The level of retiree medical benefits you receive is based on your Medicare eligibility.
Non-Medicare-Eligible Retirees and Dependents
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.
Medicare-Eligible Retirees and Dependents
If you retire and become eligible for Medicare, you (and your Medicare-eligible spouse, if applicable) are eligible to purchase additional medical coverage under the Plan’s Medicare Supplement Program, as well as prescription drug coverage through the Fund. You (and your Medicare-eligible spouse, if applicable) are responsible for enrolling in Medicare Part B (enrollment in Part A is automatic when you sign up for the Social Security benefit). If you and/or your spouse do not enroll in Medicare, the benefits of the Supplemental Medicare Plan will be reduced by the full amount of all Medicare benefits you and/or your spouse are entitled to receive, whether or not you are actually enrolled in Medicare. You may access any credits (amounts in your HRA account, but will not be able to contribute any new amounts to that account.
- Supplemental Medicare Part A (hospital) coverage. The Plan pays the deductibles not covered by Medicare.
- Supplemental Medicare Part B (physician and medical benefits) coverage. Once you enroll in Medicare Part B, the Plan pays the deductible, if not covered by Medicare. The Plan also pays the coinsurance charges, generally 20%, that are not covered by Medicare, provided that such charges do not exceed the Plan’s scheduled allowance for the particular service(s) rendered. The Plan only pays up to the amount approved by Medicare.
- Prescription drug benefits. The Plan pays prescription drug benefits in the same way as it does for active participants, regardless of whether you are Medicare-eligible. If you or your spouse enroll in a Medicare Part D prescription drug plan, you are not eligible to purchase the prescription drug coverage offered through the Fund. As a result, your (and/or your spouse’s) prescription drug coverage through the Fund will end. However, you will continue to be eligible for Medicare supplemental benefits.
Dental coverage is not available to Medicare-eligible retirees. When you become eligible for Medicare, you will have the option to continue your life and accidental death and dismemberment insurance as an individual policy.
How to File a Claim
American Benefit Corporation handles all claims for Medicare-eligible participants. Claims for supplemental benefits are processed after Medicare benefits are paid. In order to file a claim, send written notice of your claim directly to the Fund at the following address within 20 days after a covered loss:
Fund Office, 4th District IBEW Health Fund, 609 Third Avenue, Chesapeake, OH 45619
If you cannot send a notice within that time, it must be sent as soon as reasonably possible. Click here for instructions on filing a claim. Contact the Fund Office at 1-304-525-0331 or 1-888-466-9094 if you have any questions.