HIPAA Privacy Notice (210K)

2008 Benefits Summary and Rates
effective July 1, 2008
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 (26K)

Summary Plan Documents (SPD)
COBRA Continuation Coverage (119K) July 2005
Dental Plans (453K) August 2004
Health Maintenance Organizations (324K) July 2003
Vision Plan (288K) July 2005

Point of Service Medical Plans
UnitedHealthcare
Standard (178K) July 2005
High Option (178K) July 2005

Evidence of Coverage
UnitedHealthcare Closed POS Plan (43K)
UnitedHealthcare Open POS Plan (43K)
UnitedHealthcare Select (40K)
Carefirst BlueChoice (563K)
Optimum Choice (85K)
Kaiser Permanente (158K)


MCPS Retirees Association
301-279-3823

Maryland Retired Teachers Association
Membership Application

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

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)

 

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)
UnitedHealthcare Diabetic Vendor List (11K)
UnitedHealthcare Indemnity Evidence of Coverage (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
Caremark Mail Order Form (192K)
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

Vision Care
National Vision Administrators (NVA) MCPS Claim for Vision Care Expense (19K)

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

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

Optimum Choice HMO
(MCPS will no longer participate in the Optimum Choice plan effective 7/1/08. Claims issues for 2007 may be directed to the number below)
1-301-360-8040
1-800-331-2102

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
Caremark Customer Service
1-800-378-7558
8am–10pm (EST); M–F

Retirement System
State Retirement System of Maryland
Mentor Newsletter
Retiree News and Notes

Other Useful Information
Adventist Healthcare