Distribution Center Retiree

When you retire, you must complete an election form within 31 days of your retirement date to continue the medical plan you had as an active employee. The plan you select will remain your coverage until you turn age 65, unless you waive or terminate coverage or switch to a lower-cost plan in a future year.

To find your specific plan details below, you’ll need two pieces of information: your medical plan name and SBC number. Both are listed in the benefit letter LS&Co. mails to your home each October.

Below are the available plans:

1. UHC Choice Plus Plans:
   • Summary of Benefits and Coverage – 023
   • Summary of Benefits and Coverage – 024
   • Summary of Benefits and Coverage – 025
   • Summary of Benefits and Coverage – 026
2. UHC Indemnity Plans (these plans are not open to new retirees):
   • Summary of Benefits and Coverage – 028
   • Summary of Benefits and Coverage – 030
3. Blue Cross and Blue Shield of New Mexico

You can switch to a medical plan with a lower premium if the annual rate becomes too much for your budget. You can also terminate coverage at any time or use a one-time waiver. However, please note: if you terminate coverage, re-enrollment in the plan will not be permitted.

[link to Making a change content section]

Medical ID card

Use your medical ID card for all medical claims. Do you need care before your card arrives? Give your medical provider your retiree medical plan ID number: UHC plans (923812) or BCBS Mexico (20168300).

Important: Turning 65?

If you’re approaching 65, plan ahead. Your LS&Co. retiree medical coverage will end the month before your 65^th birthday. If you don’t enroll in Medicare before your LS&Co. retiree medical coverage ends, you’ll have no health care coverage. You are eligible to enroll in Medicare six months prior to and six months following your 65^th birthday. It’s best to apply early to ensure coverage.

[Link to > Turning 65 soon content]

All retiree medical plans offered by LS&Co. include prescription drug coverage.

If you’re enrolled in a UHC medical plan, your coverage is provided through Optum Rx, a national pharmacy benefit manager. Your drug cost depends on the service you use (retail or mail order), the type of drug, and where it falls on the list of preferred prescription drugs. Optum Rx also covers a 90-day supply at retail pharmacies for the same discounted mail-order rate.

The Blue Cross and Blue Shield of New Mexico medical plan includes prescription benefits as well, but you must use BCBS-network pharmacies for full benefits. 

Optum Rx ID card

You must use your Optum Rx ID card for all prescription claims — it’s the only way to get coverage.

• Call Optum Rx at +1-855-475-5082
• Give providers your Optum Rx retiree medical plan ID (923812) if you need care before receiving your ID card

Questions about your prescriptions?

Connect with Integrity Pharmaceutical Advisors (IPA) when you need help. For example, if coverage was denied, you didn’t receive a mail-order refill, or a prescription cost more than expected; IPA Concierge can be your advocate.

Registered pharmacists are ready to help you navigate any challenges — at no cost to you.

• Call IPA at +1-855-980-2064
• Schedule a consultation on calendly.com/LeviStrauss/appointment

You and LS&Co. share the cost of retiree medical and prescription coverage.  

The amount you pay for coverage depends on:

• Your years of service
• The total cost of your plan (you pay 100% of costs that exceed LS&Co.’s annual per-person maximum)

How medical premiums work

• Monthly premium covers medical and prescription drug benefits
• Per-person rates (you pay separately for yourself and your spouse/partner, so premiums may differ)
• Children are covered at no additional charge (it’s free coverage) regardless of whether you cover one or more
• Premium deducted from your pension check or paid directly to Inspira Financial

Remember

• Premiums may change annually
• You can change retiree medical plans only if you move to a lower-premium plan
• Learn how to check deductions, set up payments, or pay a bill

We’ve partnered with Allsup Benefits Coordination to ensure you have access to the best, most cost-effective health insurance options. A dedicated specialist will consult with you about your health plan decisions. LS&CO covers the service cost, so it’s completely free to you.

How Allsup Helps

Your benefits expert will:

• Walk you through available medical plans
• Compare our plans to Medicare options
• Help you find the most cost-effective coverage for you and your family
• Guide you through enrollment

Why Allsup?

Allsup is a premier nationwide provider of healthcare benefits services, having helped more than 150,000 people enroll in Medicare.

Get Started Today

Call 888-271-1173 or chat at allsuplls.com
Monday–Friday, 8 a.m.–5 p.m. Central time

Your coverage needs may shift as life changes. You can make changes to your coverage for yourself or your dependents anytime, for any reason. Contact Ask HR to waive or terminate coverage, or switch to a lower-cost plan.

Terminate coverage

You can end coverage for yourself and your dependents anytime, for any reason. Keep in mind that once you terminate, you and your dependents can never reenroll in LS&Co. retiree health benefits.

Waive coverage

You can waive retiree coverage, with the opportunity to elect coverage at a later time. Your dependents’ coverage is also waived. This is a one-time opportunity to waive coverage. To reenroll, contact Ask HR.

You must waive your LS&Co. health benefits if you take another job with group health benefits. Contact Ask HR as soon as possible. To reenroll in LS&Co. retiree health benefits after your other coverage ends, notify within 31 days of when your other coverage ends.

Switch to a lower-cost plan

You can switch to a medical plan with a lower monthly premium if your needs change. Your dependents’ coverage will change with yours, and your pension deductions will be adjusted accordingly.

If you’re approaching 65, plan ahead. Your LS&Co. retiree medical coverage will end the month before your 65^th birthday. If you don’t enroll in Medicare before your LS&Co. retiree medical coverage ends, you’ll have no health care coverage. You are eligible to enroll in Medicare six months prior to and six months following your 65^th birthday. It’s best to apply early to ensure coverage.

Medicare eligibility

As a reminder, the following are requirements for Medicare eligibility:

• You are a U.S. citizen or are lawfully present in the U.S.
• You live in the plan’s service area
• You are entitled to Medicare Part A and enrolled in Part B (visit ssa.gov to enroll)
• You keep paying your Medicare Part B premiums, unless they are paid by Medicaid or through another third party

• Learn about Medicare eligibility and important deadlines

Important deadline

Apply for Medicare at least three months before the later of your 65^th birthday or retirement date. Missing your enrollment window may result in late-enrollment penalties and gaps in coverage.

To avoid penalties, contact Medicare directly at least three months before you need coverage to request the Medicare Request for Employment CMS L564 form. Complete and return the form to Centers for Medicare & Medicaid Services (CMS) as instructed. This form provides a special enrollment period and helps you avoid late-enrollment penalties.

You are responsible for all Medicare enrollment processes. LS&Co. is not involved in Medicare enrollment.

Enrollment timeline

Reminders

• Mark your calendar now
• Notify Ask HR once you’re enrolled
• Miss the window? You may face late-enrollment penalties

Once you turn 65, you’ll need to enroll in Medicare, or you’ll have no medical coverage.

Your United Healthcare (UHC) medical plan becomes Prescription Only coverage through OptumRx, with the effective date of your Medicare coverage. You are automatically enrolled in this prescription coverage when you turn age 65. [Link > Rx content]

Your medical coverage options once you are 65 or older:

• Medicare Parts A and B
  Medicare covers hospital stays and medical services.
  Part A: Hospital insurance
  Part B: Medical insurance
• Medicare Advantage Plans (in the marketplace)
  These plans combine Parts A and B and are offered by private insurance companies through the marketplace. Most include prescription drug coverage (Part D) and may offer extra benefits like dental, vision, and hearing services.

How to apply for Medicare

You automatically receive a Medicare application when applying for Social Security benefits. If you decide to defer your Social Security benefits, initiate your Medicare enrollment with Social Security by phone or online.

• Get the complete Medicare guide
• Medicare online or call +1-800-MEDICARE
• Social Security Administration online or call +1-800-772-1213

When you turn 65, you’ll need prescription drug coverage to avoid gaps in benefits and to avoid potential Medicare penalties. That’s why we offer prescription drug coverage to retirees enrolled in a LS&Co. United Healthcare Plan. You pay full premiums for this coverage.

Automatic coverage while you decide

To ensure you have continuous prescription coverage, LS&Co. automatically enrolls UHC medical plan participants in prescription coverage through Optum Rx when you (or eligible dependents) turn 65. This gives you time to explore your options and decide what works best for you. Your drug cost depends on where you fill prescriptions (retail or mail order) and the type of drug.

You can waive or terminate this automatic prescription coverage at any time.

Optum Rx ID card

You must use your Optum Rx ID card for all prescription claims — it’s the only way to get coverage.

• Call Optum Rx at +1-855-475-5082
• Give providers your Optum Rx retiree medical plan ID (923812) if you need care before receiving your ID card

Questions about your prescriptions?

Connect with Integrity Pharmaceutical Advisors (IPA) when you need help. For example, if coverage was denied, you didn’t receive a mail-order refill, or a prescription cost more than expected; IPA Concierge can be your advocate.

Registered pharmacists are ready to help you navigate any challenges — at no cost to you.

• Call IPA at +1-855-980-2064
• Schedule a consultation on calendly.com/LeviStrauss/appointment

Your long-term prescription coverage options

• Enroll in a Medicare Part D prescription drug plan, or
• Enroll in a Medicare Advantage plan that includes drug coverage

Important: If you go longer than 63 days without prescription drug coverage, you may face late-enrollment penalties and higher premiums.

About creditable coverage

Prescription coverage through LS&Co. is considered “creditable coverage,” meaning it meets Medicare standards and is expected to pay out as much as standard Medicare drug coverage. This protects you from paying a higher premium (Part D penalty) if you enroll in Medicare Part D later. 

• Get the complete Medicare guide
• Medicare online or call +1-800-MEDICARE
• Social Security Administration online or call +1-800-772-1213

We’ve partnered with Allsup Benefits Coordination to ensure you have access to the best, most cost-effective health insurance options. A dedicated specialist will consult with you about your health plan decisions. LS&CO covers the service cost, so it’s completely free to you.

How Allsup Helps

Your benefits expert will:

• Walk you through available medical plans
• Compare our plans to Medicare options
• Help you find the most cost-effective coverage for you and your family
• Guide you through enrollment

Why Allsup?

Allsup is a premier nationwide provider of healthcare benefits services, having helped more than 150,000 people enroll in Medicare.

Get Started Today

Call 888-271-1173 or chat at allsuplls.com
Monday–Friday, 8 a.m.–5 p.m. Central time

Get immediate savings on eye care and eyewear through VSP’s trusted network of doctors:

Choose VSP’s extensive network of private-practice doctors and retail chains — convenient locations, easy access:

• Visionworks
• Walmart
• Costco and Sam’s Club
• Pearle Vision
• AccuVision
• Rosin Eyecare
• MyEyeDr.
• EyeCare Centers

Plus, thousands of independent VSP network doctors nationwide.

TruHearing offers up to 60% off hearing aids for all VSP members and their families. Pro tip: Check first — hearing aids are usually covered by your medical plan. Visit vsp.com to learn more (including information on non-VSP providers).

Get started

Find a VSP network doctor at vsp.com or call +1-800-877-7195.

Tell your VSP network doctor that you’re a VSP member to save immediately on your eye exam and eyewear.

Take advantage of your VSP Vision Savings Pass over and over — use is unlimited on materials.

Contact VSP

• Visit vsp.com
• Call +1-800-877-7195

LS&Co. provides you with $2,000 basic term life coverage — at no cost to you. The benefit is paid to your beneficiary on file after your death. Keep your beneficiaries current so your insurance goes to your intended loved ones.

If you enrolled in supplemental life at retirement for $8,000: 

• You can’t change your coverage level
• Cost for coverage is deducted from your monthly pension check or through Inspira Financial
• You can terminate your coverage anytime but will not be able to re-enroll

How to name, add, or update life insurance beneficiary

• Complete the Beneficiary Designation form
• Email completed form to Ask HR or fax to Ask HR at +1-415-978-9853
• You can also mail to:
  Levi Strauss &Co.
  Attention: Ask HR
  P.O. Box 2079
  Fort Lee, NJ 07024-2079