Upon retirement, you are eligible for certain benefits for five (5) years provided you meet the age and service requirements described below:
City-funded health coverage is limited to this five (5) year period, regardless of whether you would qualify for a pension under more than one of the requirements listed above. If you die, your eligible dependents are entitled to continue coverage from the Plan for the balance of the five years of coverage remaining at the time of your death, provided they continue to meet the definition of “eligible dependent.”
Members can convert unused sick time to additional Post Retirement Medical Benefits in accordance with the members eligibility status and the terms of the ACT 111 award in effect at the time of retirement. The decision to convert this time in lieu of the cash buy out is a personal decision and should be made after careful consideration of the members financial and health concerns presently and in their future.
You may elect to defer your eligibility for five years of City-funded coverage until a later date. This election to defer coverage must be made when you retire, and you can only re-enter coverage status one time. If you have access to other health coverage when you retire, and are interested in additional information on deferring your coverage with the Plan, please contact the Plan office prior to your retirement to discuss this option.
If you are eligible for a service-connected disability pension from the City of Philadelphia and were a participant in the pension fund for one (1) day immediately prior to retirement, you are eligible for five (5) years of retiree health coverage.
If you are eligible for a non-service-connected disability pension from the City of Philadelphia and were a participant in the pension fund for at least ten (10) consecutive years immediately prior to retirement you are eligible for five (5) years of retiree health coverage.
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. Please refer to “Continuation Coverage under COBRA” for additional details.
If you die in the line of duty, your widow or widower is eligible to receive lifetime benefits from the Plan. Any other eligible dependents will be covered for as long as they meet the eligibility criteria of the Plan, e.g., dependent children will be covered until they reach age 26.
If you die while in active service but not in the line of duty, your spouse and other eligible dependents will remain eligible for coverage as if you had retired on the date of your death.
If you die prior to retirement, while on an Approved Leave of Absence, your spouse and other eligible dependents will remain eligible for coverage as if you had retired on the date of your death.
If you are a retiree and die while eligible for health coverage your spouse will be covered for the remaining period of your retirement coverage. Any other eligible dependents will be covered for as long as they meet the eligibility criteria of the Plan.
Local 22’s Health Plan will reimburse members of the Health Plan and their spouse for their Medicare Part B Premium on a quarterly basis. Once a member and /or their spouse enrolls in Medicare Part B and begins paying the premium they are entitled to the reimbursement. Send a copy of the monthly premium statement and you will be enrolled in the reimbursement program. The only time you need to send another premium statement is when your premium changes. This way your reimbursement check can be adjusted.
The reimbursement program ends for the member and the dependent the same time their coverage under Local 22’s Health Plan Terminates.
Q. If I die will my spouse and children be able to use the balance of my converted sick time?
A. Yes, your spouse and children, up to 26 years of age, will be entitled to your medical coverage.
Q. If I am single and convert sick time and 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. Yes, you have to notify the City of Philadelphia Board of Pensions and Local 22’s Health Plan, in writing, when you want your coverage to start.
Note: 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. No, the month you retire in will be considered your last active medical eligible month. 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 immediately, can I defer coverage?
A. Once you informed the City to start your contractual five years medical coverage, along with any additional years by converting sick time, that coverage will continue to run until all time is expired.
Q. I understand that I should avoid the “medical gap” meaning my five-year contractual medical coverage plus my conversion of sick time should be enough to get myself and my spouse on to Medicare, is that right?
A. That is correct. Since your pension never increases, if your Health coverage terminates prior to you and your spouse obtaining Medicare eligibility, it may cause severe financial problems trying to pay for quality medical coverage
Q. How do I know if I qualify for Medicare? How about my spouse?
A. You can either call Medicare at 1-800-772-1213 or go to Medicare.gov on the web to check you and your spouse’s eligibility.
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. Yes, if your spouse is at least 62-years-old and Medicare eligible and you are at least 65, and not Medicare eligible, you may apply on their Social Security number.
A. If you were married for at least 10 years, and divorced, you may qualify on your ex-spouse’s Social Security number. Please contact Medicare to review your personal situation.
Q. I understand 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 and not just one time.
A. Medicare B also has an “open enrollment” meaning you complete the Medicare application between January 1 and March 31, however, your medical coverage does not start until July 1.
Q. Can you please explain Medicare supplemental insurance?
A. Basically, Medicare pays 80% of all hospital and medical surgery bills so you need additional coverage often referred to as Medicare supplemental insurance. Local 22’s Health Plan will be you and your spouse’s supplemental insurance once you are Medicare eligible until your Local 22 coverage terminates.
Q. Could you please list the information I should obtain before going to the pension board making this lifetime medical coverage decision!
A. You should know the answer to the following questions:
Q. I just retired from the Fire Department and now work with and have medical coverage. Who pays my medical bills, my new employer’s coverage, Local 22 coverage or Medicare?
A. The new employer coverage would be your active insurer since you are actively employed. They would be your primary medical insurance payer. What they do not pay, Local 22 would supplement up to our level of benefits.
Q. I am an active Local 22 member not yet eligible for Medicare, but my spouse does have Medicare coverage. Who should I submit my spouse’s medical bills to?
A. If your spouse does not have active medical coverage through their employer but does have Medicare as long as you remain an active employee and your spouse remains on your active medical policy, Local 22 would be primary.
Q. If I retire from the Fire Department and have Medicare and 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, that policy would be financially responsible for your medical bills and your spouse’s medical bills even though you have Medicare.
Q. I am now retired from the Fire Department, not working, 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 and Local 22 becomes your Medicare supplemental advantage plan.
Q. I’m now retired from the Fire Department, not working, no other active employment coverage. I understand Medicare is my primary insurer and Local 22 is secondary but who covers my spouse’s medical bills? My spouse is either not working or waived their coverage at work and not Medicare eligible.
A. Local 22 would be the primary insurer for your spouse until they become Medicare eligible and retire from active employment.
Q. Even though my spouse and I have Medicare, if I am an active employee with medical coverage for myself and my spouse, whether it be with the Fire Department or another employer, is that active coverage primary to Medicare?
A. Yes. If you or your spouse is covered under an active employee medical plan, that active coverage will be primary for both you and your spouse.
Q. If I am an active employee with coverage for myself and my spouse do I have to take Medicare B and pay monthly premium?
A. The key term is “retired”. You may work to any age and not apply for Medicare B when first made available to you at 65 years of age. However, for example; when you retire at 72 years of age, you must apply for Medicare B and there will be no 10% annual penalties imposed. Nor will you be subject to the restrictions of open enrollment. The same rule applies for your spouse.
Q. When my spouse and I are both retired, even though we still have Local 22 medical coverage available for several years, must I apply for Medicare B?
A. That is our suggestion to protect you and your spouse. You do have the option of refusing Medicare B when it is first offered at 65 years of age but then you will incur a 10% penalty for every year you did not have Medicare B and be subject to a very strict open enrollment. As an incentive for our members to enroll in Medicare Part B – Local 22 has offered to reimburse you and your spouse your Part B premiums quarterly. This incentive will save you the 10% yearly penalty for not enrolling when eligible.
Yes – The Health Plan will reimburse Health Plan members and their spouse for their Medicare Part B premium on a quarterly basis.
Does the Health Plan recommend members to sign up for Medicare Part B when they turn 65?
Yes – Every year you wait to sign up for Medicare Part B you will incur a 10% penalty. By signing up – even if you have Local 22 coverage – you will receive your premium reimbursement and avoid the late penalty.
Medicare 101 In 1965, President Lyndon Johnson signed the original Medicare program into law
The program originally covered two portions:
Part A covers a large portion of hospital-related costs for eligible people over the age of 65 and only includes medically necessary and skilled care, not custodial care. Persons not eligible for coverage can participate in the program if they pay a monthly fee Part B is optional and pays a portion of non-hospital provided medical care, such as doctor visits and other outpatient services. There is a monthly fee for this program. The fee in 2017 is $134.00 for most people and is likely to rise in the future. Part B coverage is subject to various deductibles and co-pays. The Medicare program still fulfills its original role, but was expanded in 1997 and refined in 1999 to include:
Part C – “Medicare” + Choice, now known as “Medicare Advantage”
Part C gives Medicare beneficiaries the opportunity to enroll in private healthcare plans and receive all Medicare services, including Part A and Part B, from a private provider. It operates like the healthcare coverage provided by most employers. A menu of offerings is available with a variety of coverage options, co-payments and monthly costs.
The private provider also covers services not provided by Parts A and B. Part C is available in most areas and provides a convenient way to receive medical services.
In 2006, the program expanded again to offer:
Part D – Prescription drug coverage
Part D is an optional insurance program that charges a monthly fee in exchange for prescription drug coverage. The monthly cost varies widely depending on the coverage options you choose. Like employer-provided health care plans, Part D holds an open enrollment session November 15 – December 31 each year, during which time program participants can choose to change their coverage options. While Part D is a voluntary program, Medicare recipients must seriously review their healthcare needs immediately upon eligibility because the cost of Part D increases each year for individuals who choose not to participate immediately upon eligibility.
Although prescription drug coverage is particularly important for many senior citizens and Part D does help, the program has drawn heavy criticism. Many people find the array of coverage options and pricing to be particularly confusing. (To learn more about Medicare coverage options, see Getting Through The Medicare Part D Maze.)
What to Choose? Participants in Medicare Part A and B can choose to participate in Part C and/or Part D, or they can choose to purchase supplemental insurance from a private carrier. This supplemental insurance, often referred to as “medigap” coverage, pays for expenses that are not covered by Medicare. Participants in Part C do not need to purchase medigap coverage because Part C enables them to select medical coverage that addresses most needs.
Medicare and Long-Term Care The Medicare program is designed to provide for medical care, not the cost of long-term care (LTC). As such, Medicare’s coverage for long-term needs is extremely limited. 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. In order for Medicare to pay for your LTC costs at all, you must meet three criteria:
The 72-Hour Rule – You must have been hospitalized for at least three full days and three full nights. Many hospital stays are three days and two nights. For example, you might go in for a hip replacement on Monday morning and 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.
It must result from the condition for which you were hospitalized.
Places Where Care Can Be Given – In almost all cases, patients leaving a hospital go straight to a nursing home for further care.
There’s a difference between care that is skilled and medically necessary, and 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 and need skilled care, Medicare may pay to have a caregiver come to your home to tend to your needs. Another exception is end-of-life or hospice care. The exact levels and locations for receiving skilled care vary from state to state.
Medicare is not designed to provide assistance with ADL or to provide assistance and aid to keep you in your home or in an assisted living facility. Providing funds for long-term care is the role of Medicaid and LTC. (To learn more about LTC and Medicaid, see Long-Term Care Insurance: Who Needs It? and What’s The Difference Between Medicare And Medicaid?)
