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Here are responses from PSC-CUNY Welfare Fund to Questions from the Zoom "chat" asked at the 8/30 & 9/13 Retiree Meetings:
Q: Are PSC retirees still covered by SilverScript? Is that the same as Caremark CVS?
A:The PSC CUNY retirees' prescription drug program continues to be administered by SilverScript (part of CVS Caremark). Regardless of whether retirees choose to enroll in the new MA Plus plan ($0 per member per month) or choose to opt out into the traditional GHI Senior Care plan ($191.57 per member per month), they will still be enrolled in the Fund’s SilverScript plan. This is the same Medicare D plan with the same benefits as the retirees are used to receiving and includes the recent enhancement benefit of a $0 Generic Copay if retirees fill their prescriptions at CVS.
Unlike some other union plans there is no dollar maximum on the Fund’s Medicare D prescription benefits. As the PSC CUNY Trustees intended, the CVS SilverScripts plan is still one of the most generous Medicare Part D Plans offered, and it is offered to PSC CUNY retirees at a $0 premium!
Q: Can the Welfare Fund offer retirees assistance in filling out the opt-out form?
A: The Welfare Fund has issued, by email and hard copy, a step-by-step checklist, which is also available here: How to Enroll or Opt Out of the Alliance Medicare Advantage Plus Program. If you are not sure that the Fund has your correct contact information, please send the correct mail and email contact information to firstname.lastname@example.org.
Q: If a retiree waives NYC HI plan coverage altogether, does s/he lose Welfare Fund coverage?
A: The answer is not entirely clear at the present, but if NYC follows the same rules they are presently enforcing for reimbursement of Medicare B and IRMAA payments, any retiree who waives NYC retiree health care coverage will no longer be eligible for Welfare Fund benefits. The PSC Union is questioning the legality of the City's position on reimbursement of Medicare Part B & IRMAA.
Q: What is the effect of these changes on the PSC-CUNY Welfare Fund Catstrophe Major Medical (CMM) Plan? And on the NYSUT CMM policy?
A: The Fund's CMM plan has value because after meeting the $10,000 deductible--which is not an out-of-pocket deductible but an expense your health care provider may have paid in your behalf--the CMM plan will reimburse for benefits such as convalescent Home Benefits for room and board including supplies up to $400 a week for 52 weeks, as long as the Home is a licensed institution that has a physician on staff. The Legacy Catastrophic Insurance also offers a Home Health Benefit that will pay for home health care treatment up to 300 visits in any 12- month consecutive months. The plan also covers Prescription drug reimbursements for out-of-pocket expenses, oxygen and much more for a period of up to 10 years, as long as there are no 12-month lapse in claims submissions. Note: Retirees covered by the NYSUT Catastrophic policy should review its benefits to see if similar considerations apply.
Here are answers to general questions:
The City’s 5-year contract with the Alliance for the NYC Medicare Advantage Plus (MA+) plan (effective 1/1/22) is not finished and may take until the end of 2021 to finish. Retirees who are currently covered by traditional Medicare plus Senior Care (GHI) for their supplemental coverage have been mailed pre-enrollment information about MA+ (which includes an opt-out form and how to submit it). If you have not received it by September 22nd, contact the Alliance call-in center at 1- 833-325-1190 or visit their website at www.empireblue.com/nyc-ma-plus.
Retirees currently covered by supplemental plans other than Senior Care (GHI) will receive their preenrollment information mailing (including the opt-out form) in late September/early October. If you are not sure what your current supplemental HHI plan is, call Emblem Customer Service 1-212-501-4444 PSC retirees can only opt out for an insurance plan to which they currently (as of 12/31/21) belong or to Senior Care.
If a retiree decides to submit an opt-out form, the covered spouse must submit a separate opt-out form; spouses and 65+ dependents must be in the same plan as retirees for coverage. Under-65 spouses and dependents will continue to be covered by their current HI plan (usually GHI CBP). Retirees who are under 65 or are not eligible for Medicare are not affected by these plan changes. PSC retirees and spouses will continue to be covered by the PSC-CUNY Welfare Fund for their Rx drugs, dental, hearing and vision benefits no matter what NYC health insurance (HI) plan they are in.
Starting Fall 2022, there will be an annual “Transfer Period” for retirees, when retirees can change health plans. Notification about it will be on PSC Welfare Fund and Retiree websites. Retirees enrolled in MA+ will be able to change back to their old plan or to Senior Care; retirees who opted out to stay in their current plan for 2022 will be able to change to MA+.
After 2023, the only plans retirees will be able to transfer into will be MA+ (which is guaranteed to have no premium through 2026) or Senior Care which has a premium. The Senior Care premium is $191.57/month for an individual and $383.14/month for a family/couple. Under ObamaCare, a pre-existing condition cannot be used to deny coverage. 365-day hospitalization rider only applies to retirees currently enrolled in Senior Care and will only apply to them in the future.
If you opt out of MA+ for Senior Care:
• If you already have and pay for the rider if will continue; $2.83/month for an individual, $5.66/month for a family/couple (If you cannot find a current record of payment, it is because retirees are not currently being charged anything for the rider due to an expiring NYC subsidy.)
• If you are not sure if you have the rider now, ask Emblem Customer Service 1-212-501-4444
• If you are opting out for Senior Care in 2022 and want to add the rider, you can do so during November 2021—details about HOW will be posted on PSC Welfare Fund & Retirees websites
Available providers: Medicare is a national program so providers all over the US accept it. To find out about what specific providers are in the MA+ plan, go to the “empireblue” website above, hit “Find Care” in the middle of the 1st page, then enter the zip code and full name of the doctor (omit “Dr.”) or other provider. If they appear, it means they are part of the MA+ network. According to the Alliance, you can also request a paper copy of the directory of providers by zip code (not the whole directory) by calling the Alliance call-in center, above. The directory is also available online, but PSC does not yet have a link to it.
The Alliance is continuing to reach out to providers who are part of their network but may not know it when patients ask about “Medicare advantage”. In early October there will be flyers available for retirees to share with doctors about MA+ and a list of procedures that will require pre-authorization (doctor’s responsibility/not patient’s). The Alliance claims that only about 9% of doctors that NYC retirees use are “out-of-network.” The Alliance reports that negotiations with MSK and HSS for formal contracts are in “the final stages.”
While PSC is asking the Alliance and the City when opt-out submissions will be acknowledged, retirees who are concerned that they may be mistakenly enrolled in MA+ (which is automatic for any retiree who does not affirmatively opt out) can check their Medicare status early in the month of January at www.mymedicare.gov and, if they were mistakenly enrolled in MA+, they have until 1/30/22 to submit an opt-out form.
Premium Payments: If a retiree opts out for a retiree HI plan with a premium, the premium (and the rider cost, if applicable) will be deducted from the monthly benefit check/deposit of TRS (or NYCERS) retirees or paid by TIAA for TIAA retirees. Under the current structure of payments between the health plans, the City and TIAA, if TIAA cannot pay a retiree’s premium, the retiree will be direct-billed. TIAA retirees will not lose coverage because of a lack of funds available. PSC acknowledges that TIAA retirees have raised a number of issues, and the union is pursuing ongoing discussions.
Medicare Part B reimbursement: Under current practice, retirees must belong to a NYC HI plan to be eligible. For further information see the City’s website: https://www1.nyc.gov/site/olr/health/retiree/health-retiree-medb-irmaa.page You can find the necessary forms on the Welfare Fund website.
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