Medicare Open Enrollment Election

A short description to explain the nature of a ticket.
To view your current benefits, log in to Web Views and select Flexible Benefits View under the Self-Service Section

Please Note: If you are already enrolled in Special Medicfill with prescription drug coverage, and wish to transition to the Freedom Blue Plan, no action is required; you do not have to complete this form. 

OPTIONS AND MONTHLY COST

Retiree Coverage - Highmark Blue Cross Blue Shield (BCBS) Delaware’s Freedom Blue PPO Medicare Advantage with prescription drug (Part D) coverage - $11.34 monthly cost (Zero monthly premium cost for retirees who retired on or prior to July 1, 2012).

Dependent Coverage - Highmark Blue Cross Blue Shield (BCBS) Delaware’s Freedom Blue PPO Medicare Advantage with prescription drug (Part D) coverage - $11.34 monthly cost (Zero monthly premium cost for dependents of retirees who retired on or prior to July 1, 2012).

To update your ACH Banking information, please complete and the attach the Direct Payment Authorization form.

Spousal Coordination of Benefits Policy

If you are covering your spouse under a University health plan, we also want to share some very important information with you about the Spousal Coordination of Benefits Policy. This policy affects how health insurance benefits payments are made for spouses who are eligible for, but not enrolled in, coverage through their employer. According to this policy, if your spouse works full-time and would pay 50% or less of the total premium for individual coverage (premium based on the lowest-cost individual plan available through their employer), s/he must enroll in their employer’s health plan. If your spouse meets the above criteria, but does not enroll in his/her employer’s health plan, the University’s plan will pay only 20% of allowable charges. Misinterpretation and/or failure to comply with this policy may have significant financial implications for you. Information on this policy is available on the State of Delaware Department of Human Resources website.

Questions regarding the Medicare Advantage Freedom Blue PPO plan contact Highmark BCBS Delaware Concierge team at 1-888-328-2960 (TTY call 711), seven days a week, 8 a.m. to 8 p.m.
Questions about this form or your benefits, please contact HR at hrhelp@udel.edu or call 302-831-2171.
 

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