School Retiree Benefits
For those retirees who satisfy the eligibility requirements, the School Retiree PPO Plan benefits include coverage for doctors’ visits, hospital stays and other medical services. (See School Retiree Plan Covered Services below for more information.)
For those retirees who satisfy the eligibility requirements, the School Medicare Retiree Plan benefits are limited to a Death Benefit and Medicare Part B and Part D premium reimbursements. (See School Retiree Plan Covered Services below for more information.)
There are two medical plan options for the School Retirees:
- The PPO Retiree Plan (must pay a premium & meet eligibility requirements)
- The Medicare Retiree Plan (no premium required & must meet eligibility requirements)
Eligibility and Enrollment
Eligibility in a Retiree Plan depends on whether or not you are eligible to retire. To learn more about retirement eligibility requirements, visit the Eligibility and Enrollment page.
Once you are eligible to retire, based on the eligibility requirements you have two Plan options for the School Retiree Plans. In order to be eligible for the different plans, you must meet the eligibility requirements stated above, in addition to the requirements below:
- The Medicare Retiree Plan – You are a School Retiree, either under or over age 65, and eligible for Medicare.
- The PPO Retiree Plan – You are a School Retiree between the ages of 62-64 and ineligible for Medicare.
Dependent Eligibility and Enrollment
- Your Eligible Dependent will be eligible for the PPO Retiree Benefit for as long as you remain eligible for the PPO Retiree Benefit.
- You and any Eligible Dependents’ PPO Retiree Benefit coverage will terminate on the last day of the month prior to the month in which you reach age 65. COBRA Continuation Coverage may be purchased for a maximum of 18 months for any Eligible Dependent who loses coverage following this event.
- Your eligible spouse who is terminated from the PPO Retiree Benefit coverage because you reach age 65 will be eligible for the Medicare Related Premium Reimbursement Benefit when they become Medicare eligible.
Medicare Eligibility and Enrollment
You are eligible for Medicare when you are either under or over age 65, and eligible for Medicare and meet the eligibility requirements.
The School Medicare Retiree Plan medical benefits are exclusively limited to the Death Benefit and Medicare Related Premium reimbursements (benefit formerly known as the "Reimbursement of Medicare Part B and Part D Premiums").
School Retiree Plan Covered Services
The School Medicare Retiree Plan benefits are exclusively limited to the Death Benefit and Medicare Related Premium reimbursements (benefit formerly known as the "Reimbursement of Medicare Part B and Part D Premiums").
The School PPO Retiree Plan medical benefits are covered by Empire’s plan which covers many medical services, including basic preventive screenings, doctor and specialist visits, surgical services and more.
School Retiree Plan Costs
The School Medicare Retiree Plan does not require a premium payment. You must meet the eligibility requirements to be eligible for the School Medicare Retiree Plan.
The School PPO Retiree Plan requires a premium & you must meet the eligibility requirements.
As a participant in the School PPO Retiree Plan, you share the cost of medical services with the Health and Benefit Trust Fund.
Premium—You pay a monthly premium, or small fee, to participate in the School PPO Retiree Plan. Listed below is the monthly premium for the School PPO Retiree Plan.
The School PPO Retiree Plan—is currently $850 for individual or family coverage per month. Effective June 1, 2021 the premium for the School PPO Retiree Plan will be $950.00 for individual or family coverage per month.
Continue using the Empire Blue Cross and Blue Shield PPO benefits you had while and active member. You will be responsible for any deductible, co-payments, co-insurances or any balances if you utilize an out of network provider.
Retiree Medical Claims
School PPO Retiree Plan
If you have to file a medical claim with Empire for reimbursement, download and fill out the Empire Claim Form (PDF). Once you fill out the form, mail it and any applicable documents to:
Empire BlueCross BlueShield
P.O. Box 1407
Church Street Station
New York, NY 10008-1407
School Medicare Retiree Plan
Medicare Related Premium Reimbursement
Retirees will be eligible to receive a reimbursement of an annual calendar maximum of $7,000 effective 1/1/2019 for Medicare Related Premiums for the annual calendar premiums paid. The benefit includes the eligible retiree’s spouse. The annual calendar year maximum of $7,000 is not applied on a per person basis, but instead is a combined annual maximum for Medicare Related Premiums paid by the eligible retiree and/or their spouse. Prior to 1/1/2019 the annual calendar premium reimbursement formerly known as the “reimbursement of Medicare Part B and Part D Premiums” was $3,000. The $3,000 premium reimbursement was a combined annual maximum paid by the eligible retiree and/or their spouse.
In order to be reimbursed for the Medicare Related premiums that you (or your spouse) have paid during a calendar year, you (and your spouse) must send the Plan proof of such premium payments within one year following the end of the calendar year. Please contact the Fund office for what forms of proof are acceptable for reimbursement or they are listed on the Medicare Related Premium Reimbursement form. In order to receive reimbursement you will be required to complete the Medicare Related Premium Reimbursement Form. You can download and fill out the Medicare Related Premium Reimbursement Form and mail it to the Health and Benefit Fund along with the applicable documents or you may contact the Health and Benefit Fund for the form to be mailed to you.
School Medicare Retiree Plan - Partnership with HealthPlanOne
The Fund has a partnership with HealthPlanOne to assist you in exploring the healthcare marketplace in your retirement. If you are Medicare eligible, HealthPlanOne will be able to evaluate the Retiree Health Insurance options available to you.
HealthPlanOne currently offers over 7,400 plans nationally from 80 plus carriers. There is a broad selection of designs for Medicare Supplement, Medicare Advantage and Plan D programs offered by a wide array of carriers. The Fund is confident HealthPlanOne will be able to assist you in finding a plan that meets your needs at a competitive price.
These services are available to you at no cost or obligation on your part. You are not required to use HealthPlanOne’s services nor are you required to make any changes if you are satisfied with your current plan.
Through HealthPlanOne, you will have the option of accessing a benefit website that offers online decision-tools that provide detailed information on plan designs and pricing. In addition, HealthPlanOne benefit Advisors are available to provide personalized assistance. They are knowledgeable professionals, licensed in Medicare, and they are here to be your advocate, answering all your questions, providing advice, and finally enrolling you in the healthcare plan that best fits your needs and budget. You can reach a benefit Advisor at 844-267-0569. The entire process can be handled online or on the phone. The Web Address for Fund retirees who wish to inquire on line is http://www.hpoexchange.com/local94/ HealthPlanOne can also work directly with a family member or other party that you designate and authorize to assist you with this process.
Each year thereafter if you are eligible as a School Retiree and on Medicare, HealthPlanOne is available to you if you are interested in making a change to your current Medicare coverage during the open enrollment period. HealthPlanOne can assist and guide you thru any enrollment with a new carrier. HPONE will contact all eligible School Retiree participants who are currently enrolled in Medicare in the middle of September each year leading up to the fourth quarter Annual Open enrollment period for Medicare Plans. If you choose, HealthPlanOne will set up an appointment for you to meet by phone with an advisor.
The Fund is confident, with HealthPlanOne by your side, you will be able to identify the best healthcare options to meet your current and future needs.
Visit Empire's Website
Empire’s member website lets you access tools and information to help you live a healthier life. The site is available 24/7. At Empire’s member website you can:
- Look up your health care claims
- Find a medical provider
- Chat with an Empire members service representative
- Use Empire’s 360 Health® wellness program
- Visit the MyHealth wellness portal administered by WebMD
To access the site, visit www.empireblue.com and click on the “Member” tab. If you haven’t registered, sign up and log in to start enjoying Empire’s online benefits.
School Retiree PPO Plan--Other Retiree Benefits
As a School PPO retiree, you are able to continue receiving other benefits you had while you were an Active Participant. To learn more about your other benefits, click the links below.
Empire’s plan covers many medical services, including basic preventive screenings, doctor and specialist visits, surgical services, substance abuse and rehabilitation benefits and more.
Need to Find a Doctor, Dentist or Vision Specialist?
What is our Dental Coverage?
The Fund offers Dental Benefits coverage to all eligible participants and their eligible dependents. Sele-Dent administers all dental and orthodontia claims for the Plan. The Fund has established a Local 94 Network of Participating Providers, as well as the Sele-Dent PPO Network, where eligible participants can receive discounted dental services. For a complete list of providers and for more information about your Dental Benefits, please see the Dental Benefits section of this site.