Questions...
Some of the most commonly asked questions about Trust benefits are listed below. Choose your question to jump to the answer.
I am a spouse who
is eligible to receive Trust benefits, but will be using only the prescription
drug benefit. Do I still have to pay the $35 monthly premium?
I cannot afford to pay $105 for the quarterly premium. Am I allowed to
pay $35 per month?
What's the best way to find out if my doctors are in the health plan network?
I'm
covered by the Trust's indemnity program. What are my benefits?
What is a
Preferred Provider Organization (PPO)?
Who is eligible for the
PPO option?
What does the PPO option cost?
What
happens to my Trust indemnity program coverage if I join the PPO?
Can I change coverage?
What
if I spend a significant part of the year in a different city?
What is PPO Member Services?
What happens
when I am enrolled in the PPO and then become eligible for Medicare?
What does my I.D. card look
like?
How do I enroll
in life insurance?
 |
I am a spouse who is eligible to receive Trust benefits, but will be using only the prescription drug benefit. Do I still have to pay the new $35 monthly premium? |
Yes. Any spouse who is eligible to receive Trust benefits will now be required to pay a monthly premium of $35. (This monthly premium is waived for spouses who pay the monthly premium of $45 under the Trust's PPO option.)
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I cannot afford to pay $105 for the quarterly premium. Am I allowed to pay $35 per month? |
To keep administrative costs as low as possible, Trust participants are billed $105 quarterly and should pay that amount if at all possible. Exceptions can be made, however, participants are responsible for having the $35 to the Trust office no later than the 10th of the month. The Trust will not bill monthly, and will not remind participants to send the $35.
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What's the best way to find out if my doctors are in the health plan network? |
For the most reliable information, you may do one of three things:
- Call the health plan's customer service number found on your member I.D. card Go to your health plan's website (found under Helpful Links on the Trust's home page)
- Check with your doctor's office to see if they participate in the health plan network
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To learn about the Trust's indemnity program - what it offers and how it works - go to the Health Benefits by Employer area of gmptrust.com.
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A PPO is a form of managed care, or a way of receiving health care. In a PPO, networks of hospitals, doctors and other health care providers agree to provide quality, cost-effective care to eligible participants at reduced rates. The managed care companies use a strict screening process to see that doctors have appropriate licensing and certification before they are admitted to the network. You receive a higher level of benefits by choosing providers in the PPO network (you may still see providers who are not in the network, but you pay a higher percentage of the associated costs).
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To be eligible for the PPO option, you must be a Trust participant and not yet eligible for Medicare.
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The PPO option requires a $35 per month contribution
from each Trust participant. This contribution enables the PPO to offer
a lower annual deductible, lower coinsurance (percentage you pay), and
a lower out-of-pocket maximum.
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The PPO replaces your medical coverage under the Trust indemnity program. If you are a retiree, you keep your $2,000 life insurance benefit under the Trust indemnity program no matter which medical option you choose.
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Whichever option you choose will stay in effect until you decide to make a change. If you elect the PPO and later want to opt out, you can do so at any time. You must notify the Trust office in writing of your intent to terminate your PPO coverage.
If you want to drop the PPO option and return to the Trust indemnity program, you can do so at any time. 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, 2005, the first time you would be able to re-enroll in the PPO option would be January 1, 2008. (You would be covered by the Trust indemnity program for the remainder of 2004, and all of 2005 and 2006.)
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If so, you may be wondering if managed care is suited to your situation. After all, to get the highest level of benefits from the PPO option, you need to use its network of providers.
The fastest way to get a personal answer to your question is to call PPO Member Services. Simply call the number on your member I.D. card, ask the representative your question, and find out where the PPO has providers. You may be pleasantly surprised. PPO networks often cover a large part of the United States.
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PPO Member Services provides up-to-date PPO
provider and claims information over the telephone. Be sure to call the
correct number based on your PPO network and the information you are seeking.
|
Benesight (formerly
TPA)**
|
|
| For claims and eligibility questions |
1-800-648-4480 |
| For provider network information |
MultiPlan (Formerly ProAmerica/BCE Emergis)
: |
| Prescription Drug Information |
Medco: 1-800-841-5318 |
**including
MultiPlan (formerly ProAmerica/BCE Emergis); Sagamore, Indiana; United HealthCare in Waco, Texas; and United
HealthCare in Ohio
|
Highmark Blue
Cross Blue Shield*
|
|
| For claims and eligibility questions |
1-800-241-5704 |
| For provider network information |
1-800-241-5704 |
| Prescription Drug Information |
Medco: 1-800-841-5318 |
*including Preferred Blue of PA; Illinois Blue Cross; North Eastern PA Blue Cross; and Central New York Blue Cross
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What happens when I am enrolled in the PPO and then become eligible for Medicare? |
When you become eligible for Medicare (either by reaching age 65 or becoming medically eligible), you will no longer be eligible for the PPO option. You will automatically be covered under the current Trust indemnity program. For information about Medicare, go to Medicare's official website. To learn about your Trust coverage, go to the Health Benefits by Employer page on this site.
Important: You must notify the Trust office immediately when you and/or your spouse become eligible for Medicare for any reason other than attaining age 65. Write or call the Trust at:
G.M.P. - Employers Retiree Trust
5245 Big Pine Way, S.E.
Fort Myers, FL 33907-5998
Phone: (239) 936-6242
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If you're not sure what your medical I.D. card looks like, see examples of cards used by Trust participants. Cards vary depending on your network.
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You are automatically enrolled in life insurance coverage when you retire. Retirees only - not spouses - are covered by the Trust life insurance benefits for $2,000.
Copyright 2006, G.M.P. - Employers Retiree Trust, All Rights Reserved