Administered by Via Benefits

UC sponsors a Medicare Coordinator Program for Medicare-eligible retirees and their eligible family members who live in a state outside California.

This program offers retirees and their covered family members:

  • Choice: more local plans, including Kaiser, where available
  • Value: plans to fit every budget
  • Flexibility: family members can choose their own plans to meet individual needs
  • Personalized support from Via Benefits

Who’s eligible: To be eligible for this program, retirees and all covered family members must:

  • Be eligible for and enrolled in Medicare Parts A and B
  • Live in a state outside California
  • Be eligible for UC retiree health insurance

You are not eligible for this program if you are a recipient of UCRP Disability income, or if you or your family member's eligibility for Medicare is due to a disability such as end stage renal disease (ESRD).

Questions?

Contact Via Benefits at 855-359-7381 (TTY: 711), Monday through Friday, 5 a.m. to 6 p.m. (PT) or visit my.viabenefits.com/uc

How the program works

UC has retained Via Benefits to assist retirees who live outside California. Via Benefits is a specialist in helping retirees choose individual Medicare plans and providing support after enrollment, including help with coverage, claims, and network questions.

If you are eligible, your enrollment in an individual medical plan through Via Benefits will be paired with a Health Reimbursement Account (HRA), with a maximum annual contribution of $3,000 from UC. 

In most cases, the HRA funds provided by UC will cover the cost of the premiums as well as some additional out-of-pocket health care costs (such as Medicare Part B premiums and copays for your medical care). You pay your eligible expenses first, and then request reimbursement from your HRA.

If Medicare-eligible family members – such as a spouse or domestic partner – are covered, UC will also contribute up to an additional $3,000 towards their combined HRA. There is one HRA account per family, which can be used for the out-of-pocket health care costs of one or both participants. The amount of the HRA contribution from UC is based on graduated eligibility rules.

To qualify and maintain eligibility for HRA funding, you must continue paying your Medicare Part B premiums to Social Security and enroll through and work with Via Benefits to make any changes to your medical plan at all times. Working directly with a carrier, except with Kaiser Permanente, will terminate your HRA funding. See Enrolling in Kaiser for more information about the steps you need to take to enroll in Kaiser and set up your HRA funding.

After enrollment, Via Benefits will send a Funding Guide to Reimbursement with the instructions and forms you need to manage your HRA and request reimbursement for your eligible expenses.

You can submit reimbursement requests to Via Benefits for out-of-pocket expenses as you incur charges, or you can provide them later. The deadline to submit reimbursement requests for a plan year is Dec. 31 of the following year. For example, claims for charges incurred in 2020 should be submitted to Via Benefits by Dec. 31, 2021.

Keep your original receipts and documents; you only need to provide copies to Via Benefits for reimbursements. 

Eligibility for the Medicare Coordinator Program is determined, and shared with Via Benefits, on a monthly basis. Eligibility can be triggered by any of these events:

  • Retirement
  • New address outside California
  • Medicare eligibility of the retiree and all covered family members
  • Child turns 26 and is no longer eligible for UC health coverage 

If you cover yourself only, Via Benefits will reach out to you as soon as you are identified to be potentially eligible for the program. Communications may begin the year you turn 64, to ensure you have plenty of time to prepare. 

If you are covering one or more family members, you will start to receive regular communication from Via Benefits as soon as your entire family is identified to be potentially eligible for the program. Your family's eligibility is based on the youngest family member's Medicare-eligibility date, or the date your child becomes ineligible for UC group coverage (turns 26).

What to expect if you become eligible due to age

Depending on the time of the year you and/or your family members turn 64, within months before your 65th birthday you'll receive:

  • A series of quarterly letters preparing you for your Medicare plan enrollment through Via Benefits
  • A Via Benefits Enrollment Guide which will provide you with information on what to expect and how to best prepare for your enrollment
  • Phone calls from Via Benefits customer service representatives to ensure you have Medicare Parts A & B in place before your 65th birthday, and to answer any initial questions you may have

What to expect if you become eligible because you've moved outside of California

Depending on the time of the year you notify UC of your new address, within a month you'll receive:

  • A Via Benefits Enrollment Guide which will provide you with information on what to expect and how to best prepare for your enrollment
  • Phone calls from Via Benefits customer service representatives to answer any initial questions you may have

After your Medicare enrollment through Via Benefits, you will receive a Funding Guide to Reimbursement with important information and all relevant documents necessary to access your HRA funds.

What you need to do

  • Make sure your address and contact information is current with UC. To make corrections, visit UC Retirement At Your Service (UCRAYS).
  • Make sure you and your spouse or domestic partner enroll in Medicare as soon as you become eligible. If you do not qualify, check and see if you may be eligible under a former, current or deceased spouse. Call Social Security for more information.
  • Read all correspondence from UC and Via Benefits to best prepare you for your continued medical plan insurance after your 65th birthday.
  • Remember that your enrollment through Via Benefits qualifies you for the HRA. Therefore, work directly with Via Benefits to enroll and or to make changes to your plan or coverage to ensure you do not lose your HRA funds. Do not enroll directly with the carrier unless it is Kaiser Permanente (see Enrolling in Kaiser).  

Contact the UC Retirement Administration Service Center (RASC) if you believe you are eligible for the Medicare Coordinator Program and did not receive an enrollment packet from Via Benefits, or if you received an enrollment packet but you do not believe you are not eligible.

Every fall, you’ll have an Open Enrollment period extending from October 15 to December 7. Watch your mail for information from your current plan and Via Benefits. If you are happy with the plan you have, you do not need to take any action. If you choose to make changes to your Medicare plan, make sure you work with Via Benefits so you do not lose your HRA eligibility. Your Open Enrollment plan election becomes effective January 1 of the following year. 

Kaiser Permanente Medicare Plus is available if you live in a zip code that offers Kaiser Medicare plans. Your Kaiser enrollment makes you eligible to receive the UC contribution to the HRA. It is important that you follow the process below for enrolling in a Kaiser plan to set up your HRA:

  • Call Via Benefits and tell them you are interested in enrolling in Kaiser.
  • The Via Benefits benefit advisor will give you the appropriate Kaiser number to call.
  • Call Kaiser and complete the enrollment.
  • Once enrolled, call Via Benefits to let them know you are enrolled with Kaiser.  Be prepared to provide your Kaiser identification number.
  • Via Benefits will then set up your HRA.

Note: UC does not permit direct enrollment through any other carrier/broker outside of the Via Benefits Individual Marketplace, only Kaiser.