skilled Nursing Facility
30% coinsurance after deductible 20% coinsurance after deductible
(60-day limit per calendar year)
Home Health Care
30% coinsurance after deductible 20% coinsurance after deductible
(120-day limit per calendar year)
Hospice Care 0% coinsurance, no deductible 0% coinsurance, no deductible
Vision Exam
(no optical hardware benefit) $85 copay $55 copay
Hearing Aids $1,000 maximum benefit $1,000 maximum benefit
(every 3 years)
2021 Retiree Benefit Plans | 10Kaiser HMO
Cost to You
What’s Covered
Silver HMO Gold HMO
In-Network In-Network
Durable Medical Equipment 30% coinsurance after deductible 20% coinsurance after deductible
Prescription Drugs – Kaiser Network
Pharmacy Deductible None None
Retail (up to 30 days)
Generic $30 copay $10 copay
Brand $70 copay $40 copay
Mail Order (up to 90 days)
Generic $60 copay $20 copay
Brand $140 copay $80 copay
Drug must be on Kaiser formulary to be covered unless medical
exception is approved. View Kaiser formulary at www.kp.org.
Kaiser Silver Kaiser Gold
Monthly Pre-Medicare Retiree Premium
HMO Plan HMO Plan
Retiree $205.18 $353.90
Ret + Spouse $457.03 $794.34
Ret + Child(ren) $428.79 $762.09
Ret + Family $472.21 $811.70
Monthly Blended Retiree Premium Kaiser Silver Kaiser Gold
(Pre-Medicare and Medicare Retiree) HMO Plan HMO Plan
Retiree + Spouse (1 Medicare) $375.54 $559.76
Ret + Child(ren) (1 Medicare) $340.63 $517.70
Ret + Family (2 Medicare) $351.51 $354.69
Ret + Family (1 Medicare) $392.09 $579.08
2021 Retiree Benefit Plans | 11Aetna Traditional PPO
Traditional PPO
Aetna Network: (Aetna Choice POS II)
What’s Covered (Open Access)
In-Network Out-of-Network
$1,600 per person $3,200 per person
Annual Deductible
$3,200 per family $6,400 per family
Out-of-Pocket Maximum
$4,200 per person $8,400 per person
Deductible, coinsurance, and copay accumulate toward the Out-of-
$8,400 per family $16,800 per family
Pocket Maximum
Primary Care Office Visit $50 copay 50% coinsurance after deductible
Preventive Care
Affordable Care Act Guidelines No cost 50% coinsurance after deductible
Non-ACA Services Varies based on type/place of service
Specialty Care Office Visit $75 copay 50% coinsurance after deductible
Emergency Care
Urgent Care Facility $75 copay 50% coinsurance after deductible
Ambulance 30% coinsurance after deductible 50% coinsurance after deductible
Hospital Emergency Room 30% coinsurance after deductible 30% coinsurance after deductible
Inpatient Hospital
30% coinsurance after deductible 50% coinsurance after deductible
Including Mental Health and Chemical Dependency
Inpatient/Outpatient Surgery 30% coinsurance after deductible 50% coinsurance after deductible
Lab and Imaging
Inpatient and Outpatient 30% coinsurance after deductible 50% coinsurance after deductible
Lab, Diagnostic Clinic, or Facility
Outpatient Visit
$75 copay 50% coinsurance after deductible
Mental Health and Chemical Dependency
2021 Retiree Benefit Plans | 12Aetna Traditional PPO
Traditional PPO
Aetna Network: (Aetna Choice POS II)
What’s Covered (Open Access)
In-Network Out-of-Network
Therapy Services
(Calendar year maximums are combined between in-network and out-of-network)
$75 co-pay 50% after deductible; 60-visit
Speech Therapy, Physical Therapy,
60-visit combined maximum combined per year maximum for
Occupational Therapy
per year for speech, physical, speech, physical, occupational, and
Chiropractic Services
occupational, and chiropractic visits chiropractic visits
Behavioral Health Services
(Services must be authorized by calling 1.800.292.2879)
Inpatient (Facility fee) 30% coinsurance after deductible 50% coinsurance after deductible
Inpatient (Physician fee) 30% coinsurance after deductible 50% coinsurance after deductible
Inpatient Substance Abuse Detoxification (Facility fee) 30% coinsurance after deductible 50% coinsurance after deductible
Inpatient Substance Abuse Detoxification (Physician fee) 30% coinsurance after deductible 50% coinsurance after deductible
Other Services
(Calendar year maximums are combined between in-network and out-of-network)
Urgent Care Center $75 copayment 50% coinsurance after deductible
Skilled Nursing Facility
Annual Maximum: 30 days 30% coinsurance after deductible 50% coinsurance after deductible
(Maximum = combined in-network and out-of-network days) 60-day calendar year maximum 60-day calendar year maximum
Home Health Care
Annual Maximum: 120 days (combined in-network and out-of- 30% coinsurance after deductible 50% coinsurance after deductible
network) 60-visits per calendar year 60-visit calendar year
Hospice Care 30% coinsurance 50% coinsurance
(not subject to deductible) (not subject to deductible)
Ambulance (Covered only when medically necessary) 30% coinsurance 50% coinsurance
2021 Retiree Benefit Plans | 13Aetna Traditional PPO
Traditional PPO
Aetna Network: (Aetna Choice POS II)
What’s Covered (Open Access)
In-Network Out-of-Network
Durable Medical Equipment (DME) 30% coinsurance after deductible 50% coinsurance after deductible
Prescription drug coverage is provided by CVS/Caremark. See the CVS/
Prescription Drug Coverage
Caremark summary on page 12 for details.
Rehabilitation
Physical Therapy
Occupational Therapy
$75 copay 50% coinsurance after deductible
Speech Therapy
(PT, OT, and ST – includes Autism and Cerebral Palsy: combined 60
visit limit per calendar year)
Chiropractic Visit/Spinal Manipulation $75 copay 50% coinsurance after deductible
Maternity Services
Specialty Office Visit $75 copay 50% coinsurance after deductible
Pre and Post Maternity Care 30% coinsurance after deductible
Delivery and Hospital Care
Family Planning
Specialty Office Visit $75 copay 50% coinsurance after deductible
Diagnostic Infertility Services (to diagnose condition) 30% coinsurance after deductible
(Artificial Insemination and In-Vitro Fertilization are not covered)
Skilled Nursing Facility
30% coinsurance after deductible 50% coinsurance after deductible
(Annual Maximum: 60 days combined in or out-of-network)
Home Health Care
30% coinsurance after deductible 50% coinsurance after deductible
(Annual Maximum: 60 days combined in or out-of-network)
Hospice Care 30% coinsurance after deductible 50% coinsurance after deductible
Vision Exam
$75 copay 50% coinsurance after deductible
(no optical hardware benefit)
Hearing Aids
30% coinsurance after deductible 50% coinsurance after deductible
(one per ear, every 3 years)
2021 Retiree Benefit Plans | 14Aetna Traditional PPO
Traditional PPO
Aetna Network: (Aetna Choice POS II)
What’s Covered (Open Access)
In-Network Out-of-Network
Durable Medical Equipment 30% coinsurance after deductible 50% coinsurance after deductible
Pharmacy Deductible None
Retail (up to 30 days)
Generic $20 copay
Preferred Brand $50 copay
Non-Preferred Brand $75 copay
Mail Order (up to 90 days)
Generic $40 copay
Preferred Brand $100 copay
Non-Preferred Brand $150 copay
Drug must be on Aetna formulary to be covered unless medical exception is approved. View Aetna formulary at Aetna.com.
Aetna
Monthly Pre-Medicare Retiree Premium
Traditional PPO Plan
Retiree $515.21
Ret + Spouse $1,236.11
Ret + Child(ren) $1,204.71
Ret + Family $1,253.02
Monthly Blended Retiree Premium Aetna
(Pre-Medicare and Medicare Retiree) Traditional PPO Plan
Retiree + Spouse (1 Medicare) $873.96
Ret + Child(ren) (1 Medicare) $658.83
Ret + Family (2 Medicare) $354.02
Ret + Family (1 Medicare) $894.09
2021 Retiree Benefit Plans | 15Aetna Maximum Choice HSA Gold, Silver, and Bronze Plans
Aetna Bronze Max Choice HSA Aetna Silver Max Choice HSA Aetna Gold Max Choice HSA
Aetna Network: Aetna Choice POS II Aetna Network: Aetna Choice POS II Aetna Network: Aetna Choice POS II
What’s Covered (Open Access) (Open Access) (Open Access)
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
$3,900/individual $7,800/individual $2,350/individual $4,700/individual $1,550/individual $3,100/individual
Annual Deductible
$7,800/family $15,600/family $4,700/family $9,400/family $3,100/family $6,200/family
Out-of-Pocket Maximum
Deductible, coinsurance, $6,900/ $13,800/ $4,900/individual $9,800/individual $2,800/individual $5,600/individual
and copay accumulate individual individual $9,800/family $19,600/family $5,600/family $11,200/family
toward the Out-of-Pocket $13,800/family $27,600/family
Maximum
30%
50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
Primary Care Office Visit coinsurance
after deductible after deductible after deductible after deductible after deductible
after deductible
Preventive Care
50% coinsurance 50% coinsurance 50% coinsurance
Affordable Care Act Guidelines No cost No cost No cost
after deductible after deductible after deductible
Non-ACA Services
30%
50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
Specialty Care Office Visit coinsurance
after deductible after deductible after deductible after deductible after deductible
after deductible
Emergency Care
30%
50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
Primary Care Office Visit coinsurance
after deductible after deductible after deductible after deductible after deductible
after deductible
Hospital Emergency 30%
Room 50% coinsurance 30% coinsurance 30% coinsurance 15% coinsurance 15% coinsurance
coinsurance
Urgent Care Facility after deductible after deductible after deductible after deductible after deductible
after deductible
Ambulance
Inpatient Hospital
30%
Including Mental 50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
coinsurance
Health and Chemical after deductible after deductible after deductible after deductible after deductible
after deductible
Dependency
2021 Retiree Benefit Plans | 16Aetna Maximum Choice HSA Gold, Silver, and Bronze Plans
Aetna Bronze Max Choice HSA Aetna Silver Max Choice HSA Aetna Gold Max Choice HSA
Aetna Network: Aetna Choice POS II Aetna Network: Aetna Choice POS II Aetna Network: Aetna Choice POS II
What’s Covered (Open Access) (Open Access) (Open Access)
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
30%
Inpatient/Outpatient 50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
coinsurance
Surgery after deductible after deductible after deductible after deductible after deductible
after deductible
Lab and Imaging
30%
Inpatient and Outpatient 50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
coinsurance
Lab, Diagnostic Clinic, or after deductible after deductible after deductible after deductible after deductible
after deductible
Facility
Outpatient Visit 30%
50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
Mental Health and coinsurance
after deductible after deductible after deductible after deductible after deductible
Chemical Dependency after deductible
Rehabilitation
Physical Therapy
Occupational Therapy
Speech Therapy 30%
50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
(PT, OT, and ST – coinsurance
after deductible after deductible after deductible after deductible after deductible
includes Autism and after deductible
Cerebral Palsy: combined
60 visit limit per calendar
year)
Chiropractic Visit/Spinal 30%
50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
Manipulation coinsurance
after deductible after deductible after deductible after deductible after deductible
(30 per calendar year) after deductible
Maternity Services
Specialty Office Visit 30% 50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
Pre and Post Maternity coinsurance after deductible after deductible after deductible after deductible after deductible
Care after deductible
Delivery and Hospital Care
2021 Retiree Benefit Plans | 17Aetna Maximum Choice HSA Gold, Silver, and Bronze Plans
Aetna Bronze Max Choice HSA Aetna Silver Max Choice HSA Aetna Gold Max Choice HSA
Aetna Network: Aetna Choice POS II Aetna Network: Aetna Choice POS II Aetna Network: Aetna Choice POS II
What’s Covered (Open Access) (Open Access) (Open Access)
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Family Planning
Specialty Office Visit
Diagnostic Infertility 30%
Services (to diagnose 50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
coinsurance
condition) (Artificial after deductible after deductible after deductible after deductible after deductible
after deductible
Insemination and In-
Vitro Fertilization are not
covered)
Skilled Nursing Facility
30%
(Annual Maximum: 60 days 50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
coinsurance
combined in or out-of- after deductible after deductible after deductible after deductible after deductible
after deductible
network)
Home Health Care
30%
(Annual Maximum: 60 days 50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
coinsurance
combined in or out-of- after deductible after deductible after deductible after deductible after deductible
after deductible
network)
30%
50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
Hospice Care coinsurance
after deductible after deductible after deductible after deductible after deductible
after deductible
Vision Exam 30%
50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
(no optical hardware coinsurance
after deductible after deductible after deductible after deductible after deductible
benefit) after deductible
30%
Hearing Aids 50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
coinsurance
(one per ear, every 3 years) after deductible after deductible after deductible after deductible after deductible
after deductible
30%
50% coinsurance 30% coinsurance 50% coinsurance 15% coinsurance 50% coinsurance
Durable Medical Equipment coinsurance
after deductible after deductible after deductible after deductible after deductible
after deductible
2021 Retiree Benefit Plans | 18Aetna Maximum Choice HSA Gold, Silver, and Bronze Plans
Aetna Bronze Max Choice HSA Aetna Silver Max Choice HSA Aetna Gold Max Choice HSA
Aetna Network: Aetna Choice POS II Aetna Network: Aetna Choice POS II Aetna Network: Aetna Choice POS II
What’s Covered (Open Access) (Open Access) (Open Access)
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Prescription Drugs
Pharmacy Deductible None
Retail (up to 30 days)
Generic 30%
30% coinsurance 15% coinsurance
Preferred Brand coinsurance
after deductible after deductible
Non-Preferred Brand after deductible
Mail Order (up to 90 days)
Generic 30%
30% coinsurance 15% coinsurance
Preferred Brand coinsurance
after deductible after deductible
Non-Preferred Brand after deductible
Drug must be on Aetna formulary to be covered unless medical exception is approved. View Aetna formulary at Aetna.com.
Aetna Bronze Aetna Silver Aetna Gold
Monthly Pre-Medicare Retiree Premium
HSA Plan HSA Plan HSA Plan
Retiree $146.60 $241.00 $396.33
Ret + Spouse $277.58 $383.45 $784.65
Ret + Child(ren) $245.62 $354.15 $751.17
Ret + Family $313.59 $447.95 $832.10
Monthly Blended Retiree Premium Aetna Bronze Aetna Silver Aetna Gold
(Pre-Medicare and Medicare Retiree) HSA Plan HSA Plan HSA Plan
Retiree + Spouse (1 Medicare) $244.91 $343.23 $732.08
Ret + Child(ren) (1 Medicare) $201.59 $308.06 $685.65
Ret + Family (2 Medicare) $221.43 $352.37 $355.63
Ret + Family (1 Medicare) $269.17 $348.08 $752.63
2021 Retiree Benefit Plans | 19Aetna Medicare Advantage Plan
Cost To You
What’s Covered
In-Network Out-of-Network
$150
Annual Deductible This is the amount you have to pay out of pocket before the plan will pay its share for your covered
Medicare Part A and B services.
$3,400
Out-of-Pocket Maximum per year The maximum out-of-pocket limit applies to all covered Medicare Part A and B
benefits including deductible.
Optional
Primary Care Physician Selection
There is no requirement for member pre-certification. Your provider will do this on your behalf.
Referral Requirement None.
$15 Copay
Primary Care Office Visit Includes services of an internist, general physician, family practitioner for routine care as well as
diagnosis and treatment of an illness or injury and in-office surgery.
Specialty Care Office Visit $30 Copay
Ambulance Services $75 Copay
Emergency Room $50 Copay
Urgent Care $30 Copay
Preventive Care $0
Screenings/Immunizations $0
Inpatient Hospital $500 copay per stay
Skilled Nursing $20 copay per day, day(s) 1 – 5; $0 copay per day, day(s) 6 – 100.
Limited to 100 days per Medicare Benefit Period
Retail Prescription Drugs
Generic $10 copay
Preferred Brand $30 copay
Non-Preferred Brand $60 copay
$100 Copay
Specialty
Limited to One-Month Supply
2021 Retiree Benefit Plans | 20Aetna Medicare Advantage Plan
Cost To You
What’s Covered
In-Network Out-of-Network
Mail Order Prescription Drugs (up to 90 days)
Generic $15 copay
Preferred Brand $75 copay
Non-Preferred Brand $150 copay
$100 copay
Specialty
Limited to One-Month Supply
Medicare Eligible Monthly Retiree Premium
Retiree Only $106.50
Retiree + Spouse $323.95
Important Notice: You are required to contact the Gwinnett County Benefits Division 60 days prior to the date you or your covered dependent becomes Medicare eligible
due to a disability. As soon as you become Medicare eligible, you must immediately enroll in Medicare Part A and Part B in order to continue participating in Gwinnett
County health plans.
2021 Retiree Benefit Plans | 21Dental Plans
For a complete list of DHMO copays, see Schedule of Benefits on GC Retiree.
What’s Covered PPO Mid-Option PPO High-Option
$100 per person $50 per person
Annual Deductible(s)
$300 per family $150 per family
Annual Benefit Maximum $1,000 per person $1,500 per person
Diagnostic and Preventive
Oral Exams
Teeth Cleaning No out-of-pocket costs. No out-of-pocket costs.
X-rays Expense applied to benefit maximum. Expense applied to benefit maximum.
Maximum of two visits per calendar year
Basic Benefits PPO Dentist: 20% PPO Dentist: 20%
Fillings Non-PPO Dentist: Non-PPO Dentist:
Oral Surgery – Extractions 20% of UCR * 20% of UCR *
PPO Dentist: 50% PPO Dentist: 50%
Periodontics and Endodontics
Non-PPO Dentist: Non-PPO Dentist:
Root Canals, etc.
50% of UCR * 50% of UCR *
Major Benefits PPO Dentist: 50% PPO Dentist: 50%
Crowns and Bridges Non-PPO Dentist: Non-PPO Dentist:
Prosthetics – Dentures 50% of UCR * 50% of UCR *
PPO Dentist: 50%
Orthodontic Benefits
Not Covered Non-PPO Dentist:
Children and Adults
50% of UCR
Orthodontic Lifetime Benefit Maximum Not Applicable $2,500 per person
2021 Retiree Benefit Plans | 22What’s Covered PPO Mid-Option PPO High-Option
Implants PO Dentist: 50%
Crowns and Bridges Not Covered Non-PPO Dentist:
Prosthetics – Dentures 50% of UCR *
Implant Lifetime Benefit Maximum Not Applicable $1,500 per person
*Payable after Annual Deductible is met
*See Cigna Dental Care Patient Charge Schedule posted on the GC Retiree website.
Usual, Customary, and Reasonable allowances apply to charges from non-PPO, or out-of-network dentists. Out-of-network providers are not required
to write off charges that exceed the allowable amount. The patient is responsible for those amounts. PPO High-Option Plan: Lifetime maximums
for orthodontic treatment and implants are separate from annual benefit maximums. Benefits paid for these expenses do not apply to the patient’s
annual maximum.
Removal of boney-impacted wisdom teeth is a medical expense and is not covered by the dental plans.
Monthly Premium DHMO PPO Mid-Option PPO High-Option
Retiree $13.91 $35.52 $55.14
Ret + Spouse $27.81 $70.99 $110.28
Ret + Child(ren) $34.77 $88.74 $137.84
Ret + Family $41.72 $106.40 $165.11
2021 Retiree Benefit Plans | 23Vision Plans
Basic Vision Plan Premium Vision Plan
What’s Covered Out-of-Network
(In-Network) (In-Network)
2021 Retiree Benefit Plans | 24GC RETIREE WEBSITE
Human Resources’ goal is to deliver information to you in an effective man-
ner and thus provide a website designed exclusively for retirees called GC
Retiree. This website contains information about issues and events that
impact retirees, details about benefit options for 2021, and a direct link to
log in to My GCHub for benefits enrollment.
Receive emails from
Human Resources
If you have not yet done so,
be sure to share your personal
email address with Human
To access GC Retiree, go to GwinnettCounty.com, select Login in the upper Resources. This will enable
right corner, and click on the GC Retiree logo shown above. the Benefits Division to share
information with you more
quickly and effectively. If you
Be sure to save GC Retiree in your browser “favorites.” Human Resources decide you would prefer to stop
will continue to post information for retirees on this website year-round. receiving emails from Gwinnett
County, your email address will
be promptly removed. Please
send your email address to
Benefits@GwinnettCounty.com.
2021 Retiree Benefit Plans | 25MY GCHUB
Any updates/changes made on the My GCHub To print Benefits confirmation (benefits, de- 3. Click on one of the addresses to create a
system are immediate. pendents, and cost): new entry
1. Click Benefits
Accessing My GCHub from a Gwinnett County 4. Once created, click on Save and Back or Save
network computer or from your home computer: 2. Click Benefits Confirmation Statement
5. To edit an address, click on the pencil to the
1. Go to GwinnettCounty.com; click on Login 3. Change date in Key Date to display Benefits right of the address listed
in the top right corner of the page coverage as of effective date
2. Select the GC Retiree icon 6. Once edited, click on Save and Back or Save
4. Click Print Form and an Adobe window will
To access ESS: display the Confirmation Statement
Note: Retirees must contact Voya or Transamer-
1. Click on My GCHub login 5. Click Print Icon on Adobe window to print ica Retirement directly to update their address
2. The My GCHub log on screen will appear the Confirmation Statement related to retirement benefits, 401(a) and 457(b)
plan information.
3. Enter your usual login information
Links to benefits forms, summary of docu-
4. Click Log On ments, and vendor website: To display/update dependents:
1. Click General Information and New Hire On- 1. Click Benefits
boarding 2. Select Family Members/Dependents
Important information
• Disable the pop-up blocker under Tools on 2. Click Forms and Helpful Links 3. Click on one of the family members or de-
your computer’s Internet menu bar 3. Click on the vendor name and open the pendent types to create a new entry
• The Adobe Reader® software is required in vendor link 4. Once created, click on Save and Back or Save
order to display/print forms
To display/change (or manage) 5. To edit someone listed, click on the pencil
to the right of the entry
My GCHub procedures for personal information:
retired employees 1. Click Personal Information 6. Once edited, click on Save and Back or Save
2. Click Personal Data
To enroll in benefits: 3. You can update your personal email and Services to enroll in benefits or add
1. Click Benefits other types of information under Data Main- eligible dependents are available only
2. Click Benefits Enrollment tenance header during Annual Enrollment.
3. Click Enrollment and then the Enrollment
Reason – Annual Enrollment (R) To display/update your address and emergen- Note: Refer to the Summary Plan Description lo-
4. Detailed instructions with screen prints cy contacts: cated on the GC Retiree website for details on life
are listed under the Guide tab on the next 1. Click Personal Information status changes and the required documentation.
screen within My GCHub 2. Click Address/Emergency Contacts
2021 Retiree Benefit Plans | 26IMPORTANT INFORMATION
FOR ALL GWINNETT COUNTY RETIREES
Please read the following documents carefully:
• Children’s Health Insurance Program (CHIP)
• Medicare Prescription Drug Comparable Coverage Notice
• Medicare Part D Creditable Coverage Notice
2020 Retiree Benefit Plans | 27Medicaid and the Children’s Health Insurance Program
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium
assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medic-
aid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health
Insurance Marketplace. For more information, visit Healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed below, contact your State Medicaid or CHIP office to
find out if premium assistance is available.
If you or your dependents are not currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of
these programs, contact your State Medicaid or CHIP office or dial 1.877.KIDS NOW or InsureKidsNow.gov to find out how to apply. If you qualify, ask
your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer
must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request
coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the
Department of Labor at www.askebsa.dol.gov or call 1.866.444.EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is
current as of July 31, 2015. Contact your state for more information on eligibility:
Alabama Medicaid Arkansas Medicaid Georgia Medicaid
Medicaid.Alabama.gov MyARHIPP.com DCH.Georgia.gov
1.855.692.5447 1.855.MyARHIPP (855.692.7447) Click on Health Insurance Premium Payment
404.656.4507
Alaska Medicaid Colorado Medicaid
The AK Health Insurance Colorado.gov/hcpf Indiana Medicaid
Premium Payment Program 1.800.221.3943 Healthy Indiana Plan for low-income adults 19-64
MyAKHIPP.com HIP.IN.gov
1.866.251.4861 Florida Medicaid 1.877.438.4479
Email: CustomerService@MyAKHIPP.com FLMedicaidTPLRecovery.com All other Medicaid
Medicaid Eligibility: DHSS.Alaska.gov/DPA/ 1.877.357.3268 IndianaMedicaid.com
Pages/Medicaid/default.aspx 1.800.403.0864
2021 Retiree Benefit Plans | 28Iowa Medicaid
DHS.State.IA.US/HIPP Nebraska Medicaid Oregon Medicaid
1.888.346.9562 DHHS.NE.gov/Children_Family_Services/Ac- OregonHealthyKids.gov
cessNebraska/Pages/accessnebraska_index. HijossaludablesOregon.gov
Kansas Medicaid aspx 1.855.632.7633 1.800.699.9075
KDHEKS.gov/HCF
1.785.296.3512 Nevada Medicaid Pennsylvania Medicaid
DWSS.NV.gov DHS.State.PA.us/hipp
Kentucky Medicaid 1.800.992.0900 1.800.692.7462
CHFS.KY.gov/dms/default.htm
1.800.635.2570 New Hampshire Medicaid Rhode Island Medicaid
DHHS.NH.gov/oii/documents/hippapp.pdf EOHHS.RI.gov
Louisiana Medicaid 1.603.271.5218 401.462.5300
DHH.Louisiana.gov/index.cfm/sub-
home/1/n/331 New Jersey Medicaid South Carolina Medicaid
1.888.695.2447 State.NJ.US/HumanServices/DMAHS/Clients/ SCDHHS.gov
Medicaid 1.888.549.0820
Maine Medicaid 1.609.631.2392
Maine.gov/DHHS/ofi/public-assistance South Dakota Medicaid
1.800.442.6003 New Jersey CHIP DSS.SD.gov
TTY: Maine relay 711 NJFamilyCare.org/index.html 1.888.828.0059
1.800.701.0710
Massachusetts Medicaid and CHIP Texas Medicaid
Mass.gov/MassHealth New York Medicaid GetHIPPTexas.com
1.800.462.1120 NYHealth.gov/health_care/medicaid 1.800.440.0493
1.800.541.2831
Minnesota Medicaid Utah Medicaid and CHIP
MN.gov/DHS/MA North Carolina Medicaid Health.Utah.gov/Medicaid
1.800.657.3739 NCDHHS.gov/dma Health.Utah.gov/chip
1.919.855.4100 1.877.543.8427
Missouri Medicaid
DSS.MO.gov/mhd/participants/pages/ North Dakota Medicaid Vermont Medicaid
hipp.htm ND.gov/dhs/services/medicalserv/medicaid GreenMountaincare.org
1.573.751.2005 1.844.854.4825 1.800.250.8427
Montana Medicaid Oklahoma Medicaid
DPHHS.MT.gov/MontanaHealthcarePrograms/ InsureOklahoma.org
HIPP 1.888.365.3742
1.800.694.3084 2021 Retiree Benefit Plans | 29To see if any other states have added a
Virginia Medicaid and CHIP premium assistance program since
Medicaid: CoverVA.org/programs_ July 31, 2015,
premium_assistance.cfm or for more information on special enrollment
1.800.432.5924 rights, contact:
CHIP: Coverva.org/programs_premium_
U.S. Department of Labor
assistance.cfm
Employee Benefits Security Administration
1.855.242.8282 dol.gov/ebsa • 1.866.444.EBSA (3272)
Washington Medicaid or
HCA.WA.gov/medicaid/premiumpymt/
pages/index.aspx U.S. Department of
1.800.562.3022 ext. 15473 Health and Human Services
Centers for Medicare and Medicaid Services
West Virginia Medicaid cms.hhs.gov • 1.877.267.2323,
DHHR.WV.gov/bms/Medicaid%20 Menu Option 4, Ext. 61565
Expansion/Pages/default.aspx
1.877.598.5820
Wisconsin Medicaid and CHIP
DHS.Wisconsin.gov/Medicaid/
publications/p-10095.htm
1.800.362.3002
Wyoming Medicaid
WYEqualityCare.acs-inc.com
307.777.7531
Call 1.877.KIDS NOW (1.877.543.7669) or visit In-
sureKidsNow.gov for more information.
Note: You must request coverage within 60 days of
being determined eligible for premium assistance.Medicare Part D Creditable Coverage Notice
Important notice from Gwinnett County Board of Commissioners about your prescription drug coverage and Medicare:
This notice has information about prescription drug coverage under the Aetna Medicare Advantage Plan.
Note: Read this notice carefully. It explains the options you have under Medicare prescription drug coverage.
Beginning January I, 2006, Medicare prescription drug coverage was made available to everyone with Medicare. Health
plans administering claim services on behalf of the Gwinnett County Board of Commissioners have determined that the
prescription drug coverage offered by Aetna, the prescription drug vendor for the Aetna plans is on average, for all plan
participants, expected to cover/pay as much as standard Medicare prescription drug coverage.
Because the Gwinnett County prescription drug coverage for the Aetna medical program is, on average, as good as stan-
dard Medicare prescription drug coverage, you may keep Gwinnett County health plan coverage and not pay extra if you
later decide to enroll in Medicare prescription drug coverage.
If you decide to enroll in a Medicare prescription drug plan, you will not be eligible for Gwinnett County prescription drug
coverage through the Gwinnett County Board of Commissioners health plans.
If you drop your Gwinnett County coverage and enroll in a Medicare prescription drug plan, you may not be able to
re-enroll in Gwinnett County coverage later. Compare your current coverage, including the specific drugs covered, with
the coverage and cost of plans offering Medicare prescription drug benefits.
If you drop or lose your coverage with Gwinnett County and fail to enroll in Medicare prescription drug coverage when
your current coverage ends, you may pay more to enroll in a Medicare prescription drug coverage at a later date.
Note: You may receive this notice at other times in the future. You may also request a copy from the Gwinnett County De-
partment of Human Resources.
Please refer to the Gwinnett County Summary Plan Document located on the GC Retiree website for:
• Privacy Notice
• Genetic Information Nondiscrimination
• Mental Health Parity and Addition Equity Act
• Women’s Health and Cancer Rights Act
• Patient Protection Provider Choice Notice
• EEOC Wellness notice
2021 Retiree Benefit Plans | 31DEPARTMENT OF HUMAN RESOURCES
CONTACT INFORMATION
Human Resources
Department of Human Resources 770.822.7915
770.822.7932 Office
Department of Human Resources –
770.822.7775 Fax
Benefits Division
Benefits@GwinnettCounty.com
Retirement and Health Plans
Raechell Dickinson Deputy Director
Carol Vermilya HR Benefits Manager
Kelly Ellison HR Associate III
LaTosha Smiley-Peoples HR Associate III
Cynthia Postway HR Associate III
Misty Kyle HR Benefits Manager
Nancy Purves Health and Wellness Coordinator
Cassie Shorter Wellness Coordinator
JoLynn Mills Resources and Marketing Coordinator
Connie Meyer Administrative Support Associate III
Jody Currie Administrative Support Associate
Karissa Askew HR Program Coordinator
Other Contacts
Angel Mario 770.822.7874 Gwinnett Justice and
Voya Financial Angel.Mario@Voya.com
Administration Center
Yinessia Miller 770.822.7973 75 Langley Drive
Wellness Advocate YMiller@CareHere.com
Lawrenceville, GA 30046
Laura Beck 855.330.2962 Monday – Friday • 8:00am – 5:00pm
EAP Consultant Humana.com/eap
2021 Retiree Benefit Plans | 32VENDOR CONTACT INFORMATION
Customer
Group
Plan Name Company Address Service Website
Number
Number
Aetna
Aetna Aetna 737528 P.O. Box 14079 1.866.307.6077 Aetna.com
Lexington, KY 40512-4079
Aetna
Aetna Medicare
Aetna AE466908 P.O. Box 14088 1.888.267.2637 AetnaRetireePlans.com
Advantage
Lexington, KY 40512-4088
Nine Piedmont Center
404.760.3549
Kaiser Permanente Kaiser Building 10, 3rd floor
9284 or KP.org
HMO Permanente 3495 Piedmont Road NE
1.888.865.5813
Atlanta, GA 30305-1736
PPO –
Cigna
Cigna HMO 3212404
Cigna P.O. Box 188037 1.800.244.6224 Cigna.com
& PPO Plans HMO –
Chattanooga, TN 37422-8037
10141213
Discovery Benefits
Discovery Benefits Discovery Benefits 4321 20th Ave S 866.451.3399 DiscoveryBenefits.com
Fargo, ND 58103
Vision Plans Out-of-Network Claims Only
VISION Service
VSP Basic & VSP 12-320640 P.O. Box 385018 1.800.877.7195 VSP.com
Plan (VSP)
Premier Birmingham, AL 35238-5018
2021 Retiree Benefit Plans | 33Gwinnett County
Department of Human Resources
75 Langley Drive • Lawrenceville, GA 30046
GwinnettCounty.com
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