Hi, Tony;

I read the link you posted regarding the Medicare Part B reimbursement. The phone recording has changed from the earlier message. The new message states that the reimbursement checks are to be sent out sometime in mid August. They refuse to accept any phone inquiries. If a member doesn't receive his check by Sept 15, he is to send a letter with his pension number and social security number to 40 Rector St. I know that payments are supposed to be sent automatically, but this is the first year that I'm eligible for a check ( I started Medicare Sept. 2007) and I haven't received anything yet. My question is this: being this is the first year I'm eligible do I need to notify them and maybe fill out a form or something, or do they know I became eligible this year for reimbursement and will eventually get a check out to me?
As always I'm grateful for your help.
I wish you and your family a great Labor Day holiday.

Ron Fleitman

To all members and readers of this website: I have updated the Medicare reimbursement information located on our Health & Welfare page for
the October 1, 2006 posting.

https://www.listclassaction.com/claim/Default.aspx

Thanks for the info, John.  Sounds like NYCERS screwed up and won't admit it. - Tony

Have a nice summer and hope to see you at the METS game in the fall.

From Ret. Lt. Jack Rooney, I received this information:

According to an article in the "Retirees Corner" of a recent NYPD LBA newsletter, an IRS tax exclusion of up to $3000 is allowed if premiums for accident or health insurance or long term care insurance is deducted from the pensioners monthly allowance.

If anyone has a more thorough (and easier) explanation of these items, please contact me at alomanto@optonline.net and I will post it here.

• You are a retired NYPD officer. Include your rank and retirement date.
• You participated at Ground Zero/Landfill (whatever your location) from “date” to “date”.
• The duties you performed while volunteered or assigned. 
• Date seen by a doctor and date of diagnosed “illness” related to work at Ground Zero (Attach a doctor’s note, if available. If not, provide your treating physician’s contact information).
• Date screened by Mt. Sinai, if applicable. Date you have an appointment with Mt. Sinai would also help. If you need Mt. Sinai’s phone number, it is 212-241-1554 (note: there is at least a 3 month backlog if you are making an appointment for an initial screening).
• List the best way to contact you (phone number or email).

Tax Settlement

The City's Law Department reached a settlement with the IRS, which will reimburse civil servants who paid Social Security and Medicare taxes on their line-of-duty payments.
That means more than 70,000 cops, firefighters and other uniformed city workers will share a $140 Million settlement.

The announcement marks the end of a protracted battle between the city and the IRS over the taxation of uniformed workers - police officers, firefighters, sanitation workers and correction officers - who are injured in the line of duty.

But it's not clear whether and how this settlement will affect retired workers who are receiving Social Security.  One retiree is now fretting that his monthly payments will be reduced if he accepts the reimbursement. 

Since 1992, the city has told the IRS it should not be taking Social Security and Medicare taxes from line-of-duty injury payments.  The city argued these payments are similar to Worker's Compensation payments which are exempt from Social Security and Medicare taxes and apply to other city workers.  The City eventually sued the IRS.

"It's a fascinating legal issue, and a thrill to prevail at the end,"  said Karen Griffin, a senior counsel in the Law Department's appeals division who has worked on the case for more than 10 years. 

"Uniformed forces will be treated as they should be treated.  They are in high risk industries as it is."

In addition to this article, I received information from a fellow Security Officer at St. Francis Hospital, Ret. PO Edward Keevan who started in Transit and switched over to NYPD in the early '90s (and regrets it).  Ed tells me there is a number to call for information on the settlement above.  It is 212-669-2333.

I am repeating what was posted on this site back on March 14, 2004 -

Retirees can contact the Health Benefits Program for assistance with the following:

The SBA has been pursuing a plan of action whose goal is to provide Medicare qualified members and their Medicare qualified dependents with a pharmaceutical plan. After comprehensive evaluation it was determined our basic retiree coverage would need to be modified to be qualified under the Medicare guidelines. It is with this in mind Chairman Ed Mullins and the Board of Trustees of the Sergeants Benevolent Association Health and Welfare Fund has voted to amend our prescription drug benefit plan, creating SBA Part D, for our Medicare eligible participants so they will receive coverage set forth by the Medicare guidelines. Each eligible participant will now have their own individual coverage under the new SBA Part D plan.

The SBA Part D benefit is as follows:

• $6,000.00 Individual Maximum Allowable Benefits
• 30% Co-Pay on Generic Drugs
• 30% + $5.00 Co-pay on Brand Drugs

The following drug classes will have limitations:

 PROTON PUMP INHIBITORS - Brand name coverage will be limited to Protonix which will have a 50% co-pay. The generic drug Omeprazole is subject to standard plan co-pay and all members are eligible for our free Prilosec OTC program.

NON-SEDATING ANTI-HISTAMINES - Brand name coverage will be limited to Clarinex and Zyrtec which will have a 50% co-pay. All generic drugs (i.e., Fexofenadine) in this class are subject to standard plan co-pay and all members are eligible for our free Alavert OTC program.

All other guidelines of the SBA Plan, as outlined in the current Drug Summary Plan Description, will still be in effect.

No Premiums! No Deductibles! No Donut Hole of 100% Out of Pocket!

Please note this change will have no impact on member dependent coverage where a member, spouse or dependent become Medicare eligible and the remaining members of the family are not. In those cases we have actually enhanced the benefit, for the non-Medicare eligible family member(s), to a $6,000.00 family cap. Coverage maximum allowable benefits are based on a plan fiscal year July 1-June 30.

All SBA members, spouses or dependents who are Medicare qualified or become Medicare qualified in the future will automatically be enrolled in the SBA Part D Pharmaceutical Plan.

 **Members who are currently enrolled in a Medicare Advantage Program HMO, ex: HIP VIP, Cigna, Humana, Oxford Medicare Advantage, that has a prescription component in the base plan, are automatically being registered with Medicare by their carrier as having credible prescription coverage. Members must notify the SBA Health and Welfare if they have this type of coverage so we can coordinate both plans with Medicare.

 For additional information on NYC Health Plans please visit the NYC Office of Labor Relations web site at www.nyc.gov/olr.

The SBA has created a comprehensive benefit. As a creditable plan it allows our Medicare qualified S.B.A. members, spouse or dependents to remain with the SBA plan and not be mandated to sign on to a regional Pharmacy Drug Program (P.D.P.). However there may be circumstances where a member, spouse or qualified dependent may find it beneficial to enroll in a P.D.P. For example, if a member’s drug utilization requires expenditures in excess of our level of coverage, or a member is on a drug regiment of injectable drugs or specialized bio-tech drugs not covered by our plan, they should consider alternative coverage. If a member elects alternative coverage for himself, spouse or qualified dependent, the remaining family members are still entitled to SBA coverage. Members should carefully review their individual needs and pursue the options that are best suited for their given situation.

In the event a Medicare covered participant of the SBA Health and Welfare Part D plan enrolls in a P.D.P. it is mandated that the member notify the SBA Health and Welfare office. The guidelines of Medicare Part D do not allow for participants to be claimed as a participant on multiple plans.

Members are reminded enrollment in the Medicare Part D benefit begins on November 15, 2005 and ends May 15, 2006. All Medicare qualified members, spouse or dependents that elect not to remain in the SBA Plan D and fail to select alternative coverage such as a regional P.D.P. or medical coverage that includes a qualified prescription benefit will be subject to late enrollment penalties created by Medicare.

NOTE: The law states any eligible individual who goes without creditable coverage for a continuous period of sixty three (63) days or longer, after the initial enrollment period and then elects to enroll in a qualified Medicare Part D plan will be assessed a penalty of 1% for each month that the person does not have qualified coverage. This penalty will be added on to future premiums based on the number of months the participant had no creditable coverage.

IMPORTANT :
We are required by Center for Medicare and Medicaid Services (C.M.S.) to provide the names and Social Security numbers of Medicare qualified participants in the SBA’s creditable prescription plan. Please prepare the enrollment form (Click here to download)and return it to the SBA Health & Welfare Fund:

Please forward this form as follows:  
Fax: 212-431-6487, Attention: MEDICARE ELIGIBILITY UNIT
or
Mail : Sergeants Benevolent Association Health & Welfare Fund
Attn: MEDICARE ELIGIBILITY UNIT
35 Worth St
New York , NY 10013

Failure to prepare this form or provide the necessary information will delay enrollment notification to Centers of Medicare and Medicaid (C.M.S..) and could result in penalties and a discontinuance of coverage in the SBA Health and Welfare Plan for covered spouse and qualified dependents.

For more information about this notice or your SBA Plan D prescription drug plan, contact the SBA Health and Welfare Fund at 212-431-6555.

FYI:
You can obtain more detailed information about Medicare plans that offer prescription drug coverage from the following:

Visit http://www.medicare.gov/ for personalized help,

Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook you received from Medicare, for their telephone number)

Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

For those with limited income and resources, extra help paying for a Medicare prescription drug plan is available from Social Security Administration (SSA). For more information about extra help, visit SSA online at http://www.socialsecurity.gov/, or call them at 1-800-772-1213 (TTY 1-800-325-0778)

Starting January 1, 2006, prescription drug coverage will be available to everyone with Medicare through Medicare prescription drug plans. All Medicare prescription drug plans will provide at least a standard level of coverage set by Medicare. Some plans might also offer more coverage for a higher monthly premium.

Because your existing coverage is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay extra if you later decide to enroll in Medicare coverage.

People with Medicare can enroll in a Medicare prescription drug plan from November 15, 2005 through May 15, 2006. However, because you have existing prescription drug coverage that, on average, is as good as Medicare coverage, you can choose to join a Medicare prescription drug plan later. Each year, you will have the opportunity to enroll in a Medicare prescription drug plan beginning November 15th through December 31st.

If you do decide to enroll in a Medicare prescription drug plan, you will still be covered by the Fund. Your prescription drug coverage through the Fund will be secondary to your Medicare prescription drug coverage.

For further information, click on this web-link: http://nycpba.org/benefits/medicare.html

For retirees on a drug plan, this information may be of no value but for others, searching for better prices will undoubtedly be beneficial.

HEALTH
McClellan Outlines New Rules On Medicare Drug Coverage
Medicare's new drug benefit includes incentives aimed at keeping employers from dropping retiree coverage, Centers for Medicare and Medicaid Services Administrator Mark McClellan said today. HHS (Health and Human Services) today released the final rules that will govern the new Medicare drug benefit, outlining for the first time how the law will work. Lawmakers will be closely watching provisions giving employers subsidies to prevent them from dropping drug coverage they provide their retirees. The new law called for subsidies but left the details to HHS. Under the new rules, Medicare will subsidize employers who keep retiree drug coverage by an average of $668 per retiree, which could be worth more than $1,000 in taxable income to companies. To qualify, employers must offer a plan at least as generous as the Medicare plan and contribute at least as much as Medicare does.
Democrats, and some Republicans, fear employers will drop retiree coverage once retirees are eligible for the Medicare benefit. During a briefing to discuss the rules, McClellan dismissed those concerns, saying the benefit "is designed to work with other sources of coverage, not just replace them with a costly government plan." McClellan said the rules intend to prevent employers from pocketing "windfalls" through subsidies but acknowledged employers could drop the level of coverage to equal the Medicare benefit and get the subsidy. "But employers are already doing that today," he said. "We've seen an erosion in the generosity of benefits."
In 2006, about 9.8 million beneficiaries will get their drug coverage from an employer or union-sponsored plan, CMS estimates. Under other provisions of the rules, Medicare will automatically enroll "dual-eligibles," those who qualify for both Medicare and Medicaid, McClellan announced. Medicare will enroll those people in selected plans during the first half of 2005, and give them the option of changing plans before the full drug benefit becomes available in 2006. CMS also outlined rules governing new Medicare Advantage plans, the private managed care plans in Medicare, saying the plans would competitively bid to provide Medicare coverage. McClellan likened the Medicare Advantage plans to those that cover federal employees.
-- by Emily Heil

We'll be keeping an eye on this matter to see what transpires, Marty