“Self-Pay” Enhanced Retirees

All “Self-Pay” Enhanced Retiree Plans benefit packages for 2016 – 2017
include benefit options equal to the Active Members’ coverage levels
(Bereavement and Survivors benefits end at retirement and are NOT included).

“SELF-PAY” ENHANCED RETIREE PLANS RULES

1) Effective date of Plan coverage is for two (2) consecutive years, regardless of enrollment month at the Active Level of benefit coverage.

2)  Self-Pay Enhanced Retiree Plans are offered in three (3) benefit levels:

  1. Premium; Dental, at the Active Level of coverage, Optical and Hearing Aid.
  2. b. Premium Plus; add Prescription Co-Payment Reimbursement (same Coverage Level within COBRA.)
  3. Platinum; add Legal and Tax Preparation.

Retirees who opt for coverage in either the Premium or the Premium Plus Plans will be able to move up” to greater coverage during any future open enrollment period, but must remain there for two (2) consecutive years before dropping-down to lesser coverage and only after submitting a notarized Enrollment form.

 3) Retirees are permitted to “drop-down” to the “No-Cost” Basic Retiree Plan after enrolling in and paying for one of the “Self-Pay” Enhanced Retiree Plans for two (2) consecutive years.

4) New enrollees for a “Self-Pay” Enhanced Retiree Plan must enroll with a 2-year (24 months) commitment.

5) A retiree may only “drop-down” to a reduced coverage plan after they remain in and pay for the selected “Self-Pay” Enhanced Retiree Plan for two (2) consecutive years and by completing and submitting a notarized Enrollment Form.

NOTE: When a retiree decides to “drop-down” to the “No-Cost” Basic Retiree Plan, they must remain in the Basic plan for at least two (2) consecutive years before being given the opportunity to enroll again in one of the “Self-Pay” Enhanced Retiree Plans.

6) Pay  your premium once annually, instead of on a quarterly payment plan, and you will enjoy a 10% savings or save 5% by paying semi-annually.  Choose one (1) of three (3) payment options:

  1. Quarterly (no Premium savings)
  2. b. Semi-Annually (Premium savings of 5%)
  3. Annually (Premium savings of 10%)

 7) Even if previously terminated from the “No-Cost” Basic Retiree Plan, or if they were enrolled or re-enrolled in the “No-Cost” Basic Retiree Plan for at least two (2) consecutive years, enrollment is available in one of the “Self-Pay” Enhanced Retiree Plans.

NOTE: Failure to maintain timely payments for the two (2) year enrollment requirement will result in an immediate termination of benefits including coverage in the Fund’s “No-Cost” Basic Retire Plan. A two (2) year waiting period, after the last day of the enrollment period previously selected, will be required before being permitted to re-enroll in another “Self-Pay” Enhanced Retiree Plan and only during the Open Enrollment period.

8)  Self-Pay Enhanced Retiree Plans offer three (3) dependent coverage options:

  1. Individual*        b. Individual + 1           c. Family

If a member predeceases their dependents, the dependent or dependents, may remain in their enrolled “Self-Pay” Enhanced Retiree plan or on Post-Active COBRA, or on Retiree Basic COBRA indefinitely, as long as timely payments are made. Once terminated for untimely payments, dependents will not be permitted to re-enroll in any other plan offered by the Fund.

*If a member with dependents opts for a plan with individual coverage only, neither their spouse nor dependents can remain on the member’s “No-Cost” Basic Retiree Plan. All dependents will lose coverage while the member is on an individual “Self-Pay” plan. Dependent coverage can only be restored after the member satisfies two (2) additional consecutive years on a “Self-Pay” Enhanced Retiree Plan which includes dependent coverage, before having their dependents become eligible for the “No-Cost” Basic Plan again, unless the new dependent was due to a life event, (i.e., marriage, the birth or adoption of a child.)   

 

“SELF-PAY” ENHANCED RETIREE PLANS OPTIONS:

All “Self-Pay” Enhanced Retiree Plan benefit packages include various benefits options at the active levels (except Bereavement and Survivors benefits).

1. The Premium Plan:

  • Full Dental
    • General – $2,750.00 per individual, per calendar year
    • Implants – $4,000 – per individual, per lifetime, for implants and abutments reimbursable at up to $500 each. Dentist can bill usual and customary charges.
    • Orthodontia – $1,995 – per individual, per lifetime. In-network covered in full with at least a $1,000 co-pay.
    • Periodontal – $2,000 – per individual, per calendar year, at the adopted fee schedule.
  • Hearing Aids – $400 per individual, for out-of-pocket expenses every 36 months.
  • Optical – $80 per individual, per calendar year.
Individual Individual + 1 Family Frequency of Payment
$ 178.75 $ 357.50 $ 539.00 Quarterly
$ 341.25 $ 582.50 $1,029.00 Semi-Annual (price reflects a 5% savings)
$ 650.00 $1,300.00 $1,960.00 Annual (price reflects a 10% savings)

 

2. The Premium Plus Plan includes coverages up to the adopted fee schedule with some usual and customary charges:

  • Includes ALL the benefits in the Premium Plan and:
  • Prescription Drug Co-Payment Reimbursement for expenses, up to $20 per eligible prescription up to $350 per family, per calendar year, PLUS $1.00 each for every script over $350
    (payable in fill-date order only), effective 1/1/2014.
Individual Individual + 1 Family Frequency of Payment
$ 220.00 $ 415.25 $ 613.25 Quarterly
$ 420.00 $ 792.75 $1,170.75 Semi-Annual (price reflects a 5% savings)
$ 800.00 $1,510.00 $2,230.00 Annual (price reflects a 10% savings)

 

3. The Platinum Plan includes coverages up to the adopted fee schedule with some usual and customary charges:

  • Includes ALL the benefits in the Premium PLUS Plan and:
  • Tax Preparation – $30 short form or $70 long form per member, per calendar year
  • Legal Services – up to $1,000 per family, limited to the service fee schedule, per calendar year.
Individual Individual + 1 Family Frequency of Payment
$ 242.00 $ 442.75 $ 649.00 Quarterly
$ 462.00 $ 845.25 $1,239.00 Semi-Annual (price reflects a 5% savings)
$ 880.00 $1,610.00 $2,360.00 Annual (price reflects a 10% savings)

 

Steps to Follow to Upgrade or Enroll in the “Self-Pay” Retiree Enhanced Plans:

  1. If you are already enrolled in the “No-Cost” Basic Retiree Plan and do not wish to change, you do not have to complete any forms.
  2. If you previously lost your “No-Cost” Basic Plan coverage, you may not re-enroll for that plan during the Open Enrollment Period.  You may, however, enroll in one of our Self-Pay Enhanced Retiree Plans.
  3. If you wish to enroll in one of the “Self-Pay” Enhanced Retiree Plans, follow steps 1 – 6 below.
  4. If you wish to upgrade to one of the other “Self-Pay” Enhanced Retiree Plans, you must currently have been participating in an “Enhanced” Plan.  Simply do the following:
    1. Complete the selected Plan Enrollment Form.
    2. Select Dependent Coverage Levels
    3. Select Payment Options (if selecting a “Self-Pay” Enhanced Retiree Plan)
    4. Have the form Notarized or you can visit the Fund for Notary Services. (The Fund always offers free notary service for Fund members and their families!)
    5. Return the Notarized Enrollment Form with your payment to the Fund.
    6. Still have questions or would like to schedule an appointment, just contact the Fund’s Eligibility Department at: 631-319-4099 ext. 321.  We are here to help!

Important: If the Fund does not receive your “Self-Pay” Enhanced Retiree Plan payment to continue benefits, your coverage will cease. If coverage is terminated, you may not be entitled to resme participation in any future retiree plan offered by the Fund.