Escolar Documentos
Profissional Documentos
Cultura Documentos
2009 benefits
enrollment
choose well
what’s inside when you’re ready to enroll
You can enroll or make changes to your coverage online, via
Welcome to Annual NetBenefits®:
Enrollment for 2009............................ 1 1. Log on to www.netbenefits.com.
What’s New for 2009 ........................ 2 2. On the Health & Insurance tab, select Get Started Now to
begin your enrollment.
Your IBM Health Benefits
3. When you’re satisfied with your elections, select Save Your
IBM Medical Options Benefits on the Benefit Elections page; your elections will
If You Are Not Eligible not be saved otherwise.
for Medicare .................................. 4
If You Are Eligible
4. The elections listed will be recorded as your new coverage
and displayed on a confirmation screen. Save the
for Medicare .................................. 6
confirmation number and print the page for your records.
Prescription Drug The confirmation screen will also direct you to any follow
Benefit Overview ......................... 12
up activities to complete your enrollment.
IBM Dental Options ............................ 14
IMPORTANT: Enrollment via NetBenefits is not available
IBM Vision Options ............................. 16
for the Aetna Medicare Open Plan (PFFS), Aetna Golden
Additional Enrollment Information Medicare Plan (HMO), and other Medicare Advantage/
Cost health plans; see page 17 for instructions on
Special Enrollment Instructions
enrolling in these medical options.
for Medicare Advantage Plans ............ 17
To Enroll in a Health You can also call the IBM Employee Services Center at
Savings Account ................................. 18 1-800-796-9876 to speak with a service representative on
Confirmation of Your 2009 Benefits .... 18 business days (excluding holidays recognized by the New York
Stock Exchange) between 8:30 a.m. and 8:30 p.m. Eastern time.
Coverage for Your Family ............... 19
Special Service Numbers
Other Programs and Services
Available to IBM Retirees ................ 23 • Deaf and Hard of Hearing Access: 1-800-426-6537,
available on business days (excluding holidays recognized
Contact Information ......................... 26 by the New York Stock Exchange) between 8:30 a.m. and
6 p.m. Eastern time.
Administrative and
• Overseas Access: Dial your country’s toll-free AT&T
Legal Information .............................. 28
Direct® access number, then enter 800-796-9876. In the
For More Information U.S., call 1-800-331-1140 to obtain AT&T Direct access
numbers. From anywhere in the world, access numbers are
This guide summarizes the key features of
your IBM health benefits. For detailed informa- available online at www.att.com/traveler or from your local
tion on all of your retiree benefit plans, includ- operator.
ing covered services and exclusions, refer to
About Your Benefits: Post-Employment, the IBM
Summary Plan Description. Copies are available Enrollment for 2009
in the Reference Library on NetBenefits®, or by
calling the IBM Employee Services Center at • Thursday, Oct. 30 — Friday, Nov. 21, 2008
1-800-796-9876. This guide is also available on
compact disc (CD) by calling the IBM Employee
Services Center.
Welcome to Annual Enrollment for 2009
welcome to annual enrollment for 2009
Annual enrollment is your opportunity to select – For Medicare-eligible retirees, the IBM
your health benefits for the upcoming year. This Medical Supplement option is available at no
guide will help, with an overview of IBM medical, cost for all levels of coverage.
dental and vision options, including useful feature – For Medicare-eligible retirees in some areas,
comparison charts. two Retiree Health AccessSM options will
IBM continuously looks for ways to expand your also be available at no cost.
choices with lower-cost options. We will again offer • For most other IBM medical options, monthly
medical options available through our association contributions will increase — particularly if you
with Retiree Health AccessSM, an initiative/program cover a spouse/domestic partner or other
sponsored by the Human Resources Policy eligible family members.
Association (HRPA) and led by IBM. HRPA brings • IBM will again share a portion of the federal
together the senior human resource executives of government’s Medicare prescription drug
more than 250 of the largest U.S. employers, using reimbursement with our participants, lowering
the collective power of its membership to influence monthly contribution amounts $18 for
policy on health care, among other issues. individual coverage and $36 for Medicare-
Many of you will find these options very attractive eligible couples. IBM expects to share this
— in many cases, the Retiree Health AccessSM subsidy with you as long as it is available.
options available from Aetna will offer lower costs • Out-of-pocket costs — deductibles,
than the IBM-only plans. You’ll find details about copayments and coinsurance — for IBM
these options beginning on page 4 (for those retiree medical plan options have not
not eligible for Medicare) and page 6 (for those increased in several years.
eligible for Medicare) and in the enclosed • Your cost for coverage under most dental
comparison charts. options will increase slightly; costs for vision
Here’s a quick look ahead for 2009: coverage will not increase.
• IBM is introducing GenericsAdvantage, a new As you make your benefit choices, consider what
component of the IBM Managed Pharmacy your total costs for coverage and care are likely
program that reduces your out-of-pocket costs to be under each option. While cost is important,
when you buy generic instead of brand name it’s only part of the value equation. Think about
prescription drugs under IBM medical options. your medical needs and those of the family
See page 2 for details. members you cover, as well as how you access
• Two new Medicare Integration plans, offered care under each option. The comparison charts
through Retiree Health AccessSM, will be and Health Plan Detail Sheets in your enrollment
available to those eligible for Medicare. For package include important information. Please
more information, see page 2. note that you will only receive Health Plan Detail
• IBM will continue to offer “contribution-free” Sheets for fully insured medical and dental plans,
medical options*: if available in your area. For IBM’s self-insured
– For non-Medicare eligible retirees, the IBM medical and dental options, please refer to the
High Deductible PPO is available at no cost enclosed comparison charts for medical coverage
for retiree-only coverage. information and page 14 of this guide for dental
coverage details. Contact information is available
*Note: Except for those eligible for the Future beginning on page 26.
Health Account and Access-Only.
2 Enrollment for 2009: Thursday, Oct. 30, 2008 — Friday, Nov. 21, 2008
What’s New for 2009
Health Savings Account (HSA) If you are not eligible for Medicare and enroll in
the IBM High Deductible PPO with HSA, you
Contribution Limits for 2009
may contribute up to $3,000 to a health savings
A health savings account helps you pay for account in 2009 and $5,950 if more than one
current eligible expenses or save for future individual is enrolled, according to IRS rules. If
health care needs. Unused savings remain you are between the ages of 55 and 65, you
invested, and any interest and investment can make an additional “catch-up” contribution
earnings are not subject to federal taxes. of up to $1,000 in 2009.
You can use savings to pay for Note: You may contribute up to the annual maximum
• your out-of-pocket expenses — including amount, even if you are not enrolled in the IBM High
prescription drugs, deductibles and Deductible PPO with HSA for the full calendar year.
For more information about HSAs, refer to the 2009
coinsurance — that are also eligible
Health Savings Account Participant Information for
expenses under the IBM High Deductible
Non-Medicare Eligible Retirees document or About
PPO with HSA
Your Benefits: Post-Employment, both available in the
• certain medical expenses — such as laser Reference Library on NetBenefits.
eye surgery, hearing aids and batteries,
and acupuncture — that the IRS considers
“qualified medical expenses” Please note that United Behavioral Health
will change its name to OptumHealth
• long-term care insurance premiums, subject Behavioral Solutions by United Behavioral
to certain limits Health, effective Jan. 1, 2009. This is
• premiums for COBRA coverage a name change only; there will be no
changes to the program and benefits.
• Medicare premiums, once you are enrolled
in Medicare
* Except IBM EPO – HealthPartners, which provides coverage directly for Medicare-eligible dependents
** Except IBM EPO – HealthPartners, which provides coverage directly
*** If you enroll in the IBM High Deductible PPO with HSA administered by Empire BlueCross BlueShield,
Empire will continue to provide prescription drug benefits through its new pharmacy benefit manager,
WellPoint NextRx. You will receive further information directly from Empire.
Note: If you live outside the network coverage area for the IBM self-insured options, you will be able to enroll in an
Out-of-Area (OOA) option for the IBM Low, Medium and High Deductible PPO, and the IBM High Deductible PPO
with HSA. Your Personal Fact Sheet will indicate whether you are eligible for these OOA options.
4 Enrollment for 2009: Thursday, Oct. 30, 2008 — Friday, Nov. 21, 2008
IBM Medical Options – If You Are Not Eligible for Medicare
More about the Aetna Open If You Choose No Coverage
Choice PPO Choose the No Coverage option only if you do
The Aetna Open Choice PPO is a fully-insured, not want IBM medical coverage — including
high deductible, preferred provider organization prescription drug coverage — for 2009. If you
plan. It offers the same type of coverage as decline coverage, you can enroll again in next
other IBM options, but Aetna provides these year’s annual enrollment period for retirees,
services directly. typically each fall, or if you experience a qualified
status change during the year. However, if
The Aetna Open Choice PPO network is different you are currently enrolled in No Coverage and
from the networks available through other Aetna want to enroll in the Aetna Open Choice PPO
plans offered to you by IBM. You should call in 2009, or if you choose No Coverage for
your providers and ask specifically whether they 2009 and wish to enroll at a future date, you
belong to the network. You can call Aetna at will be required to provide proof of continuous
1-800-248-9236 (TTY 1-800-325-4591) or log coverage under another (non-IBM) employer-
on to www.aetna.com and search under “Aetna sponsored group medical plan in order to be
Open Choice PPO” to determine if your provider eligible for the Aetna Open Choice PPO option.
is a member of the network.
Note: Participants in the Special Retiree Medical Option
Under this type of plan, you meet a deductible, and those in Access-Only who do not enroll in IBM
then pay a fixed fee (copayment) or percentage retiree health benefits for 2009 may not enroll during a
of the covered expense (coinsurance) — or a future enrollment period and may not enroll for 2009 if
combination of both, depending on the service. not currently enrolled.
A higher level of benefits is paid when you
receive care from in-network providers.
Application of the annual deductible and out-
of-pocket maximum for the Aetna Open Choice
PPO works differently than it does under most Meet MONICA and ROY
other IBM medical options. The individual Monica and Roy are in their 50s. With their
deductible and the out-of-pocket maximum kids out of college, Monica left her job as a
applies only if you enroll for self-only coverage. social worker to return to graduate school full-
If you enroll one or more dependents (in time and has no other health care coverage.
addition to yourself), the entire family deductible She has a thyroid condition, takes a generic
must be met before benefits are paid to any medication and has periodic lab tests. Otherwise, she’s fairly
individual family member; and the entire out-of- healthy, although she may need outpatient surgery. Roy has
pocket maximum must be met before certain allergies and suffers from a minor back injury. He visits his
benefits will be paid at 100%. primary care physician and has seen a specialist about his
back problem.
Note: According to guidelines governing the Retiree
Health AccessSM program, the Aetna Open Choice PPO Monica and Roy expect to have a fair amount of medical
is not available to employees on Long-term Disability expenses next year, but with Monica in school, they don’t want
or the Medical Disability Income Plan. In addition, the most expensive plan. They review the options available to
employees who retire based on years of service only them on their Personal Fact Sheet and examine the medical
must have attained 30 years of service as of Jan. 1, option comparison charts in their enrollment kit.
2008, to be eligible to enroll in this option.
DeCISION: They elect the IBM Medium Deductible PPO to limit
their monthly contributions and to cover their prescription drug
coverage needs.
6 Enrollment for 2009: Thursday, Oct. 30, 2008 — Friday, Nov. 21, 2008
IBM Medical Options – If You Are Eligible for Medicare
Generally, the IBM supplement options and Original Medicare provide the same level of
reimbursement for medical services. In most cases, the IBM Medicare Supplement options provide
no additional benefits for medical services until you reach the plan’s annual out-of-pocket maximum,
as shown in the table below. You pay the 20% Medicare coinsurance until your IBM plan out-of-
pocket maximum is satisfied, except for routine preventive services. After you’ve reached the IBM
plan’s out-of-pocket maximum, the IBM plan pays the 20% Medicare coinsurance.
8 Enrollment for 2009: Thursday, Oct. 30, 2008 — Friday, Nov. 21, 2008
IBM Medical Options – If You Are Eligible for Medicare
• Your out-of-pocket costs for care Aetna Medicare Open Plan (PFFS) and
(copayments or coinsurance) may be lower Aetna Golden Medicare Plan (HMO)
compared with Original Medicare coverage.
You must be enrolled in both Medicare Part A
• Medicare Advantage plans, like many and Part B to participate in these plans, which
HMOs, are fully insured. This means that the provide primary coverage for doctor visits,
health plan administers benefit provisions, specialists, hospitalization and prescription
appeals, and pays the cost of claims directly drugs, as well as 100% coverage for certain
— unlike self-insured plans where IBM preventive services.
administers benefit provisions, appeals,
and pays the cost of claims.
Aetna Medicare Open Plan (PFFS) Aetna Golden Medicare Plan (HMO)
A private fee-for-service plan An HMO
Primary care
Not required Required
physician
Referrals for
Not required Required
specialty care
How the plan Benefits are available if your provider Benefits are only available if you use
pays for care accepts the plan’s terms and the plan’s network of providers
conditions and is a Medicare-eligible
provider; see below for details
Coverage for
prescription Included Included
drugs
Discounts for
vision products Available Available
and services
Other discounts Special rates for massage therapy, acupuncture and chiropractic services,
available vitamins and nutritional supplements
Your Costs for Care under the Aetna If your provider is eligible to receive
Medicare Open Plan (PFFS) Medicare payments and accepts Medicare
assignment, and also accepts the Aetna
Before you enroll in this option, you should ask Medicare Open Plan (PFFS)’s terms and
your doctors, hospitals and other providers conditions:
if they are eligible for Medicare payment
and if they will accept this plan’s terms and • After you satisfy the plan’s deductible, you’ll
conditions. pay a copayment or coinsurance for eligible
covered services.
IMPORTANT: Providers not eligible to receive
Medicare payments are not covered under the • The plan will pay the remainder, up to the
Aetna Medicare Open Plan (PFFS) even if they Medicare allowable charge for each service.
agree to the plan’s terms and conditions.
10 Enrollment for 2009: Thursday, Oct. 30, 2008 — Friday, Nov. 21, 2008
IBM Medical Options – If You Are Eligible for Medicare
• You have end-stage renal disease. Is your doctor a member of the Medicare
(This limitation does not apply to the Advantage HMO’s network?
Aetna Medicare Open Plan (PFFS) and Some Medicare Advantage HMO plans require
the Aetna Golden Medicare Plan (HMO).) that you receive care through their network of
physicians, hospitals and other providers in
• You live in a county that restricts enrollment
order to receive coverage.
in Medicare Advantage plans. Before
enrolling, call the health plan to confirm that For a list of doctors, hospitals, pharmacies and
it is available in your county of residence. other providers that belong to your health plan’s
Contact information is available on the network, contact the health plan directly at the
Health Plan Detail Sheet for the plan. phone number (or Web site) shown on your
The Aetna Medicare Open Plan (PFFS) Health Plan Detail Sheet.
is available nationwide.
Are you currently enrolled in a Medicare
Note: According to guidelines governing the Retiree Part D prescription drug plan?
Health AccessSM program, the Aetna Medicare Open If you enroll in a Medicare Advantage Plan
Plan (PFFS) and Aetna Golden Medicare Plan (HMO) are that provides coverage for prescription
not available to employees on Long-term Disability or the drugs, you may not also enroll in a separate
Medical Disability Income Plan. In addition, employees Medicare prescription drug plan. Review your
who retire based on years of service only must have
Health Plan Detail Sheets to determine if the
attained 30 years of service as of Jan. 1, 2008, to be
Medicare Advantage plan provides coverage
eligible for the Retiree Health AccessSM program.
for prescription drugs.
Are you covering a non-Medicare eligible
Are you enrolling in a Medicare Advantage
spouse or dependent?
plan for the first time?
If so, keep in mind:
You’ll need to call the IBM Employee Services
• If you enroll in an Aetna Retiree Health Center to enroll. You’ll need to have your
AccessSM plan, your non-Medicare eligible Medicare ID card available to provide your
dependents will be covered by the Aetna Medicare Health Insurance Claim Number
Open Choice PPO, which provides different (HICN), as well as the HICN for any Medicare
coverage than Retiree Health AccessSM eligible dependents you are enrolling.
plans available to Medicare-eligible Depending on the Medicare Advantage plan
participants. you select, the IBM Employee Services Center
may direct you to contact the plan to complete
• Not all Medicare Advantage/Cost health
a Centers for Medicare and Medicaid Services
plans offer coverage for non-Medicare
(CMS) enrollment form. See page 17 for more
eligible dependents. If a plan is available in
information.
your area, the Health Plan Detail Sheet for
the plan and your Personal Fact Sheet will
indicate whether it provides coverage for
non-Medicare eligible dependents.
• If the Medicare Advantage/Cost health plan
offers coverage for non-Medicare eligible
dependents, that coverage may be different
from Medicare coverage, and the Medicare
network may differ from its non-Medicare
network.
Annual Maximum
Provides
Benefit Plan Pays
Creditable Administrator
(Per Covered
Coverage
Individual)
12 Enrollment for 2009: Thursday, Oct. 30, 2008 — Friday, Nov. 21, 2008
Prescription Drug Benefit Overview
Annual Maximum
Provides
Benefit Plan Pays
Creditable Administrator
(Per Covered
Coverage
Individual)
* Under IBM EPO – Health Partners, prescription drug benefits for Medicare-eligible dependents are
administered by the health plan rather than by Medco.
** Under the Aetna Open Choice PPO, some states may mandate a level of coverage that differs from the
coverage shown on your Health Plan Detail Sheets. Contact Aetna directly for details.
*** There is no limit on what Aetna Open Choice PPO pays in a calendar year; however, prescription drug
benefits are included in the plan’s $1.25 million medical lifetime maximum.
**** Prescription drug coverage for the IBM Medicare Supplement Plan administered by MVP Select Care is
administered by Medco.
Maximum Benefits
Option Covered Services* Plan Pays Per Other Provisions
Covered Individual
Options if you retired or became eligible for LTD benefits before Jan. 1, 2000
Dental Option A • Preventive/diagnostic • $9,000 lifetime • $40 annual deductible
• Basic and major maximum combined per covered individual
restorative care for all covered
• Patient pays amount
services in Option A
• Orthodontia charged which
& Option B
• Dental implants** exceeds the scheduled
• $1,500 lifetime reimbursement level
maximum per
covered individual
for orthodontia,
included in the
$9,000 lifetime
maximum
Dental Option B • Preventive/diagnostic • $9,000 lifetime • Patient pays amount
• Basic and major maximum combined charged which
restorative care for all covered exceeds the scheduled
services in Option A reimbursement level
& Option B
MetLife PDP • Preventive/diagnostic • No limit for non- • Patient pays amount
• Basic restorative care orthodontic covered charged which
services exceeds in-network
• Major restorative care
• $1,500 lifetime reimbursement
(in-network only)
maximum per percentage.
• Orthodontia
covered individual • Patient pays amount
(in-network only)
for orthodontia charged which
• Dental implants (combined with exceeds out-of-
(in-network only)** payments previously network scheduled
received under reimbursement level.
Option A)
CIGNA DMA • Preventive/diagnostic • No limit*** • In-network coverage only
(also referred • Basic and major
to as CIGNA restorative care
DHMA), if
• Orthodontia
available
14 Enrollment for 2009: Thursday, Oct. 30, 2008 — Friday, Nov. 21, 2008
IBM Dental Options
Maximum Benefits
Option Covered Services* Plan Pays Per Other Provisions
Covered Individual
Options if you retired or became eligible for LTD benefits on or after Jan. 1, 2000
IBM Dental • Preventive/diagnostic • $500 yearly • Patient pays amount
Basic maximum for all charged which
• Basic restorative care
covered services, exceeds in-network
combined for reimbursement
in-network & percentage.
out-of-network
• Patient pays amount
charged which exceeds
out-of-network usual &
prevailing reimbursement
level.
IBM Dental Plus • Preventive/diagnostic • $2,000**** yearly • $50 per covered
maximum combined individual for out-of-
• Basic and major
for all non-orthodon- network services; waived
restorative care
tic covered services, for preventive/diagnostic
• Orthodontia combined for and orthodontia
in-network &
• Dental implants** • Patient pays amount
out-of-network
charged which
• $1,500 lifetime exceeds in-network
maximum per reimbursement
covered individual percentage.
for orthodontia
• Patient pays amount
charged which exceeds
out-of-network usual &
prevailing reimbursement
level.
CIGNA DMA • Preventive/diagnostic • No limit*** • In-network coverage only
(also referred
• Basic and major
to as CIGNA
restorative care
DHMA), if
available • Orthodontia
* Frequency and treatment limits apply; contact the plan administrator for details.
** A pretreatment estimate is required for implants and other related services.
*** Additional payment required for atypical orthodontia cases.
**** If you became eligible for LTD benefits on or after Jan. 1, 2000, special provisions apply under IBM Dental
Plus; contact the plan administrator for details.
16 Enrollment for 2009: Thursday, Oct. 30, 2008 — Friday, Nov. 21, 2008
Additional Enrollment Information
Additional Enrollment Information
Special Enrollment Instructions for Other Medicare Advantage/Cost
Health Plans
Medicare Advantage Plans
If you and/or any Medicare-eligible dependent
If you are eligible for Medicare, you and any
will be enrolling for the first time, or leaving or
Medicare-eligible dependents must be enrolled in
changing Medicare Advantage/Cost health
Medicare Part A and Part B and continue to pay
plans (except those offered through Retiree
your Part B premium to enroll in any Medicare
Health AccessSM) for 2009, you must complete
Advantage plan, including Retiree Health
the following before your new coverage will
AccessSM medical options. Note: You will not be
take effect. Note: If you are not changing your
able to enroll via NetBenefits for these plans.
enrollment for 2009, no action is required.
Aetna Medicare Open Plan (PFFS) and 1. Call the IBM Employee Services Center
Aetna Golden Medicare Plan (HMO) to enroll. You will not be able to enroll in
a Medicare Advantage/Cost health plan
You will no longer need to complete U.S. directly on NetBenefits. You need your
Centers for Medicare and Medicaid Services Medicare ID card to provide your Medicare
(CMS) enrollment forms if you enroll in the Aetna Health Insurance Claim Number (HICN).
Medicare Open Plan (PFFS) or Aetna Golden Depending on the Medicare Advantage
Medicare Plan (HMO) option. After you have plan you select, the IBM Employee Services
made your benefit selection, simply call the Center may direct you to contact the plan
IBM Employee Services Center at 1-800- to complete a Centers for Medicare and
796-9876 to enroll. This means Medicaid Services (CMS) enrollment form.
• no waiting for enrollment forms from Aetna 2. If required, call the health plan and
• no complicated forms to complete request a CMS form for each Medicare-
eligible individual (i.e., a form for you and
• more timely issuance of ID cards a form for your spouse, if he or she is
Note: CMS approval is still required for any new Medicare-eligible). You should request an
enrollment into these plan options. Once you enroll application form if you are enrolling in a
through the IBM Employee Services Center, upon Medicare Advantage/Cost health plan and a
receipt of your enrollment Aetna will confirm your disenrollment form if you are leaving one.
eligibility with CMS.
3. Complete the CMS form(s) and return it to
If you and/or any Medicare-eligible dependent the health plan. If you do not submit the
will be enrolling for the first time or changing to special forms required, your enrollment(s)
a different Retiree Health AccessSM Medicare will not take effect and you will be
Advantage plan option, you will need to call automatically enrolled in the IBM Medical/
the IBM Employee Services Center to enroll. Prescription Drug Supplement option.
You will need your Medicare ID card to provide
your Medicare Health Insurance Claim Number
(HICN). You will also need to provide the HICN By enrolling in a Medicare Advantage plan,
for any Medicare-eligible dependent you also you acknowledge that the health plan will
wish to enroll. release your information to Medicare and
other health plans as necessary for treatment,
payment and health care operations.
18 Enrollment for 2009: Thursday, Oct. 30, 2008 — Friday, Nov. 21, 2008
Coverage for Your Family
Coverage for Your Family
Under the IBM retiree health benefits plan, “qualifying child” by any other taxpayer, and
you may choose coverage for your eligible (6) meet the full-time student requirements
family members, including your spouse (same
Depending on your retirement date, you may
or opposite gender) or domestic partner and
cover these eligible dependents:
eligible dependent children. Before deciding,
be sure to review this important information. • If you retired on or before Dec. 31, 2004,
you may only enroll those dependents in your
IBM medical, dental and/or vision coverage
Eligible Dependents who met dependent eligibility guidelines as
The following individuals are considered eligible of that date. Any new dependents — such
dependents: as those you gain through marriage, birth
or adoption — after Dec. 31, 2004 are not
• Your spouse eligible to enroll in your IBM medical, dental
and/or vision coverage.
• An eligible domestic partner (see page 20)
• If you retired on or after Jan. 1, 2005,
• Your natural and legally adopted unmarried
only those dependents who meet dependent
children under the age of 19. They maintain
eligibility guidelines as of your retirement date
eligibility up to age 23 as long as they
will be eligible to enroll in your IBM medical,
are not employed full-time, are principally
dental and/or vision coverage. You may
dependent upon you for maintenance and
not enroll dependents you gain after your
support, and meet the full-time student
retirement date (for example, a new spouse,
requirements.
or a dependent child acquired by birth,
• Your unmarried stepchildren under age 23 adoption or marriage).
if they (1) are not employed full-time, and
For additional information, refer to About
(2) receive over 50 percent of their support
Your Benefits: Post-Employment, available in
from you, the retiree, for maintenance and
the Reference Library on NetBenefits, or by
support, and (3) when not in attendance at
requesting a copy from the IBM Employee
school, are “permanently residing in your
Services Center.
household” in what is considered a “parent/
child relationship,” and (4) meet the full-time
student requirements IRS Requirements for Certain
Dependents
• Other unmarried children under age 23 will
be considered eligible if IBM determines According to federal tax laws, dependents
that they (1) are not employed full-time, and must meet certain tax requirements to
(2) receive over 50 percent of their support enroll in IBM health coverage on a tax-free
from you, and (3) when not in attendance basis. Dependents who meet the coverage
at school, are permanently residing in requirements under the IBM plan, but do not
your household in what is considered a meet the tax requirements, may still enroll in
“parent/child relationship,” and (4) are IBM health coverage; however, the value of their
subject to a court order under which you, coverage will be considered imputed income to
the retiree, have been granted permanent you and will be taxed accordingly.
legal guardianship of the child’s person and
property, and (5) cannot be claimed as a
20 Enrollment for 2009: Thursday, Oct. 30, 2008 — Friday, Nov. 21, 2008
Coverage for Your Family
• After that, the plan generally pays the If You Enroll in a Medicare Advantage/Cost
following for covered services: Health Plan
–– 80% of the discounted rate for care from Your non-Medicare eligible dependents will be
a UnitedHealthcare network provider covered by the plan’s non-Medicare benefits,
OR if it provides this type of coverage. If a plan is
–– 80% of the billed or “usual & prevailing” available in your area, the Health Plan Detail
amount for care from a non-network Sheet for the plan and your Personal Fact Sheet
provider, whichever is less. will indicate whether it provides coverage for
–– 100% of the discounted or usual & non-Medicare eligible dependents.
prevailing amount once your out-of-
pocket expenses reach the plan’s Coverage for Medicare-Eligible
annual out-of-pocket maximum Dependents
(Dependents are urged to obtain About Prescription Drug Coverage
services from UnitedHealthcare network Medicare-eligible individuals may be enrolled in
providers to receive the network an IBM medical option that provides coverage
discounts; dependents who do not use for prescription drugs or a Medicare prescription
UnitedHealthcare network providers will drug plan, but not both. If your Medicare-eligible
be responsible for paying any charges dependent enrolls in a Medicare prescription
above usual & prevailing rates.) drug plan and is also covered under an IBM
Precertification is required for inpatient hospital medical option that provides prescription drug
stays for non-Medicare eligible dependents to coverage, his or her coverage under the IBM
ensure the treatment is appropriate, effective plan will end.
and medically necessary. If you don’t receive About In-Network Benefits
approval, you may be responsible for paying the To receive the in-network level of benefits under
full cost, plus a $150 penalty. the following medical options, Medicare-eligible
Remember, if you choose the IBM Prescription individuals must receive services from a health
Drug Supplement option, your non-Medicare plan network provider who also participates
eligible dependent(s) will not have coverage for with Medicare:
medical services through IBM. • IBM Low Deductible PPO
If You Enroll in the Aetna Medicare Open • IBM Medium Deductible PPO
Plan (PFFS) or Aetna Golden Medicare
Plan (HMO), or Aetna Traditional Choice® • IBM High Deductible PPO
Medicare Integration Plan A or B • IBM Exclusive Provider Organization
Your non-Medicare eligible dependents will be
covered by the Aetna Open Choice PPO. There • IBM High Deductible PPO with HSA
will not be any cross-application of the family • Aetna Open Choice PPO
deductible, out-of-pocket maximum, lifetime
maximum, or other financial accumulators
between your plan and your non-Medicare
eligible dependent’s plan. For more information
about these plans, call Aetna.
Coverage is provided according to each individual’s eligibility for Medicare, as shown in the table below.
22 Enrollment for 2009: Thursday, Oct. 30, 2008 — Friday, Nov. 21, 2008
Other Benefits, Programs and Services Available to IBMers
Other Programs and Services
Available to IBM Retirees
AfterIBM: Your Online Guide to • jobs at IBM, because you may be
reemployed as an IBM supplemental
Additional Programs for IBM
employee, provided that six months have
Retirees passed from your date of retirement
AfterIBM links to a variety of programs and
resources available after you leave IBM. Visit Employee Assistance Program
www.ibm.com/employment/us/benefits/afteribm
to learn more about All benefits-eligible participants and their eligible
family members have access to the Employee
• the Greater IBM Connection, the business
Assistance Program (EAP), which offers up
network for current and former IBMers
to eight counseling sessions per situation per
• On Demand Community, IBM’s network to year at no cost to you. This benefit is available
help you expand the value and impact of regardless of your benefits plan, or even if you
your volunteer work elect No Coverage through IBM. To access the
EAP, call Optum Health Behavioral Solutions’
• Retiree Charitable Contribution Campaign
referral line at 1-800-445-9720 (TTY: 1-800-
• the IBM Club for discounts on 525-5668), available 24 hours a day, 7 days
entertainment, leisure and recreational a week and staffed by licensed mental health
venues and events professionals with clinical experience in treating
a range of mental health and substance abuse
• Employee Purchase Program for PCs,
care needs.
notebooks, monitors and accessories
• discounts on products, services and
programs from IBM’s clients, partners and IBM Care Advantage Program
vendors Available to non-Medicare-eligible
• Thomas J. Watson Memorial Scholarship participants*, the program gives you and any
Program, an annual scholarship program of your non-Medicare-eligible covered family
that is open to children of IBM employees members easy access to knowledgeable
and retirees. Applications will be accepted resources and support when you need medical
for the 2009 Watson Scholarship program care. The program offers you assistance in
beginning September 2008. three ways: hospital precertification, care
management and condition management.
• community grants, including guidelines on
how to apply for an IBM grant *Note: Care Advantage is not available to those
over age 65 enrolled in the IBM Prescription Drug
• matching grants, solutions and services Supplement, IBM Medical Supplement, IBM Medical/
available to eligible educational institutions Prescription Drug Supplement, IBM Medical/
Prescription Drug Supplement Plus, HMO, Retiree
• employment verification Health AccessSM or Medicare Advantage Plan options
or to retirees or dependents who are eligible for
Medicare. Similar services may be available through
the health plan for HMO, Retiree Health AccessSM and
Medicare Advantage options.
24 Enrollment for 2009: Thursday, Oct. 30, 2008 — Friday, Nov. 21, 2008
Other Benefits, Programs and Services Available to IBMers
Crossover Claims Processing IBM Managed Pharmacy Program
If you enroll in the IBM Medical Supplement, The IBM Managed Pharmacy Program is
IBM Medical/Prescription Drug Supplement or available to those whose prescription drug
IBM Medical/Prescription Drug Supplement coverage is administered by Medco (see page
Plus option and register for crossover claims 12 for more information).
processing, UnitedHealthcare will credit
• Coverage for short-term medication:
your eligible Original Medicare Part A and
You can use retail pharmacies for
Part B expenses to your IBM Supplement
medication — such as an antibiotic for a
plan’s annual deductible and out-of-pocket
sudden illness — for up to a 30-day supply.
maximum automatically. Using this process,
You’ll save money if you use a pharmacy
UnitedHealthcare also pays any benefits
that participates in Medco’s network.
to you automatically — you won’t need to
submit claims. • Coverage for long-term medication:
If you are taking medication for a chronic
To register for crossover claims processing:
condition such as high blood pressure, you
• Call UnitedHealthcare to register by phone will receive benefits for a 30-day supply at a
or request a crossover registration form. retail pharmacy (plus up to two refills) for the
initial prescription only*. Subsequent refills
• You will need your Medicare ID number and
must be ordered through Medco By Mail
suffix, located on your Medicare ID card, to
(mail order service) or you’ll pay the entire
complete your registration.
cost for the refill at the retail pharmacy.*
• If your spouse is eligible for Medicare, you
Note: If you are currently covered by the IBM
may enroll him or her at the same time. Managed Pharmacy Program, are taking long-term
• Once you are registered (which can take medication and have filled an existing prescription
four to six weeks while the Centers for three times, you must continue to order this
medication through the Medco By Mail program.
Medicare and Medicaid Services activates
the program), your Medicare Part A and • If your medication requires special
Part B claims will be sent directly to handling: If you need covered prescription
UnitedHealthcare by your Medicare carrier. medication that requires special handling or
Note: There is no need to re-register each year with administration — such as chemotherapy —
UnitedHealthcare. and are currently receiving it through your
doctor’s office or other treatment center,
you can order it through Accredo, the
Medco special care pharmacy. By ordering
covered prescription medication this way,
you may pay less for it overall. Additionally,
you may be able to have it shipped
directly to you or your doctor’s office at no
additional charge. Contact Medco Member
Services for more details.
Please note that, effective Jan. 1, 2009, new
provisions will apply to the IBM Managed
Pharmacy Program. Refer to page 2 of this
guide for more information.
26 Enrollment for 2009: Thursday, Oct. 30, 2008 — Friday, Nov. 21, 2008
Contact Information
Administrator Phone Number(s) TTY Number Web Site
IBM Managed Pharmacy Program
Medco Toll-free within the U.S.: 1-800-289-1089 www.medco.com
1-800-987-5254
Outside the U.S.: 1-800-497-4641
IBM Mental Health Care Program
Optum Health Toll-free within the U.S.: 1-800-525-5668 www.liveandwork
Behavioral 1-800-445-9720 well.com
Solutions
Outside the U.S.: 267-216-3277 Password = IBM
Dental
MetLife Toll-free within the U.S.: 1-800-843-2896 www.metlife.com/
1-800-872-6963 mybenefits
Outside the U.S.: AT&T direct access
number +800-962-1401
CIGNA DMA Toll-free within the U.S.: 1-800-962-5169 www.cigna.com/
1-800-367-1037 consumer/services/
dental
Vision
Vision Service Plan Toll-free within the U.S.: 1-800-428-4833 www.vsp.com/ibm
1-888-877-4426
Outside the U.S.: 916-635-7373
Employee Assistance Program
Optum Health Toll-free within the U.S.: 1-800-525-5668 www.liveand
Behavioral 1-800-445-9720 workwell.com
Solutions
Outside the U.S.: 267-216-3277 Password = IBM
Care Advantage Programs
Care Coordination Contact the health plan administrator directly.
Matria Healthcare, 1-800-586-0322 1-800-255-0135 www.Matria
Inc. Condition (GA Relay) Cares.com/IBM
Management CareAdvantage
1-800-227-5746
Program
(GA Speech)
Nurse Helplines
UnitedHealthcare’s 1-866-540-5920 Call N/A
Optum Nurseline 1-800-855-2880
and ask for
1-866-540-5920
Other Health Contact the health plan administrator directly.
Plans
If you are not eligible for Medicare, IBM medical Medicare; you will receive an ID card for the
benefits provide your primary coverage; Aetna plan you enroll in and your dependent
therefore, IBM contributes, on average, a higher will receive a separate ID card for the Aetna
amount than for those whose primary coverage Open Choice PPO.
is provided by Medicare.
However, if you enrolled in one of these options
Note: Certain groups, including participants in the for 2008 and will remain enrolled for 2009, you
Special Retiree Medical Option and Access-Only, do not will not receive new ID cards.
receive subsidized benefits. The IBM subsidy is delivered
differently through the Future Health Account for more Prescription Drug: Under the IBM Managed
recent retirees. Pharmacy Program, if your prescription drug
benefits are currently provided by Medco and
About ID Cards the medical option you select for 2009 also
provides prescription drug coverage through
ID cards for 2009 will be mailed between
Medco, you will not receive a new prescription
late December and mid-January. If you have
drug ID card.
questions, contact the administrator for your
medical, dental or vision option. If you enroll in the Aetna Open Choice PPO,
Aetna Medicare Open Plan (PFFS) or Aetna
Medical: You will receive new medical ID cards if:
Golden Medicare Plan (HMO), you will receive
• You enroll in a new medical option for 2009.
a separate ID card for your prescription drug
• You are eligible for Medicare and change
benefit. If you enrolled in one of these options
your enrollment to or from a Medicare
for 2008 and will remain enrolled for 2009, you
Advantage plan (including the Aetna
will not receive new ID cards.
Medicare Open Plan (PFFS), Aetna Golden
Medicare Plan (HMO) or a Medicare Dental: If you are not currently enrolled in the
Supplement HMO). CIGNA DMA but enroll for 2009, you will receive
a dental ID card. Participants in Dental Option A,
• You enroll in the Aetna Medicare Open
Dental Option B, MetLife PDP, IBM Dental Basic
Plan (PFFS), Aetna Golden Medicare
or IBM Dental Plus do not receive ID cards.
Plan (HMO), or Aetna Traditional Choice®
Medicare Integration Plan A or B and cover Vision: You will receive a vision ID card if you are
a dependent who is not eligible for enrolled in No Coverage for 2008 and enroll in
the IBM Vision Plan or VSP Vision Card for 2009.
28 Enrollment for 2009: Thursday, Oct. 30, 2008 — Friday, Nov. 21, 2008
Administrative and Legal Information
Transition of Care Your personal health information will remain
confidential and will not be shared outside the
If your health plan administrator is changing or
administration of the plan.
you are selecting a new medical option for 2009
and you or one of your covered dependents Conversations with a Care Coordinator or
is currently undergoing treatment for certain personal care manager are confidential as
serious medical conditions or prenatal/maternity required by federal and state privacy laws. It
care, you may be eligible to continue receiving is important to remember that care managers
in-network benefits for a limited period of time, provide support and information, but their
even if your doctor does not belong to your new services are not intended to replace those of
plan network. Contact the administrator of your your doctor. In an emergency, seek medical
new medical option for more information. treatment immediately.
Note: Transition of care is not available in all HMOs.
If you are considering enrolling in an HMO for 2009, HIPAA Notification
contact the HMO directly to determine whether IBM’s Health Insurance Portability and
transition of care is available. Accountability Act of 1996 (HIPAA) privacy
policy is available in the Reference Library
Qualified Status Changes on NetBenefits, or you may contact the IBM
A qualified status change is a specific change Employee Services Center to request a copy.
to your family, employment or coverage status
that enables you to make certain benefit Women’s Health and Cancer Rights
changes during the calendar year. These types Act of 1998
of changes are defined by Internal Revenue
The Women’s Health and Cancer Rights Act of
Code Section 125 and include events like
1998 requires all group health plans that provide
marriage, birth of a child, death, divorce and
medical and surgical benefits with respect to a
other changes which affect benefits eligibility
mastectomy must provide coverage for
for you and/or your dependents. You must
call the IBM Employee Services Center or log • reconstruction of the breast on which the
on to NetBenefits to make eligible changes to mastectomy has been performed
your coverage within 30 days of the date of the • surgery and reconstruction of the
qualified status change; otherwise, you will not other breast to produce a symmetrical
be able to make changes until the next annual appearance
enrollment period. • prostheses and treatment of physical
complications of all stages of the
Protecting Your Privacy mastectomy, including lymphedema
Medical and pharmacy claims data and Health These services must be provided in a manner
Risk Assessment results may be used to determined in consultation with the attending
determine if you or a covered family member physician and the patient. This coverage may be
might be eligible for care management, subject to annual deductibles and copayment
condition management, or other voluntary provisions applicable to other such medical and
health support programs. IBM does not surgical benefits provided under the plan. Refer
have access to personally identifiable health to your benefit plan description for deductibles
information for any employee, retiree or and copayment information applicable to the
dependent from any source, and is not involved plan in which you choose to enroll.
in identifying or notifying Care Advantage
health plan or Matria program participants.
3.IM-H-515S.102