IRS Form 1095-A and 1095-C for 2018
Form 1095 for the Affordable Care Act is often called the “W-2 of benefits”.
IRS Form 1095-A: You will receive a 1095-A if you are participating in a Medicare-eligible retiree plan.
IRS Form 1095-C: You will receive a 1095-C if you are participating in the retiree PPO or PPO Savings Plan.
- Updated November 2018: On November 29, 2018, the IRS extended the due date for the 2018 form 1095-C reporting requirements. This means that the original deadline for issuing form 1095-C to plan participants has moved from January 31, 2019 to March 4, 2019. Even with the extended deadline, Penn State will have the 1095-C forms mailed out in January 2019.
Additional details can be found within the 1095-C FAQs.
Highmark and UPMC
UPDATE: June 25, 2019
The recent announcement of an impending contract with UPMC means that your Freedom Blue PPO plan’s coverage includes continued in-network access to UPMC. More details to follow soon!
|Resources for All Retirees|
|University Health Services Pharmacy||Retiree Billing Lifetime Benefit Solutions Website|
|2019 Rates||Retiree Summary Plan Document|
|Dental & Vision Options for Retirees with PARSE||FAQs|
|Non-Medicare Eligible Summary of Benefits|
|2019 PPO Plan Overview of Coverage Grid||2019 PPO Savings Plan Overview of Coverage Grid|
|Becoming Medicare Eligible Resources||Freedom Blue Resources|
|Freedom Blue Informational Packet||Freedom Blue Website|
|Freedom Blue Application||2019 Highmark Freedom Blue Network Sharing|
|2019 Freedom Blue Summary of Benefits||2019 Freedom Blue Annual Notice of Change|
2019 Retiree Plan Information
- Non-Medicare eligible retirees will remain with Aetna and CVS in 2019 for the PPO Plan and the PPO Savings Plan
- Medicare-eligible retirees will remain covered under the Highmark Freedom Blue PPO for 2019
Below are electronic copies of the letters mailed to retiree homes the week of October 29, 2018. Please click on the letter that is applicable to your retiree status.
- 2019 Freedom Blue Retiree Letter
- 2019 Under 65 Retiree Letter
- 2019 EyeMed Announcement for 2019
Highmark will be issuing new identification cards to all members enrolled in Freedom Blue PPO. Please know there is no change to your information.
Retiring and Over Age 65-Creditable Prescription Coverage
If you are over the age of 65, you may receive a letter from the Department of Health and Human Services stating “it appears you did not have prescription drug coverage that met Medicare’s minimum standards.” The letter goes on to indicate you may be subject to a late enrollment penalty.
If you receive this letter, please complete the form and send it back to Highmark. They will adjust their records accordingly to ensure they reflect your creditable coverage during the time you were enrolled in a Penn State sponsored medical plan. If you have any questions or concerns, please contact HR Services at 814.865.1473.
Becoming Medicare Eligible
Upon becoming eligible for Medicare Parts A and B, your medical coverage is required to change to the University-sponsored Medicare Advantage plan, Freedom Blue PPO offered through Highmark.
In order to enroll in the Penn State Medicare Advantage plan, individuals must enroll in Medicare Parts A and B. If you have not yet received information regarding Medicare Parts A and B, please contact your local Social Security Office as soon as possible.
If it is determined that a retiree is 65 and not currently enrolled in Medicare Part B, Aetna will pay Part B expenses as primary until the member has the ability to enroll in Medicare at the earliest General Open Enrollment period. If the retiree still does not enroll in Medicare Part B, Penn State will cancel the member due to not being enrolled in the correct plan based on their Medicare eligibility.
If a retiree becomes Medicare eligible due to disability, and has not yet turned 65; Part A will pay as primary for hospital services and Aetna will pay as primary for Part B expenses. They will NOT be required to pick up Part B at their next eligibility date and may continue until they become Medicare Part B eligible due to turning 65. Medicare eligible retirees due to disability will have the option of remaining in Part A and continuing on the non-65 retiree plan. However, if they are enrolled in both Medicare Parts A and B, they will be required to move to our Medicare Advantage plan.
The Freedom Blue application must be received in the Penn State Employee Benefits office prior to your 65th birthday with a copy of your Medicare card. Freedom Blue PPO will become your primary coverage for medical and prescription services. Do NOT enroll in a separate Medicare Part D program for prescription drugs. Freedom Blue PPO includes coverage for Part D prescription drugs.
Please contact Freedom Blue PPO at 1-866-918-5285, please have Reference Code: 19FB8428 ready when you call with any questions or concerns regarding the plan.
Retiree Request for Change Form
If you wish to refuse medical coverage, you must complete the Retiree Request for Change Form. Retirees who refuse coverage will not be able to re-enroll at a later date.
Retiree dependent coverage can be added ONLY if the eligible dependent experiences an IRS qualifying life event change. Changes must be requested within 31 days of the event by completing a Retiree Request for Change form. You can also contact Penn State HR Services at 814-8658-1473 to request a copy be mailed to you. The following are examples of IRS-defined life event changes when you are able to add an eligible dependent:
- Employee's legal marital status changes, due to marriage, divorce, legal separation, or the death of a spouse;
- Changes in employment status of a spouse, which can include the ending of their employment, new or different working hours resulting in a change of their employer-sponsored benefits
If your eligible dependent loses coverage and needs to enroll in the Penn State Retiree Medical Benefits as your dependent, please complete the Retiree Request for Change Form. If your dependent is also Medicare eligible, they will also need to complete a Freedom Blue application and provide a copy of their Medicare card outlining the Part A and Part B effective dates.
If you have a dependent child turning age 26, you may be eligible to continue the dependent child coverage if that dependent is physically or intellectually handicapped, so as to be incapable of earning a living when coverage would normally terminate due to age. In order to receive the needed information regarding coverage for a dependent child over the age of 26, you will need to contact HR Services, (814) 865-1473, to initiate a request on the process. Once you initiate the request, Penn State Employee Benefits will be in touch with further information.
After a dependent child is no longer eligible under your retiree plan, they will receive information from Lifetime Benefit Solutions regarding continuation of benefits under COBRA.
Retiree Billing Process
We have contracted with Lifetime Benefit Solutions to administer, bill, and collect the health care premiums from all of our retirees who have the Penn State medical benefit.
- Welcome Letter
- Frequently Asked Questions - Retiree Billing Administrator
Important Notes for Retiree Billing Process
- ACH forms need to be completed with Lifetime Benefit Solutions.
- ACH withdrawals will now be taken monthly.
- Penn State ID’s can be used instead of SSN for Member Portal and ACH-just call Lifetime Benefit Solutions (800) 828-0078.
Retiree Vision Discount Program
Retirees can take advantage of a FREE vision discount program available through EyeMed.
Retiree ID Card
In accordance with HR102, all retirees will be required to surrender their active Faculty/Staff id+ card to their department supervisor. Retirees who meet the years of service requirement are eligible to obtain a new Retiree id+ card after their official retirement date. For more information, please visit Penn State id+ website.
Educational privileges are available to full-time faculty, staff, technical service employees, retirees, and those with Emeritus status, their spouse, and dependent children up to the age of 26. The grant-in-aid benefit is a 75% discount on the tuition charge and applies to World Campus, Penn State resident instruction at all campuses, and Pennsylvania College of Technology. Please see University policies HR36 and HR37 for additional information.
If you have not already completed the dependent verification program within Workday, you will be required to do so in order to maintain the dependent tuition discount. For information on dependent verification, please review information provided in the WorkLion HR portal or contact HR Services.
For more details about the dependent verification program please refer to Eligibility and Dependent Information. Dependents who do not successfully complete the verification will have the tuition discount removed from their accounts and will be responsible for the entire tuition amount.
Please contact HR Services if you have any questions regarding the Grant-in-Aid benefit. After your Grant-in-Aid request is approved, you will see the discount reflected on your next student account statement in LionPATH.
Educational privileges DO NOT apply to courses offered through:
- The College of Medicine, Medical School Program and Physician's Assistant Program, at the Milton S. Hershey Medical Center
- The Smeal College of Business Administration Executive MBA Program
- The Dickinson School of Law and Penn State Law
- Summer camps or workshops operated by the University unless University credit is given and regular tuition is charged
A spouse, except one receiving educational assistance from the University, such as a graduate assistantship, is eligible for the grant-in-aid for any semester or summer session in which classes begin on or after the employee's date of full-time employment. There is no limitation on the number of credits that may be taken. All levels of degrees may be earned. Tuition discounts on Graduate level classes for a spouse are a taxable benefit. For more information regarding taxation on Graduate-level courses for a spouse, please visit the controller's office FAQ.
Eligible dependent children are eligible for any semester or summer session in which classes begin on or after the employee's date of full-time employment. The grant-in-aid applies only toward undergraduate credits only until a Penn State bachelor's degree is attained. The discount does not apply toward Master's level class or higher. Undergraduate classes for dependent children are not a taxable benefit.
Retirees wishing to use the tuition discount for themselves do not need to submit any forms. The discount will automatically be applied through the Bursar's office.
Retirees wishing to extend the tuition discount to an eligible spouse and/or eligible children must complete a Retiree Application for Dependent Grant-in-Aid form
All forms must be submitted within the dates outlined below. (this schedule applies to all eligible Penn State, World Campus, and Pennsylvania College of Technology Classes)
A separate grant-in-aid request must be made on behalf of EACH dependent.
A new grant-in-aid request must be made for EACH semester or summer session.
Grant-in-aid approvals will not be applied retroactively to previous semesters.
Students will be responsible for the full cost of tuition, in accordance with University Bursar policies, if the application procedure is not followed, and/or the application deadlines are not met.
|Semester||First Day to Apply||Last Day to Apply|
|Summer 2019||Monday, February 4, 2019||Wednesday, August 7, 2019|
|Fall 2019||Wednesday, March 20, 2019||Sunday, September 1, 2019|
Zostavax/Shingles Vaccine For Medicare-eligible Freedom Blue PPO members:
This vaccine is covered under the Part D drug benefit. You will pay the $20 prescription copay if you receive the vaccine at a pharmacy that provides them. A great resource for you is the pharmacy at Wegman’s, who has stores across the state of Pennsylvania, for your convenience. To find a Wegman’s pharmacy near you, please use the "Find your store" feature on the Wegman's website.
If you have questions regarding coverage of the Zostavax/Shingles vaccine, please call Highmark’s Freedom Blue PPO customer service at (866) 918-5285.
Important Past Updates
For the Medicare-eligible retirees in the FreedomBlue PPO, effective March 1, 2013, ALL Geisinger physicians and hospitals will be out-of-network providers. The out-of-network benefit for the FreedomBlue PPO has a maximum out-of-pocket of $750 per person, per year.