Eligibility for PFT Health and Welfare Fund

Retiree Prescription Benefit

I.            Definition of Eligibility (Note: Anyone who elects to participate in a Medicare Part D plan either through a “Medicare Advantage Plan” with a prescription benefit or through a stand alone prescription drug plan is not eligible for the PFT Health and Welfare Fund retiree prescription benefit.)

A.                A person who has retired from a PFT bargaining unit and is at least 65 years of age.  A retiree under 65 years of age see below, section IV.

B.                Those who retire under a State Early Retirement Plan (30 years of service or more).  No age requirement.

C.        A retiree who has been approved for PSERS Disability Retirement and/or the Health and Welfare Fund's Long Term Disability benefit.  No age requirement.

II.            Retirees may use their own or their spouse's Major Medical Plan if such a plan covers prescriptions.

          A.      Simply send to the Fund Office the original Major Medical Explanation of Benefits form which shows a reimbursement for prescriptions.

B.      Be sure to write your name, social security number, home address and telephone number on the original form before mailing it to the Fund Office.

C.                Claims may be filed immediately or no later than the Calendar year following the year in which the claim is paid.

D.                You will receive a check in the amount of 20% of what Major Medical paid for the retiree prescription.  The overall reimbursement shall not exceed 100% of charges.

III.       If you are eligible for the fund prescription benefit and choose to use it instead of a Major Medical plan or any of the PSERS' plans:

A.                You will be required to pay $54.00 a month.  You will be billed $324 February 1(for the 6 month period starting March 1st) and August 1 (for the 6 month period starting September 1st).  These figures are based on COBRA charges, which can change every year. 

B.       The prescription card and the Mail Order will both require a $22.00 co-pay for brand named drugs and a  $11.25 co-pay for generic drugs.

C.       Mail order is a 60 day supply.  Drugs purchased at a pharmacy are limited to a 14 day supply.  There are no caps.           

IV.              Retirees under age 65 - Eligibility

A.        A person who has retired from a PFT bargaining unit and is at least 55 years of  age and has a combination of age and years of service that equal 65 or more is eligible for the Fund prescription benefit if they have an HMO or Personal Choice that does not include a prescription plan.

1.                  Call the Health & Welfare Fund Office and request an application.

2.                  Send in completed application with a copy of your HMO, Personal Choice or other medical identification card.

B.                If you have a Major Medical Plan that covers prescriptions you may use it by following the instructions in II above.  See III above for a description of the Fund's prescription benefit.

C.                If you meet the criteria listed in IVA, above, and have a PSERS prescription benefit you are not eligible for the Fund's prescription plan.

V.                 PACE Program

            A.            Eligible retirees must use the Pace Program (funded by the State)

1.                  You must be 65 years of age or older.

2.                  Your total annual income was less than $14,500 for a single person, or a combined income of less than $17,700 for a married couple.

3.                  You have lived in Pennsylvania for at least 90 days.

B.        The Pace Program requires only a $6.00 co-pay per generic drugs and a $9.00 co-pay for brand name drugs.

                   1.        Send us a copy of your PACE card along with the receipt(s) for the deductible.

2.                  Your receipt must show the name of the patient (eligible retirees only), the name of the prescription and payment of $6.00.

3.                  Make sure you include your name, social security number, home address and telephone number.

4.                  The Fund will reimburse $4.00 per prescription for generic and $6.00 per brand name prescription.

5.                  The Coordinators of the Fund will help you complete the application.

VI.       All retirees, who meet the above requirements, must submit an application for           prescription coverage to the Fund.

A.                Remember, the prescription plan only covers the retired employee.

B.                You, the retiree, are responsible for notifying the Fund of any changes in your medical coverage.

C.                The special Dental and Vision Benefits do not require prescription eligibility.  

VII.     COBRA

A.        Remember, upon retiring, retirees are eligible for COBRA benefits for 18 months. 

Each retiree, upon retirement is sent a letter detailing the benefits and their costs. These include prescriptions.

B.                A retiree that is eligible for the Fund Retiree Prescription plan may elect to use COBRA first.

C.                If you plan on using the Fund's prescription plan after COBRA make sure you contact our office and have sufficient time to apply so that there is a smooth transition.

D.                If you are a recipient of social security disability, you may be eligible for an additional eleven (11) months of COBRA.

VIII.    Enrollment periods

A.                Within six months of retiring.

B.                Or within 20 months of retiring if the retiree uses the COBRA prescription plan

C.                A retiree that drops out of the plan will have two months to re-enter and will be charged for the two months missed.  This missed period will only be permitted once.

D.                A retiree that drops out of the plan more than once will not be readmitted.

E.                 Because of the additional clerical work involved with these changes, the six month re-enrollment periods have been moved to March 1 and September 1.

F.                 The billing period will be approximately February 1 to February 23 and August 1 to August 23

G.                Applications accepted between the first and fifteenth will receive the prescription benefit the following month.

H.                Enrollment after the fifteenth may have to wait until the month after.  Of course, those who enroll in the middle of a six month period will pay only for the months enrolled.

03/06