Retirees

 

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.

 

Retired Employee
(Not Eligible for Medicare)

Including Spouses & Dependent Children

Retired Employees

(Eligible for Medicare)

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.) X

Benefits Supplement Medicare Coverage Only

Well Woman X

Benefits Supplement Medicare Coverage Only

Routine Physicals X

Benefits Supplement Medicare Coverage Only

Lab & X-rays X

Benefits Supplement Medicare Coverage Only

Chiropractic care, physical therapy, occupational therapy, & speech therapy

X

Contact UnitedHealthcarefor Pre-Notification

1-800-850-1418

Benefits Supplement Medicare Coverage Only

Hospitalization & Surgery X

Benefits Supplement Medicare Coverage Only

Maternity & Gynecological Care

X

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) X

Benefits Supplement Medicare Coverage Only

Substance Abuse & Mental Health

X

Contact Business Health Services for Pre-Certification

1-800-765-EAPS 

Benefits Supplement Medicare Coverage Only

Prescription Drugs 

X

X
Dental

X

(Effective January 1, 2007) 

X

(Effective January 1, 2007)

Vision 

X

(Effective January 1, 2007)

X

(Effective January 1, 2007)

Hearing 

X

X
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)
© Local 26 IBEW-NECA Joint Trust Funds 2008. All rights reserved.