City Of New York 1
What is a ESA ?
"The ESA PLAN works as if every doctor is in network, in terms of copay. Same share cost as in network!
The Provider ( Hospital or doctor's office ) HAS to accept 3 key Features:
1.They must accept Medicare
2.Willing to Treat
3. Willing to receive payment from aetna
-They don't have to be in network with aetna to receive payment from aetna. We WILL pay them even if they're out of network."
How can retirees send in the completed HBA Application /change form to city?
Hot topic- Click health benefits form or Communications Tab
Mailed - Health Benefits Program 22 Cortland Street-12th Floor, New York ,New York 10007
Fax-212-306-7756
What must you validate at beginning of call?
-First and Last name- Phonetically
-Phone number
-zip code
-sponsor/Union
Are spouse eligible for plan ?
Eligibility Tab- Spouses are eligible to be enrolled , but the retiree must also be on the plan .If Retiree terminate for any reason, the spouse no longer eligible for coverage
My Husband is the Retiree, If he Passes away will i ( Spouse) still be covered ?
Eligibility Tab-If the Primary passes away, the surviving spouse is not eligible for these plans.
The Surviving spouse is ONLY COVERED under the group IF THEY WERE PART OF THE MANAGEMENT BENEFIT FUND.
WHAT RESOURCES CAN RESOURCES FOR
LIVING HELP WITH?
Communication Tab -HELP AT HOME
-TRANSPORTATION
-LOCAL SUPPORT PROGRAMS
-CAREGIVER SUPPORT AND MORE
Union-Doctors Council
State- Florida
Is there a fitness benefit available ? Do i have to pay ?
Yes- Silver sneaker
-Silver sneakers .Free Gym Membership.You will take you Aetna ID card in to register for free gym membership.Yes there is a fitness benefit thats covered its called Silver Sneakers. For more information you can go to Silversneakers.com /866-584-7389
Is City of New York a Passive Enrollment or Active Enrollment ?
City of New York is Active Enrollment -means that the retiree s/beneficiaries must take some action to be enrolled in the plan.
What is City of New York Billing type?
Billing Information- Employer Billed
Meaning- The bill is sent to the sponsor who pays it and the member pays the sponsor
What is the 3-1-3 Rule?
The 3-1-3 rule is used to determine when a retiree can enroll into a medicare advantage plan and/or medicare drug plan because they are turning/turned 65.
The 7 month period we call 3-1-3
3 - during one of the 3 months before you turn 65
1 - includes the month you turn 65
3 - Ends 3 months after the month you turn 65
Does a PPO plan require a Referral?
NO REFERRAL REQUIRED
Union-PBA (Police)
State -New Jersey
Does this plan Cover Telehealth Services?
Communications Tab- TeleHealth Services: Can't make it to the Doctors office? You can get care from any network provider that offers Telehealth services.You'll pay the same amount as in person visit.Contact you doctor or walk in clinic to find out details .
I currently reside in Florida and my union is Local 30 Plant Maint. What plan am I eligible for?
ESA PPO 100 w/RX
I currently reside in Scranton, PA and I am not part of any union. What plan am I eligible for?
ESA PPO 15 w/RX
Detectives Endow Association is the union I am part of, and I live in Virginia Beach, VA. What plan option do I have?
ESA PPO 100 MA ONLY
For Retirees that are Eligible for MAPD , is the RX optional ?
PST PAGE-The RX coverage is not optional . Retirees can contact Jennifer Robertson
Union-Plumbers PipeFitters
State -PA
Is My Medication covered ? and How much in Coverage Gap Phase?
Abilify Mycite-
Refer to Union for RX Coverage - Plan Eligible for is a ESA PPO 15 MA Only
To look up medication I would use this formulary
open 2 plus 3 tier
Union-Local 246 Auto Mechanic
State-TX
Does this plan have Enhanced Drug Benefit?
ESA PPO 100 W/ RX Plan Benefits Page 9- Enhanced Benefits-
Agents when used for Anorexia,weight loss, or weight gain
Agents when used for treatment of sexual or erectile dysfunction (ED)
Prescription Vitamin and Mineral products, except prenatal vitamins and Fluoride Preparations.
UNION-Local 246 Auto Mechanic
STATE-New York
How much is the Premium on this plan ?
UNION LIST-pension deduction for MA & RX rider is paid by member ,$193.86 MA & $197.67 RX
Can we provide the premium?
Yes ,_*Premium and Pension Deduction are the Same Thing !*_ _*If it is available on the UNION list We can provide it to the retiree .The only time we will refer back to Union for Premium/pension deduction information is if they DO NOT HAVE A UNION , We will then be unable to see the premium / pension deduction cost and will need to refer back to union *_
Union-Local 237 Teamsters
State -Pennsylvania
Retiree wants to check if a Nurse line available ?
Communications tab - Nurse Line -You have toll-free 24 hour access to nurses who can help answer your health Questions.This doesn't replace care from your regular doctor .Just call 1-800-556-1555, 24/7
Union-Superior Officers Council
State -New Jersey
Are there any Discount programs available?
Communications tab- Aetna Discount Program": Save on health and lifestyle products such as eye and hearing exams,frames and even discounts on massage and nutrition servies. Log in to your member website and then link to LifeMart
How Are pre 65 spouses and dependents covered ?
Eligibility Tab -Under 65 will remain on active plan (Aetna Commercial HMO)
What is the segment owner and company code we look for in PST ?
PST- SEGMENT OWNER
Segment Owner-MA
Company Code - AE OR US