IBM — 2011 Guide to Benefits Enrollment for IBM Retirees Eligible for Medicare
Change Language:
What’s New For 2011

Retiree Health AccessSM

For 2011, IBM will offer four medical options through our association with Retiree Health AccessSM, a national initiative/program sponsored by the Human Resources Policy Association (HRPA) that combines the buying power of many large employers.

• NEW! Aetna MedicareSM Plan (PPO)

• Aetna MedicareSM Plan (HMO)

• Aetna Traditional Choice® Medicare Integration Plan A

• Aetna Traditional Choice® Medicare Integration Plan B

The Aetna MedicareSM Open Plan (PFFS) will no longer be available as of Jan. 1, 2011, because of a new federal law that requires group PFFS plans to include a provider network.

The new Aetna MedicareSM Plan (PPO) offers many of the same features as the Aetna MedicareSM Open Plan (PFFS). This PPO Plan has a large national network of Aetna Medicare providers. You have the fl exibility to use providers either in or out of the plan’s network. Since the plan has an extended service area, you won’t pay a higher cost share when receiving covered services from non-network providers. You will receive all covered services at the in-network level of benefi t. This means that you have the same freedom of choice that was available through the Aetna MedicareSM Open Plan (PFFS).

More information on this new option is available, beginning on page 6.

Contribution-Free Medical Coverage Remains

In 2011, the IBM Medical Supplement option will once again be available at no cost for retiree-only coverage.

(Please note that this does not apply for retirees eligible for the Special Retiree Medical Option (SRMO) or Access-Only and retirees eligible for benefi ts under the Future Health Account.) Coverage information begins on page 4 of this guide.

100% Coverage for Routine Preventive Care and Primary Care

At IBM, we know that investing in prevention and wellbeing makes sense because those who receive regular care and discover health problems early tend to get well faster and spend less on medical care.

In 2011, IBM will provide 100% coverage for routine preventive care and primary care under the following IBM medical options:

• IBM Medical Supplement

• IBM Medical/Prescription Drug Supplement

• IBM Medical/Prescription Drug Supplement Plus

Note: Dependents who are not eligible for Medicare must use an in-network provider to receive 100% coverage for preventive care and primary care.

Routine Preventive Care

Routine preventive care services will be covered at 100%. Examples of eligible services, such as those recommended by the U.S. Preventive Services Task Force, include: annual physical exam, annual OB/GYN exam, immunizations/vaccines, routine mammography, pap smear, prostate cancer screening, skin cancer screening, colorectal cancer screening, cholesterol screening, hypertension screening, and certain other routine preventive services and screenings that are a part of a checkup or physical exam.

Keep in mind that if you receive routine preventive services as part of a diagnosis or treatment, you will be required to pay any applicable deductible and coinsurance or copayment. Benefits are paid based on medical billing codes submitted by your doctor or other health care provider; contact your provider directly if you have questions.

Primary Care

Care provided by a primary care physician will be covered at 100%. Primary care physicians include general practitioners, internists, family practitioners, geriatricians, primary care osteopathic physicians, and pediatricians. The doctor may perform tests or request other services (e.g., lab) that will have a separate charge that may be subject to the deductible and applicable coinsurance.

For coverage information for each of your medical options, refer to the enclosed Health Benefit Comparison Charts.

Health Care Reform and Your IBM Retiree Health Benefits

The provisions of the Patient Protection and Affordable Care Act, including the one which allows dependent children to be covered under their parents’ health benefits until they reach age 26, do not apply to retiree health benefit plans.

Annual Deductible and Out-of-Pocket Maximums

Effective Jan. 1, 2011, annual deductible and out-ofpocket maximums will increase for the following IBM medical options:

• IBM Medical Supplement

• IBM Medical/Prescription Drug Supplement

• IBM Medical/Prescription Drug Supplement Plus

Please refer to the enclosed Health Benefit Comparison Charts for the specific annual deductible and out-ofpocket maximum amounts that will apply for each of these options.

Annual Maximum for Prescription Drugs

The IBM Medical/Prescription Drug Supplement has an annual benefit maximum that limits the amount the plan will pay per covered individual each year for eligible prescription drugs. For 2011, this annual maximum will increase; the IBM Medical/Prescription Drug Supplement will pay up to $4,200 per covered individual for prescription drugs. Please refer to the enclosed Health Benefit Comparison Charts for more information about prescription drug coverage available under each IBM medical plan option.

Under the IBM Managed Pharmacy Program, beginning Jan. 1, 2011, you will be able to refill your retail and mail prescriptions when you’ve used 75% of the medication you have on hand.

Employee Assistance Program

All benefits-eligible participants and their eligible family members have access to the Employee Assistance Program (EAP), which offers up to eight counseling sessions per situation per year at no cost to you. This benefit is available regardless of your benefits plan, or even if you elect No Coverage through IBM. To access the EAP, call OptumHealth Behavioral Solutions’ referral line at 800-445-9720 (TTY: 800-525-5668), available 24 hours a day, 7 days a week, and staffed by licensed mental health professionals with clinical experience in treating a range of mental health and substance abuse care needs.

New Look for NetBenefits®

When you log on to, you may notice some changes to the Health & Insurance home page, which has been enhanced to help make the enrollment process easier and more intuitive.

NetBenefits’ new format was designed to provide you with state-of-the-art planning and decision tools in a way that can best help you understand your options, research your choices, and select your benefits for the upcoming year. To guide you through the process, helpful answers to frequently asked questions are offered as you complete each step. And, if you cover eligible family members, you’ll find the new Dependent Information tab on the Health & Insurance home page very helpful in managing personal and coverage information for your dependents.