Medicare Part A, Medicare Part B, Medicare Part C and Medicare Part D become effective at age 65. Medicare Part B, C and D are also effective at age 65 but can be later depending on your employment status.
Medicare Part A [Hospital Coverage] which does not cost you anything and covers hospital costs
Medicare Part B [Medical Coverage] which has a base cost of $136.00 per month but maybe higher depending on your income [Refer to www.medicare.gov] for additional rates.
Medicare Part C [Advantage Plans] covers your Medicare Part A and B benefits plus they include prescription drug coverage [Medicare Part D]. It’s the convenience of having everything under one health insurer.
Medicare Part D [Prescription Drug Coverage] there is a monthly premium that you must pay to the insurance company that you choose depending on your prescription usage.
MetLife does not issue cards. Whenever you go to the dentist, you must give the dental office your Social Security number and your appropriate group number. (Steamfitters: 1630609 Metal Trades: 102654)
This Plan is required to provide certain information on a public website pursuant to the Federal Transparency in Coverage Final Rule published in the Federal Register on November 12, 2020.
The Rule requires that the Plan post links to machine-readable files that contain information about the price of health care services. A machine-readable file is written in computer code and is an extremely large file. It is not intended to be downloaded or read by participants but to be used in research studies. The files do not contain Protected Health Information (PHI) about you or your family.
Links on this website provide machine-readable files for the Plan’s in-network negotiated rate and historical allowed amounts for out-of-network charges. The files attached to the links are maintained by Anthem BlueCross BlueShield and will be updated monthly.
The link for Empire Blue Cross Blue Shield is: https://www.empireblue.com/machine-readable-file/search/
If you have any questions about the Rule, you can read more information at https://www.cms.gov/newsroom/fact-sheets/transparency-coverage-final-rule-fact-sheet-cms-9915-f
Since you can no longer work, you may be eligible to apply for a Metal Trades Pension if you have the required years of credited service. If you are eligible for a Metal Trades pension and you have health coverage up until the date your Social Security Disability Award is effective or are eligible 48 out of the last 60 months prior to your award date, you would continue health coverage for 2 years [as you would be entitled to Medicare Part A and Part B due to your disability -2 years from the date of your SS Award]. Your spouse and dependent children can enroll in COBRA [Continuation of Health Coverage on a self-pay basis] for a period of three years once your coverage terminates.
COBRA known as the “Consolidation Omnibus Budget Reconciliation Act” is the Continuation of your health coverage on a self- pay basis. If you should lose coverage based on loss of hours or are retiring prior to age 62 and would like to qualify for the “retiree prepaid health coverage” at age 62, you can self- pay for the coverage for a maximum of three[3] years until the “retiree prepaid health coverage” begins. You can purchase All Benefits [medical, hospital, prescription, dental and vision or Core Benefits [medical, hospital and prescriptions]. You can purchase an individual plan or family plan. However, you cannot purchase COBRA if you are Medicare eligible either through age or through a disability.
If you are working past your 65th birthday, you do not need to enroll in Medicare Part A or Part B, as you are covered with health coverage through the Welfare Fund. Once you decide to retire, you must be sure to apply for both Medicare Part A and Part B.
The “retiree pre-paid health coverage” is available to any Metal Trades retiree who is eligible for health benefits whether through COBRA [Continuation of Health Coverage on a self-pay basis] or through employment the month before their 62nd birthday.
The union’s phone number is 718-392-3420. They are located at 27-08 40th Avenue Long Island City, New York 11101.
In order for you to qualify for the “retiree prepaid health coverage,” you must have coverage the day before you turn age 62. Therefore once your coverage terminates, you and your family would have a COBRA [Continuation of Health Coverage on a self-pay basis] option. In order for the family to be covered under the “prepaid health” period, they must all purchase COBRA.
Since you are currently employed, we would continue to provide coverage for your spouse until you retire. At that point, you would have to make sure that she enroll in both Medicare Part A and Medicare Part B.
Once you retire, the life insurance [$50,000.00 and $20,000.00 - accidental death policy] through the Welfare Fund is no longer available. You can convert your life insurance policy to a self-pay policy by reaching out to MetLife at 1-800-638-6420 for conversion information. You have 30 days from the date your health insurance policy terminates to convert. Please be aware that while you are on COBRA [Continuation of Health Coverage on self-pay basis] you are not eligible for the life insurance. You will be eligible for the Pension Fund Death Benefit in the amount of $10,000.00.
As you are a retired member and eligible under the “prepaid health” period, your spouse would only be covered until the first of the month that she turns 65. Therefore, you have to make sure that your spouse is enrolled in both Medicare Part A and Medicare Part B as of the first of the month that she turns 65. Also remember that if your spouse is already 65 when you qualify for the prepaid health coverage at age 62, she will not be eligible for health benefits.
As long as you are actively working, the health coverage for your spouse would be with the Welfare Fund. If she has accepted both Medicare Part A and Part B, she can use the Medicare Insurance as secondary.
Once you are eligible for the retiree “prepaid health” coverage, your life insurance policy in the amount of $50,000.00 and accidental death policy in the amount of $20,000.00 under the Welfare Fund is in effect again through MetLife, in addition to your Pension Fund Death Benefit of $10,000.00.
The coverage for your spouse and dependent children would terminate upon your death. However, your dependents would have a COBRA option to self-pay for the insurance for a period of three years.
Your dependent child would be offered COBRA ”Continuation of health coverage on a self-pay basis] for a period of three (3) years from the first for the month following the month of their 26th birthday.
Medicare Part A covers the hospital – Medicare Part B covers medical [doctors, labs, radiology etc.]. Medicare basically cover 80%, so you have to find a supplemental plan that would cover the 20% and any deductible and also a prescription drug plan [Medicare Part D]. There are different insurance carriers that you can contact Aetna, Empire etc. that would make up the 20% difference or you can enroll in what are called “Advantage Plans” [Medicare Part C] that include medical, hospital and prescription drug coverage all together under one insurer. You would have to see which plan suits your individual specific needs.
The Express Scripts plan allows the original prescription plus one refill; any refill after that must go through mail order.
Completing a change of address form and submitting it to the Fund Office, will change your address with the Fund Office, Empire BlueCross BlueShield, Express Scripts and MetLife. You must notify the union separately so that your address will change with them as well.
The baby will automatically be covered for 30 days with Empire after the birth. It is your responsibility to complete an Insurance Census card, (which you can download by visiting the forms section of this website), and submit a copy of the birth certificate.
In order for you to replace your insurance cards, you must call the Fund Office, Empire and Express Scripts will not send out replacement cards without the Fund Office authorization.
