Health Benefits...

If You Are Not Eligible For Medicare...

New Annual Deductible for 2008
For participants not eligible for Medicare, deductibles have changed in both available programs:
  1. For participants in the Trust's indemnity program, the annual deductible for 2008 will be $4,325.
  2. For participants in the Trust's optional PPO program, the annual in-network deductible for 2008 will be $1,690. The monthly premium is $45.

These changes are reflected in the details below.

The Trust Gazette

To read about plan amendments that are effective January 1, 2008, please see the Trust Gazette.
Plan of Benefits and Plan of Summary Coverage
For additional details see the:

Voluntary Disease Management Programs
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.

What We Offer and How You Benefit...

If you are not yet eligible for Medicare, you are still eligible for the Life Insurance benefits explained elsewhere on this site.

You are also available for two different retiree medical plans: the Trust's indemnity program and a preferred provider organization (PPO) option. Both options cover you and your eligible spouse. Both options also provide discount prescription drug benefits.

 

Trust Indemnity Program...

In the Trust indemnity program, when you need medical care, you go to any Medicare-approved health care provider you choose and you pay all of your covered medical expenses until you have met the annual deductible (a separate deductible applies to you and your eligible spouse). When you reach that amount, the Trust indemnity program will begin to pay 80 percent of the covered medical expenses (you file claims to be reimbursed). You pay 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.

Trust Indemnity Program
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 $4,325
Annual out-of-pocket maximum $12,975
Lifetime maximum benefit $100,000
Prescription Drug Benefits
  • The prescription drug benefit covers 80% of eligible prescription drug charges after you meet the $4,325 deductible.
  • To use the discount, show your Trust I.D. card when you visit a participating pharmacy. To file a prescription drug claim with the Trust office, you must submit an itemized list from the pharmacy.

 

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.

PPO Option

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 $1,690 $5,070
Annual out-of-pocket maximum $5,070 $15,210
Lifetime maximum benefit $100,000 $100,000
Prescription Drug Benefits
  • The prescription drug benefit covers 90% of eligible prescription drug charges after you meet the plan deductible.
  • To use the discount, show your Trust I.D. card when you visit a participating pharmacy.

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 deductible and lower out-of-pocket maximum to see how you can save money.

 
Trust Indemnity Program PPO Option Using 
Network Providers
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 $4,325
Plan Pays 80%
Out-of-Pocket Maximum $12,975

 Annual Deductible $1,690
Plan Pays 90%
Out-of-Pocket Maximum $5,070
Monthly Cost $0 for retirees, $35 for eligible spouses $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 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 website.

Copyright 2008, G.M.P. - Employers Retiree Trust, All Rights Reserved