Local 22 Firefighters/Paramedics

/ 22

第五大街415号. 费城., PA 19123.

退休人员

Upon retirement, 你有资格在五(5)年内享有某些福利,只要你符合以下的年龄和服务要求:

  1. you have reached age 45 和 are eligible to participate in Plan X; or
  2. you have reached age 50 和 are eligible to participate in Plan 87 (Plan A); or
  3. you have satisfied the minimum requirements to qualify for a pension benefit through the City uniformed pension plan; or
  4. you were a participant in the City of 费城 pension fund for a least ten (10) years; or
  5. 你是受雇于当地22健康计划或当地22联盟至少每周35小时连续至少十(10)年之前立即退休,你至少55岁当你离开就业与健康计划或联盟
    1. any Health Plan or Union employee (or their eligible dependent) who is eligible to enroll in Medicare, must enroll in Medicare 部分 和 B部分 to qualify for the five (5) years of City-funded coverage

城市资助的医疗保险仅限于这五(5)年期间, regardless of whether you would qualify for a pension under more than one of the requirements listed above. 如果你死了, 您的合格家属有权继续享受该计划在您死亡时剩余五年的保险余额, 只要他们继续满足“合格家属”的定义.”

Additional Post – Retirement Benefits.

根据成员的资格地位和在退休时生效的ACT 111条款,成员可以将未用病假转换为额外的退休后医疗福利. 决定转换这一次取代现金买断是一个个人的决定,应该在认真考虑成员的财务和健康问题目前和未来.

Deferred Retirement Benefits

You may elect to defer your eligibility for five years of City-funded coverage until a later date. 这种推迟保险的选择必须在你退休时进行, 和 you can only re-enter coverage status one time. 如果你退休后有其他的医疗保险, 及有意了解有关延迟投保本计划的额外信息, please contact the Plan office 之前 to your retirement to discuss this option.

Service Connected Disability Retirement Benefits 

如果您有资格从费城领取与服务有关的伤残抚恤金,并且在退休前曾在该养老基金中参加过一天, 你有资格享受5年的退休人员健康保险.

Non-Service Connected Disability Retirement Benefits

如果你有资格获得费城市的非与服务有关的残疾养老金,并且在退休前连续至少10年参加该养老基金,你就有资格享受5年的退休人员健康保险.

Your City-sponsored retiree health coverage runs concurrently with your eligibility for continuation coverage under COBRA. This means that at the end of your five years of City-funded coverage you will NOT be offered a COBRA election. 详情请参阅“COBRA下的延续保险”.

因公死亡雇员的合资格家属

如果你死了 in the line of duty, 您的遗孀或鳏夫有资格从该计划中获得终身福利. Any other eligible dependents will be covered for as long as they meet the eligibility criteria of the Plan, e.g.在美国,受抚养的儿童将享受保险,直到他们年满26岁.

因服现役而非因公死亡的雇员的合资格家属

如果你死于现役而不是因公殉职, 你的配偶和其他合格的家属将继续有资格享受保险,就像你在你死亡的日期退休一样.

雇员在获准休假期间死亡的合资格受养人

如果你死了 之前 to retirement, while on an Approved Leave of Absence, 你的配偶和其他合格的家属将继续有资格享受保险,就像你在你死亡的日期退休一样.

Eligible Dependent of Retired Employee

如果你是一名退休人员,在符合健康保险条件的情况下死亡,你的配偶将在你的退休保险的剩余期间受到保护. Any other eligible dependents will be covered for as long as they meet the eligibility criteria of the Plan.

Medicare B部分 Reimbursement

Local 22’s Health Plan will reimburse members of the Health Plan 和他们的配偶为他们的医疗保险B部分保费的季度基础. 一旦成员和/或他们的配偶加入医疗保险B部分,并开始支付保费,他们有权报销. Send a copy of the monthly premium statement 和 you will be enrolled in the reimbursement program. 只有当您的保险费发生变化时,您才需要再发送一份保险费声明. This way your reimbursement check can be adjusted.

成员和受抚养人的报销计划结束的同时,他们在地方22健康计划的覆盖终止.

Retiree And Medicare Q&A

Q. If I die will my spouse 和 children be able to use the balance of my converted sick time?
A. 是的, your spouse 和 children, up to 26 years of age, will be entitled to your medical coverage.

Q. If I am single 和 convert sick time 和 die before the time is used does the money go to my estate?
A. No, the City will keep the balance of your money.

Q. If I defer my coverage can I begin it at any time?
A. 是的, you have to notify the City of 费城 Board of Pensions 和 Local 22’s Health Plan, 以书面形式, when you want your coverage to start.
注意: coverage always begins on the first of the month.

Q. Does it make any difference if I retire on the 1st of the month or on the 28th of the month?
A. 不可以,您退休的月份将被视为您最后一个有效的符合医疗条件的月份. The beginning of the next month would be your first “pension medical coverage” unless you defer.

Q. What happens if convert an additional five years sick time for a total of 10 years medical coverage, which I start 立即, can I defer coverage?
A. 一旦你通知市政府开始你五年的医疗保险, 再加上额外的几年,把病假时间转换成其他时间, 该保险将继续运行,直到所有时间到期.

Q. 我明白我应该避免“医疗缺口”,这意味着我的五年合同医疗保险加上我的病假转换应该足够让我和我的配偶享受医疗保险, is that right?
A. That is correct. Since your pension never increases, if your Health coverage terminates 之前 to you 和 your spouse obtaining Medicare eligibility, 它可能会导致严重的财政问题,试图支付高质量的医疗保险

Q. How do I know if I qualify for Medicare? How about my spouse?
A. You can either call Medicare at 1- or go to Medicare.在网上查询你和你的配偶的资格.

Q. If I do not qualify for Medicare, can I obtain coverage on my wife’s Social Security number? How about my ex-spouse’s Social Security number?
A. 是的, 如果你的配偶至少62岁,有医疗保险资格,而你至少65岁, 和 not Medicare eligible, you may apply on their Social Security number.
A. If you were married for at least 10 years, 和 divorced, 你可以通过你的前配偶的社会安全号码获得资格. 请联系医疗保险以了解您的个人情况.

Q. I underst和 there may be penalties imposed if I do not take Medicare when I first become eligible?
A. Since Medicare A is free, we strongly suggest you sign up when you are first eligible for Medicare. Medicare B imposes a 10% penalty for every year you do not take Medicare B when you first became eligible. This is an ongoing penalty 和 not just one time.
A. Medicare B also has an “open enrollment” meaning you complete the Medicare application between January 1 和 March 31, 然而, your medical coverage does not start until July 1.

Q. 你能解释一下医疗保险补充保险吗?
A. 基本上, 医疗保险支付所有医院和医疗手术费用的80%,所以你需要额外的保险,通常被称为医疗保险补充保险. 当地22的健康计划将是你和你的配偶的补充保险,一旦你有医疗保险资格,直到你的当地22的保险终止.

Q. 在我去养老委员会做这个终生医疗保险决定之前,你能列出我应该获得的信息吗!
A. You should know the answer to the following questions:

  • Do you or your spouse qualify for Medicare?
  • 你和你的配偶之间的年龄差距是多少,以确保本地22的保险,直到你们都符合医疗保险的资格?
  • 我退休后会得到有医疗福利的工作吗?
  • Does my spouse have medical coverage available? If so, I may want to consider deferring.

I now have Medicare. 我如何知道是否医疗保险或地方22的健康计划首先支付?

Q. 我刚从消防队退休,现在和他们一起工作,有医疗保险. 谁来支付我的医疗费用,我的新雇主的保险,地方保险还是医疗保险?
A. 新雇主的保险范围将是你的主动保险,因为你是积极的受雇. They would be your primary medical insurance payer. 他们不支付,本地22将补充到dafabet网页手机登录的福利水平.

Q. 我是一个活跃的地方22成员,还没有资格享受医疗保险, but my spouse does have Medicare coverage. Who should I submit my spouse’s medical bills to?
A. 如果你的配偶没有通过他们的雇主获得有效的医疗保险,但有医疗保险,只要你仍然是一名在职员工,而你的配偶仍然在你的有效医疗保险中, Local 22 would be primary.

Q. If I retire from the Fire Department 和 have Medicare 和 have coverage on my spouse’s active employment coverage, where would I submit my bills?
A. Since you are covered on an active employee policy, 该政策将为你和你配偶的医疗账单承担经济责任,即使你有医疗保险.

Q. I am now retired from the Fire Department, 不工作, having no other active employment coverage, but have Medicare, who now do I submit my medical bills to?
A. Since you are retired Medicare becomes your primary insurer 和 Local 22 becomes your Medicare supplemental advantage plan.

Q. I’m now retired from the Fire Department, 不工作, no other active employment coverage. I underst和 Medicare is my primary insurer 和 Local 22 is secondary but who covers my spouse’s medical bills? My spouse is either 不工作 or waived their coverage at work 和 not Medicare eligible.
A. 当地22将是你的配偶的主要保险公司,直到他们符合医疗保险的资格并从积极的就业中退休.

Q. Even though my spouse 和 I have Medicare, 如果我是一个积极的员工,为我和我的配偶提供医疗保险, 无论是消防部门还是其他雇主, is that active coverage primary to Medicare?
A. 是的. 如果您或您的配偶参加了现行的员工医疗计划, 这种积极的保险将是你和你的配偶的主要保障.

Q. If I am an active employee with coverage for myself 和 my spouse do I have to take Medicare B 和 pay monthly premium?
A. The key term is “retired”. You may work to any age 和 not apply for Medicare B when first made available to you at 65 years of age. 然而, for example; when you retire at 72 years of age, 你必须申请医疗保险B,而且不会有10%的年度罚款. 你也不会受到开放注册的限制. The same rule applies for your spouse.

Q. When my spouse 和 I are both retired, 尽管dafabet网页手机登录的地方22医疗保险已经有好几年了, must I apply for Medicare B?
A. That is our suggestion to protect you 和 your spouse. 你确实可以选择拒绝在65岁时第一次提供医疗保险B,但你将招致10%的罚款,因为你每一年没有医疗保险B,并受到一个非常严格的开放登记. 作为激励dafabet网页手机登录的成员参加医疗保险B部分- Local 22已经提供偿还你和你的配偶你的B部分保费季度. 这个奖励将为您节省10%的年度罚款时,没有报名时,合格. 

Medicare B部分 Premium Reimbursement.

本地22健康计划是否报销医疗保险B部分保费?

是的, 健康计划将按季度偿还健康计划成员及其配偶的医疗保险B部分保费.

Does the Health Plan recommend members to sign up for Medicare B部分 when they turn 65?

是的, 每一年,你等待注册医疗保险B部分,你将招致10%的罚款. 通过注册-即使你有当地22保险-你将收到你的保费报销和避免滞纳金.

医疗保险101 1965年,林登·约翰逊总统签署了最初的医疗保险计划,使之成为法律

The program originally covered two portions:

  • 部分 – Hospital insurance
  • B部分 – Medical insurance

部分 为65岁以上符合条件的人支付很大一部分与医院有关的费用,只包括医疗上必要的和熟练的护理, not custodial care. Persons not eligible for coverage can participate in the program if they pay a monthly fee B部分 是可选的,并支付一部分非医院提供的医疗服务, such as doctor visits 和 other outpatient services. There is a monthly fee for this program. The fee in 2017 is $134.00 for most people 和 is likely to rise in the future. B部分的保险范围取决于各种免赔额和自付额. The Medicare program still fulfills its original role, 但在1997年扩大并在1999年改进,包括:

C部-”Medicare” + Choice, now known as “Medicare Advantage”

C部分使医疗保险受益人有机会参加私人医疗保健计划并获得所有医疗保险服务, including 部分 和 B部分, from a private provider. 它的运作方式就像大多数雇主提供的医疗保险一样. A menu of offerings is available with a variety of coverage options, co-payments 和 monthly costs.

私人提供商还包括A和B部分不提供的服务. Part C is available in most areas 和 provides a convenient way to receive medical services.

In 2006, the program exp和ed again to offer:

D -部分 Prescription drug coverage

Part D is an optional insurance program that charges a monthly fee in exchange for prescription drug coverage. 每个月的费用取决于你选择的保险项目. Like employer-provided health care plans, D部每年11月15日至12月31日开放招生, 在此期间,节目参与者可以选择改变他们的覆盖选项. While Part D is a voluntary program, 医疗保险受益人必须认真审查他们的医疗保健需要立即资格,因为D部分的成本每年增加的个人谁选择不参加 立即 upon eligibility.

Although prescription drug coverage is particularly important for many senior citizens 和 Part D does help, the program has drawn heavy criticism. 许多人发现一系列的保险选项和定价特别令人困惑. (To learn more about Medicare coverage options, see Getting Through The Medicare Part D Maze.)

What to Choose? Participants in Medicare 部分 和 B can choose to participate in Part C 和/or Part D, 或者他们可以选择从私人保险公司购买补充保险. This supplemental insurance, often referred to as “medigap” coverage, pays for expenses that are not covered by Medicare. C部分的参与者不需要购买医疗缺口保险,因为C部分使他们能够选择满足大多数需求的医疗保险.

Medicare 和 Long-Term Care The Medicare program is designed to provide for medical care, not the cost of long-term care (LTC). 因此,医疗保险对长期需求的覆盖极其有限. Assuming you qualify, Medicare may pay up to 100% of your costs in a nursing home for the first 20 days in a benefit period. Once 20 days have passed, you must pay a hefty co-insurance amount for days 21 through 100 for each benefit period. 为了让医疗保险支付你的长期医疗费用,你必须满足三个标准: 

The 72-Hour Rule -你必须住院至少三天三夜. Many hospital stays are three days 和 two nights. For example, you might go in for a hip replacement on Monday morning 和 leave Wednesday afternoon.

Medical Necessity – Your care must fulfill the following requirements:

It must be medically necessary.

It must be care that can only be given in a nursing home, in most cases by skilled personnel.

这一定是你住院时的状况造成的.

Places Where Care Can Be Given – In almost all cases, patients leaving a hospital go straight to a nursing home for further care.

熟练的护理和医学上必要的护理是有区别的, 和 care that is custodial. The bottom line is determining whether you need assistance with activities of daily living (ADL) or custodial care. (For related reading, see Taking the Surprise Out of Long-Term Care.) With some exceptions, Medicare pays for medically necessary skilled care in a nursing home setting. If you are homebound 和 need skilled care, 医疗保险可能会出钱请一位护理人员到你家来照顾你的需求. Another exception is end-of-life or hospice care. 接受技术护理的确切水平和地点因州而异.

医疗保险的目的不是为ADL提供帮助或提供帮助让你呆在家里或辅助生活设施中. 为长期护理提供资金是医疗补助和长期护理中心的职责. (To learn more about LTC 和 Medicaid, see Long-Term Care Insurance: Who Needs It? What’s The Difference Between Medicare And Medicaid?)

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