HIPAA Privacy Notice (210K)

2009 Benefits Summary and Rates
effective July 1, 2009
Retirees 2009
Retiree Health Care Rates 2009 April 2009

2008 Benefits Summary and Rates
Retirees 2008 (361K) April 2008
Retiree Health Care Rates 2008 (22K) April 2008

Frequently Requested Web sites and Phone Numbers (22K)

Benefits at a Glance (22K)

Rates
COBRA Rates effective July 1, 2009
COBRA Rates 2008 (26K)

Summary Plan Documents (SPD)
COBRA Continuation Coverage (119K) July 2005
Dental Plans (453K) August 2004
Vision Plan (288K) July 2005

Evidence of Coverage
UnitedHealthcare Closed POS Plan (43K)
UnitedHealthcare Open POS Plan (43K)
UnitedHealthcare Select (40K)
Carefirst BlueChoice (563K)
Kaiser Permanente (158K)
UnitedHealthcare Indemnity Evidence of Coverage (34K)



 

Enrollment
Retiree Benefit Plan Enrollment-MCPS Form 455-22 (44K)

Dental
Aetna Dental PPO Claim Form (278K)

CareFirst
BlueChoice HMO–Primary Care Physician Selection Form (35K)

UnitedHealthcare
UnitedHealthcare Claim Form (979K)
UnitedHealthcare International Claim Form (139K)

UnitedHealthcare Provider Information
UnitedHealthcare Provider Directory
UnitedHealthcare Provider Nomination Form (34K)


Medicare Information
Medicare Crossover Letter
Medicare Crossover Q&A
Medicare Crossover Enrollment Form

United Healthcare Medicare Information
United Healthcare Medicare Supplement Brochure (72K)

Medicare D
Medicare D Letter

Prescriptions
CVS Caremark Mail Order Form (192K)
CVS Caremark Claim Form (72K)
Caremark AOB Form NEW
Please note: The AOB form must be printed, signed, and mailed with original signature to Caremark at the address below. Electronic signatures are not acceptable.
Caremark
PO Box 659541
San Antonio, TX 78265

CVS Caremark Primary/Preferred Drug List
January 2009

Vision Care
National Vision Administrators (NVA) MCPS Claim for Vision Care Expense (19K)
Opti-Vision Discount Benefits
Lasik Benefits

Life Insurance
Prudential
1-800-732-0416
8am–8pm (EST); M–F

Retirement Forms
State Retirement Direct Deposit Form (150K)
Aetna Direct Deposit Form (161K)
MCPS Employees’ Retirement/Pension System Federal and Maryland State Withholding Request

Life Insurance Beneficiary Form
MCPS Designation of Life Insurance Beneficiary (ies)(16K)

Other Important Information
Social Security Administration
1-800-772-1213
Medicare
1-800-633-4227

Quick Notes
An e-mail service to help retirees stay in touch with MCPS. Click here to register.

Health Plans

Point-of-Service
UnitedHealthcare Select Plus POS Plans  
1-888-607-5214
8am–8pm (EST); M–F
United Behaviorial Healthcare
1-888-291-2507
8am–6pm (EST); M–F

HMO
CareFirst BlueChoice HMO
1-800-296-5555
9am–5pm (EST); M–F
Kaiser Permanente HMO
301-468-6000 & 1-800-777-7902
7:30am–5:30pm (EST); M–F
703-359-7878
5:30am–8:30pm (EST); M–F
7:30am–11:30am (EST); S/S/Hol
UnitedHealthcare Select HMO
1-800-638-1103 (available 7-1-08)
8am–8pm (EST); M–F

Indemnity
UnitedHealthcare Indemnity  
1-866-873-3903
8am–8pm (EST); M–F

Dental Plan
Aetna PPO Dental
1-800-282-0555
8am–8pm (EST); M–F
Aetna DMO Dental
1-800-843-3661
8am–8pm (EST); M–F

Vision Plan
National Vision Administrators
1-800-672-7723
8am–6pm (EST); M–F
8:30am–5pm (EST); Saturday

Prescription Drug Plans
Kaiser Permanente
Refill-By-Phone
1-800-700-1479; Anytime
CVS Caremark Customer Service
1-800-378-7558
8am–10pm (EST); M–F

Retirement System
State Retirement and Pension System of Maryland (SRPS)
1-800-492-5909
Mentor Newsletter
State Retiree Newsletter

MCPS Retirees Association
301-279-3823

Maryland Retired Teachers Association
Membership Application

Other Useful Information
Adventist Healthcare
Smoking Cessation: A Personal Journey