University of Maine System Retiree Health Benefits
Frequently Asked Questions
Below are answers about health plans available for University of Maine System retirees.
Enrollment and Un-Enrollment Questions
Yes, the University of Maine System will provide a letter to you confirming that we have received your request to re-enroll in the University-sponsored group plan. If we have an email address available, this will be sent to your email; otherwise, a letter will be sent to your home.
Retirees and their spouses/eligible dependents must both choose from either the plans available on the Alight Retiree Health Exchange or the University-sponsored Aetna group plan.
Only in situations where both family members are retirees of the University of Maine System can one retiree choose a plan from the Alight Retiree Health Exchange and the other retiree may select Aetna.
Dental Insurance Questions
If you are staying in the Aetna health plan, you may continue coverage in the University of Maine System Cigna dental plan if you are already covered. If you are continuing in the Aetna health plan and did not sign up for a plan through the Alight Exchange, your dental coverage will continue with no action on your part. If you signed up for a health plan through the Alight Exchange and then unenrolled from that to remain in the Aetna plan, you will need to complete the brief enrollment form that includes the option to continue dental coverage. Click here to access the form (External Site).
Medical Insurance Questions
The Center for Medicare Services (CMS) allows for guarantee issue (GI) when a retiree is initially eligible for Medicare (turning 65 or SSA Disabled) or when a group health plan is ending. The same rights are not universally afforded for Medigap plans and may be subject to underwriting. Given the UMS plan is no longer ending, the ‘loss of coverage’ letter is no longer applicable and should not be provided to the Carrier.
If you enrolled in a Medicare Advantage or a Part D prescription plan there is no impact to your guarantee issue protection. However, if you enrolled in a Medicare Supplement product, the answer depends on your state of residence and carrier-specific rules. The vast majority of people will experience no impact at all.
Enrollments completed through Alight Retiree Health Exchange will likely not be reassessed by the respective carrier for underwriting due to this recent change in the UMS Group Health Plan Choice. In rare instances, a carrier may choose to review your application. In this case, the carrier will notify you if they have additional questions. Once you have received confirmation from your carrier that you have been approved, additional documentation will not be requested.
The United States government provides a comprehensive guide for Medicare Services. To access the Medicare and You brochure, visit: https://www.medicare.gov/forms-help-resources/medicare-you-handbook/download-medicare-you-in-different-formats
The State of Maine provides resources for retirees online, visit the Medicare website (External Site) to learn more about Medicare for Maine residents.
Community rating means that the premium prices are the same for all beneficiaries regardless of age or medical condition.
Health Reimbursement Account and Catastrophic HRA Coverage Questions
No. The Health Reimbursement Account (HRA) only applies to individuals enrolled in a plan on the Alight Retiree Health Exchange.
A participant needs to incur $1,500 of drug cost out of their pocket within the calendar year before getting reimbursed 100% for their drug cost for the rest of the year, up to one million dollars. Any drugs not covered under the drug plan’s formulary will not be included in the $1,500 out of pocket tabulation and will not be reimbursable. The $1,500 limit has to be verified through the drug plan’s EOB (Explanation Of Benefits). The EOB is mailed out to the participant each month, in which they fill a prescription using their Part D drug plan. Once the EOB states the participant incurred $1,500 out of their pocket, the participant should notify Alight. The participant will send in a copy of the EOB to Alight for verification. Alight will then set up the drug reimbursement benefit for the participant. Afterward, the participant will send in all out of pocket drug expenses, that are covered under the plan, to Alight for reimbursement.
The participant will be responsible for costs of drugs not on the formulary. That is true in the current group health plan as well. One example of drugs not on a formulary might be drugs in trials that are not yet approved for use. In that case there may be assistance available from the drug manufacturer. Compounded drugs would be another example. If there is a specific specialty drug you are concerned about, check the formulary of the plan you selected.
For all questions related to the HRA accounts, starting January 1, 2021, use the online tools on your Alight account or call Alight Retiree Health Solutions 1-833-704-1028 (TTY 711) • 9 a.m. – 9 p.m. Eastern Time, Monday – Friday • Closed on holidays
Wait until January 1 or later to access your account. HRA accounts are effective 1/1/21.
Future Open Enrollment Questions
There will be an open enrollment in the fall of 2021 and eligible retirees and dependents will be able to select either a plan through the Alight Exchange or the group plan offered by the University of Maine System.
The selection you make for 2021 (Alight plan or UMS plan) will not affect your ability to select among available plans for 2022.
The University of Maine System will continue to offer a group health plan in 2022. Specific information about plan coverages and costs will be available later in 2021.
There will be an open enrollment in the fall of 2021 and eligible retirees and dependents will be able to select either a plan through the Alight Exchange or the group plan offered by the University of Maine System.
Yes, there will continue to be an HRA available to those who enroll in individual plans through the Alight Exchange in 2022. The HRA does not apply to those in the UMS-sponsored group plan.
Billing Questions
Retirees may contact EBPA with questions regarding billing at 1-888-232-3203.
Yes. The University of Maine System will coordinate with EBPA and Aetna to ensure timely and accurate processing of premium billing and related payments during this transition.
Amounts for the Aetna group health plan are available at this University of Maine System benefits page.
Contacts
For questions regarding Medicare, please contact Medicare directly at 1-800-633-4227.
Questions about your insurance coverage should first be directed to the carrier. If the result is not satisfactory, your Alight representative may also provide support in resolving questions.
For pending reimbursement or HRA balance questions, first contact Alight at 1-833-704-1028.
If you are planning to retire and need more information about your retiree benefits, please call the Employee Benefits Center at 207-973-3373.