HMO MEDICAL PLANS

In most cases within the jurisdiction of the Retiree Health Plan, you can choose among a choice of HMO Plans.  You can choose among one of the Health Maintenance Organizations (HMOs) with which the Plan has an agreement, depending on where you live.  You have an opportunity to make this choice of health Plans for medical benefits once each year.  If you are enrolled in Medicare Parts A and B, you can also choose (Kaiser Permanente) Senior Advantage or (PacifiCare) Secure Horizons as an HMO choice

A Health Maintenance Organization is a group of healthcare providers who have contracted with the Retiree Health Plan to provide medical services at a predetermined cost.  The services provided and exclusions are explained in the brochure and other descriptive literature that you receive during the open enrollment period.  However, to obtain these services you must use the doctors and hospitals associated with the HMO.  The medical facilities you may use are listed in the HMO descriptive literature or HMO directories.  You must use the doctors and hospitals associated with the HMO of your choice.

In order to enroll in an HMO, you must live or work within that HMO's service area. For Kaiser Permanente, your home or principal place of work zip code must be included within Kaiser Permanente's zip code listing. For PacifiCare, you must live or work within a 30-mile radius of the Medical Group selected.

Under the HMO Plans, covered services are generally provided without charge, or for a fixed co-payment.

In this Summary Plan Description, you have been provided with general information for each of the two HMO's under contract with the Trust. However, this information is only a summary, included herein for easy reference. For complete information on any of the HMO Plans, you should contact the HMO directly or the Administrative Office and request that they send you complete descriptive literature for the specific HMO in which you are enrolled

Retirees and their eligible spouses who use an HMO and who are over 65 or eligible for Medicare Parts A and B must enroll in Medicare.  Under a contract between Medicare and the HMO, Medicare pays the HMO a fixed amount each month to provide you with all Medicare-approved benefits.  The benefits of the HMO are generally greater than that provided under private Medicare insurance.