Getting Ready To Retire?

Transcription

1 Chicago Regional Council of Carpenters Welfare Fund Getting Ready To Retire? The Retiree Plan of Benefits Offers Comprehensive Medical and Prescription Coverage Effective January 1, 2011 The Chicago Regional Council of Carpenters Welfare Fund s Retiree Plan of Benefits supports the health care needs of you and your family members during your retirement years both before and after you are eligible for Medicare. This brochure highlights key features of the Plan as of January 1, We encourage you to take full advantage of all the Plan has to offer. If you have questions about the benefits described in this brochure, please contact the Pension Department at , Menu Option 4. Pension Service Representatives are available to take your calls Monday through Friday, 8 a.m. 4:30 p.m. More information is also available at Sincerely, The Board of Trustees What s Inside Eligibility... 2 Enrollment & Effective Date... 2 Coverage Changes (Additions/Cancellations)... 3 Premiums... 3 If You Return to Active Employment... 3 If You Die... 3 Prescription Drug Benefit... 4 Health Benefits for Non-Medicare-Eligible Retirees... 5 Health Benefits for Medicare-Eligible Retirees... 7 Important Contact Information... 8 Highlights Brochure Retiree Plan of Benefits Comprehensive Medical and Prescription Coverage 1

2 Eligibility To be eligible for Retiree health benefits, you must be receiving pension benefits from one of the following Pension Funds: Chicago Regional Council of Carpenters Pension Fund Chicago Regional Council of Carpenters Millmen Pension Fund Carpenters Pension Fund of Illinois (Geneva) Carpenters Local 496 Pension Fund Eligibility for Retiree health benefits is based on Vesting Credit. You must have at least ten years of Vesting Credit. However, if at some time during your career as a carpenter you did not earn Vesting Credit for a period of three or more consecutive calendar years, you must have at least 15 years of Vesting Credit. You can only earn one year of Vesting Credit per calendar year. Enrollment & Effective Date When you apply for a pension benefit from the Pension Fund, the Pension Department will let you know if you meet the eligibility requirements for Retiree health benefits. If you do, an enrollment form will be sent to you which must be completed and returned to the Pension Department along with any requested supporting documentation (marriage document, children s birth certificates, etc.). Your Retiree health benefits will begin on the first day of the month that your first pension check is processed. Please note: If for any reason your pension is processed with a retroactive start date, Retiree health benefits will NOT be retroactive. Special Circumstances In certain situations, Retiree health benefits will not begin when your initial pension check is processed. Instead, benefits and deductions will begin on the first day of the month after the other coverage ends when: You are still eligible for health benefits under the Active Plan of Benefits You elect to enroll in COBRA continuation coverage for the Active Plan of Benefits Your spouse (and dependent children) is covered through your spouse s employer Please note: In these situations, you must still enroll in Retiree health benefits at the time of retirement. If you do not, you will NOT be given another opportunity to enroll in the future. Additionally, although you can postpone coverage for your spouse and your dependent children, you cannot postpone coverage for yourself. Even if you are covered by your spouse s insurance, you must elect Retiree health benefits for yourself at the time of your retirement. If you do not, you will not be allowed to enroll yourself, your spouse or your eligible dependents at a later date. 2 CHICAGO REGIONAL COUNCIL OF CARPENTERS WELFARE FUND

3 Coverage Changes (Additions/Cancellations) You must enroll a new spouse or dependent within 60 days of the date of the marriage or the date you acquire the new dependent. You may postpone coverage for a new spouse or dependent only if there is other coverage through your spouse s employer. In this situation, enrollment must take place immediately following the termination of your spouse s employer insurance. Please request an enrollment form from the Pension Department and return the completed form, along with the required supporting documentation that is listed on the form, 30 days prior to the add date. If you enroll in coverage at the time of your retirement, you may cancel at a later date. However, once you cancel your coverage, you will not be allowed to re-enroll at any time in the future. To cancel coverage, please request a cancellation form from the Pension Department and return the completed form 30 days prior to the cancellation date. You must immediately notify the Pension Department of your divorce or legal separation by submitting the divorce decree or separation papers so your former spouse s coverage can be terminated. You should also immediately notify the Pension Department if your spouse or a covered dependent dies so that coverage can be terminated and your premium adjusted. Premiums Premiums are deducted from your pension check. If the amount of your pension check is not enough to cover your premium, the Pension Department will make special arrangements with you to pay the difference between the premium and your pension check. If You Return to Active Employment If you return to work in Prohibited Employment, coverage ends the first day of the month in which you return to work. You and your eligible dependents will be offered a conversion policy on a self-pay basis directly through BlueCross BlueShield. This type of conversion policy is not necessarily the same coverage as the Retiree health benefits. BlueCross BlueShield sets the rates for the conversion policy and premiums are paid directly to them. Contact the Pension Department if you have questions about what type of work you can perform while still receiving your pension. If You Die If you pass away while covered under the Retiree health benefits, coverage for your spouse and dependent children ends at the end of the month in which you die. If your surviving spouse is: Younger than age 65 (not Medicare-Eligible), he or she (and any eligible dependent children) can continue coverage through a self-pay COBRA policy for up to 36 months. Age 65 or older (Medicare-Eligible), he or she can continue medical coverage by converting to an independent self-pay BlueCross BlueShield Medicare Supplement policy. In addition, the Pension Department will issue a Prescription Drug Certificate of Creditable Coverage to help your surviving spouse enroll in a Medicare Part D Prescription Drug Plan. Highlights Brochure Retiree Plan of Benefits Comprehensive Medical and Prescription Coverage 3

4 Prescription Drug Benefit Enrollment in the Prescription Drug Benefit is an option for all eligible retirees. However, if you are eligible for Medicare and want coverage under the Prescription Drug Benefit, you should not enroll in Medicare Part D (prescription drug) coverage. If you enroll in Medicare Part D, your coverage under the Plan s Prescription Drug Benefit will be discontinued for both you and your covered dependents. To reduce your prescription drug costs, fill your prescriptions through a Medco network pharmacy or Medco by Mail and use generic medications whenever possible. Register at The Prescription Drug Benefit offers significant discounts for prescription medications through Medco Health Solutions (Medco). If you use a Medco Participating Retail Pharmacy, you only pay a copayment. If you use a non-participating retail pharmacy, you pay the full cost of the drug and submit a claim for reimbursement. Reimbursement is partial and based on the amount Medco would pay a participating network pharmacy for the same medication. All long-term medications (e.g., blood pressure medication) must be filled through the mail order program, Medco by Mail. You may only have three fills at the retail pharmacy for any long-term medication. After that, the long-term medication will only be covered if you use the mail order program. Medco Participating Retail Pharmacy (Lesser of 100 pills or a 30-day supply) Medco by Mail (Up to a 90-day supply through mail order) Accredo, Medco s Specialty Pharmacy (For specialty drugs) Generic Copayment $5 $12.50 N/A Single-source Brand Copayment (Generic is not available) Multi-source Brand Copayment (Generic available, but you elect brand name for any reason) Specialty Medication Copayment (Used to treat complex conditions such as cancer, hemophilia, immune deficiency, rheumatoid arthritis, etc.) 20% $10 minimum 20% $25 minimum Subject to $1,500 Annual Out-of-Pocket Maximum per Individual*. Then, Plan pays 100% for remainder of that calendar year 35% $20 minimum N/A 35% $50 minimum N/A N/A 20% $20 minimum / $100 maximum Subject to $1,500 Annual Out-of-Pocket Maximum per Individual*. Then, Plan pays 100% for the remainder of that calendar year * Out-of-Pocket Maximums for Single-source Brand Copayments and Specialty Medication Copayments are separate and cannot be combined. Note: If the cost of the medication is less than the copayment, you will only pay the cost of the medication. PREFERRED DRUG PROGRAM The Plan has coverage limitations on the following types of medications: Proton Pump Inhibitors (to treat certain stomach conditions): Plan only covers Nexium and omeprazole. Sleep Aids: Plan only covers generic sleep aids. Anti-Depressants: For all new anti-depressant medication, the Plan requires that you try the generic-equivalent drug first. If certain generic medications do not work effectively for you, your health care provider should contact Medco at to discuss alternatives. 4 CHICAGO REGIONAL COUNCIL OF CARPENTERS WELFARE FUND

5 Health Benefits for Non-Medicare-Eligible Retirees If you are not yet eligible for Medicare, which generally occurs at age 65, you may be eligible for Comprehensive Major Medical Coverage (BlueCross BlueShield Plan #50445). Benefits are paid as follows and provided through BlueCross BlueShield of Illinois (BCBS), the Fund s preferred network provider (PPO). Please note: Deductibles and Coinsurance Maximums for the Active Plan of Benefits do not carry over to the Retiree Plan of Benefits. However, any portion of the Deductible met in the last three months of a calendar year is also applied toward your Deductible for the following calendar year. BCBS In-Network PPO Provider Calendar Year Deductible* $300 per Individual $600 per Individual Out-of-Network Non-PPO Provider Coinsurance Plan pays 80% / Participant pays 20% Plan pays 60%** / Participant pays 40% Annual Coinsurance Maximum* (per calendar year) Emergency Room (ER) Copayment Medical Services Advisory Non-Notification Penalty $2,000 per Individual $6,000 per Individual $250, waived if admitted to the hospital directly from ER (Copayment does not apply to Annual Coinsurance Maximum) $500 per admission * There are separate Calendar Year Deductibles and Annual Coinsurance Maximums for in-network and out-of-network expenses. ** Out-of-network expenses are subject to Reasonable and Customary Allowances (R&C), as adopted by the Fund Office. Amounts over R&C are the covered Individual s responsibility. Plan benefits are subject to the following limitations and exceptions: Chiropractic Care: Calendar year maximum of $3,000 per Retired Carpenter, $1,000 per Spouse, $0 per Dependent Child Convalescent Facility: Up to 120 days per convalescent period Home Health Care: Up to 120 days per calendar year Hospice Care: Up to 180 days per lifetime Infertility Services (Hospital, Physician, Drugs, Treatments, etc.): Lifetime maximum of $10,000 per Family Preventive Care (Routine Physicals/Well Child Care): $300 per Individual per year, not subject to Calendar Year Deductibles or Coinsurance Preventive Colorectal Screening: Plan pays 100%, once every five years, for covered Retirees and Spouses over the age of 50, when performed by a BCBS In-Network PPO Provider. Screenings performed by out-of-network providers are subject to Calendar Year Deductibles and Coinsurance Hearing Benefits The Plan pays a maximum of $1,500 per covered Individual for prescribed hearing aid instruments, or their repair, once every five consecutive years. Coverage is only for the device itself and is not subject to Calendar Year Deductibles. A hearing exam is not covered. Discounts on hearing aids are available through EPIC Hearing Services (EPIC). If you do not go through EPIC, claims must be submitted through BCBS. BE SURE TO MAKE THE CALL BEFORE ALL HOSPITAL ADMISSIONS If you are NOT YET Medicare-eligible, you or a family member must call BlueCross Medical Services Advisory (MSA) within one business day BEFORE you or a dependent are admitted to the hospital or within two business days AFTER emergency or maternity care admissions. If you do not, you will be required to pay a $500 penalty for each hospital admission in addition to any Deductibles and Coinsurance that may apply. Required notification applies to both In-Network PPO and Out-of-Network Non-PPO hospitals. Highlights Brochure Retiree Plan of Benefits Comprehensive Medical and Prescription Coverage 5

6 HOW THE PLAN PAYS BENEFITS Here is how the Comprehensive Major Medical Plan works when you or an eligible family member need medical care: First, you pay 100% of the covered medical expenses you have during the year up to a dollar amount called your Calendar Year Deductible. Next, you and the Plan share the costs of the covered medical expenses you have during the year. In most cases, the Plan pays a higher percentage for in-network expenses (80%) than for out-of-network expenses (60%). You pay the remaining percentage, called your Coinsurance, up to a specified annual cap which is called your Annual Coinsurance Maximum. Then the Plan pays 100% of the covered medical expenses for the rest of the calendar year. 100% Coverage After You Meet Your Out-of-Pocket Maximum The most you will pay during the year, called your Out-of-Pocket Maximum, is the Calendar Year Deductible plus the Annual Coinsurance Maximum. For example: If you require care during the year and use an in-network PPO provider, the most you ll pay during the year is $2,300 ($300 Individual Calendar Year Deductible + $2,000 Annual Coinsurance Maximum). PPO VS. NON-PPO: KNOWING THE DIFFERENCE SAVES YOU MONEY PPO Providers are health care providers such as doctors or hospitals who are under contract to provide services at a discounted rate. When you or a covered family member need medical care, be sure to use an in-network PPO provider. Doing so saves you money in two ways: 1) The overall cost of the service is lower, as a result of negotiated discounts, and 2) The Plan typically pays a higher percentage of the covered expenses. If your in-network PPO physician refers you to a hospital or facility, be sure to ask if it is in-network. By using healthcare providers in the PPO network, you can maximize your medical benefits and save money for yourself and the Fund. 6 CHICAGO REGIONAL COUNCIL OF CARPENTERS WELFARE FUND

7 Health Benefits for Medicare-Eligible Retirees If you are eligible for Medicare, which generally occurs when you reach age 65, you may be eligible for coverage under the Secondary Comprehensive Medical Benefits (BlueCross BlueShield Plan #50446). The Plan pays covered expenses, secondary to Medicare and covers most, but not all, of the Medicare-eligible expenses that Medicare does not cover. Benefits under the Plan are modified to take Medicare benefits into account whether or not you are enrolled in Medicare. Therefore, when you become eligible for Medicare, you should enroll in Medicare Part A and Medicare Part B. However, if you want to participate in the Plan s Prescription Drug Benefit, you should not enroll in Medicare Part D. When you, your spouse, or your dependent becomes eligible for Medicare, a copy of the covered Individual s Medicare Card must be sent to the Pension Department. Benefits are paid as follows and provided through BlueCross BlueShield of Illinois (BCBS), the Fund s preferred network provider (PPO). First 60 days Medicare Part A Supplement (Hospital Benefit) Plan pays Medicare Part A Deductible 61 st through 90 th day Plan pays Medicare Part A Copayment 91 st day and after (while using 60 Lifetime reserve days) Plan pays Medicare Part A Copayment Additional 365 days Medicare Part B Deductible Medical Expenses (physician services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipment) Blood Chiropractic Care Skilled Nursing Facility Care* First 20 days 21 st through 100 th day At Home Recovery Services Not Covered by Medicare** Foreign Travel Not Covered by Medicare Calendar Year Deductible Coinsurance Medicare Part B Supplement Lifetime Maximum Benefit $50,000 Plan pays 100% of Medicare-eligible expenses Not covered by Plan 20% of Medicare-eligible expenses at the Medicareapproved amount, after the Medicare Part B Deductible Plan pays for the first three pints Plan pays secondary to Medicare, up to the following annual maximums: $3,000 per Retired Carpenter / $1,000 per Spouse / $0 per Dependent Child Medicare pays all approved amounts Plan pays Medicare Part A Copayment Plan pays actual charges up to $40 per visit, up to the number of Medicare-approved visits, not to exceed seven visits each week. Calendar Year Maximum is $1,600 $250 per Individual Plan pays 80% of charges, after Calendar Year Deductible * You must meet Medicare s Requirements, including having been in a hospital for at least three days and enter a Medicare-approved facility within 30 days of leaving the hospital. ** Home care certified by your doctor, for personal care during recovery from an injury or sickness for which Medicare approved a home treatment plan. Hearing Benefits The Plan pays a maximum of $1,500 per covered Individual for prescribed hearing aid instruments, or their repair, once every five consecutive years. Coverage is only for the device itself. A hearing exam is not covered. Discounts on hearing aids are available through EPIC Hearing Services (EPIC). If you do not go through EPIC, claims must be submitted through BCBS. Highlights Brochure Retiree Plan of Benefits Comprehensive Medical and Prescription Coverage 7

8 HAVE QUESTIONS ABOUT MEDICARE? Each year Medicare publishes a handbook called Medicare & You which details the benefits available to Medicare recipients. Contact Medicare directly at MEDICARE ( ) to obtain a copy of the handbook and if you have any questions about: The benefits provided by Medicare Your eligibility for Medicare Enrolling in Medicare You can also access Medicare information (including the handbook) on the internet at Important Contact Information For inquiries about: Contact: Phone Number: Website: Eligibility, Enrollment, Premiums Fund Office Pension Department , Option 4 Claim Status and Specific Coverage Questions Finding a Physician, Hospital or Surgi-Center in the BCBS PPO Network All Hospital Admissions (only for participants in the Non-Medicare-Eligible Plan #50445) BlueCross BlueShield of Illinois (BCBS) BlueCross BlueShield of Illinois (BCBS) BlueCross Medical Advisory Services (MSA) (in Illinois) (outside Illinois) N/A Prescription Drug Program Medco Health Solutions, Inc Discounted Hearing Exams and Hearing Aids EPIC Hearing Services Medicare Benefits Medicare Chicago Regional Council of Carpenters Welfare Fund 12 East Erie Street Chicago, Illinois Union Trustees Frank T. Libby Jeffrey Isaacson Keith Jutkins Joseph Pastorino Gary Perinar, Jr. Bruce Werning Employer Trustees J. David Pepper Benjamin A. Johnston Paul R. Hellermann Roger A. Monaco Gerald W. Thiel, Jr. Todd H. Harris The benefits highlighted in this brochure are effective as of January 1, This brochure provides only highlights of certain features of the Chicago Regional Council of Carpenters Welfare Fund Retiree Plan of Benefits. Full details are contained in the documents that establish the Plan provisions. If there is a discrepancy between the wording here and the documents that establish the Plan, the Plan Document language will govern. The Trustees reserve the right to amend, modify, or terminate the Plans at any time. 8 CHICAGO REGIONAL COUNCIL OF CARPENTERS WELFARE FUND