CSA RETIREE CHAPTER UPDATE (October 2015)

 

1.   Marsh (Mercer) Catastrophic Major Medical (CMM) Insurance

 

As a reminder, this policy is a private one administered by Mercer, which many of you purchased through NYSUT or AFSA many years ago when you were working in the school system. It has nothing to do with the CSA Welfare Retiree Fund benefit, Catastrophic Stop-Loss Supplemental CSA Medical Benefit.

 

Mercer recently sent a Medicare mandated letter to those policy holders who purchased their policy through NYSUT and will be 65 or older, answering questions about the holder's drug coverage under this policy. The letter was intended strictly to be informative. Keep in mind, Mercer's drug coverage kicks in only when you meet the deductible ($10,000, $15,000 or $25,000) and will reimburse you up to 100% for reasonable and customary charges for out-of-pocket expenses, including drug co-pays.

 

Most of our Medicare members are on the GHI Enhanced Plan D drug plan. There is nothing they have to do about the Mercer letter other than filing it.

  

2. Surprise Medical Bill

 You are a non-Medicare CSA retiree with GHI coverage and received a surprise bill for a health care service. How could it happen? Let me answer with an example.

 During an operation, your in-network (GHI) doctor calls in an out-of-network doctor (sometimes an out-of-network doctor practices at an in-network hospital) to assist him. You know nothing about this until you receive a surprise medical bill from the out-of-network doctor. What should you do? Do not pay the bill. Instead, fill out a NYS Out-of-Network Surprise Medical Bill Assignment of Benefits Form. This form instructs the out-of-network doctor to seek payment from GHI and for GHI to make payment. It also certifies that, in fact, the bill was a surprise medical bill. For your convenience I have attached a copy. If you use form, send it to: Surprise Medical Bill/GHI, P.O. Box 1701, NY, NY 10023.

 Much of the above information was given to me by Lenore Kay, an Executive Board member of the SE Florida Unit. She is extremely knowledgeable about good Non-Medicare doctors and would like to share with Non-Medicare retirees their experience and information regarding participating providers. Her email address is lenore8nj@yahoo.com.

 

3. Medicare Open Enrollment Period

Every year, Medicare’s open enrollment period runs from October 15 through December 7. What is this period? It is the time of the year when those people on Medicare can change their health plans and prescription drug coverage for the following year. Why would anyone on Medicare want to make a change? Because it may no longer meet the person’s needs since Medicare health and drug plans can hike their costs, change their coverage and drop some of their providers from their network.

 

As you know, most CSA retirees on Medicare have original Medicare coverage, and the GHI enhanced drug plan paid for by the high option rider. I would suggest they review whatever these plans send them and, if satisfied and do not wish to make a change, do nothing during the open enrollment period.