Retiree Medical Benefits
When you retire and move from an active plan to a retiree plan, any deductibles and out-of-pocket maximums you met under the active plan will not be credited under the retiree plan. You will be required to meet any deductibles and out-of-pocket maximums under the retiree plan as of the effective date you retire.
Medical Plan Options: Retirees/Dependents Under Age 65
The medical plan options available to retirees and dependents under age 65 are listed below. Retirees and dependents under age 65 who elect medical coverage through Penn will automatically be covered under Penn's retiree prescription plan through CVS/Caremark [pdf]. For more information about these plans, view a
detailed comparison chart.
Aetna HMO
- Use providers in the HMO network
- Select a PCP and obtain referrals
This is a Health Maintenance Organization (HMO) administered by Aetna. You must select and coordinate your care through a Primary Care Physician (PCP) and obtain referrals when you go to specialists. Your providers must be part of the HMO network and you must live in a covered service area [pdf] to be eligible for this plan. Most services are covered at 100% after applicable copays.
Keystone/AmeriHealth HMO
- Use providers in the HMO network
- Select a PCP and obtain referrals
This is a Health Maintenance Organization (HMO) administered by Keystone Health Plan East/AmeriHealth. You must select and coordinate your care through a Primary Care Physician (PCP) and obtain referrals when you go to specialists. Your providers must be part of the HMO network and you must live in a covered service area [pdf] to be eligible for this plan. Most services are covered at 100% after applicable copays.
PENNCare/Personal Choice Preferred Provider Organization (PPO)
- Use any provider you wish
- No PCP or referrals needed
- Use PENNCare or Personal Choice providers to pay less out of your pocket
This is a Preferred Provider Organization administered by Independence Blue Cross. You may use any provider you wish, and you do not need to select a Primary Care Physician (PCP) or obtain referrals. Benefits differ according to the health care provider you use:
- PENNCare Preferred Providers — If you use health care providers who are part of or affiliated with the PENNCare network and the Personal Choice network, most services are covered at 100% after applicable copays.
- Personal Choice Preferred Providers — If you use health care providers who are part of the Personal Choice network but not the PENNCare network, services are generally covered at 100% or 80% after applicable deductibles, copays and coinsurance.
- Non-Preferred Providers — If you use health care providers who are not part of either the PENNCare or Personal Choice networks, most services are covered at 70% after applicable deductibles and coinsurance.
Medical Plan Options: Retirees/Dependents Age 65 and Over
The medical plan options available to retirees and dependents age 65 and over are listed below. For more information about the differences between these plans, view a detailed comparison chart [pdf]. Retirees and dependents age 65 and over who elect medical coverage through Penn have options regarding prescription drug coverage—please see the prescription drug benefits page for more information.
Aetna Golden Choice Preferred Provider Organization Plan (PPO)
- Use any provider you wish
- No PCP or referrals needed
- Use Preferred Providers to pay less out of your pocket
- Full preventive care coverage
This is a Medicare-Advantage (PPO) plan administered by Aetna. You may use any provider you wish, and you do not need to select a Primary Care Physician (PCP) or obtain referrals. Benefits differ according to the health care provider you use. If you use health care providers who are part of the Golden Choice network, most services are covered at 100% after applicable copays. If you use health care providers who are not part of the Golden Choice network, most services are covered at 80%. You must live in a covered service area [pdf] to be eligible for this plan.
Keystone/AmeriHealth 65 Medicare-Advantage (HMO) Plan
- Use providers in the Medicare-Advantage (HMO) network
- Select a PCP and obtain referrals
- Full preventive care coverage
- No deductible, coinsurance, or out-of-pocket maximum
- Virtually no paperwork necessary
This is a Medicare-Advantage (HMO) plan administered by Keystone Health Plan East/AmeriHealth. Medicare-Advantage plans manage health services for people with Medicare. You must select and coordinate your care through a Primary Care Physician (PCP) and obtain referrals when you go to specialists. Your providers must be part of the Medicare-Advantage (HMO) network. Most services are covered at 100% after applicable copays. You must live in a covered service area [pdf] to be eligible for this plan.
Independence Blue Cross (IBC) 65 Special (a Medicare Supplement plan)
- Use any provider you wish, anywhere in the U.S.
- No PCP or referrals needed
- Many preventive care services not covered
- Deductible and coinsurance apply only for Major Medical expenses
This is a Medicare Supplement plan administered by Independence Blue Cross. You can go to any provider you choose, and you don’t need to select a Primary Care Physician (PCP) or obtain referrals. This coverage coordinates with Medicare. In general, the balance for eligible expenses not covered by Medicare Parts A and B is reimbursed in full. Expenses that are not reimbursed in full may be eligible under the Major Medical benefit. Under Major Medical, most services are covered at 80% after a deductible. There is no out-of-pocket maximum on Major Medical expenses, as the majority of expenses are covered in full under the hospital and medical/surgical aspects of the plan. It is recommended that you visit Medicare-participating providers in order to maximize your benefits.
Aetna Indemnity Plan (a traditional indemnity plan)
- Use any provider you wish, anywhere in the U.S.
- No PCP or referrals needed
- Many preventive care services are covered
- Deductible, coinsurance, and out-of-pocket maximum apply for eligible expenses not covered by Medicare
This is a traditional indemnity plan administered by Aetna. You can go to any provider you choose, and you don’t need to select a Primary Care Physician (PCP) or obtain referrals. This coverage coordinates with Medicare. Eligible expenses not covered by Medicare are generally covered at 80% after a deductible. An out-of-pocket maximum (which includes the deductible) applies to the plan.
Coordination with Medicare (Medicare-Eligible Retirees/Dependents)
Medicare Part A. Eligibility for premium-free Medicare Part A starts: (1) when you are age 65 or over and (2) you are eligible for Social Security. If you are receiving Social Security, enrollment in Medicare Part A is automatic. If you are receiving Social Security but have opted not to start receiving the benefit, perhaps because you have decided to continue working, you must still enroll in Medicare Part A. This enrollment establishes your entitlement with the Social Security Administration (SSA).
Medicare Part B. If you are covered by a group health plan sponsored by your employer or your spouse/partner’s employer while either of you are in active employment, you need not enroll in Medicare Part B. When you enroll in Medicare Part A, you must notify the SSA that you want to decline Part B because of your coverage. When your coverage ends under the group health plan, the SSA will allow you to sign up for Part B during a Special Enrollment Period without any penalty.
Retirees and eligible dependents age 65 and over, or under 65 and Medicare-eligible, must be enrolled in Medicare Parts A and B in order to enroll in a Penn medical plan for Medicare-eligible retirees/dependents. Penn's medical plans are secondary to Medicare. You should apply for Medicare at your local Social Security office 90 days prior to reaching age 65 in order to give Social Security time to process the application. For information about contacting the Social Security Office directly, please see the Retiree Health Plan Directory [pdf].
Retirees age 65 and over with dependents who are not eligible for Medicare should note that your dependents will be enrolled in a pre-65 retiree medical plan until becoming eligible for Medicare. Then the dependent(s) must enroll in Medicare Parts A and B, and you must select a Medicare-eligible plan for them. Social Security should be contacted 90 days prior to the dependent’s 65th birthday to avoid coverage delays and late enrollment penalties.