PEBP offers a comprehensive benefit package to retirees which includes the option of a PPO, HMO or Medicare + Choice plan. Retiree plans include medical, dental, pharmacy, vision, accidental death and dismemberment and basic life coverage.

To learn more about the self-funded PPO and HMO medical plans, select the PEBP Health Plans link at the top of this page, or to learn more about the retiree enrollment process click here.

Summary of topics on this page:

• Retiree Eligibility

• Retiree Benefits Orientation (RBO) Classes

• Health Assessment

• Medicare Part B Reimbursement

• Medicare and Coordination of Benefits (COB)

• Medicare Direct Program

• Declining Coverage

Retiree Eligibility

Retiring public employees must receive a retirement distribution from one of the following retirement plans:

• Legislators' Retirement System (LRS)

• Public Employees' Retirement System (PERS)

• Judges' Retirement System (JRS)

• Retirement Plan Alternatives (RPA)

Medicare and Coordination of Benefits (COB)

The Self-funded PPO Plan coordinates benefits with Medicare and other primary insurance plans using the Maintenance of Benefits method. Under this method, the PPO Plan reduces its normal benefit by the benefit amount paid by the other primary health insurance. Coordination of benefits using the Maintenance of Benefits method allows the participant to receive as much in benefits as he/she would have received in the absence of other primary coverage; the participant is not guaranteed 100% coverage, but will receive the same benefit had they not been covered under other primary coverage.

Medicare Direct Program

The Medicare Direct Program is a free service offered to retirees or surviving spouses or retirees who are enrolled in the Self-funded PPO Plan and who have Medicare Part A and/or B coverage. Enrollment in this program authorizes Medicare (as the primary insurance carrier) to electronically submit the Medicare Explanation of Benefits to Benefit Planners as the secondary payer. Electronic Submission expedites the claims process and eliminates the need of having to forward hard copies of the Medicare Explanation of Benefits to Benefit Planners.

Declining Retiree Coverage

Retirees may opt-out-of or decline PEBP's retiree coverage by signing the declination of insurance form (Benefit Enrollment and Change Form). Coverage declination will become effective on the first day of the month following the month the declination is received. Retirees who decline coverage will lose medical, pharmacy, dental, vision, life, accidental death and dismemberment coverage.