Retirees
Summary of Benefits
- 2021 ASE Schedule of Benefits – Medicare Primary Retiree
- 2021 PSE Schedule of Benefits – Medicare Primary Retiree
- 2020 ASE Schedule of Benefits – Medicare Primary Retiree
- 2020 PSE Schedule of Benefits – Medicare Primary Retiree
Rates
- 2021 Plan Year
- PSE
- 2021 Plan Year- Non-Medicare Retirees – PSE
- 2021 Plan Year – Medicare Retiree – PSE
- ASE
- 2021 Plan Year- Non-Medicare Retirees – ASE
- 2021 Plan Year – Medicare Retiree – ASE
- 2021 Plan Year – Medicare Retiree with ARBenefits Drug Coverage – ASE
- 2020 Plan Year
- PSE
- 2020 Plan Year- Non-Medicare Retirees – PSE
- 2020 Plan Year – Medicare Retiree – PSE
- ASE
2020 Plan Year- Non-Medicare Retirees – ASE
2020 Plan Year – Medicare Retiree – ASE
Retiree Forms and Resources
General Forms
- Affidavit of Spousal Coverage Form
- Authorization to Release Information
- Bank Draft Authorization Form
- Retiree Change of Address Form
- Retiree Health Enrollment and Instructions
- State Retiree Packet
- School Retiree Packet
- Retiree Election Form
