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Health
Benefits
If
You Are Not Eligible for Medicare...
For
participants not eligible for Medicare, deductibles have changed in
both available programs:
- For participants
in the Trust's indemnity program, the annual deductible for
2008 will be $2,310
- For participants
in the Trust's optional PPO program, the annual in-network
deductible for 2008 will be $745. The monthly premium is $45.
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To read about plan amendments that are effective January 1, 2008, view the Trust Tribune |
| For additional details see the:
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The
Trust offers heart disease and diabetes management programs to eligible
participants through Nurtur (formerly Cardium Health). Nurtur's
programs are free to Trust participants who have a:
- History of cardiovascular
disease;
- Diagnosis of diabetes; or
- Diagnosis of congestive
heart failure.
Counselors work with
enrollees to develop personalized plans designed to improve the
quality of their lives. The programs enhance, but do not replace,
the medical care you receive from your doctor. On average, participation
in the program lasts 24 months. If you have questions or would like
to enroll, call toll-free 1-877-676-7700, or visit
NurturHealth.com to see if you are eligible to participate.
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What We Offer...
If you are not yet
eligible for Medicare, you are still eligible for the Life
Insurance benefits.
You are also eligible
for two different retiree medical plans: the Trust
indemnity program and/or a preferred
provider organization (PPO) option. Both options cover you
and your eligible spouse. Both options also provide discount
prescription drug benefits.
To learn more about
these programs, continue reading this page or see the More
Than You Expect brochure.
Trust Indemnity Program...
In the Trust indemnity
program, when you need medical care, you go to any Medicare-approved health
care provider you choose. Once you have met the annual deductible (a separate
deductible applies to you and your eligible spouse), the Trust indemnity
program will begin to pay 80 percent of the covered medical expenses (you
file
claims to be reimbursed). You are responsible for the remaining
amount not paid by the Plan.
If you reach your
annual limit — called the out-of-pocket maximum — the Plan will pay the
rest of your covered medical expenses for that year at 100 percent.
| Your
monthly contribution |
$0
for retirees,
$35 for eligible spouses
|
| Plan
Pays |
80%
for covered medical expenses
after
you pay the annual deductible.
You pay the remaining 20%.
|
| Deductible |
$2,310 |
| Annual
out-of-pocket maximum |
$6,930 |
| Lifetime
maximum benefit |
$170,000 |
| Prescription
Drug Benefits |
- After you meet a separate $635 deductible, generic
drugs are covered at 90%, "plan-preferred" brand-name drugs are
covered at 75%, and "non-plan-preferred" drugs are covered at
60%.
- To use the discount, show your Trust
I.D. card when you visit a participating pharmacy.
- Mail-order service is mandatory on maintenance medications.
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Preferred
Provider Organization (PPO) Option...
You may choose to
replace your Trust indemnity program with coverage in a preferred provider
organization (PPO) option. The PPO option, just like the Trust indemnity
program, covers you and your eligible spouse, as long as you are not eligible
for Medicare.
|
Provision |
In-network |
Out-of-network |
| Your
monthly contribution |
$45
per participant |
$45
per participant |
| Plan
Pays |
90%
for covered medical expenses. You pay the remaining 10%. |
70%
for covered medical expenses. You pay the remaining 30%. |
| Deductible |
$745 |
$2,235 |
| Annual
out-of-pocket maximum |
$2,235 |
$6,705 |
| Lifetime
maximum benefit |
$250,000 |
$250,000 |
| Prescription
Drug Benefits |
- After you meet a separate $635 deductible, generic drugs
are covered at 90%, "plan-preferred" brand-name drugs are covered
at 75%, and "non-plan-preferred" drugs are covered at 60%.
- To use the discount, show your Trust
I.D. card when you visit a participating pharmacy.
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By visiting health
care providers in the PPO network, you can affect your annual deductible
(the amount you pay in a calendar year before a plan begins to pay any
benefits). The PPO option costs $45 per month ($540 per year), but compare
this with the lower deducible and lower out-of-pocket maximum to see how
you can save money.
| Choice |
Any Medicare-approved
health care provider |
Any
doctor within the network. (Your doctor may already be a member
of the network.)
|
| Benefits |
Annual Deductible
$2,310
Plan Pays 80%
Out-of-Pocket Maximum $6,930 |
Annual
Deductible $745
Plan Pays 90%
Out-of-Pocket Maximum $2,235
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| Monthly
Cost |
$0 |
$45
Per Month Per Participant |
What
You Need To Do...
Although you are automatically
enrolled in other Trust benefits, you must actively enroll in the PPO
option by filling out a PPO
enrollment form (available here and through the Trust office)
and returning it to:
G.M.P. – Employers
Retiree Trust
PPO Enrollment
5245 Big Pine Way, S.E.
Fort Myers, FL 33907-5998
Phone: (239) 936-6242
Your enrollment form
will be reviewed and, if you are eligible, you will be enrolled in the
PPO option as soon as possible. Initially, you may enroll in the PPO option
at any time.
If you want to drop
the PPO option and return to the Trust Plan, you may do so at any time,
but you must notify the Trust office in writing of your intent. If you
want to re-enroll in the PPO option at a later date, however, you
must wait two years from the January 1 following the date you drop out
of the PPO option before you can re-enroll. For instance, if you
decide to drop the PPO option effective February 1, 2008, the first time
you would be able to re-enroll in the PPO option would be January 1, 2011.
(You would be covered by the Trust indemnity program for the remainder
of 2008, and all of 2009 and 2010.)
How
You Benefit...
A PPO offers several
advantages:
- Much lower deductibles.
When you see network providers, the PPO's deductible is a fraction of
the indemnity program's current deductible.
- Usually no claim
forms. By choosing network doctors and health care facilities, you
usually are not responsible for completing and filing claim forms.
- Urgent or emergency
care. If you're away from home and have an accident or other health
care crisis, you are usually covered as if you were at home under the
care of network providers.
- Service and
credentials. Network providers are required to meet guidelines for
quality of service, including patient satisfaction, by the managed care
organization.
It's important
to know the level of your former employer's current contributions
to the Trust. The medical plan and prescription drug benefit details explained
on this site are different, depending on whether or not your employer
contributes to the Trust at the highest rate per hour.
To find out the level of your employer's contributions
to the Trust, ask your employer′s benefits specialist, call the Trust office at (239) 936-6242, or send an email through the feedback section of this Web site.
Copyright
2008, G.M.P. - Employers Retiree Trust, All Rights Reserved
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