Is the nature of the coverage for medical care, dental care and prescription costs the same for retirees as for current employees? If not, how do they differ? An appropriate way to answer this might be to compare the retiree's benefits with those pre-retirement using the same "plan features" listed in the April 2 Almanac (and on pages 20-21 of the PENNFLEX brochure [Web Note: this chart is too large to display online.]).
If retiree coverage is significantly different, at what point in the process is this communicated to those who must come to a decision within the deadline?
-- Phoebe S. Leboy
Professor of Biochemistry/Dent
In response to Dr. Leboy's letter, the current retiree medical benefits for:
Medical coverage is the same as that for active faculty and staff members. That is, retired individuals under age 65 are offered the same medical plan options as active faculty and staff members.
They are also offered the same prescription coverage as active faculty and staff members. Currently the benefits are available under the Blue Cross plans, PENN Care, Greater Atlantic, and HIP Health Plan of NJ.
The University provides Medicare supplement benefits to retirees eligible for Medicare benefits. The benefits are provided through Blue Cross's 65-Special plan and Keystone's Medicare HMO plan and will also be provided through U.S. Healthcare's HMO plan. The best way to describe these benefits is to first describe what the federal Medicare program covers.
Medicare has two parts: Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B). Part A covers inpatient care in a hospital and skilled nursing facility, home health care, and hospice care. Part B covers physician services, outpatient hospital care, clinical laboratory tests, and various other medical services and supplies, excluding prescription drugs. The retiree must enroll in Medicare Part B and pay Part B premiums (enrollment in Part A is automatic and currently no premiums are required.) All of the University's Medicare supplement plans cover Medicare Part A's copays and deductible and the 20% balance of Medicare Part B's approved charges. The HMOs' prescription benefits vary by plans. After a $100 family deductible, the Blue Cross 65-Special plan provides the same prescription coverage as the Blue Cross plans for active faculty and staff members; the benefits are administered by Blue Cross and not PCS. The Major Medical component of the 65-Special plan contains a $100,000 per individual lifetime maximum. The benefits that are charged against this maximum are a very minor portion of the 20% supplementary insurance of the Medicare Part B benefits that are not paid under the Blue Shield component of the 65-Special plan and some additional benefits not covered by Medicare, particularly prescription benefits.
The fundamental difference between the Blue Cross 65-Special plan and Keystone and U.S. Healthcare's Medicare HMO plans is that all non-emergency medical care covered by the HMO plans must be provided or authorized in advance by a primary physician. Also, unlike the 65-Special plan (and the other Blue Cross plans), the HMO Medicare plans provide benefits for preventive dental care, hearing aids, routine vision care and eyeglasses.
Detailed charts showing benefits provided by Medicare Part A & B and the University Medicare supplement plans are available from the Benefits Office. Dependents of retirees eligible for University retiree benefits
Regardless of the retiree's age, the medical coverage for a dependent of a retiree is determined by the dependent's age. For example, if a retiree is over age 65 but the spouse is under 65 (non-Medicare eligible), the spouse's medical benefits would continue to be provided through one of the medical plans offered to active faculty and staff members.
As for Dental coverage:
As stated in the "Q&A" article referenced by Dr. Leboy, no dental benefits are provided to retirees. Under the current federal COBRA law, a retiree may continue dental benefits at full cost plus a 2% administrative fee up to 18 months. The dental coverage that is available through the 18-month COBRA period is the same as that offered to active faculty and staff members.
Faculty and staff members considering retirement should contact the Benefits Office at 8-7282 for individual counseling.
-- Human Resources/Benefits Office
Volume 42 Number 29
April 23, 1996
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