How To Find UnclaimedFunds
from Thomas DiNapoli, Comptroller
How to find unclaimed funds:
Search using the person's full legal name as well as nicknames and maiden names that might have been used on accounts.
New York State Comptroller's Office: osc.state.ny.us/unclaimed-funds or 1-800-221-9311
National Association of Unclaimed Property Administrators (for out-of-state searches): unclaimed.org/search/
U.S. Treasury (for misplaced Savings Bonds and other Treasury securities): treasurydirect.gov/savings-bonds/treasury-hunt/
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 white 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
2022 IRMAA Application
The 2022 Medicare Part B IRMAA Reimbursement Form has been released by the City Office of Labor Relations. It is available by on the yellow button below.
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 14 #8 August 26. 2023
1. Advance Beneficiary Notice (ABN) – One of the major criticisms of Medicare Advantage plans are their prior authorization requirement. Prior Authorization, which the plans use for relatively high cost services, was one of the major reasons Judge Frank ruled in favor of the petitioners, stopping the City from forcing Medicare-eligible public retirees who have Original Medicare and a supplemental Medicare insurance plan into the Aetna Medicare Advantage plan.
Although not widely known, Original Medicare has a similar constraint as an advantage plan known as an Advance Beneficiary Notice.
What is it?
An Advance Beneficiary Notice is a waiver of liability that medical providers issue to their Medicare-eligible recipients, warning them that Original Medicare may not cover the services they are receiving. The recipient will be asked to sign the ABN
When does a Provider Issue an ABN?
Medical providers will generally issue an ABN if the Medicare item or service is
Not indicated under the normal method for the diagnosis, treatment of illness, injury or to improve the functioning of a malformed body part,
Experimental or considered research, or
More than the number of allowable services in a specific period
This list is far from exhaustive. There are many other instances when an ABN is issued.
What Rules Govern the Use of an ABN?
There are rules governing how an ABN may be used. Here are some of them:
1. Every ABN requires specific information including your personal information, the name of the service that may not be covered, the reason Medicare may not cover it, and the estimated cost.
2. ABNs may be issued to you only if you have Original Medicare. If you have a Medicare Advantage plan, you cannot receive an ABN.
3. The provider is required to ensure that you read and understand what is written on the ABN. He or she must also all questions related to it.
4. The provider may not issue an ABN immediately before an appointment. You must be given adequate time to consider all of your options.
Who Pays if Medicare Denies the Claim?
It depends. If you were issued an ABN, then you are responsible for payment. If the doctor did not issue an ABN, then the doctor is responsible.
Receiving an ABN can be very stressful, especially if Medicare denies a claim. An option you have is to file an appeal. If you do it properly, you will generally receive a decision within 60 day
2. Skilled Nursing Facility
What is a Skilled Nursing Facility?
Often, individuals confuse nursing homes with a skilled nursing facility (SNF) because of their 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 (must be in from the hospital (must be in the hospital a minimum of 3 days). 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. Question of the Month
Q. I was in the hospital for 1 week and received a $300 bill. What was that for?
A. Sorry to hear about your hospital stay. Your hospital stay is generally fully covered except for the $300 deductible that you received. The good news is that the CSA Retiree Welfare Fund and CSA Retiree Chapter cover this cost.
After a $100 deductible, you get back 80% of the cost or $160. The CSA Retiree Chapter will then reimburse you an additional 20% of what the Fund gave you, or $32. So of the $300 (with a max of $750 deducted per year) charge you get back $192.
To apply for the reimbursement just send a copy of the $300 bill and proof of payment to the CSA Retiree Welfare Fund. Once you get the check from the Fund you will automatically get a check from the Chapter about 2 weeks later.
Informational Update Vol 14 #7 August 1, 2023
1. Prescription Drug Benefit – The CSA Retiree Fund drug benefit is your coverage for drugs. Below is how it works for retirees as well as surviving spouses/registered partners.
· Non-Medicare Eligible Members – After an annual $100 deductible, 80% of the drug costs are reimbursable up to $10,000. On top of that, the CSA Retiree Chapter will reimburse another 20% of whatever the Fund pays. For example, if your drug co-pay is $250, you will get back after a $100 deductible, 80% of $150 or $120 plus an additional 20% of $120 or an additional $24 for a grand total of $144. The reimbursement from the Retiree Chapter is seamless, i.e., you apply for the Fund reimbursement, and you will automatically get your Chapter reimbursement (separate check) without application. The important thing is to save your quarterly statements from Express Scripts. To ease the processing of payments, the Fund has requested that you submit the statements for reimbursement once a year after you receive your final statement. Please make sure to make copies of the statements. I recommend you mail them return-receipt-requested.
· Medicare Eligible Members – Most members in this category are on the GHI Enhanced Plan D drug plan thanks as result of having purchased the High Option Rider (probably before they even retired). The Rider costs $125 per month and $250 per month for a family. The amount is deducted from the pension check.
Under the Part D plan there is no deductible. The cost of drug co-pays depends on the cost of the drugs you purchase and which of the 3 drug stages you are in. The cost in each stage for 2023 is as follows:
1. Stage I – You start in this stage at the beginning of a year in January and pay 25% of the drug cost, GHI pays 75%. Once your Out-of-Pocket cost – known as TrOOP - plus GHI’s cost surpasses $4,660 (your TrOOP portion is $1,165), you enter Stage II.
2. Stage II – Nothing really changes regarding your drug cost, i.e., you continue to pay 25% of the cost whether you are purchasing brand or generic drugs. The plan pays the other 75%. However, you are stuck in this stage until your TrOOP surpasses $7,400 for both Stages I & II ($1,165 + $6,235) when you enter Stage III and there are significant savings.
3. Stage III – You pay 5% of the drug cost, GHI pays 15%, and Medicare pays 80%. In addition, you will be reimbursed 100% of your co-pays up to a max of $5,000. Unlike Non-Medicare members, who receive quarterly statements, Medicare-eligible members receive monthly statements. But like Non-Medicare members, submit them at the end of the year for reimbursement.
· Surviving Spouses/Registered Partners – Surviving spouses or registered partners are eligible for reimbursement if they have a city plan through COBRA or their own health plan with Rx coverage. After an annual $100 deductible, the reimbursement is 80% of the cost up to an annual maximum of $5,000. In addition, the CSA Retiree Chapter will reimburse an additional 20% of the Fund payment. As a result, the annual maximum is $5,000 + $1,000 or $6,000
2. Medicare Home Health Benefits – Did you know that Medicare covers many caregiving costs? The key to whether you are eligible for such services is whether you are considered “homebound.”
To be considered “homebound” you either have trouble leaving home without help because you are seriously ill or injured OR you have a medical condition in which it is not recommended that you leave home. However, leaving for adult care, religious services, infrequent medical services or special occasions are considered acceptable exceptions.
So if you are “homebound” and under a doctor’s orders and careful planning, you would be entitled to many at-home services including:
Home health services – this would be part-time or intermittent, provided by certified home health aides
Medical social workers – help with emotional concerns and with understanding a disability or illness.
Occupational therapists – help people do their daily activities.
Physical therapists – help restore movement for those who might have been weakened by a hospital stay or limbs require therapy.
Speech-language pathologists – help those who suffered strokes restore communication skills and swallowing.
Skilled Nursing Care – provides nursing care such as changing dressings or giving an injection.
Remember, these services must be conducted under a doctor’s care and none is full-time.
3. Question of the Month
Q. Is a Medicare-eligible member covered for emergency ambulance service to the hospital?
A. Medicare plus the secondary insurance overs ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility for medically necessary services, and transportation in any other vehicle could endanger your health.
Informational Update Vol 14 #6 June 30, 2023
1. Aetna: Retiree Special Enrollment /Waiver Form
The Office of Labor Relations has introduced a Retiree Special Enrollment/Waiver Form intended for:
NYC Medicare-eligible retirees who have HIP VIP Premier Medicare HMO (only people who live in the NYC metropolitan area - the 5 boroughs, Nassau, Suffolk, and the Westchester, Rockland, and Orange counties - are eligible for this coverage) and wish to enroll in the Aetna Medicare Advantage (PPO) Plan.
NYC Medicare-eligible retirees who wish to add the Aetna Medicare Advantage Plan Prescription Drug Rider for prescription drug coverage. (Effective September 1, 2023). These are for retirees who have a private Medicare Part D plan for which they will no longer be eligible.
HIP VIP members who wish to add the HIP VIP Prescription Drug Rider (Effective Sept 1, 2024). These are for retirees who have a private Medicare Part D plan for which they will no longer be eligible.
NYC Medicare-eligible retirees who wish to waive (terminate) their NYC Health Plan instead of automatically transitioning to the Aetna Medicare Advantage Plan on September 1, 2023. By waiving their health plan, these retirees are giving up their annual Part B premium reimbursement (standard and, if applicable, IRMAA) as well as their $480 “VALENTINE’S GIFT to help pay for the drug rider.
If any of the above categories are applicable to you, you will need to fill out this special form. This includes 1) filling in the profile information, 2) checking the appropriate box, and 3) signing your name.
The date when the application is due has been extended from June 30, 2023 to July 10, 2023. Mail form to: NYC Health Benefits Program 22 Cortland Street, 12 th Floor
THOSE NYC MEDICARE ELIGIBLE RETIREES WHO LIVE OUTSIDE THE NYC AREA (e.g. ARE NOT TO FILL OUT THIS FORM UNLESS THEY HAVE A PRIVATE MEDICARE PART D. IN THAT CASE, THEY SHOULD CHECK OFF OPTION 2 ON THE FORM.
2. Surviving Spouses/ Registered Partners
During the course of the year, I receive many calls from members’ non-CSA surviving spouses/registered partners about whether they are still entitled to the CSA Welfare Fund benefits. As a result of so many calls, I am re-printing the article I wrote on this topic last year.
While the passing of a member is a very difficult time for the surviving spouse/registered partner, the good news is that the CSA Retiree Welfare Fund continues to provide him/her with supplemental medical coverage WITHOUT COST for a period of 5 years from the date of the member’s passing. The only condition is that the surviving spouse/registered partner must have a basic city health plan or the equivalent through another health plan to receive the Fund coverage. Also, the Fund’s retiree benefits stop before the 5 years should the survivor remarry.
The Fund coverage includes dental, optical, hearing aid, drugs, and many other medical items. The whole list of benefits can be downloaded from the CSA Welfare Fund website.
Surviving spouses/registered partners are also entitled to the CSA Retiree Chapter supplemental benefits. However, to enjoy these extra benefits, the surviving spouse/registered partner must join the Chapter. While being a member of the Chapter has a monthly charge, it is money well spent since the Chapter benefits will greatly enhance the Welfare Fund benefits
After 5 years from the member’s passing, the Welfare Fund supplemental benefits automatically end unless the surviving spouse/registered partner extends the benefits by paying a monthly COBRA premium. This extension will be necessary if the surviving spouse/registered partner belongs to the CSA Retiree Chapter and wants to continue to get their supplementary medical benefits.
3. Question of the Month
Q. How do I know if I am entitled to 2022 IRMMA reimbursement?
A. Do one of two things: Look at the 2021 November SSA verification letter. It will show what your standard premium is and, if applicable, your IRMAA surcharge. If there is a surcharge, you are entitled to an IRMAA reimbursement. Look at your 2022 1099 SSA letter. In 2022 the standard amount was 170.10 per month or $2,041.20 a year. If the amount listed on the letter is greater than the yearly amount, then you paid an IRMAA surcharge and are entitled to an IRMAA reimbursement.
Informational Update Vol 13 #6 May 22,2023
1. 2022 IRMAA Application
The 2022 IRMAA application is now available. You can also download the form from the CSA Welfare Fund website, www.csawf.org. This application may also be used for the years 2020 & 2021.
Please make sure to include the following with your 2022 IRMAA reimbursement request.
1) A completed reimbursement request application. Be sure to check off 2022 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.
2) The November 2021 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 2021) & your Medicare Part B & D premiums.
3) The 2022 Social Security 1099 letter. Please note that if you went on Medicare in 2022, you are entitled to a prorated 2022 IRMAA reimbursement. Also, if you never applied for IRMAA reimbursement for 2020 and/or 2021, you may use the same 2022 IRMAA application but mark off the year in question and submit each year’s request in a separate package.
So, for example, if you are applying for 2020, 2021 & 2022 IRMAA reimbursement, submit 3 separate packages. Each package will contain 3 documents; an application, appropriate SSA letter (for 2020, the November, 2019 letter and for 2021 the November 2020 letter), and appropriate SS 1099 letter (for 2020, the 2020 SS 1099 letter and for 2021, the 2021 SS 1099 letter.
2. Aetna’s Continuity of Care Transmission Assistance & Authorization for Release of Protected Health Information (PHI} Forms
Two of the most important forms Aetna has sent to its Medicare-eligible members have been the Continuity of Care form and the Release of PHI form. If you (or your dependent) are planning an operation after September 1, 2023 (when Parts A & B of Aetna plan goes into effect) or you have an ongoing critical care situation, such as receiving chemotherapy or dialysis, it is important that you complete the Continuity of Care form. This form collects the data that will alert Aetna to your situation and will help keep your ongoing medical care uninterrupted, including maintaining ongoing prescription specialty medicine.
When you complete and submit this form in the envelope that Aetna provided, a nurse case manager should reach out to you to ease the transition to the new Aetna Medicare Advantage PPO plan. To help ensure this happens, check off the box on the form, Request to Speak to a Nurse Case Manager.
If you have not received the Continuity of Care form you can download one from the CSA Welfare Fund website and submit the completed form to:
Attn: City of NY F314 Aetna
P.O. Box 818013
Cleveland, OH 44181-9920
Or you can email to: CONYMailbox@aetna.com.
Aetna recently mailed out an Authorization for Release of PHI form to those members who had submitted a completed Continuity of Care form. If you received the PHI form, be sure you complete and submit it to Aetna.
Included with the PHI form was an outreach letter in which Aetna confirmed they will work with you and your physicians to ensure quality medical care and that you will be “covered for any upcoming care or procedures.” The letter also included a support plan for your physical, emotional and social health.
If you have submitted a Continuity of Care form but did not receive the authorization form then either call Aetna, 855-648-0389 or email Aetna at CONYMailbox@aetna.com.
3. Question of the Month
Q. I recently received a bill of $84 from my doctor who claims that was my deductible. However, I already paid my complete deductible previously. How could that discrepancy happen?
A. At the time you received service from the doctor, you still had not exhausted your deductible and so he charged you accordingly. However, the doctor apparently held on to the bill and by the time you received it, other doctors that you had gone to already used up your deductible. Consequently, you do not owe the $84 and the doctor will have to re-file the bill with Medicare. Motto: Keep track of your deductibles.
Informational Update Vol 14 #4 April 20,2023
1. 2022 Medicare Part B Reimbursement
On or around April 14, 2023, Medicare-eligible retiree members and their Medicare-eligible dependents received the annual Part B standard reimbursement for 2022 of $2,041.20 ($170.10 x 12 months). Those who went on Medicare sometime during 2021 will receive a pro-rated amount, although the exact date when this will happen is unknown at this time.
Those members who receive their pension payments electronically should check their bank account for the payment. Those members who receive their pensions by check, should have received the reimbursement the same way.
Unlike IRMAA, the standard reimbursement is automatic and requires no application providing the Office of Labor Relations (OLR) has a copy of your Medicare Parts A & B card. As a courtesy, the CSA Retiree Welfare Fund will send OLR a copy of your card providing you first send the Fund a copy.
2. 2022 IRMAA
Federal law requires Medicare-eligible retirees to pay a surcharge on top of the Part B standard amount and Part D (drugs) premiums if their taxable income surpasses a certain amount. This surcharge is called the Income-Related Monthly Adjustment Amount (IRMAA). Part B IRMAA is reimbursable, but unfortunately, Part D is not.
In order for you to receive the Part B IRMAA reimbursement, you must file a completed NYC IRMAA reimbursement application. The Office of Labor Relations (OLR) has said that this application will be available sometime between the end of April and the beginning of May. The CSA Retiree Chapter will let you know when the applications are available.
3. Aetna Medicare Advantage Plan (PPO) – Prior Authorization
A sensible discussion concerning Prior Authorization requires first understanding what it is in healthcare.
Prior Authorization (PA) is a process in which the health provider must obtain prior approval from your health plan before prescribing a particular medical procedure or medication. If this approval is not obtained for the treatment, your health plan may not pay the provider, leaving you responsible for the full payment. Under traditional Medicare, which rarely requires a PA, you may have to sign a waiver for a particular procedure or medication. The waiver makes you responsible to pay if Original Medicare will not pay for the treatment.
Health plans have their own rules as to which medical services require medical services. Under the new customized NYC Aetna Medicare Advantage Plan, which begins September 1, 2023, many of the services that required PA under the previous NYC Advantage Plus Plan are no longer required. These include MRIs, CT Scans, PET Scans, Diagnostic cardiology, sleep study, pain management, physical therapy, occupational therapy, speech therapy and radiation. In short, most of the PAs have now been removed.
4. Question of the Month
Q. I recently came home from the hospital after emergency surgery and have been using a Home Health Aide for my personal needs. Does the CSA Retiree Welfare Fund reimburse my costs for the aide?
A. Sorry to hear about your surgery. I’m happy to tell you that you are entitled to Home Health Aide benefits under the CSA Retiree Fund as well as the CSA Retiree Chapter. Here is how it works: after a $100 deductible, the Fund will reimburse you up to 80% of the cost to a maximum of $10,000. There is a lifetime maximum of $30,000. On top of that, the CSA Retiree Chapter will pay you an additional 20% of whatever payment you receive from the Fund seamlessly. The Chapter has no deductible
To receive these benefits you will have to submit a completed Home Health Aide form (attached) to CSA Retiree Welfare Fund. The form will ask for a doctor to describe the need for an aide. Also, the aide must be certified and should be paid only by check or credit card.
Once you receive a check from the Fund, you will receive a 2nd check from the Retiree Chapter shortly thereafter.
Informational Update Vol 14 #3 1. 3/28/2023
Aetna Medicare Advantage PPO Plan (AMAP)
In early March of this year, the Municipal Labor Union approved the Aetna Medicare Advantage PPO Plan (AMAP), paving the way for the city to transition Medicare-eligible members and their Medicare-eligible dependents to this plan. Once this plan goes into effect, there will only be two city health plans: AMAP and HIP VIP.
AMAP is required to cover all Part A and Part B services. All Medicareeligible members, except HIP VIP Premier Medicare members, will automatically be enrolled in this plan on September 1, 2023.
AMAP also includes a prescription drug plan offered by SilverScripts. Medicare-eligible members and their Medicare-eligible dependents currently enrolled in the GHI Enhanced Plan D, will remain in this plan until December 31, 2023. Then, on January 1st, 2024, this group will automatically be enrolled in the Aetna drug plan.
If Medicare-eligible members and their Medicare-eligible dependents do not have a Senior Care drug rider, and instead, are enrolled in a different City drug prescription plan, they will also be automatically enrolled in the Aetna drug prescription plan. However, the enrollment date is September 1, 2023.
Once AMAP was approved, Aetna produced a plethora of information for the members to absorb. In addition, Aetna scheduled many meetings in various formats including Web conferences, Teleconferences, and inperson meetings. In addition, members can listen to prerecorded meetings of previous Aetna presentations and learn all about the plan.
This past week Aetna sent you a pamphlet, Join Us, which lists the schedule of each of these meetings. If you want to view a prerecorded meeting, visit Aetna’s website, www.CONY.AetnaMedicare.com, for the link which appears toward the bottom of the website. Then click Webinar, check the box next to City of New York and Aetna Retiree Informational Session, Register, and click the URL for the presentation. If you did not receive this publication, you can also get the schedule from Aetna’s website, www.CONY.aetnamedicare.com, calling the Aetna hotline telephone number at 855-648-0389, or from the CSA Welfare Fund website, www.csawf.org/aetna.
When you call the hotline number, you will also be able to ask questions about:
Doctors/providers not showing in the look-up tool
Coverage for a specific drug or procedure
Locations of hospitals and urgent care centers in the network
Because AMAP is new & unique health plan that impacts so many members, I plan to discuss various aspects of it in future Updates. In the meantime, I strongly suggest you become familiar with the documents that are online on the CSA Welfare Fund website (www. csawf.org/Aetna) and attend one of the scheduled Aetna meetings.
Also, for further information, please SAVE THE DATE for a unique CSA Hybrid Aetna Presentation on April 27, 2023. An additional email will go out with an opportunity to register for an in-person seat at CSA Headquarters or a Zoom link. Questions will be collected in advance and throughout the presentation.
2. The Value of the CSA Retiree Welfare Fund and CSA Retiree Chapter Benefits
Two years ago, I wrote about the value of our retiree benefits. Because there have been so many retirees since then, I decided to reprint the article.
I often talk about how our CSA Retiree Welfare Fund and CSA Retiree Chapter Fund offer 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 could put a monetary value on these benefits. To do this, I added all the monies that were listed on the document that contains both the CSA Welfare Retiree Fund and CSA 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 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 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 $125.00 deduction taken from my pension check. What does this amount represent?
A. The $125.00 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 14 #2 March 3, 2023
1. Medicare Part D Drug Costs - 2023
The GHI enhanced Medicare Part D drug plan in 2023 still 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, 2023, no matter what stage you ended in on December 31, 2022. 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 $4,660 (up $230 from 2022) at some point in 2023, you enter Stage II, formerly 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 $7,400 (up $350 from 2022) you enter Stage III, or the Catastrophic Coverage. In this Stage your co-payment continues as it was in 2022: you pay 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 monthly 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 claim.
2. “Valentine’s Gift”
If you are Medicare eligible and have the GHI Enhanced Plan D plan, you should receive your “Valentine’s” gift of $480 for 2022 by the end of this week, depending on your mail service. The checks were mailed out on Friday, February 24.
The “Valentine’s” gift 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, you should receive a pro-rated check. The pro-rata is $40 a month for every month on Medicare.
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.
3. Part B Co-Pays
In my last Update (Vol 14 #1) I mentioned that effective January 11, the judge ordered the City to stop charging retired workers the $15 co-pay for doctor visits & numerous other medical services. However, some doctors have continued to charge this co-pay because they claim the secondary insurer has not informed them to stop. It happened to me two weeks ago.
Fortunately, you can now get a new EmblemHealth Health Plan Medical Card that states there are no co-pays. When you get this card show it to your provider to ensure that you should not have to pay a co-pay
To get this card, just call 212-501-4444 and ask for a new Medical card. They may also send you an Empire Blue Cross Blue Shield card which is for hospitalization.
4. Question of the Month
Q. Since I now have to file a claim with GVS to receive an eyeglass reimbursement from the CSA Retiree Welfare Fund, do I also have to file a claim with the CSA Retiree Chapter to get its reimbursement?
A. No. Receiving the Chapter reimbursement is still a seamless operation. After GVS notifies the Chapter that your claim was approved, the Chapter will reimburse the $65. On another positive note, the eyeglass reimbursement has risen 50% to $150.
Informational Update Vol 14 #1 January 29,2023
1. 2023 Medicare Part B Deductible & Premiums
As you start to visit your Medicare doctors in 2023, you will have to pay Medicare Part B deductibles again since they reset on January 1, 2023. The deductible for Medicare Part B decreased $7 from $233 to $226. The GHI Emblem Health Medicare Part B deductible remains at $50. The part of the $226 deductible that you pay when you visit a doctor will depend on the doctor’s service and what Medicare allows for the service. The likelihood is that it will be less than the full amount of the deductible. You will pay the amount that is left at future doctor visits. Remember, Medicare will not pay its part of a doctor’s bill, which is about 80%, until you have fully met the deductible.
This year the standard Medicare Part B premium decreased $5.20 from $170.10 to 164.90. Although most people pay the standard premium, some pay more. For those whose Medicare Adjusted 2021 taxable income was greater than $97,000 if they filed individually or $194,000 if they filed jointly, they will pay a Part B & a Part D surcharge known as the income-related monthly adjusted amount or IRMAA in addition to the standard amount. The extra amount that they will pay varies on how much taxable income they received in 2021.
The good news is that BOTH the standard and Part B IRMAA amounts are still reimbursable. Unfortunately, the Part D IRMAA surcharge is not. While the Office of Labor Relations (OLR) reimburse the standard amount automatically, they require an application for the Part B IRMAA reimbursement. At this time, the date when the 2022 application will be available is unknown.
2. Increase & Change in Optical Reimbursement Benefit Great news!
Effective January 1, 2023, the CSA Welfare Fund optical reimbursement benefit has increased from up to $100 to up to $150. The CSA Retiree Chapter reimbursement benefit will continue at up to $65. There has also been a change in the way you file a claim for the optical benefit. No longer will you get an optical voucher from the CSA Welfare Fund. Instead, the Fund has contracted with General Vision Services (GVS) which will not only handle all of the reimbursement claims, but will offer additional comprehensive benefits as well. These generous benefits include, but are not limited to, a thorough GVS care examination, including dilation, cataract, and glaucoma screenings when required.
The CSA Welfare Fund has sent you a GVS flyer and letter that fully explains the GVS benefits and procedure for filing an optical claim. The Fund also included in the mailing a combined dental and vision ID card that validates both your GVS network and dental (SIDS/ASO) network benefits. Please note: the dental program remains the same and will function separately from the new vision benefit.
To learn more about your GVS benefits, which started January 1, 2023, go on the website, www.generalvision.com, and register for an account. To register follow these steps:
1. Click on “Register.”
2. Enter Benefit # 6025
3. Fill out the Requested Information
4. Put in a Password of your Choice.
Congratulations! You now have an account.
When you sign in, your home page will contain your name and benefit number (6025). On this page, there are links that will allow you to view your optical benefits, schedule appointments with your provider, and search for participating providers using the zip code locator.
You can also search for and register on the “GVS” App which is downloadable from the IPhone and Android App stores.
If you use a participating provider, he or she will file the claim form. You should have nothing to do other than filling in your personal information. If you are using a non-participating provider (out-ofnetwork)
Call GVS directly at 888-346-1802 and ask for a claim form.
Have the provider fill out his portion of the form.
Submit the claim form to: GVS, 520 8th Ave,, New York, NY 10018
GVS will review the claim and reimburse up to $150. The CSA Retiree Chapter will receive your name and will reimburse you the additional $65.
3. $15 Co-Pay
As you probably know, the judge has ordered the City to immediately stop charging the retired city workers the $15 co-pays for doctor visits. The City plans to appeal this ruling. In the meantime, if your doctor charges the $15 co-pay (he should not if you have not yet met your deductible), pay it and keep a copy of the receipt. Hopefully, this matter will be resolved shortly.
4. Questions of the Month
Q. I am turning 65 and have health insurance through my spouse’s job. Must I sign up now for Medicare Part B so I don’t incur a late fee?
A. No, if your spouse’s employer has 20 or more employees. Generally, Medicare will consider your health coverage credible, allowing you to delay signing up for Part B without penalty until your spouse retires.
Informational Update Vol 13 # 12 1. December 31, 2022
What is Meant by Tier Drugs? –
Your doctor prescribes you a new drug and tells you that it is a tier 3 drug. Generally, you would have no idea what the drug would cost, but knowing what tier it is lets you know if the drug is cheap or expensive.
Drug tiers are the main way drug companies inform you how much a specific drug will cost. Based on what tier the drug is in, it will have a specific co-payment.
Most of the drugs that you are prescribed are generally placed in tiers 1, 2, 3 or 4, with tier 4 drugs, known as specialty drugs, being the most expensive drugs and tier 1 drugs the cheapest.
If you are covered by the Emblem Health/GHI Enhanced Medicare Drug Plan (PDP), you recently received a letter giving you the 2023 Cost Sharing Guide for Medicare Members (click on the button below to see a copy.)
The guide gives the tier levels, type of drugs covered in those tiers, and the coverage based on whether you are in the Initial Coverage (starts January 1, 2023), Gap (formerly called the Donut Hole) Coverage, or Catastrophic Coverage categories.
Initial Coverage - the co-payment is 25% of the cost of the drug for either a 30-, 60-, or 90-day supply. The charge for insulin is $35 for a 30-day, $70 for a 60-day, or $105 for a 90-day supply. Most vaccines are free.
Gap Coverage – Formally when you were in gap coverage, you paid 75% of the drug cost. Now you pay the same 25% as in the in the Initial coverage. The charge for insulin is also $35 for a 30-day, $70 for a 60-day, or $105 for a 90-day supply.
Catastrophic Coverage - the co-payment is the greater of $4.15 or 5% of the cost for generic drugs and the greater of $10.35 or 5% of the cost of brand-name drugs. The CSA Welfare fund will also reimburse your co-pays in this category 100% up to $5,000 with no deductible.
2.TRS Income Verification Letter – RP68
Some members have called me to ask whether a letter they received from TRS requesting confirmation they are alive is legitimate. Below is the response that Mark Brodsky wrote in the last CSA Retiree Chapter Update.
TRS, on a random basis, sends out a letter asking for you to confirm that you are alive. It appears, based on the calls and emails we have received, that a significant number of these letters were recently sent out. Simply follow the instructions that TRS requests and send it back to them. You can call TRS at 888 869- 2877.
3. Catastrophe Major Medical (CMM) Plan Participation
The CMM plan purchased under NYSUT Member Benefits has had some significant changes (no changes for those who purchased CMM under AFSA or CSREA) effective January 1, 2023. These include the following:
♦ In-Network Deductible – reduced to $2,000 from current $4,000 for an individual, and $4,000 from current $5,000 for a family. The deductible is annual and out-of-pocket. Coverage is only good for a calendar year.
For example, if you meet your deductible for 2023 on July 13 and the Plan approves the 13th as the date your coverage begins, then you will be covered from July 13th through December 31st. You would have to meet the deductible in 2024 to apply for coverage again.
♦ $1,000 Critical Illness benefit. - If you are diagnosed with a critical illness on or after January 1, 2023, this benefit will provide a one-time lump sum payment of $1,000 to help defray the costs of increased medical care.
♦ Out-of-Network home health care charges – The Plan has increased the reimbursement rate from 20% to 30% of Covered Charges, I.e., the amount of remaining charge after payment by your basic plan, up to the maximum weekly and lifetime benefits when using an Out-of-Network provider for home health care
Informational Update Vol 13 # 11 November 29, 2022
1. 2023 Social Security Letter – If you are eligible for Medicare, you should have received a letter from Social Security this past week informing you of your 2023 Social Security benefit amount before and after deductions.
Due to a rise in the cost of living, your Social Security benefit amount will increase 8.7% starting January 1, 2023. Social Security deducts from this amount your Medicare Part B (medical) premium & your IRMAA Medicare Part D (drugs).premium, and, if you want it deducted, taxes.
Medicare Part B Premium
Your Medicare Part B premium is divided into 2 parts: the standard amount & IRMAA (Income-Related Monthly Adjustment Amounts). Everyone who is Medicare-eligible pays the same standard amount. For 2023, the standard amount is $164.90.per month, down $5.20 from $170.10 in 2022.
The Income-Related Monthly Adjustment Amounts (IRMAA) is a monthly surcharge that is deducted ONLY from those Medicare eligible members whose taxable income (based on your 2021 income tax return) surpasses a certain threshold. In 2023 the threshold is $97,000 if you filed individually (up $6,000 from 2022) and $194,000 if you filed jointly (up $12,000 from 2022). The SSA letter contains a chart indicating various income thresholds and the monthly amounts of the surcharge
Medicare Part D Premium
If you have a Medicare Part D drug plan through the union, you must have a High Option Rider. You either purchased this rider as an active employee or purchased it after you retired. The High Option Rider is currently $125 a month and is deducted from your pension check.
If you are eligible, you will also pay IRMAA Medicare Part D. The amount is based on your 2021 income tax return. The SSA letter contains a chart indicating various income thresholds and the monthly amounts of the surcharge.
How Much You Will Get
Please note the first page of the SSA letter contains 4 bullets. The first one shows how much your SS benefit for 2023 is before deductions, providing you are collecting Social Security. The second shows the 2023 deductions for Medicare Part B for the standard amount and for IRMAA (if not eligible for 2023 IRMAA, IRMAA deduction should be 0).
The good news is that the 2023 Part B standard amount & IRMAA deductions are both reimbursable. You will receive the standard amount automatically, probably sometime in April 2024. IRMAA reimbursement is not automatic; you must apply for it. The application is generally available when you receive your standard reimbursement.
The 3rd bullet shows the 2023 deduction for Part D IRMAA. If you have an IRMAA deduction for Part B then you will also have one for Part D. Please note that Part D IRMAA is NOT reimbursable.
The 4th bullet lists your SSA benefit amount after all deductions.
If you are eligible for IRMAA in 2023, keep your 2023 SSA letter in a safe place. You will need to include it, along with your 2023 SSA1099 letter, in the application package when you file for 2023 Part B IRMAA.
2. Payment of Medicare Part B Premium – Most Medicare members have their Part B premium electronically deducted from their Social Security Check. However, if you are NOT collecting Social Security (you may be waiting until you are old enough to receive full payment) you will receive a bill called “Notice of Medicare Premium Payment Due” (CMS-500). You can pay this bill by:
using your bank’s online bill payment service,
signing up for Medicare Easy Pay, a free service that automatically deducts the premium payments from your savings or checking account each month, or
paying by check, money order or credit card or debit card. If you are paying by credit card or debit card, you must complete of sign the coupon at the bottom of the Medicare bill. Use the return envelope to send your Medicare payment along with your Medicare payment coupon to:
Medicare Premium Collection Center
P.O. Box 790355
St. Louis, MO 63179-0355
Questions of the Month
Q. I did not receive my SSA letter listing my 2023 Social Security benefits and deductions. How can I get a copy?
A. There are 3 ways:
You can call Social Security at 1-800-772-1213.
Visit your local Social Security office and request the SSA letter. Have a previous SSA letter or facsimile of the letter available with you so that you can clearly describe to the SSA agent what you want, OR
Download a copy from the SSA website, www.SSA.gov. This will require your having an online SSA account, which, if you don’t have one, you can open one on the SSA website by just following the prompts.