AlaskaCare Retiree Medical Plan

The State of Alaska retirement systems provide extensive and valuable benefits for you and your family including hospitalization, medical, surgical, maternity care, and other services necessary for the diagnosis and treatment of an injury or disease. Please check the current booklet for the most up-to-date and complete information about health benefits.

Retirees Who Don't Pay a Premium for Medical Coverage

Coverage for members and their eligible dependents starts on the date of retirement.

How to Elect Medical Coverage

For benefit recipients who don't pay a premium for medical coverage, enrollment is automatic when they retire or become eligible at age 60.

Benefit recipients who must pay a premium

Do I have to pay a premium?

Benefit recipients who must pay a premium must elect coverage either:

  • Before the effective date of their retirement benefit,
  • With their application for survivor benefits, or
  • During the annual open enrollment period.

Coverage may be elected for:

  • Retiree only,
  • Retiree and spouse,
  • Retiree and child/children, or
  • Retiree and family (spouse and child/children).

Decrease your coverage at any time.

Increase dependent coverage only:

Retirees Who Don't Pay a Premium for Medical Coverage

Coverage for members and their eligible dependents starts on the date of retirement.

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When Medical Coverage Starts

New Benefit Recipients

New benefit recipients will be covered under this plan on the date of appointment to receive retirement, disability, or survivor/ death benefits. Those who must pay for coverage are also covered on their appointment date if they elect coverage prior to retirement.

Open enrollment

Benefit recipients who are eligible for and elect coverage during open enrollment (see pages 5- 6) are covered on January 1 of the year following the open enrollment, assuming they pay the required premium.

Marine Engineers Beneficial Association Members

Eligible benefit recipients of the Marine Engineers Beneficial Association (MEBA) are covered on the date of their appointment to receive benefits from MEBA.

Dependents

Eligible dependents are covered on the dates specified below.

If you elect or are provided with coverage for dependents, your dependents are eligible for benefits on the same day you are eligible if they meet all eligibility requirements. If you add new dependents, they will be covered under this plan immediately.

If you elect dependent coverage during an open enrollment period, your dependents are covered on January 1, assuming you pay the required premium.

If you increase your coverage to include dependents following marriage or birth of a child, their coverage begins on the first of the month following receipt of your written request.

When Medical Coverage Ends

At the earliest time one of the following occurs:

Ineligible Retirees

Coverage ends on the last day of the calendar month in which you cease to be eligible for a benefit from any retirement system.

Failure to pay premium

Coverage ends on the last day of the calendar month in which you last make the required monthly premium (if you are required to pay a premium for coverage).

Dependents

If you are provided with or have elected coverage for your dependents, their coverage ends on the same day as your coverage ends, unless:

  • You divorce. Coverage for your spouse ends on the date the divorce is final.
  • Your child no longer meets all eligibility requirements. Coverage ends at the end of the month in which your child first fails to meet these requirements.
  • Coverage is discontinued for all dependents.

Health coverage may be continued if one of the above situations (except for failure to pay a premium) occurs. Please see the “Continued Health Coverage” section on pages 97-101 of the booklet.

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Covered Medical Expenses

Benefits are available for medically necessary services and supplies necessary to diagnose, care for, or treat a physical or medical condition. Any portion of a claim which is itemized as sales, excise or other taxes is not reimbursable.

  • Care or treatment which is expected to improve or maintain your health or to ease pain and suffering without aggravating the condition or causing additional health problems; 18
  • A diagnostic procedure indicated by the health status of the patient and expected to provide information to determine the course of treatment without aggravating the condition or causing additional health problems; and
  • No more costly than another service or supply (taking into account all health expenses incurred in connection with the service or supply) which could fulfill these requirements.

The Retiree Insurance Information Booklet lists further specifications. Refer to the booklet (and appropriate addenda) for information regarding the following covered expenses:

  • Provider services
  • Nurse advice line
  • Hospitalization
  • Home health care
  • Skilled nursing care
  • Skilled nursing facility
  • Outpatient procedures and plan-required second opinions
  • Retiree-elected second opinions
  • Prescription Drugs
  • Radiation, X-rays and Laboratory Tests
  • Rehabilitative Care
  • Outpatient Preoperative Testing
  • Outpatient Ambulatory Surgery
  • Anesthetic
  • Pregnancy
  • Durable Medical Equipment/Supplies
  • Travel
  • Mental Disorder and Chemical Dependency
  • Medical Treatment of mouth, jaws and teeth
  • Medical treatment of obesity
  • Plastic, Cosmetic and reconstructive surgery
  • Mastectomy/Breast reconstruction

When is a colonoscopy covered?

Your AlaskaCare Health Plan may cover a colonoscopy, but only under certain conditions.

Retirees covered by Medicare may be eligible for a screening colonoscopy. Read about preventive services covered by Medicare.

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Medical Plan Highlights - Retiree

Benefit Year
January 1 to December 31
Annual Deductible
$150 Individual, Maximum 3 per family
Deductible satisfied in last quarter (Oct-Dec) carries into next benefit year
Coinsurance
80% first $4,000 in covered expenses for each person
100% for remainder of benefit year
Annual out-of-pocket maximum
$800/person after deductible
Lifetime Maximum
$2,000,000
$5000 automatic annual restoration
Preferred Hospital
None required but Alaska Regional in Anchorage is available and provides substantial discounts
Prescription Drugs
Participating Pharmacy
  • $8 copay brand
  • $4 copay generic
  • 90 day supply
Nonparticipating Pharmacy
  • same reimbursement but cost to the plan is substantially greater and a claim must be filed
Mail order
  • $0 copay brand
  • $0 copay generic
  • 90 day supply
Outpatient surgery, Preoperative Testing, Second Opinions, Skilled Nursing Facilities
100% with no deductible
Skilled nursing facility subject to deductible
Preventive Care
Adult - Covers only:
  • Pap smears
  • Prostate Specific Antigen(PSA) Tests
  • Mammograms
Mental/Nervous Treatment
Inpatient with plan referral - normal coinsurance
Inpatient without plan referral - $400 penalty and 50% reimbursement
Physician services with plan referral - normal coinsurance
Physician services without plan referral - 50%
Nurse Line
Available
Travel
Round trip subject to coinsurance and deductible. Must be pre-authorized.

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