||Freedom Blue Website
|2015 Rates||Freedom Blue Summary of Benefits|
|2015 Rates - Retired and 70 before 2007||2015 Annual Notice of Change - Freedom Blue Members|
|Retiree Summary Plan Document||PPO Blue Summary of Benefits|
|PPO Blue Retiree Letter
||Signature 65 Retiree Letter
||Freedom Blue Retiree Letter
|2016 Retiree Rates - PPO Blue & Freedom Blue||2016 Retiree Rates - PPO Blue & Freedom Blue|
|2016 Rates Retired and 70 before 2007|
NEW - IRS Forms for 2016
Form 1095 for the Affordable Care Act is often called the “W-2 of benefits”.
Penn State will distribute 1095-C forms in early 2016. You will only receive this form if you are a benefit-eligible employee with the University. These forms are similar to your W-2 and will be required when filing your taxes with the IRS. The 1095-C will be mailed to your home address from Equifax, Penn State’s partner in 1095 form administration.
Zostavax/Shingles Vaccine For Medicare-eligible FreedomBlue PPO members:
This vaccine is covered under the Part D drug benefit. You will pay the $20 prescription copay if you receive the vaccine at a pharmacy that provides them. A great resource for you is the pharmacy at Wegman’s, who has stores across the state of Pennsylvania, for your convenience. To find a Wegman’s pharmacy near you, please use the "Find your store" feature on the Wegman's website.
If you have questions regarding Geisinger physician or coverage of the Zostavax/Shingles vaccine, please call Highmark’s FreedomBlue PPO customer service at (866) 918-5285.
Updated Geisinger Information:
For the Medicare-eligible retirees in the FreedomBlue PPO, effective March 1, 2013, ALL Geisinger physicians and hospitals will be out-of-network providers, as described within. The out-of-network benefit for the FreedomBlue PPO has a maximum out-of-pocket of $500 per person, per year.