 |
 |
 |
 |
 |
 |
 |
 |
|
|
|
|
|
|
 |
|
|
 |
|
|
 |
 |
|
|
|
 |
Summary Plan Description (SPD)
PREMIUM REIMBURSEMENT PLAN
This section replaced by: Amendment 13. View Previous Language
The Premium Reimbursement Plan is for those retirees who live outside of the HMO service area; or who choose not to elect coverage with an HMO under contract with the Retiree Health Plan; or who choose not to elect coverage under the Medicare Supplement Plan. The Premium Reimbursement Plan provides an option to obtain private medical insurance (including long-term care insurance) on your own and receive a limited dollar reimbursement from the Retiree Health Plan for your cost of your private medical insurance. The Premium Reimbursement Plan also provides prescription drug benefits under the “Mandatory Generic Prescription Drug Plan”. It offers retirees participating in the Retiree Health Plan the following three benefits:
- Prescription Drug Plan
You and your spouse, if covered, have prescription drug benefits with Prescription Solutions. Refer to the section entitled “Mandatory Generic Prescription Drug Plan”. - Periodic Reimbursement of Your Cost of Your Private Medical Insurance
You receive reimbursement upon submission of a fully completed claim form showing that you have paid for a private plan of medical insurance. Reimbursement is based on the lesser of:- Lowest Trust Early Retiree HMO Plan cost per person; or
- The cost to you of your private medical insurance (including premiums for long-term care insurance).
- Future HMO Enrollment if Outside Service Area of HMOs. If you remain a participant in the voluntary Retiree Health Plan, you would later be eligible to enroll in one of the Health Maintenance Organizations (HMOs) offered (Kaiser Permanente/Senior Advantage or PacifiCare Secure Horizons) if you move into the service area of any of the HMO Plans. Also, when you (and your eligible spouse) receive Medicare benefits, either by reaching age 65 or from the Social Security Disability Benefits, you would become eligible to participate in the Medicare Supplement Plan, which is available regardless of where you live in the United States. This Plan reimburses you for the annual Medicare deductible and the 20% of charges not paid by Medicare, up to an annual maximum payment of $2,500 for you and $2,500 for your spouse (if eligible).