GE: At Age 65 and Older Medical Insurance

by Local 201 Vice President Alex Brown

            When retirees turn age 65 they become eligible for Medicare, the federal health insurance program.  Retirees may have two choices of GE health plans in addition to Medicare: the GE Medicare Benefit Plans that supplement Medicare or the GE MedicarePlus plans (where available) that replace the GE plans and Medicare in an HMO type approach.

            The union has fought over the years to increase the benefits the GE Plans pay, and keep their rates affordable for retirees.  This is a difficult job given the rising costs and inefficiencies in the private insurance health care system.  With the number of unionized shops shrinking due to outsourcing and anti- organizing laws, the number of Companies offering post-65 insurance is at an all time low.  Look for retiree medical to remain a key issue for the 2007 contract.   With the Medicare premiums and deductibles rising, increasing the GE plans’ payments will be critical for retirees.

            Be sure to refer to the post 65 retiree handbook (included in your retirement kit from GE) and the information GE sends out three months before your 65th birthday for more details.

Traditional GE Plans:

Hospital coverage: Medicare Part A covers part of the expenses for inpatient hospitalization which GE plans supplement.

1) GE Medical Care Plan for Pensioners  (MCPP)

·        There is no premium if you had 15 or more years of continuous service when you retired. 

·        Pays almost 80% of Part A costs that Medicare does not pay.

2) GE Pensioners Hospital Indemnity Plan (PHIP)  

·        2007 monthly contribution rate is $8/month/person.

·        The plan pays almost 20% of the Part A charges that Medicare does not pay.

·        Taken together the MCPP and the PHIP combine with Medicare Part A to pay almost 100% of the short term hospital admissions, the first 100 days in an extended care facility, and up to $450 toward the 20% not covered by Medicare in an outpatient ambulatory surgery center.

·        For example, Medicare has a $992 deductible in 2007 for days 1-60 in the hospital.  The MCPP pays $675 and the PHIP pays $150, so the retiree pays $167. For days 61-90, the Medicare deductible is $288, the GE plans pay $137 and $62.50, so the retiree pays $48.  For days 91 – 150 the Medicare deductible is $496, the GE plans pay $275 and $125 so the retiree pays $96. 

·        These plans do not cover custodial care.

Filing claims for MCPP and PHIP

·        Both the MCPP and the PHIP plans require retirees/or their provider to submit claims forms.  The address is on the back of your ID card, or call the GE Pensioner Medical Claims Center at 1-800-848-8406 to get a form.

·        Even if you have other insurance, such as coverage under an open market plan such as Medex Bronze, you are eligible for claims payments if you are enrolled and paying any required premiums.

·        There is a claims deadline of the end of the calendar year following the year in which the claim was incurred. The estate of a deceased participant has an additional year to file claims.

·        Save your paperwork. To make a claim for a hospital inpatient stay, you need your Medicare statement, and an itemized bill from the hospital.  The back of the claim form has the details.

Doctor’s Bills: Medicare Part B, medical insurance, covers 80% of Medicare allowable amounts for physician care and emergency care after a $131 deductible. The Medicare Part B 2007 premium paid out of your Social Security check is $93.50 person/month.

3) GE Medicare Insurance Plan (GEMIP)

·        The plan pays the remaining 20% of Medicare approved charges for doctor’s care and emergency care. The 2007 premium is $96/month/person.

·        It doesn’t cover annual physicals but does cover a limited list of preventive tests such as cancer screenings, diabetes self-management benefits, and immunizations.

·        It doesn’t cover routine dental, hearing aids, eyeglasses and eye exams.

·        There is a limited vision discounts program called Vision Value Option through Davis Vision.  Call 1-888-433-9370 for details.

·        GEMIP does cover some services not covered by Medicare such as limited mental health and nursing services.

Filing Claims for GEMIP

·        Medicare automatically forwards medical claims to the GE Pensioner Medical Claims Center under the “crossover program.” 

·        Claims deadline is the end of the calendar year following the year in which the claim was incurred, and a year more for the estate of a deceased participant.

4) GE Pensioners Prescription Drug Plan (PPDP)

The recently passed Medicare D prescription drug plan is so limited and costly that it is worse than the GE PPDP plan.  The GE Plan has the following features:

·        There is no premium if you had 15 more years of continuous service when you retired.

·        Co-pays are based on whether you attained age 65 before or after Jan. 1, 2004. 

·        If you attain age 65 before Jan.1, 2004, co-pays are:

$15 for a 21 day supply at a network pharmacy,

$25 for a 90 day supply through mail order.

Co-pay maximum is $1500 per participant.

·        If you attain age 65 after Jan 1, 2004, co-pays are:

$12 for a 21 day supply, generic drug, at a network pharmacy,

$16 for a 21 day supply, brand name drug, at a network pharmacy.

$20 for a 90 day supply, generic, through mail order service,

$36 for a 90 day supply, brand name, through mail order service.

Co-pay maximum is $2000 per participant or $4000 per family.

·        Remember, you get charged extra if your doctor requests brand name over generic unless the doctor proves that it is medically necessary. Also some drugs require prior authorization. The doctor has to call Medco at 1-800-355-4379.

·        Claim forms are necessary if you go to a non-network pharmacy.

GE MedicarePlus Plans:

·        These plans replace Medicare and the GE Medicare Benefit Plans and provide one plan in an HMO type approach requiring you to see doctors in a specified plan network. The plans are only available in some zip codes and the rates and terms are different. So it’s important to review the terms of the particular plan.

·        In the North Shore area Harvard Pilgrim (2007 premium, $97 per person/month) and Tufts (2007 premium, $97 per person/month) are available.  Fallon is available in the Worcester area. (2007 premium, $97 per person/month.)  MedicarePlus is not currently available in Maine. These are not the same plans/rates as ones on the open market with the same names.

·        Retirees still must take Medicare Part B and pay the required $93.50 premium out of your Social Security check.

·        Covers some things Medicare plus GEMIP doesn’t: annual physical, limited vision, and hearing benefits.

·        Some of the plans have high inpatient hospital co-pays as much $200-300 per visit.

·        The prescription drug co-pays are somewhat higher and more complicated than the GE plan. (Note: You can’t take MedicarePlus and the GE PPDP.)

·        Your doctors must be in the plan network. Co-pays required for primary and specialist doctor visits.

·        Don’t have to fill out claims forms.

How to sign-up for the plans.

·        It’s important to pay attention to deadlines in enrolling in the plans. If you are required to make contributions, you must enroll within 90 days of turning 65. GE should send out information 3 months before your 65 birthday.  (For more information on the  MedicarePlus programs contact GE Ambassadors Marge and Cecil Kelly, 1-978-774-1832.)

·        Can pre-enroll in the GE plans when you fill out your retirement paperwork to protect you from missing the 90 day deadline.  Premiums do not begin until you turn 65.

·        “Reaching age 65” means the first day of the month unless your birth date fall on the first of the month, then reaching age 65 means the first day of the preceding month.

 
   

For further information contact Local 201 IUE-CWA at (781) 598-2760
     
   

   

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