2011 SFFU Retiree Guide

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Seattle Fire Fighters HealthCare Trust…for Fire Fighters by Fire Fighters…

PLAN YEAR 2011

Annual Benefits Enrollment Guide

Retiree Plans



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Welcome to

Your 2011

Annual Benefits

Enrollment Guide!The Board of Trustees for the Seattle Fire Fighters HealthCare Trust presents toyou the 2011 Annual Benefits Enrollment Guide.

As Trustees, we strive to offer our members valued, comprehensive,sustainable and affordable health plans that are here for all of us –from Recruit through Retirement – and to our families.

We encourage you to take the time to educateyourselves about your benefit optionsand choose the best coveragefor you and your family.



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A Word about this Annual Benefits Enrollment Guide

The Seattle Fire Fighters HealthCare Trust prides itself in offering benefits to all members,from Recruit through Retirement. In this Annual Benefits Enrollment Guide, you will findinformation regarding benefits available to our honored and retired members:

• Section One: Plan B – Retiree Medical and Prescription Drug Plan

• Section Two: Medicare Supplemental Plan and Medicare Part D



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SECTION ONE

Plan B – Retiree Medical and Prescription Drug Plan

Who is Eligible?An individual must meet the following three requirements in order to be an Eligible Participant:

1. The individual must have retired from the Seattle Fire Department as amember in good standing of Local 27 and is not enrolled in Medicare PartA and Part B;

2. The individual must either:a. Have been a participant in the Seattle Fire Fighters HealthCare Plan

since its inception on January 1, 2008; orb. Have been a participant in the Seattle Fire Fighters HealthCare Plan

for a minimum of 10 years; orc. Have applied for a LEOFF system disability pension and have

exhausted his or her COBRA rights under the Seattle Fire FightersHealthCare Plan.

3. The individual must either:a. Be receiving a LEOFF system pension check; orb. Have a combination of years of service as a Local 27 Member PLUS

his or her age at separation from employment that equal to at least 70(“Rule of 70”).

Important Eligibility Note: Participants enrolled in Plan B for the 2010 Plan Year continue to be Eligible Participants without meeting the above-listed requirements as long as they maintain continuous enrollment in Plan B.

Eligible Family Members* include:

• Your legal spouse or domestic partner (registered with the City ofSeattle or State of Washington), who is not enrolled in Medicare Part Aand Part B and who is not himself and herself a LEOFF 1 fire fighter

• Your children under the age of 26

• Surviving spouse/domestic partner and children of deceased eligible:retired fire fighter, retired LEOFF 1 fire fighter, or active fire fighter

*Eligible Family Member is more fully described on the back of the enclosed Enrollment

Application and full eligibility rules are included in the Retiree Plan B Benefit Booklet.



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When to Enroll When you meet the Definition of Eligible Participant (see “Who is Eligible?” section on page 4 ), you may enroll in Plan B. Any benefitselections you make at this time for you and your family will bebinding throughout the Plan Year until the next open enrollmentperiod, unless you experience a qualified change in status (see “How to Make Changes” section below ).

If you meet the Definition of Eligible Participant, but wish to deferyour enrollment in Plan B you may do so only if you and any eligibledependents remain covered under another group insurance plan untilsuch time as you wish to enroll in Plan B. Individual insurance plansdo not qualify you for deferred enrollment. You may only deferenrollment at the time you first meet the Definition of EligibleParticipant.

How to EnrollNewly retired Eligible Participants: You must complete and submitthe Enrollment Application to the Trust Office within 30 days of your

retirement date. The Trust Office Information may be found in the“Helpful Information” section on page 15 of this Guide.Late Entrant Retiree: If you did not enroll in this Plan at your initialeligibility (that is, you deferred your enrollment in Plan B), but wouldlike to enter the Plan at some future date, you must have creditablegroup coverage during the time you were not enrolled on this Plan(individual insurance plans do not qualify you for deferredenrollment). To enroll, you must complete and submit the EnrollmentApplication and proof of other group insurance to the Trust Officewithin 30 days of the expiration of your other group insurance. TheTrust Office Information may be found in the “Helpful Information”

section on page 15 of this Guide.

How to Make ChangesUnless you have a qualified change in status, you cannot makechanges to the benefits you select until the next Open Enrollmentperiod. Qualified changes in status include: marriage, divorce, legalseparation, domestic partnership status change, birth or adoption of achild, change in child’s dependent status, death of spouse, death ofdomestic partner, death of child or other qualified dependent, changein residence due to an employment transfer for you, your spouse ordomestic partner, commencement or termination of adoption

proceedings, loss of other coverage due to a change in yourspouse’s or domestic partner’s employment status, or a loss of othercoverage due to your spouse’s or domestic partner’s employerceasing to make contributions toward their coverage. Loss of othercoverage due to a failure to timely pay premiums or termination ofcoverage for cause is not a qualified change in status. Should you wish to make an enrollment change, you must complete and submit the Enrollment Application to the Trust Office within 30 days of adding a new family member and within 60 days of loss of other group coverage.



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How Plan B Works…Plan B offers coverage for both medical and prescription drugs. Regence BlueShield, theclaims administrator, also provides the network of providers and an array of services andprograms that complement the medical and prescription drug coverage through this Plan.

Provider Access To receive the benefits summarized below, you may select any Regence Provider. To search

for a provider, or confirm that your provider is in the Regence network, you may:

• Call Regence for assistance in searching for a provider:

Customer Service: (800) 458-3523

Or

• You can use their on-line provider search engine:

www.wa.regence.com

Other Regence Services and Programs available to you at no additional cost:

• Disease Management - assistance from health professionals in managingchronic conditions and/or diseases (such as Coronary Artery Disease,Diabetes, etc.)

• Case Management - assistance from a health professional in managingcomplex conditions and/or procedures (such as hip replacement surgery orother extensive surgeries)

• myRegence.com - online services which allow you to view your ownpersonal claims and prescription drug history, access health information andeven chat online with other members and Regence professionals.



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Trust Plan B Medical and Prescription Drug Plan SummaryBenefit Plan B

Provider Access Regence Network ofPreferred, Participating, andNon-Participating Providers

Calendar Year Deductible $750 per person / $2,250 per familyCoinsurance 80%

Out of Pocket Maximum $3,000 per person / $9,000 per familyProfessional Services

Outpatient(Up to 15 visits per calendar year)

Subject to deductible and

then plan pays 80%Inpatient Subject to deductible and

then plan pays 80%Preventive Care

Routine Exam(Including well baby exams, adult physicals, and women’s health exams and immunizations)

Covered in Full

Preventive CareMammograms/Routine Prostate Screenings

Covered in Full

Diagnostic Labs and ImagingOutpatient Subject to deductible and

then plan pays 80%

Inpatient Subject to deductible andthen plan pays 80%

Hospital ServicesOutpatient Subject to deductiblethen plan pays 80%

Inpatient(Provider must notify Regence prior to any admission except for emergencies)

Subject to deductiblethen plan pays 80%

ER Services(Copay waived if admitted, still subject to deductible and coinsurance)

$150 copaySubject to deductiblethen plan pays 80%

Ambulance Service Subject to deductiblethen plan pays 80% up to $500 per incident

when medically necessary

Acupuncture Up to 1 exam per calendar yearUp to 10 visits per calendar year


This is a summary of benefit plans and is not intended to be relied upon as a contract. If a discrepancy occurs between this Enrollment

Guide and the benefit booklet, the language in the benefit booklet will prevail.



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Trust Plan B Medical and Prescription Drug Plan Summary (continued)Benefit Plan B

Spinal Manipulations Up to 1 exam per calendar yearUp to 10 visits per calendar year


Rehabilitation Services

Outpatient(Includes physical/massage/speech and occupational therapy)

Up to $2,000 per calendar yearSubject to deductiblethen plan pays 80%

Inpatient(Includes physical/massage/speech and occupational therapy)

Up to $30,000 per calendar yearSubject to deductiblethen plan pays 80%

Home Health Care Up to 10 visits per calendar yearSubject to deductiblethen plan pays 80%

Hospice Up to $10,000 per yearSubject to deductible

then plan pays 80% Skilled Nursing Facility Up to $10,000 per calendar year


Chemical Dependency TreatmentOutpatient Subject to deductible

then plan pays 80%Inpatient Subject to deductible

then plan pays 80%Medical Supplies Subject to deductible

then plan pays 80%Mental Health Care

Outpatient Subject to deductiblethen plan pays 80%

Inpatient Subject to deductiblethen plan pays 80%

Medical Supplies Up to $7,500 per calendar yearSubject to deductiblethen plan pays 80%

VisionRoutine Eye ExamOne every calendar year

Lenses and FramesOne pair every calendar year

$25 copay

Up to $120


Guide and the benefit booklet, the language in the benefit booklet will prevail.



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Trust Plan B Medical and Prescription Drug Plan Summary (continued)Benefit Plan B

Prescription DrugsRetail Generic 30% (with a $15 minimum)

Brand 50% (with a $30 minimum)Non-preferred Brand 50% (with a $30 minimum)

Mail Order

Generic $ 45Brand $ 90 Non-preferred Brand $ 90


Guide and the benefit booklet, the language in the Retiree Plan B Benefit Booklet will prevail.

How Much Does Plan B Cost?The costs to enroll in this Plan B Medical and Prescription Drug Plan are illustrated below.

Any changes as a result of enrollment changes (e.g., adding a spouse or deleting a spouse)will reflect in your December 2010 checks for coverage that will become effective January 1,2011. Otherwise Note: There were no changes to contribution rates for 2011!

LEOFF II – Contributions are illustrated on a monthly basis

Level of Coverage PLAN B

Fire Fighter Only $ 778.40

Fire Fighter + Spouse2/DP $ 1,556.80

Fire Fighter + Spouse/DP + Ch(ren) $ 1,849.40

Fire Fighter + Ch(ren) $ 1,071.00

LEOFF I – Contributions are illustrated on a monthly basis

Level of Coverage PLAN B

LEOFF I Fire Fighter Only1 N/A

LEOFF I Spouse2/DP Only $ 778.40

LEOFF I Spouse/DP + Ch(ren) $ 1,071.01LEOFF I Fire Fighters are not eligible to participate in this Plan.2 Spouses who are themselves LEOFF I fire fighters are not eligible to participate in this Plan.



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SECTION TWO

Medicare Supplemental Plan

Who is Eligible?An individual must meet the following four requirements in order to be anEligible Participant:

1. The individual must have retired from the Seattle Fire Department as amember in good standing of Local 27;

2. The individual is enrolled in Medicare Part A and Part B3. The individual must either:

a. Have been a participant in the Seattle Fire Fighters HealthCare Plansince its inception on January 1, 2008; or

b. Have been a participant in the Seattle Fire Fighters HealthCare Planfor a minimum of 10 years; or

c. Have applied for a LEOFF system disability pension and haveexhausted his or her COBRA rights under the Seattle Fire FightersHealthCare Plan; or

d. Has been a participant in Plan B with no lapse in coverage from PlanB.

4. The individual must either:a. Be receiving a LEOFF system pension check; orb. Have a combination of years of service as a Local 27 Member PLUS

his or her age at separation from service equal to 70 years (“Rule of70”).

Important Eligibility Note: Participants enrolled in this Medicare Supplemental Plan for the 2010 Plan Year continue to be Eligible Participants without meeting the above-listed requirements as long as they maintain continuous enrollment in this Medicare Supplemental

Plan. If you are an eligible participant under Plan B or the Medicare SupplementalPlan, Eligible Family Members include:• Legal spouse or domestic partner (registered with the City of Seattle or State

of Washington) who is enrolled in Medicare Part A and Part B



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When to Enroll When you meet the Definition of Eligible Participant (see “Who is Eligible?” section on page 10 ), you may enroll in the MedicareSupplemental Plan. Any benefit selections you make at this timewill be binding throughout the Plan Year until the next OpenEnrollment period, unless you experience a qualified change instatus (see “How to Make Changes” section below ).

How to EnrollNewly enrolled in Medicare Part A and Part B: You must completeand submit the Enrollment Application to the Trust Office within 30days of your Medicare enrollment date. The Trust Office Informationmay be found in the “Helpful Information” section on page 15 of thisGuide.

If you are interested in enrolling in the SilverScript program, contactthe Trust Office to request an enrollment packet. If you have enrolledin a Medicare Part D prescription drug plan elsewhere, you may stillbe eligible to receive reimbursements for prescription drug throughthis Plan. Contact the Trust office with questions regarding MedicarePart D prescription drug reimbursements.

How to Make ChangesUnless you have a qualified change in status, you cannot make

changes to the benefits you select until the next Open Enrollmentperiod. Qualified changes in status include: marriage, divorce, legalseparation, domestic partnership status change, death of spouse,death of domestic partner, or death of other qualified dependent,change in residence due to an employment transfer for you, yourspouse or domestic partner, loss of other coverage due to a changein your spouse’s or domestic partner’s employment status, or a lossof other coverage due to your spouse’s or domestic partner’semployer ceasing to make contributions toward their coverage. Lossof other coverage due to a failure to timely pay premiums ortermination of coverage for cause is not a qualified change in status.

Should you wish to make an enrollment change, you must complete and submit the Enrollment Application to the Trust Office within 30 days of the qualified change in status.



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How the Medicare Supplemental Plan Works…The Medicare Supplemental Plan offers supplemental coverage for approved Medicarecharges. The summary of eligible reimbursements is listed below:

Medicare Supplemental Plan Summary

Benefit Medicare Supplemental Plan

Medicare Deductibles

(Part A and Part B) Reimbursed at 100%Part B Coinsurance(20% paid by member)

Reimbursed at 100%

Covered Services Physician Services Surgeon & assistant surgeon Physician consultation (while hospitalized ) X-rays Laboratory work Physical therapy (up to $2,000 per calendar year ) Radiation Therapy Diagnostic Scans

Chiropractic Charges Allergy care Alcohol Treatment Durable Medical Equipment

Reimbursement Payment ScheduleHospitalization (Inpatient Part A)

Hospitalization (Outpatient Part B)

Rehabilitative Charges (Physical, occupational, speechtherapies)

Deductible is reimbursedDeductible and 20% coinsurance is reimbursed20% coinsurance reimbursed

Total Payments from this Medicare Supplemental Plan are not to exceed the original claimamount.

Non-Trust Medicare Prescription Drug Program – Medicare Part D

reimbursementsIf you have enrolled in a Medicare Part D program through another carrier or health plan, youmay also receive reimbursement for your out-of-pocket expenses for Medicare Part Dprescription drug costs. The Medicare Supplemental Plan offers reimbursements for MedicarePart D deductibles and coinsurance, up to your True Out of Pocket. The cost for this Part Dportion of the Plan is included in the Medicare Supplemental Plan costs illustrated on page 13.

Trust Medicare Prescription Drug Program –

SilverScript Medicare Part D and Part D reimbursement InformationIf you have not enrolled in a Medicare Part D program through another carrier or health plan,the Seattle Fire Fighters HealthCare Trust offers you access to SilverScript Medicare Part D,which is an approved Medicare Part D prescription drug plan. The cost of the SilverScriptMedicare Part D plan is $38.00 per enrolled member per month. This cost is in addition to theMedicare Supplemental Plan costs listed on page 13, and will be included in your deduction



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from your pension check (or if you pay the Trust directly, should be included in your monthlypayment).

For information regarding the SilverScript Medicare Part D program and changes for 2011,please visit:

http://seattlefirefighters.silverscript.com

How Much Does The Medicare Supplemental Plan Cost?The cost to enroll in this Medicare Supplemental Plan is illustrated below.

This change will reflect in your December 2010 checks for coverage that will become effectiveJanuary 1, 2011.

Contributions are illustrated on a monthly basis

Level of Coverage MEDICARE SUPPLEMENTAL PLAN

Per Enrolled Individual $ 148.50

If you are enrolled in the SilverScript Medicare Part D and Reimbursement Plan through CVSCaremark, your 2011 costs are listed below. Please note: This additional cost will be billedseparate from your Medicare Supplemental Plan (above) and your payment should be directedto the Trust Office.

Contributions are illustrated on a monthly basis and will be added to the Medicare

Supplemental Plan cost illustrated above.

Level of CoverageSILVERSCRIPT MEDICARE PART D AND

REIMBURSEMENTSPer Enrolled Individual $ 38.00



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Questions and Answers:

Forms to be completed if making changes to Plan B and/or MedicareSupplemental Plan:

• Enrollment Application to add or drop eligible family member

To enroll in Plan B:• If you wish to enroll in Plan B for the first time , you must complete the Enrollment

Application.• If you are making any enrollment changes to Plan B (e.g., adding a spouse,

dropping an eligible family member), you must complete the Enrollment Application.

To enroll or re-enroll in Medicare Supplemental Plan and/or SilverScript Medicare PartD:

• If you wish to enroll in the Medicare Supplemental Plan and/or SilverScript MedicarePart D for the first time , you must complete the Enrollment Application.

• If you are an existing Medicare Supplemental Plan and/or SilverScript member, youdo not complete the Enrollment Application to continue your coverage for 2011.

Where do I find Plan B and Medicare Supplemental Plan forms?• A 2011 Enrollment Application was included in the Enrollment Packet with this

Guide.• You may also contact the Trust Office for forms.

When are the Plan B and Medicare Supplemental Plan forms due and wheredo I return them?

• All 2011 Enrollment Application forms are due by December 6, 2010 and mustbe returned to:

Seattle Fire Fighters HealthCare Trust Officec/o Suzan KolbP.O. Box 6Mukilteo, WA 98275-0006

Who do I contact with questions about Plan B, Medicare SupplementalPlan, and/or SilverScript?

• You may contact:

Suzan Kolb, Trust Administrator (206) 859-2600Nancy Grier, Trust Administrator (206) 859-2693



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Helpful Information:DESCRIPTION OF INFORMATION CONTACT

TRUST OFFICEPLAN B, MEDICARE SUPPLEMENTAL PLANCUSTOMER SERVICESFor questions regarding Open Enrollment, requestbenefits/enrollment forms, eligibility, generalbenefits questions, Trust Operations

Nancy GrierBenefit Solutions, Inc.

(206) 859-2693

REGENCE BLUESHIELDFor questions regarding claims, pharmacybenefits, requesting new ID cards, finding aprovider or pharmacy

Customer ServiceHours: Monday – Friday from 8:00 am to 5:00 pm

(800) 458-3523

To find a provider:www.wa.regence.com

To access your personal informationwww.myregence.com

TRUST CONSULTANTS For questions regarding, general benefitsquestions, Trust business

DiMartino Associates, Inc.(206) 623-2430

SILVERSCRIPT MEDICARE PART DFor questions regarding claims, pharmacybenefits, requesting new ID cards, finding aprovider or pharmacy

Monday through Friday from 8:30 am to 5:00 pm(206) 859-2693

Online information:http://seattlefirefighters.silverscript.com

The information in this Enrollment Guide is presented for illustrative purposes only. The text contained in this Guide was taken from various sources. While every effort was taken to accurately report your benefits, discrepancies, or errors are always

possible. In case of discrepancy between the Guide and the formal plan documents, which are the Summary Plan Description and the Benefit Booklet for the Plan in which you are enrolled, the formal plan documents will prevail. All information is

confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996.If you have any questions about your 2011 Annual Benefits Enrollment Guide, contact the Trust Office.



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Seattle Fire Fighters HealthCare Trust

Board of TrusteesDallas BakerAaron KarlsJeff Milton

Tim O’MahonyChris RobinsonZach SchadeKenny Stuart

Trust AdministratorBenefit Solutions, Inc.

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2011 SFFU Retiree Guide

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