Medicare Supplemental Plan

Active and retired employees and their dependent spouses who are age 65 and over, or who are totally and permanently disabled, or who have end-stage renal disease (kidney failure) are entitled to obtain benefits under the federal government’s medical program known as Medicare. There are two parts to Medicare that relate to this Plan.  They are hospital insurance (Medicare Part A) and medical insurance, such as for the cost of physicians and outpatient care (Medicare Part B).  Medicare Part A is financed by payroll taxes, and, if you are eligible to receive it based on your own–or your spouse’s–employment, you do not pay a premium.  You will, however, have to make copayments under a schedule established by Medicare.  Medicare Part B is partly financed by monthly premiums paid by those who enroll.  Medicare sets the Part B premiums each year.

Eligibility

If you are still working at 65 and you or your enrolled dependent is eligible for Medicare, the Plan remains your primary medical coverage.  You should enroll in Medicare as soon as possible, however, because Medicare will pay secondary benefits (up to its limits), which will reduce or possibly eliminate your costs for many medical services.

Once you or your spouse reach age 65 and become eligible for Medicare, you or your spouse must enroll in Medicare and elect either the PPO Medicare Supplemental Plan or the HMO Medicare-Risk Program of Kaiser Permanente, called Senior Advantage.  You and your spouse must either be 1) both in the PPO or 2) both in Kaiser.

Benefit Information

Although Medicare provides certain medical benefits, some charges are not covered under that program, such as private duty nursing fees and charges incurred outside the United States.  To provide certain benefits which are not provided by Medicare, a specially designed Plan supplementing Medicare has been adopted, as outlined below. This Medicare Supplemental Plan applies to all persons for whom the Plan is permitted by law to be the secondary payer. The regular schedule of benefits of the PPO Plan applies to all Medicare-eligible persons for whom the Plan is required to be primary.

Persons who are covered under the Medicare Supplemental Plan receive the same prescription drug benefits and vision care benefits as persons covered under the PPO Plan.  A retiree is entitled to dental, vision care, hearing aid, where applicable, and death and dismemberment insurance benefits, regardless of which medical benefits provider he has selected.

IMPORTANT NOTE:  To be eligible for either primary or secondary benefits under this Plan, every Medicare-eligible member or dependent must be enrolled in Medicare Parts A and B. If you fail to enroll in Medicare Part B, or you allow your Medicare Part B coverage to lapse, then your coverage under the Plan will terminate on the last day of the month preceding the month in which you were eligible for Medicare but failed to pay for Medicare Part B.  You should enroll in Medicare within 3 months prior to your 65th birthday.  For enrollment and eligibility information, call Social Security at 1-800-633-4227.  You can also find Medicare information on the Internet at www.medicare.gov.

The Medicare Supplemental Plan covers 100% of the Medicare hospital deductible.  It pays 80% of the charges not covered by Medicare for Hospital services and Medicare-qualified Skilled Nursing Facilities expenses.  For Medical Services, there is a $50 deductible each calendar year.  After you pay that, the Plan pays 80% of the UCR charges for services from licensed physicians and registered nurses, and 50% of the UCR charges by a licensed practical or vocational nurse  for services provided within 60 days of an accident or within 60 days of the last day of a period of hospital confinement.  There is a Lifetime Maximum of $70,000 under this Plan, which is restored by up to $2,500 per year.

If a service is not covered by Medicare, the Plan will not cover any portion of it.

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