What are the benefits

As you know, in 2007 the Suffolk County Municipal Employees Benefit Fund (Fund) offered, in addition to the no-cost “Basic Retiree Plan” and COBRA, three (3) options of self-pay retiree benefits coverage. The Trustees are pleased to announce some very valuable changes about those plans:

NEW PLAN YEAR:

Starting with this year’s annual open enrollment period, the self-pay Retiree Enhanced Plan’s new plan year will be a calendar year, starting January 1, 2012. Therefore, this open-enrollment period will provide for an “early renewal” for those of you already purchasing one (1) of the self-pay plans. Currently, the retiree plan year is March 1 through February 28^th.

SELF-PAY RETIREE ENHANCED PLANS:

All benefit packages offered on a self-pay basis are at the same level of benefits as those currently enjoyed by the active members of the Benefit Fund!

1. The Premium Plan offers eligible retirees the opportunity to continue coverage at the level of benefits available to active members for:

· Dental, $2250.00 per individual per year

Implants, $2000.00 – 1/L* per individual per lifetime

Orthodontia, $1,995.00 – 1/L* per individual per lifetime

Periodontal, $2,000.00 per individual per year

· Hearing aid, $400.00 per individual every 36 months

· Optical, $80.00 per individual per year

2. The Premium Plus Plan offers:

· Dental, $2250.00 per individual per year (plus dental services listed above)

· Hearing aid, $400.00 per individual every 36 months

· Optical, $80.00 per individual per year

· Prescription Drug Co-Payment Reimbursement, $350.00 per family per year,

with a maximum of up to $20.00 per eligible prescription

3. The Platinum Plan offers:

· Dental, $2250.00 per individual per year (plus dental services listed above)

· Hearing aid, $400.00 per individual every 36 months

· Optical, $80.00 per individual per year

· Prescription Drug Co-Payment Reimbursement, $350.00 per family per year,

with a maximum of up to $20.00 per eligible prescription

· Tax Preparation, $30.00 short form or $70.00 long form per member per year

· Legal Services, $1,000.00 per family per year

* 1/L Once-in-a-lifetime

CONSULT YOUR BENEFIT REFERENCE GUIDE FOR FULL DETAILS OF YOUR PLAN

RENEW AT NO RATE INCREASE:

The 2012 rates below reflect NO INCREASE from the 2011 rates and are guaranteed not to increase for two (2) consecutive calendar years, through December 2013! As a piece of history, these rates are a whopping 30% less than they were in 2007!!! The Board of Trustees continually reviews these rates and makes the appropriate adjustments.

NEW RULE ALLOWING FOR DROP DOWN TO “BASIC RETIREE PLAN”:

Retirees who opt for coverage in either the Premium or the Premium Plus Plans will be provided yearly opportunities to move up to greater coverage during the open enrollment period (usually November and December of each year). All retirees who opt for any of the self-pay plans will be offered the opportunity to move down to lesser coverage, INCLUDING THE FREE “BASIC RETIREE PLAN”, provided they remain in and pay for two (2) consecutive calendar years of the self-pay plan they selected. If a retiree drops down, then s/he must stay on the reduced coverage plan for two (2) consecutive calendar years before any upgrade in coverage is permitted.

ENROLLMENT REQUIRED:

To be covered under any of the above plans, you must enroll and pay for two (2) consecutive calendar years. The appropriate enrollment form is enclosed.

NONPAYMENT MEANS LOSS OF BENEFITS FOREVER:

If the Fund does not receive your self-pay plan payment to continue benefits, your coverage will cease and you will not be entitled to resume participation in the future in any retiree plan offered by the Fund, including the “Basic Retiree Plan”! All benefits will cease.

COVERAGE FOR ELIGIBLE DEPENDENTS:

Eligibility for dependents is based upon the coverage you choose during this open enrollment period. If you elect individual coverage at this time, you will not be entitled to add dependent coverage for a period of at least two (2) full consecutive calendar years, unless you add a dependent to your family because of a life event (i.e., you get married, you have a child) occurring during those two (2) years. In addition, should you subsequently drop a dependent, that dependent may not be re-enrolled by you until two (2) full years of non-coverage lapses.

QUESTIONS? JUST CALL:

Should you have any questions, please contact the Fund’s Eligibility Department at 631-319-4099 ext. 321.

DUE DATE FOR ENROLLMENT FORM AND PAYMENT:

The completed notarized Plan enrollment form and payment for the Plan type and frequency of your choice must be

received at the Fund no later than December 16, 2011.

We hope you are as pleased as we Trustees are, that we may offer these options to our retirees so they may be able to continue to reap the enriched benefits of the Benefit Fund and be afforded even greater choice.

The Board of Trustees has unanimously decided to loosen the rules for enrollment in the CapDent or Healthplex America plans. In addition, the Fund will no longer be accepting new enrollees to either of these plans.

As a CapDent or Healthplex America enrollee, the Benefit Fund is offering you a choice of one (1) of the three (3) following options during this year’s open enrollment period:

A. Drop down to the no-cost Basic Retiree Plan. Please see plan details below:

· Dental, $750.00 per year for the family, with no one person using more than the individual limit of $500.00

· Optical, $80.00 per year per individual (not limited to Davis Vision)

· Hearing Aid, $400.00 every 36 months per individual

B. Remain in your CapDent or Healthplex America plan for one (1) more year at the same rate as 2011.

Purchase one (1) of the self-pay Enhanced Retiree Plans sponsored by the Benefit Fund. The 2012 rates below reflect NO INCREASE from the 2011 rates and are guaranteed not to increase for two (2) consecutive calendar years, through December 2013! As a piece of history, these rates are a whopping 30% less than they were in 2007!!!

Who is eligible

A former participant of the Benefit Fund who initially retired on or after January 1, l985 and is in receipt of a monthly pension from either the New York State Retirement System or a related organization (as defined by the Fund) is eligible for retiree coverage, provided that the former participant satisfies at least one of the following conditions:

He or she initially left employment with Suffolk County or a related organization on or after age 55 and had 10 years of employment in either organization or;
He or she is currently age 55 or older and had 20 years of employment with Suffolk County or a related organization and has maintained continued coverage with the Fund by self-paying from the date of separation from the employer through to the age of 55; or
He or she is in receipt of a disability retirement benefit from either the New York State Retirement System or a related organization.

Certain employees may be eligible at a future time providing that they meet the Fund's eligibility requirements.

Dependent coverage

Dependents of eligible retirees are covered for benefits and are defined as the retiree's spouse, unmarried dependent children who have not reached their l9th birthday, and unmarried dependent children who are full time students and have not reached their 25th birthday. Coverage is also extended to unmarried children, regardless of age, who are incapable of self-sustaining employment by reason of mental retardation or physical handicap who became so prior to age l9.

Limitations

Coverage is not extended to dependents of deceased retirees members. However, upon the death of the retired member, the dependent may choose to continue coverage under COBRA. The Fund office must be contacted within 60 days of the death for the qualified beneficiary/dependent to be eligible for continuation of coverage.

Payment will not be made for any benefit that is claimed after a period that exceeds one year from the calendar year in which services were rendered. Services rendered in 2011, for example, must be claimed no later than December 31, 2012.

It is the responsibility of the retiree to inform the Fund of his or her eligibility for coverage. In a case of late notification, payment will be made only for claims submitted in the calendar year in which services were rendered.

How to obtain the self-pay Retiree Plan Benefits

To elect any of the plans above, you must complete and return the enrollment form to the Benefit Fund office within sixty (60) days of the date of your retirement. This is the only opportunity you will have to obtain this coverage. You will not be given another opportunity to buy the self-pay enhanced coverage.

If you do not elect to enroll in any of the self-pay plans within the 60 day period, your active level of benefits coverage will cease and you will only receive the limited benefits available via the “basic” no-cost retiree plan (dental—up to $500 per person per year, maximum $750 per family per year; optical and hearing aid).

As you already know, once you choose to buy any one of these self-pay retiree plans, you are NEVER eligible for coverage through the no-cost basic plan again. You will lose all Fund benefits should you fail to remit plan payments. If you don’t pay your premiums on time, your coverage will be cancelled and you will have no Fund benefits. In other words, there is no “going back” to no-cost basic coverage once you have chosen an enhanced self-pay plan.

However, if you want to change from one self-pay plan to another, this can be done once every year, during open enrollment. The open enrollment period is in the months of November and December of every year, starting November 2011. Your new coverage will become effective the January following your decision to change. This open enrollment period will be offered every year.

To be covered under any of the plans noted above, you must enroll and emit payments for a full fiscal year (January 1 through December 31). Payment frequency is limited to quarterly, semi-annual or annually. If you opt to pay semi-annually or annually, your self-pay premium will be discounted by either 5% (for a semi-annual payment) or 10% (for an annual payment).

If the Fund does not receive your self-pay premium payment to continue benefits, your coverage will cease and you cannot resume participation until the next open enrollment period.

Eligibility for dependents is based on the coverage you choose during the applicable enrollment period. If you elect individual coverage, you will not be entitled to elect dependent coverage at a later date, unless you add a dependent to your family because of a life event (e.g., you get married). You may not enroll a dependent at a later date who was eligible for enrollment at the time of your initial enrollment. In addition, should you subsequently drop a dependent, that dependent may never be re-enrolled by you.