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Choose YourCounty of RiversideBenefit OptionsANNUAL BENEFITS ENROLLMENT FORCOUNTY OF RIVERSIDE RETIREESANNUAL ENROLLMENTIS COMING SOON!September 21–October 9, 2020Watch for more information in the coming weeks.IMPORTANT REMINDERIf you retired from a group that’s eligible forCalPERS medical plans, you’ll coordinate youropen enrollment changes directly throughCalPERS during their Open Enrollment period:September 21–October 16, 2020.IT’S THAT TIME AGAIN!Annual Enrollment for County retirees begins September 21. Take advantage of this once-a-year opportunity to confirmyour benefits coverage for the coming year. The deadline to enroll or make changes is midnight on October 9, 2020.This guide provides information for the 2021 plan year about medical, dental and vision coverage options for County ofRiverside eligible retirees.Retirees who retired from the County of Riverside and were covered by one of the following bargaining units or groupsare also eligible for the CalPERS Health Program: Management, Confidential and Unrepresented groupsDeputy District Attorney Association (DDAA)Law Enforcement Management (LEMU)RSA Public Safety (PSU)Service Employees International Union (SEIU), Local 721You will elect medical coverage directly with CalPERS during the CalPERS Open Enrollment period:September 21–October 16, 2020. Please visit CalPERS online at: http://www.calpers.ca.gov or call (888) 225-7377.You may elect vision and dental benefits separately through the County of Riverside as described in this guide.All eligible County retirees are eligible to elect the County’s self-insured Exclusive Care medical plan, including retireeswho are eligible for CalPERS medical plans.2021 COR Retiree Guide1

What’s New in 2021?LIUNA retirees – The following plans will not be offered beginningJanuary 2021: UnitedHealthcare SignatureValue Full HMO network and United HealthcarePPO plans offered to pre-Medicare retirees UnitedHealthcare Coordination of Benefits plans (Indemnity, EPO and PPO)for Medicare-eligible retireesIf you’re currently enrolled in one of these plans, you must select a newplan during this enrollment period.The Kaiser Permanente Senior Advantage and UnitedHealthcareMedicare Advantage plans will include new supplemental benefits: Post-hospital discharge meal delivery Post-hospital discharge transportation Routine transportation to medical careThings to Consider Before EnrollmentYour enrollment guide provides basic information about your Countysponsored medical, dental and vision care plans, including resources thatyou may need to evaluate your options. Use the guide to learn more aboutthe benefit options available to you.You were also sent a personalized enrollment letter which shows yourcurrent coverage. Take the time to review each document to make sureyou have coverage that meets your needs. (Note: If you’re enrolled in aCalPERS medical plan, your medical plan information will not appear onyour personalized enrollment letter.)Here are a few things you might consider about your health and financialneeds before you select benefits for the coming year: Does your current benefits coverage meet your needs? Are your current prescription drugs covered under the plan you have orthe plan you’re considering? Is your CalPERS warrant sufficient to cover your premium? Are you or your dependent(s) newly eligible for Medicare, or will youbecome eligible this year? Does the plan’s premium cost fit your budget? Have your health care needs changed? Has your marital status changed? Have your eligible dependents changed?If you decide that you would like to change your elections, you can indicateyour new choices on the Retiree Benefit Election Form was mailed to you.Note: You do NOT need to submit a new election form if you are notmaking any changes to your current coverage.22021 COR Retiree Guide

YOUR COUNTY OF RIVERSIDE BENEFITSHow to EnrollDuring Annual Enrollment, you can: Choose a different plan or cancel your medical, dental or vision plan; Add or delete coverage for an eligible dependent; or Do nothing and your current health care coverage will continue as longas you and your dependents remain eligible.IF YOU ARE MAKING CHANGES TO YOUR BENEFITS,ENROLLING IS FAIRLY STRAIGHTFORWARD.Just follow this checklist:C omplete any additional enrollment forms required by the plan you’veselected. These additional forms are generally required if you oryour dependent is over 65 and/or eligible for Medicare and you areenrolling in or dis-enrolling from one of the following plans:a. UnitedHealthcare Medicare Advantage Plan,b. K aiser Senior Advantage High Option or Low Option,c. Scan HMO.We will not be able to process your medical plan enrollment withoutthese completed forms. You must also provide a copy of theMedicare card that verifies enrollment in Parts A and B. To obtain acopy of these additional forms, please call the Benefits InformationLine at (951) 955-4981, option 1.O nce you have chosen your benefits, add up all of your costs.Your benefit costs will continue to be deducted monthly, wheneverpossible, from your CalPERS pension warrant for 2021. Remember,we will reduce the cost of your medical premium by applying yourCounty retiree contribution that’s shown on your personalizedenrollment statement.REMEMBERUnless you’re currentlyenrolled in the County’sUnitedHealthcare SignatureValue Full HMO networkor PPO plan, if you do notwish to change your benefitelections, you do not needto complete a Retiree BenefitElection Form for the 2021plan year.B e sure to provide your current dependent information.S ign and date each of your completed forms.A ttach copies of documentation that verifies the eligibility of yourdependents, if any.M ake a copy of your form(s) and any documentation for your records.S ubmit your benefit forms to the County of Riverside Benefits Divisionno later than October 9, 2020.FOR MORE INFORMATIONVisit the County’s benefits website at http://benefits.rc-hr.com formore information about your benefit options, including eligibility rules,plan descriptions and plan comparison charts.2021 COR Retiree Guide3

How Your Medicare Eligibility Affects Your Choice of PlansThe County medical plans available to you depend on your age, your eligibility for Medicare and where you live. If youare enrolling dependents, you must also consider their ages, eligibility and residence to make sure that you enroll in aplan that is appropriate for you and your eligible dependents.FOR RETIREES WHO ARE NOT ELIGIBLE FOR MEDICAREIF YOU ARE UNDER AGE 65 AND ARE NOT ELIGIBLE FOR MEDICARE, YOU CAN ENROLL IN THESE PLANS:If you live in the plan’s service area Exclusive Care EPO UnitedHealthcare SignatureValue Alliance HMO Kaiser Permanente HMOFamily members who are Medicare-eligible will be enrolled in the Medicare version of the plan you select. For example,if you are not Medicare-eligible and choose the Exclusive Care EPO plan, your spouse who is eligible for Medicare willbe enrolled in the Exclusive Care Select Medicare Supplement Plan. If your dependent is over age 65 but not enrolled inMedicare Parts A and B, your premium will be higher. Please contact the Benefits Information Line for options and costs.FOR RETIREES WHO ARE ELIGIBLE FOR MEDICAREIF YOU AND/OR YOUR DEPENDENTS ARE ELIGIBLE FOR MEDICARE, YOU CAN ENROLL IN THESE PLANS:If you live in the plan’s service area Exclusive Care Select Medicare Coordination Plan,available nationwide Exclusive Care Select Medicare Supplement Plan,available nationwide aiser Senior Advantage HMO - High OptionKKaiser Senior Advantage HMO - Low OptionUnitedHealthcare Medicare Advantage HMO PlanSCAN HMOChoose one of these plans if you—or one or more of your dependents—are eligible for Medicare. Family members whoare not Medicare-eligible will be enrolled in the non-Medicare version of the plan. For example, if you are Medicareeligible and choose a Kaiser Senior Advantage plan, your dependents who are not eligible for Medicare will be enrolledin the Kaiser Permanente HMO plan. (Keep in mind that you and your dependents may be enrolled in plans with differentcopayments for this reason.) The one exception is the SCAN plan, which is open to Medicare-eligible members only andhas no non-Medicare counterpart. If you are eligible for Medicare but your dependents are not, you cannot enroll in theSCAN plan.42021 COR Retiree Guide

YOUR COUNTY OF RIVERSIDE BENEFITSCost of CoverageMONTHLY PLAN COSTS FOR EARLY RETIREESThe following rates are the total costs for premiums prior to the County contribution. Refer to the Countycontributions shown on your personalized enrollment form to determine how much the County willcontribute toward your medical coverage, and deduct it from the monthly rates listed below.MEDICAL PLANS FOR RETIREES AND DEPENDENTS WHO ARE UNDER AGE 65 AND NOT ELIGIBLE FOR MEDICARE*2021 RateExclusive Care EPORetiree only 1,286.00Retiree plus one dependent 2,619.62Retiree plus family 3,295.45UnitedHealthcare SignatureValue Alliance HMORetiree only 1,211.26Retiree plus one dependent 2,407.94Retiree plus family 3,126.30Kaiser Permanente HMORetiree only 1,081.27Retiree plus one dependent 2,157.90Retiree plus family 2,802.00* If you or your dependents are OVER age 65 and you are NOT eligible for Medicare, please contact the Benefits Information Line forassistance calculating your rate.MONTHLY COUNTY CONTRIBUTIONSWhen you enroll in a County-sponsored medical plan, either when you retire or during a subsequent AnnualEnrollment, the County will make a monthly contribution toward your medical plan premiums. The amount of themonthly contribution is based on the bargaining unit or employee group you were in at the time of your retirement.The monthly contributions are as follows:Bargaining Unit at RetirementCounty ContributionConfidential 256DDAA (Prosecution) 256Elected Officials 256LEMU 143LIUNA 25Management 256RSA Public Safety 143SEIU 143Unrepresented 256FOR MOREINFORMATIONVisit the County’sbenefits website athttp://benefits.rc-hr.comfor more information aboutyour benefit options.2021 COR Retiree Guide5

MONTHLY COSTS FOR MEDICARE-ELIGIBLE RETIREESMedical Plans for MEDICARE-ELIGIBLE Retirees2021 Monthly Plan CostsExclusive Care Select Medicare Coordination Plan and Combination RatesRetiree only, 65 and over with Medicare Parts A and B 1,201.87Retiree plus one dependent, one over 65 with Medicare Parts A and B 2,540.80Retiree plus one dependent, both over 65 with Medicare Parts A and B 2,403.71Exclusive Care Supplement Plan and Combination RatesRetiree only 598.33Retiree and spouse, one with Medicare 1,931.96Retiree and spouse, both with Medicare 1,197.11Note: Participants who are under age 65 and are not eligible for Medicare will be enrolled in the Exclusive Care EPO plan. Participants must live within theplan’s service area.Medical Plans for MEDICARE-ELIGIBLE Retirees2021 Monthly Plan CostsUnitedHealthcare Medicare Advantage HMORetiree only 423.31Retiree and spouse (one with Medicare) Alliance Network 1,634.57Retiree and spouse, both with Medicare 846.62Medical Plans for MEDICARE-ELIGIBLE Retirees2021 Monthly Plan CostsSCAN HMORetiree only 319.87Retiree plus one dependent (both with Medicare Parts A and B) 639.74Note: You and your dependent must be eligible for Medicare to enroll in this plan.Note: If you or your dependents are OVER age 65 and you are NOT eligible for Medicare, please contact the BenefitsInformation Line for assistance. The rates listed are the most frequently used rates. If your specific Medicare status is notlisted above or if you are not sure what your rate will be, please call the Benefits Information Line at (951) 955-4981. We’llbe happy to assist you.If retiree is non-Medicare and spouse is Medicare, rates may be up to 2.00 higher.62021 COR Retiree Guide