Review the Summary Comparison of Medical & Dental Plans booklet to get detailed information regarding your retiree health benefits. Basic information is provided below.
The following medical plans are available:
- Indemnity PPO Medical Plan
- Kaiser HMO Plans: Kaiser Permanente HMO (non-Medicare) and Kaiser Senior Advantage (a Medicare HMO)
- Anthem HMO and Medicare PPO Plans: Anthem Blue Cross HMO (non-Medicare) and Anthem Medicare Advantage Indemnity PPO (a Medicare HMO)
Indemnity PPO Medical Plan
The Indemnity PPO Medical Plan helps pay the cost for doctors’ services, hospital stays, specialist care and other health care services. The plan pays higher benefits if you use a network provider.
For those who are not yet eligible for Medicare, the plan pays benefits in accordance with plan limits and allowances. (Refer to the chart included in the Summary Comparison of Medical & Dental Plans booklet to see coverage details for non-Medicare eligible retirees and their dependents.)
For those who are eligible for Medicare, the plan supplements Medicare and will reimburse you for Medicare deductibles and copayments up to the plan’s allowances for each covered expense. (Reminder: You (and any of your covered dependents) must enroll in Medicare Parts A and B when you become eligible for Medicare.)
The plan provides up to $1,000,000 in benefits for each covered person’s lifetime.
You may only enroll in an HMO if you live within its service area. Also, enrollees in Kaiser Senior Advantage or UnitedHealthcare Medicare Advantage must be enrolled in Medicare Part A and Part B.
When you enroll in an HMO, you are restricted to using only that HMO’s doctors and hospitals. If you use a doctor or hospital not affiliated with your HMO, your charges will not be reimbursed. Exceptions are made only for care that is recognized as emergency medical care.
In general, HMOs cover most medical services at 100% after a copay. There are no deductibles or lifetime maximum dollar limits for medical care. Covered medical care includes routine preventive care and wellness programs.
Your covered dependents will be enrolled in the same HMO that you have. For example, if you choose Kaiser and you are on Medicare, you will be enrolled in Kaiser’s Senior Advantage HMO and your non-Medicare dependents (if any) will be enrolled in the traditional Kaiser Permanente non-Medicare HMO.
If you or an enrolled dependent are eligible for Medicare and choose HMO coverage, you must enroll in that HMO’s Medicare plan and in Medicare Part A and Part B.
Refer to the chart included in the Summary Comparison of Medical & Dental Plans booklet to compare benefits between the HMOs and the Indemnity PPO Medical Plan.
If you are Medicare-eligible, you should review the following notices regarding your prescription drug coverage and Medicare Part D:
- Notice of Non-Creditable Coverage for Class E Retirees who are enrolled in the Indemnity PPO Medical Plan or Anthem Medicare PPO.
- Notice of Creditable Coverage for Class E Retirees who are members of Kaiser Senior Advantage.
The Fund offers a choice between the Indemnity Dental Plan and the Prepaid Dental Plan to eligible retirees.
The Fund offers a choice between the Indemnity Dental Plan and the Prepaid Dental Plan to eligible retirees. Dental coverage is optional; if you elect this coverage you pay a monthly premium, and you must enroll for a full year’s coverage. The monthly premium is a fixed amount that does not change based on how many family members are covered, but can be adjusted on an annual basis.
Both dental plan options cover dental services defined by the terms of the plan as “covered procedures.” Covered procedures are those procedures considered necessary to prevent and eliminate oral disease and those services required to maintain and restore function. No benefits are provided for services that do not meet the definition of covered procedures.
Refer to the Summary Comparison of Medical & Dental Plans booklet for more details on dental coverage.
Indemnity Dental Plan
The Indemnity Dental Plan has an $1,800 annual benefit maximum per person. Once the plan has paid the maximum, you are responsible for all additional charges through the end of the year.
If you choose the Indemnity Dental Plan, you may use any dentist. The plan will reimburse a portion of your dentist’s charges according to the dental plan allowances after you meet your annual deductible. You pay any difference between what the plan pays and what your dentist charges.
Dental services (except for emergency care) rendered outside of the United States are not covered, except for those retirees living permanently abroad. Services performed in Mexico may be covered, provided x-rays are submitted with each claim.
Prepaid Dental Plan
If you enroll in the Prepaid Dental Plan, you must select a Prepaid Dental Plan Office for your dental care. A list of Prepaid Dental Plan Offices is provided with your plan enrollment materials and included in the Dental Program description booklet. You can also contact the Fund Office for a copy.
The Prepaid Dental Plan provides many diagnostic, preventive and restorative services at little or no charge to you. However, if you go to a dentist who is not affiliated with the Prepaid Dental Plan Office in which you have enrolled, you are responsible for 100% of the cost of such dental services, including charges for emergency services outside of your Prepaid Dental Plan’s Service Area.