Retiree Benefits

The level of retiree medical benefits you receive is based on your Medicare eligibility. See the links below for additional information.

• Benefits for retirees and dependents who are not eligible for Medicare.

  If you are retired, but not eligible for Medicare, or if you are retired due to a disability, you and your dependents will be eligible to receive primarily the same benefits coverage as active participants. However, you are not eligible to receive Weekly Disability benefits. You may access any credits (amounts) in your HRA account, but will not be able to contribute any new amounts to that account.

  Click here for an overview of your benefits and claims information. Note: Retirees are not eligible for Weekly Disability benefits.

• Benefits for retirees and dependents who are eligiblefor Medicare due to age.

  When you (and your spouse) become eligible for Medicare and are covered under Medicare Part A and Part B, you will be eligible to purchase additional medical coverage for yourself and your spouse under the Plan’s Medicare Supplement Program, as well as prescription drug coverage through the Fund. You may access any credits (amounts in your HRA account, but will not be able to contribute any new amounts to that account.

  Note: Life Insurance, Accidental Death and Dismemberment, Vision, Dental, and Weekly Disability benefits are not available to retirees who are Medicare-eligible.

  Hospital and Physician Services. The Medicare Supplement Program provides a level of coverage for hospital and physician services that are not covered by Medicare, as well as coverage for services provided by a skilled nursing facility. Click here to view the Monumental Life Insurance Company’s Certificate of Insurance, which includes a full Schedule of Benefits.

  • How to file a claim.

    The Monumental Life Insurance Company handles all claims for Medicare-eligible participants. In order to file a claim, send written notice of your claim directly to the Monumental Life Insurance Company at the following address within 20 days after a covered loss:

    Monumental Life Insurance Company, 520 Park Avenue, Baltimore, Maryland 21201-4500

    If you cannot send a notice within that time, it must be sent as soon as reasonably possible.

    The notice must contain your name and enough information to identify you (or your spouse) as the covered person under the Monumental Life Insurance Company policy. The Monumental Life Insurance Company will send you forms to file Proof of Loss within 15 days of receiving your claim. If you do not receive the forms within this time period, you will be given 90 days after the date that the loss occurred to provide the Monumental Life Insurance Company with a written statement of the nature and extent of the loss.

    The Monumental Life Insurance Company has the right to have you examined as often as necessary while a claim is pending. No legal action may be brought to recover against the policy within 60 days after written Proof of Loss has been given. In addition, no such action may be brought after three years from the time written Proof of Loss is required to be given. If any time limit under the policy is less than that allowed by the laws of the state where you reside, the limit is extended to meet the minimum time allowed by such law.

    Claims for benefits provided under the policy will be paid as soon as written proof is received. All benefits are paid directly to you (or your spouse), unless you request otherwise. If a benefit is unpaid at the time of your death or if you are not able to give a valid receipt for payment, the benefit will be paid to your spouse, parent, child(ren), brother(s), sister(s), or estate.

    If a payment for claims exceeds the maximum amount payable under any benefit provisions or riders of the policy, the Monumental Life Insurance Company has the right to recover the excess of such payments.

  Prescription Drug Benefits. You will have the same prescription drug coverage as that available to active participants under the Plan’s Prescription Drug Benefit. The Plan’s prescription drug coverage is “creditable” coverage. This means that the benefits are, on average, as good as or better than the standard coverage offered by Medicare, so you do not have to enroll in Medicare Part D. 

  For more information about Medicare prescription drug coverage, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

  If you elect to purchase a Part D Medicare prescription drug plan, you will not be eligible to purchase the Medicare Supplement Program offered through the Fund with Monumental Life Insurance Company. The only way you would be able to reinstate your eligibility for the supplement program and the Fund’s prescription drug coverage would be to return to work and satisfy the Fund’s eligibility requirements for active employees.

   

• Benefits for retirees and dependents who are eligiblefor Medicare due to disability.

  When you (and your spouse) become eligible for Medicare and are covered under Medicare Part A and Part B due to disability, you will be eligible to purchase additional medical coverage for yourself and your spouse under the Plan’s self-funded Medicare Supplement Program, as well as prescription drug coverage through the Fund. You may access any credits (amounts in your HRA account, but will not be able to contribute any new amounts to that account.

  Note: Life Insurance, Accidental Death and Dismemberment, Vision, Dental, and Weekly Disability benefits are not available to retirees who are Medicare-eligible.

  Hospital and Physician Services. The Medicare Supplement Program provides a level of coverage for hospital and physician services that are not covered by Medicare, as well as coverage for services provided by a skilled nursing facility.

  Prescription Drug Benefits. You will have the same prescription drug coverage as that available to active participants under the Plan’s Prescription Drug Benefit. The Plan’s prescription drug coverage is “creditable” coverage. This means that the benefits are, on average, as good as or better than the standard coverage offered by Medicare, so you do not have to enroll in Medicare Part D. 

  For more information about Medicare prescription drug coverage, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

  How to file a claim. In order to file a claim, send written notice of your disability directly to the Fund Office at American Benefit Corporation (mailing address: 3150- US Route 60, Ona, WV 25545) as soon as reasonably possible.

  If you elect to purchase a Part D Medicare prescription drug plan, you will not be eligible to purchase the Plan’s self-funded Medicare Supplement Program. The only way you would be able to reinstate your eligibility for the supplement program and the Fund’s prescription drug coverage would be to return to work and satisfy the Fund’s eligibility requirements for active employees.