Directory of Useful Telephone Numbers & Websites
Attached is a list of useful telephone numbers and websites for Federal Agencies and other organizations.
Click on the button for the list.
How You Can Help Your Family After Your Death or Incapacitation
A Checklist for a Surviving CSA Spouse or Domestic Partner
2020 IRMAA Application
CSA Legal Service Plan
CSA has negotiated a free legal service plan for all CSA Retirees. Click on the red button below for detailed information.
Zoom Hosting Resource Sheet
On December 21, 2020 the CSA Queens Retiree Chapter held a virtual a Zoom Hosting Workshop presented by Susan Rippe Hoffman. Click on the white button for the Resource Sheet from that workshop.
Updates from Norm Sherman
Informational Update Vol 12 #5 May 15, 2021
1. 2020 IRMAA Application - The 2020 IRMAA application is now available. I have attached the application to this email. The CSA Retiree Welfare Fund also emailed a Member Update which allowed you to get the application by clicking on a link that the Update provided. Moreover, you can download the form from the CSA Welfare Fund website, www.csawf.org. IRMAA forms for the years 2017 through 2019 are also on the website as well as the corresponding differential forms.
Please make sure to include the following in your request for 2020 IRMAA:
A completed reimbursement request application. Be sure to check off 2020 and sign and date the application. If your spouse/domestic partner is your dependent, be sure to complete the Eligible Spouse/Dependent section of the application. If your spouse/domestic partner is also a NYC retiree and has a separate NYC health plan, then she/he has to submit a separate reimbursement request application.
The November 2019 Social Security Award letter. This is the annual letter that tells you how much Social Security you will be receiving the following year (in this case 2020) & your Medicare Part B & D premiums.
The Social Security 1099 for 2020.
Please note that if you went on Medicare during 2020, you are entitled to a pro-rated 2020 IRMAA reimbursement.
Send the application & documents either electronically to the Doug Hathaway (email@example.com) or by snail mail to the CSA Retiree Welfare Fund, 40 Rector St., 12th Floor, New York, NY 10006-1729. If you would like confirmation of receipt & verification of your application and documents, then include a note and your email address in your submission.
As in the past, the CSA Retiree Fund will review your request for completeness and accuracy, and then walk it over to the City Office of Labor Relations. If there is an error in the application or in the documents you have submitted, the Fund will inform you of the exact problem so that you can correct it and re-submit the request for reimbursement.
2. CSA Welfare Fund Stop-Loss Benefit - As retired CSA members, we are quite fortunate to have outstanding CSA Retiree Fund & Retiree Chapter health benefits. Perhaps one of the best of them is the Stop-Loss benefit. Why? Because it limits the member’s out-of-pocket medical expenses. Let’s see how it works.
First, the benefit reimburses all out-of-pocket medical expenses not covered by the Basic NYC Health Plan including office visits and lab charges.
Second, after a $1,000 deductible (annual) you are reimbursed 80% of the next $1250. Thereafter, you receive 100% of your remaining out-of-pocket expenses up to $50,000 annually/$250,000 lifetime. Also, the CSA Retiree Chapter will reimburse you 20% of the Welfare payment. Keep in mind that Stop-Loss does not cover hospital costs.
As an example of how it works, suppose you put in a claim to the CSA Retiree Welfare Fund for a $3,000 out-of-pocket expense that falls under the stop-loss benefit. If this is your first claim for the year, you must pay an annual $1,000 deductible out of the $3,000. The Fund will then reimburse you for 80% of the next $1,250 of the claim or $1,000 and then 100% of the remaining part of the claim or $750. Your total reimbursement from the Fund for this claim is $1,000 + $750 or $1,750. About 2 weeks later, the CSA Retiree Chapter will send you a supplementary reimbursement of 20% of $1,750 or $350. Therefore your total reimbursement for the $3,000 claim is $1,750 + $350 or $2,100, and you will no longer have any future out-of-pocket expenses for any claims within the same year.
While the benefit sounds great, and it really is, there are some hitches.
First, the out-of-pocket expenses must be reasonable and customary. You will not get back what you think you should if it is not.
Second, if you are on Medicare and choose not to use a Medicare doctor, the allowance will be based on Medicare rates or even less. If there is no Medicare doctor available, then the rate could be much higher. In this instance, I strongly recommend you call the Fund to determine the rate of the reimbursement.
Informational Update Vol 12 #4 May 1, 2021
1. What Medical Services are not Covered by Original Medicare - Original Medicare covers costs associated with doctors and hospital services that are considered medically necessary. However, it generally does not cover services that are cosmetic or alternative health treatments. Routine dental, vision and hearing services are also not covered by Original Medicare unless they are related to a medical condition. For example, routine eye exams to determine a prescription for eyeglasses is not covered. However, Original Medicare would cover an eye exam for glaucoma. If you are in a hospital, Part A will cover emergency dental procedures and some dental services, but not dentures.
The following are additional services Original Medicare does not cover:
Nursing home care – Includes help with daily personal care such as bathing, dressing, and using the bathroom.
Non-medical services – Includes canceled appointments for which you are charged, private hospital rooms, and any other no-medical services.
Routine foot care – Routine medical care for feet, such as callus removal, is not covered. However, Original Medicare will cover foot exams or treatment if it is related to a diabetes condition, or care for such foot issues as hammertoe, bunion deformities and heel spurs.
Care in foreign countries – With few exceptions, generally not covered. However, some secondary plans, like Emblem Health, may cover the service.
Hearing aids – Original Medicare will cover ear-related medical conditions but not hearing aids or routine hearing tests.
2. Skilled Nursing Facility – If you are on Medicare and in need of a physical therapy after an operation, you normally will be sent to a skilled nursing facility if it’s needed to meet your health goal. This goal is determined by your doctor who has decided you need daily skilled care given by skilled nursing or therapy staff.
What is a Skilled Nursing Facility?
Often, individuals confuse nursing homes with a skilled nursing facility (SNF) because of the similarities. In fact, many times the terms are used interchangeably. To be clear, a SNF provides more “skilled” medical expertise and services than a nursing home. Basically, a SNF provides rehabilitation services to help injured, sick or disabled individuals get back on their feet.
Generally, hospitals make the arrangements to transfer a patient to a SNF after an acute hospital stay, such as surgery. The transfer occurs when the patient is released from the hospital. In the SNF, the patient will receive whatever rehab he or she needs like physical or speech therapy until he or she is ready to go home.
What is the coverage for staying at an SNF?
Days 1-20: $0 (covered by Medicare)
Days 21-100: $0. (covered by Blue Cross Blue Shield)
Days 101 and beyond: You pay all costs.
3. Medicare Summary Notice – If you are on Medicare, you will receive a Medicare Summary Notice each time you used a Medicare doctor or were in the hospital. This document lists your claims and costs for a given period. It is NOT a bill, although it will inform you how much you may be billed, the providers involved, and whether Medicare approved your claims. The document also mentions how to report a fraud and how to file an appeal for a denied claim.
Because it is the right thing to do, you should report any claims that appear fraudulent. But what you may not realize, a fraudulent claim can have a negative impact on your coverage. For example, you review a Medicare Summary Notice and see a claim from a physical therapist for $600. However, you report this claim as fraudulent since you never received the therapy on the date mentioned. If you had not reported it, then your $2,110 of Medicare coverage for physical therapy would have been reduced by $600. Motto? Review the Medicare Summary Notices carefully.
4. Question of the Month
Q. My wife and I each received a check from the city for $1,735.20. What was that for?
A. The $1,735.20 is the reimbursement of your 2019 Medicare Part B premium. The reimbursement was based on your monthly payments of $144.60. In the past it was calculated on your monthly payments of $109, requiring you to file for the difference of what you received and were actually paid. In 2019, that is not the case; you were reimbursed for what you actually paid. You no longer will have to file for a difference since there is none
Informational Update Vol 12 #2 April 1, 2021
1. Eligibility for Home Health Care
You are in a hospital for shoulder surgery and transfer after a 3 day stay to a skilled nursing facility (SNF) for physical therapy. You now are told that you will be leaving the facility shortly, but feel you still may need physical therapy at home because it will be very difficult for you to leave the home. Will Medicare cover my home health care? Most likely yes is the simple answer.
Medicare covers a wide range of health services under its Medicare home health benefits. To be eligible for home health care, you must meet the following conditions:
Your physical disability makes you homebound as it is extremely difficult for you to leave your home. This requirement can be met in additional ways during the pandemic. For example, your immune system is compromised and your doctor certifies that you must stay home, or you are suspected of having, or have COVID-19.
You need skilled nursing services and/or home physical therapy care on an intermittent basis. Intermittent is defined in this context as needing a skilled nurse or physical therapy at least once every 60 days and at most once a day for up to three weeks. The physical therapy must be done by a professional or under the supervision of a professional.
You met face-to-face with a doctor within 90 days before your home health care begins, or 30 days after the first day that you receive care. Face-to-face visits can take place in an office, hospital or by video conferencing.
Your doctor certifies that you are homebound and need intermittent skilled care. The certification should contain a plan of care and that the face-to-face meeting requirement was met. The doctor should review and re-certify the plan every 60 day.
Your care is given by a Medicare-certified home health agency (HHA).
If you meet all these requirements Medicare should pay for the skilled nursing care and/or physical therapy regardless of whether your condition is temporary or chronic. If you have any questions call 1-800-MEDICARE.
2. The Value of the CSA Retiree Welfare Fund and CSA Retiree Chapter Benefits
We often hear, and I often said, that our CSA Retiree Welfare Fund and CSA Retiree Fund are some of the best retiree benefits you can find anywhere. But how good are they really? To answer that question I decided to see if I can put a monetary value on our benefits. So one day I added all the monies that were listed on the document that contains the Retiree Fund and Retiree Chapter benefits. Amazingly, I came up with almost $325,000 worth of benefits. But that number only tells part of the story.
There were several other benefit factors on the sheet that were not included in the $325,000.
1) The 20% CSA Retiree Chapter Reimbursement. Many of the Fund reimbursements also include an additional 20% of whatever the amount the Fund reimburses you. For example, if the Fund reimbursed you $500 for a home health aide, you will also receive an additional $100 seamlessly from the Retiree Chapter about 2 weeks later.
2) The Dental Program – I cannot put a monetary value on it, but obviously it is worth a lot.
3) Supplemental Medical Program – Some of the benefits under this program, such as Surgery/Anesthesia/Colonoscopies and Bronchoscopies, had no monetary value listed.
4) Extended Hospitalization – The city health plan provides for 365 days of hospitalization for non-Medicare members. No monetary value was given, but given the cost of hospitalization, this benefit is worth a lot of money.
And here is something else I did not take into account: some of the benefits reset on January 1 or after 12 months from the time they are used. Eyeglass benefits falls under this category.
Clearly, your retiree benefits from both the Fund and Retiree Chapter are extremely valuable. However, they are of little value unless you know them and use them. The document containing the benefits can be accessed from the CSA Welfare Fund website.
3. Question of the Month
Q. I am a Medicare-eligible retiree and have a $142.50 deduction taken from my pension check. What does this amount represent?
A. The $142.50 is the high option rider that you bought when you were probably active. It is your monthly premium for your GHI Enhanced Plan D. It also provides 365 days of extended hospitalization, although the CSA will pick up the cost if the member does not have the high option rider.
Informational Update Vol 12 # March 1, 2021
1. Medicare Part D Drug Costs
The GHI enhanced Medicare Part D drug plan consists of 3 stages. If you noticed a change in your prescription costs in January it may be the result of starting again in Stage I on January 1, 2021, no matter what stage you ended in on December 31, 2020. In Stage I, you pay 25% of the drug cost while the plan (GHI enhanced Plan D) pays the other 75%.
If your total drug cost (what you and your plan both pay} exceeds $4,130 (up from $4020 in 2020) at some point in 2021, you enter Stage II, formally known as the donut hole. Fortunately, the donut hole has closed for both generic and non-generic drugs; you continue to pay the same 25% of the drug cost while your plan pays 75%
If your true-out-of-pocket expense – known as TROOP – for both Stages I & II exceed $6,550 (up from $6,350 in 2020) you enter Stage III, or the Catastrophic Coverage. In this Stage your co-payment continues as it was in 2020 at 5% of the drug cost. Medicare pays 80% and the plan pays the remaining 15%.
The CSA Welfare Fund also offers an added benefit in this Stage by reimbursing you the 5% cost up to $5,000. There is no deductible. Just send your Express Scripts statements to the CSA Welfare Fund for reimbursement. These statements should be sent at the end of the calendar year to help facilitate the CSA Retiree Fund’s processing of your request.
2. “Valentine’s Gift”
If you are Medicare eligible and have the GHI Enhanced Plan D plan, you should have received your “Valentine’s” gift of $480 for 2020 this past February. This is a CSA Welfare Fund benefit designed to help defray the cost of the High Option Rider that pays for the Enhanced Plan D. If you were eligible for reimbursement, but were not on Medicare for the full year, should have received a pro-rated check. The pro-rata is $40 a month for every month on Medicare.
If you have not yet received your check, wait a little longer before calling the Welfare Fund as there may have been a delay in the mail.
Please note that only Medicare-eligible CSA retirees are entitled to the “Valentine’s” gift; non-CSA Medicare-eligible people are not. If both husband and wife are Medicare-eligible CSA retirees, then both are entitled to the $480 providing EACH has their own NYC medical coverage. If one member is covering the other member, then only the member who is covering is entitled to the $480.
For non-Medicare CSA retirees and non-Medicare dependent spouses, the CSA Welfare Fund and CSA Retiree Chapter will continue to cover copays, providing the member and spouse are under the GHI or City HMO plans. After a $100 deductible, the reimbursement is 80% of the drug cost up to a maximum of $10,000. In addition, the CSA Retiree Chapter automatically (no filing of a claim necessary) supplements this reimbursement with an additional 20% of the Fund payment.
Medicare covers acupuncture for 12 visits within 90 days for chronic lower back pain. If the Medicare-eligible patient shows improvement, he or she may get an additional 8 visits for an annual maximum of 20 visits.
Chronic lower back pain is defined as:
· Lasting 12 weeks of longer
· Having no known cause (no relation to cancer that has spread, inflammatory or infectious disease)
· Pain not associated with surgery of pregnancy
Only a doctor, or a health care provider, such as a nurse practitioner or physician assistant, may administer acupuncture providing they have:
A masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine
A current, full, active, and unrestricted license to practice acupuncture in the state where the acupuncture is being given
The CSA Retiree Welfare Fund also has an acupuncture benefit under its Supplemental Medical Program that you may use after you have exhausted your Medicare Acupuncture benefit, or directly, if you are not Medicare-eligible.
After an annual $100 deductible, you get back 80% of the cost for 36 visits per year. The maximum allowable charge is $100 per visit. In addition, the CSA Retiree Chapter will reimburse you an additional 20% of the Fund reimbursement.
Consequently, the maximum reimbursement you can get for 36 visits costing $100 per visit is calculated as follows:
a) The 1st visit costing $100 covers your deductible.
b) The next 35 visits cost @ $100 per visit $3,500.
c) The CSA Retiree Welfare Fund will reimburse you $3,500 x 80% or $2,800.
d) The CSA Retiree Chapter will reimburse you seamlessly $2,800 x 20% or $560.
e) The total reimbursement is $2,800 + $560 = $3,360