This chart contains information on the benefits available for Retirees not yet on Medicare and for Retirees on Medicare. Certain restrictions, limits, pre-authorizations, deductibles and co-pays apply. Refer to the Summary Plan Description (SPD) for details.  If there is a discrepancy between the SPD and the Plan Document, the Plan Document governs.

Benefits are available to the spouses and dependent children of Retired Employees provided they meet the definitions of the plan and the premium is paid. The premium is for medical, dental, vision and prescription card benefits.

If you and/or your eligible dependents (including your spouse) are on Medicare, then Medicare is the primary health care coverage. EWTF will supplement the Medicare coverage. NOTE: If Medicare does not cover the service, then neither will EWTF.

NOTE: If you are age 65, the Plan assumes you are enrolled for Medicare and will not pay for any expenses that are covered under Medicare if not enrolled. That is why it is essential that you apply for Medicare at least 3 months before you reach age 65 to assure continued coverage. The same rules apply to any of your eligible family members who are also covered by Medicare. The Plan does not pay the Medicare Part B premium for participants.

Benefits Pre-Medicare Retired Employee Including Spouse & Dependent Children Medicare-Eligible Retired Employees
Eligibility Requirements Must make self-payments for coverage and meet definition of spouse and dependent. Must make self-payments for coverage
Medical (office visits, doctor charges, etc.) Benefits Supplement Medicare Coverage Only
Well Woman Benefits Supplement Medicare Coverage Only
Routine Physicals Benefits Supplement Medicare Coverage Only
Lab & X-rays Benefits Supplement Medicare Coverage Only
Chiropractic care, physical therapy, occupational therapy, & speech therapy

Contact UnitedHealthcare for Pre-Notification

1-800-850-1418

Benefits Supplement Medicare Coverage Only
Hospitalization & Surgery Benefits Supplement Medicare Coverage Only
Maternity & Gynecological Care

Maternity benefits not available to dependent children

Benefits Supplement Medicare Coverage Only
Emergency Room Benefits Supplement Medicare Coverage Only
Employee Assistance Plan (Business Health Services) Benefits Supplement Medicare Coverage Only
Substance Abuse & Mental Health

Contact Business Health Services for Benefit Navigation

1-800-765-EAPS

Benefits Supplement Medicare Coverage Only
Prescription Drugs 
Dental

(Effective January 1, 2007)

(Effective January 1, 2007)

Vision 

(Effective January 1, 2007)

(Effective January 1, 2007)

Hearing 
Death Benefits $6,000.00 (benefits are not available for the spouse and any dependents) $6,000.00 (benefits are not available for the spouse and any dependents)

Retiree Premium

Retiree Premiums Remain the Same in 2014

Pre-Medicare Retirees Current Monthly Rates+
Age 55 and Under $200.29
Age 56 $200.29
Age 57 $200.29
Age 58 $200.29
Age 59 $200.29
Age 60 – 64 $145.16

* A cap of $400.58 per month per family is in effect for non-Medicare retirees and surviving spouses.

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