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Frequently Asked Questions (FAQs)
GeneralWhat are the eligibility requirements to qualify for enrollment in the Retiree Health Plan?Can I change my choice of medical plans? Is it true that once you choose a medical plan you are stuck with that plan? Will the Retiree medical coverage be the same as when I was an Active participant? Will I have the same benefits (Medical, Dental, Vision, Prescription, EAP) as I have now as an Active participant? Who is covered under the RHP? Is Active coverage immediately prior to RHP participation required? If health hours are not current, can I still qualify for RHP? Is there a cost to enrolling in the Retiree Health Plan? What are my COBRA rights under the Plan? Briefly, explain what my medical plan choices are I am an early retiree in the Kaiser Plan and want to know what benefits I am entitled to at a glance. I am an early retiree in the PacifiCare Plan and want to know what benefits I am entitled to at a glance. I am enrolled in Medicare in the Kaiser Senior Advantage Plan and want to know what benefits I am entitled to at a glance. I am enrolled in Medicare in the PacifiCare Secure Horizon Plan and want to know what benefits I am entitled to at a glance. Briefly, what are the benefits of the Medicare Supplement Plan? For each plan choice, who provides my prescription drug benefits? WHCRAI've been diagnosed with breast cancer and plan to have a mastectomy. How will WHCRA affect my benefits?Will WHCRA require all group health plans, insurance companies, and HMOs to provide reconstructive surgery benefits? Under WHCRA, may group health plans, insurance companies, or HMOs impose deductibles or coinsurance requirements for reconstructive surgery in connection with a mastectomy? Premium ReimbursmentHow long will the Premium Reimbursement Plan continue?Can I choose to cover just myself, or just my spouse? Will my spouse still be covered when I die? What is my prescription drug benefit? Medicare SupplementDoes the Medicare Supplement Plan take into consideration other group insurance plans to which a retiree or spouse is entitled?What drugs are covered under my drug benefit? What drugs are not covered under my drug benefit? Do I have to pay anything for prescriptions? Generic DrugsAre generic drugs effective?What is a generic drug? Why are most generic drugs less expensive than brand name products? How are generic drugs approved for use? QUESTION: What are the eligibility requirements to qualify for enrollment in the Retiree Health Plan? ANSWER: Refer to the BenefitTab regarding eligibility for the Retiree Health Plan.
QUESTION: Can I change my choice of medical plans? ANSWER: Yes, during the annual open enrollment period which is explained on pages 13 and 14 of the Retiree SPD.
QUESTION: Is it true that once you choose a medical plan you are stuck with that plan? ANSWER: Open enrollment occurs each year in September. A change of medical plan can be requested during this month.
QUESTION: Will the Retiree medical coverage be the same as when I was an Active participant? Will I have the same benefits (Medical, Dental, Vision, Prescription, EAP) as I have now as an Active participant? ANSWER: As a pensioner you will maintain Medical and Prescription benefits. The Prescription benefits will be offered through Prescription Solutions or one of the HMO's.
QUESTION: Who is covered under the RHP? ANSWER: The Participant and the last known enrolled spouse.
QUESTION: Is Active coverage immediately prior to RHP participation required? ANSWER: A.No.
QUESTION: If health hours are not current, can I still qualify for RHP? ANSWER: Yes.
QUESTION: Is there a cost to enrolling in the Retiree Health Plan? ANSWER: Refer to the SPD section entitled "Required Monthly Self-payment Deduction".
QUESTION: What are my COBRA rights under the Plan? ANSWER: Refer to the SPD section entitled "COBRA".
QUESTION: Briefly, explain what my medical plan choices are ANSWER: Refer to the SPD section entitled "Selecting an HMO, Premium Reimbursement or Medicare Supplement Plan".
QUESTION: I am an early retiree in the Kaiser Plan and want to know what benefits I am entitled to at a glance. ANSWER: Refer to the summary of benefits chart available here.
QUESTION: I am an early retiree in the PacifiCare Plan and want to know what benefits I am entitled to at a glance. ANSWER: Refer to the summary of benefits chart available here.
QUESTION: I am enrolled in Medicare in the Kaiser Senior Advantage Plan and want to know what benefits I am entitled to at a glance. ANSWER: Refer to the principal benefits chart available here.
QUESTION: I am enrolled in Medicare in the PacifiCare Secure Horizon Plan and want to know what benefits I am entitled to at a glance. ANSWER: Refer to the summary of benefits chart available here.
QUESTION: Briefly, what are the benefits of the Medicare Supplement Plan? ANSWER: Refer to the SPD section entitled "Retiree Health Plan Medicare Supplement Benefits".
QUESTION: For each plan choice, who provides my prescription drug benefits? ANSWER: The following information will be useful:
QUESTION: I've been diagnosed with breast cancer and plan to have a mastectomy. How will WHCRA affect my benefits? ANSWER: Under WHCRA, group health plans, insurance companies, and health maintenance organizations (HMOs) offering mastectomy coverage must also provide coverage for reconstructive surgery in a manner determined in consultation with the attending physician and the patient. Coverage includes reconstruction of the breast on which the mastectomy was performed, surgery, and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas.
QUESTION: Will WHCRA require all group health plans, insurance companies, and HMOs to provide reconstructive surgery benefits? ANSWER: All group health plans, and their insurance companies or HMOs that provide coverage for medical and surgical benefits with respect to a mastectomy are subject to the requirements of WHCRA.
QUESTION: Under WHCRA, may group health plans, insurance companies, or HMOs impose deductibles or coinsurance requirements for reconstructive surgery in connection with a mastectomy? ANSWER: Yes, but only if the deductibles and coinsurance are consistent with those established for other benefits under the plan or coverage.
QUESTION: How long will the Premium Reimbursement Plan continue? ANSWER: Premium Reimbursement and the prescription drug benefit are provided as part of the Retiree Health Plan. The Retiree Health Plan will continue as long as funds are available. These Plans may be modified or eliminated, including the self-payment, at any time by the Board of Trustees as needed.
QUESTION: Can I choose to cover just myself, or just my spouse? ANSWER: You may choose to cover only yourself (or yourself and your spouse) to receive benefits under the Retiree Health Plan, but you may not choose to cover just your spouse because the rules of the Retiree Health Plan do not allow you to cover your spouse only. If you wish to no longer cover your spouse, you may cancel this coverage by writing to the Administrative Office.
QUESTION: Will my spouse still be covered when I die? ANSWER: Coverage would be made available to your surviving spouse on the same basis as any other widow covered under the Retiree Health Plan at the time of your death. The Administrative Office will provide information on benefits and costs at that time.
QUESTION: What is my prescription drug benefit? ANSWER: Under the Premium Reimbursement Plan, you are entitled to the Prescription Solutions Drug Plan. Refer to the separate section entitled "Mandatory Prescription Drug Plan" that is listed in the Table of Contents in the Summary Plan Description.
QUESTION: Does the Medicare Supplement Plan take into consideration other group insurance plans to which a retiree or spouse is entitled? ANSWER: Yes. The Medicare Supplement Plan only reimburses you for eligible charges not paid by both Medicare and other insurance plan(s) up to the maximum of $2,500 per year. The Medicare Supplement Plan will make reimbursement to you after Medicare and any other group insurance plans have adjudicated the claim.
QUESTION: What drugs are covered under my drug benefit? ANSWER: Generally most drugs which can only be dispensed under Federal or State law upon a written prescription plan.
QUESTION: What drugs are not covered under my drug benefit? ANSWER: Refer to the section entitled, "Exclusions: Applicable to both Walk-In Pharmacies and Mail Order Prescription Plans."
QUESTION: Do I have to pay anything for prescriptions? ANSWER: For a complete description of the prescription drug plan refer to the section entitled "Mandatory Prescription Drug Plan" as listed in the Table of Contents of the Summary Plan Description.
QUESTION: Are generic drugs effective? ANSWER: The role of the FDA is to ensure that all new brand and generic drugs are safe and effective. The FDA also monitors reports from doctors, pharmacists, and nurses on adverse drug reactions. As with all drugs, brand and generic, some adverse reactions are possible. To learn more about generic drugs, you can contact the FDA at 1-888-INFO-FDA, or visit the FDA Center for Drug Evaluation and Research, Office of Generic Drugs website at http://www.fds.gov/cder/ogd/index.htm. Important notice to retired participants enrolled in the Medicare Supplement Plan or enrolled in Medicare. The Mandatory Prescription Drug Plan provides a comprehensive prescription drug plan which has been certified as creditable coverage. This means that the actuarial value of the Mandatory Prescription Drug Plan equals or exceeds the actuarial value of standard prescription drug coverage under Medicare Part D. Therefore, do not enroll in Medicare Part D. If you do enroll in a Medicare Part D prescription drug plan, you will be charged an additional $32 per month which will be deducted from your monthly pension check effective upon enrollment in the Medicare Part D. plan.
If you erroneously enroll in a Medicare Part D drug plan and later chose to disenroll from this plan, you should contact Medicare for your disenrollment rights.
QUESTION: What is a generic drug? ANSWER: A new drug is given two names. One is the brand name, which is what the manufacturer chooses to call the product. The other is the generic drug, which is the name of the chemical compound of the drug. Every drug has a generic name to describe its active ingredient.
QUESTION: Why are most generic drugs less expensive than brand name products? ANSWER: When a company develops a new drug, it has a patent for about 17 years. The patent protects the drug company's right to be the only manufacturer of that drug. After the patent expires, other companies can then manufacture and sell the drug under either a different brand name or the generic name. Because of lower research costs and more competition, the new product is usually sold at a lower price than the original brand name product.
QUESTION: How are generic drugs approved for use? ANSWER: The Food and Drug Administration (FDA) reviews all name brand and generic products for safety and effectiveness. Before a generic drug is approved for use in the United States, the drug company must provide proof to the FDA that the product has the same active ingredient when compared to the brand name product. In addition, the generic product must meet FDA standards for the amount of active ingredient and speed of absorption into the body. When the generic product meets these standards, it is considered equivalent.
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