Commercial Retiree Benefits
For those retirees who satisfy the eligibility requirements, Commercial Retiree medical benefits include coverage for doctor visits, hospital stays and other medical services.
There are three medical plan options for Commercial Retirees:
- The Basic Retiree Plan
- The Medicare Retiree Plan
- The PPO Retiree Plan
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, you can choose between three Commercial 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 Basic Retiree Plan – You are a Commercial Retiree under age 65 not eligible for Medicare, and do not want PPO coverage.
- The Medicare Retiree Plan – You are a Commercial Retiree, either under or over age 65, and eligible for Medicare.
- The PPO Retiree Plan – You are a Commercial Retiree under age 65 and ineligible for Medicare. Note that after enrolling in the PPO Retiree Plan you have a one-time opportunity to switch to the Basic Retiree Plan. After switching, you will not be able to switch back to the PPO Retiree Plan.
The main difference between the Plans is the amount each Plan covers for medical services.
Dependent Eligibility and Enrollment
As long as you are eligible and enrolled in a Commercial Retiree Plan, your eligible dependents will also be eligible for a Plan. For example, if you are in the Medicare Retiree Plan and your dependents are ineligible for Medicare, your dependents may be eligible for the Basic or PPO Retiree Plan.
Medicare Eligibility and Enrollment
You are eligible for Medicare when you are at least age 65 or you have a disability. Retirees eligible for Medicare benefits have their benefits coordinated with the Health and Benefit Trust Fund. That means that Medicare acts as the primary source of medical and hospital benefits, and the Health and Benefit Trust Fund Retiree Plan acts as the secondary source.
Retiree Plan Covered Services
Empire’s plan covers many medical services, including basic preventive screenings, doctor and specialist visits, surgical services and more.
Retiree Plan Costs
As a participant in a Retiree Plan, you share the cost of medical services with the Health and Benefit Trust Fund. There are three main ways you and the Fund split the cost.
Premiums—You pay a monthly premium, or small fee, to participate in the Retiree Plans. The amount of your premium depends on the Retiree Plan. Below are the monthly premiums for the different Retiree Plans:
- The Basic Retiree Plan—is currently $460 for individual or family coverage per month.
You and your Eligible Dependents will be covered for certain Plan benefits. Your Claims will be paid according to a limited fee schedule. The maximum payment you can receive for each procedure is based on a schedule of allowances for medical and surgical benefits.
- The Medicare Retiree Plan—is currently $460 for individual or family coverage month.
The Fund will reimburse you for the annual deductible and the 20% co-insurance amounts applicable to expenses approved under Medicare Part “B”.
- The PPO Retiree Plan— is currently $950 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
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
Typically, Medicare providers file your medical claims for you. For more information about Medicare claims, visit www.medicare.gov.
Visit Empire’s Member 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.
Visit Medicare’s Website
At Medicare’s website, you can find information on how Medicare works, where to find Medicare network providers and get tips on how to stay healthy.
Visit www.medicare.gov for more information.
Other Retiree Benefits
As a 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 the Family and Medical Leave Act (FMLA)?
Generally, the Family and Medical Leave Act (“FMLA”) allows you to take up to 12 weeks of unpaid leave during any 12-month period due to:
- the birth, adoption, or placement with you for adoption of a child;
- to provide care for a spouse, child, or parent who is seriously ill; or
- your own serious illness.
You are generally eligible for a leave under the FMLA if you:
- have worked for the same Contributing Employer for at least 12 months;
- have worked at least 1,250 hours over the previous 12 months; and
- work at a location where at least 50 employees are employed by the Contributing Employer within 75 miles.