Information from Norm Sherman, Florida CSARC SE Florida Liaison & Outreach Coordinator, Council of School Supervisors and Administrators (3/14)

 

1. Drug Reimbursements - I have received several calls concerning Doug Hathaway's Welfare Fund Primer article in the May issue of the CSA News. In it he writes that if a retired DOE participates in a GHI drug plan (which most of you do) then you are entitled to a drug reimbursement as follows: After you pay a $100 deductible, the Welfare Fund reimburses co-payments at 80 percent, to a maximum of $5,000. Unfortunately, this is only true for NON-MEDICARE RETIREES. So if you are on Medicare, please do not send the CSA Welfare Fund your quarterly Express Scripts reports looking for a refund. It's not going to happen. However, those on Medicare do receive the Fund's drug benefit of $480. This is what Doug has humorously referred to as the Fund's Valentine Gift since the reimbursement comes around Valentine's Day. In addition, if your out-of-pocket-expenses are large enough to move you out of the "donut hole," the Fund will reimburse you up to $5,000 of drug co-pays at 100% with no deductible. Further, the Retiree Chapter will reimburse you an additional 15% of the Fund reimbursement.

 

2. IRMAA - As many of you know, IRMAA checks, which are issued by the Office of Labor Relations (OLR), were delayed. In fact, although OLR announced the checks would be issued around March 31, many members did not receive theirs until mid-April. Who knows why there was a delay. What we do know is that there are still members who haven't received their 2012 IRMAA reimbursement. If you fall in the above category, please understand the CSA Welfare Fund is working on getting your IRMAA  check(s) PROVIDING YOU HAVE LET ME (OR THE FUND) KNOW YOU DID NOT RECEIVE IT (THEM). Remember, IRMAA refunds are for both the member and spouse.

 

3. Medicare Coverage of a Skilled Nursing Facility (SNF) - Medicare will cover a skilled nursing facility providing you meet the following conditions:

  • You need skilled nursing care seven days a week or skilled therapy services at least 5 days a week.

  • You were formally admitted to a hospital as an inpatient for at least 3 consecutive days and you enter a Medicare-certified a SNF within 39 days after leaving the hospital.

  • You need care that can only be provided in a SNF

 

Remember, being admitted to an emergency room to receive ER services or be under observation does not count toward meeting the 3 day prior hospital requirement for meeting SNF coverage.

 

4. Hospital Deductible - If you are on admitted to a hospital there will be a $300 deductible. However, under the CSA Retiree Welfare Fund's Supplemental Medical Program, you will be refunded after an annual $100 deductible, 80% of the hospital cost. If this is your 1st use of this benefit for the year, the Fund will refund you 80% of $200 or $160. If you are admitted again to the hospital during a different benefit period (you are out of the hospital for 60 consecutive days), your deductible will again be $300. However, this time you will be refunded 80% of $300 or $240. The max you can be refunded in a year is $750. To obtain a refund, you must submit your bill and proof of payment to the CSA Retiree Welfare Fund.