Retiree Health Plan

• There are no deductibles or co-insurances paid by the Retiree or Retiree’s spouse when using the Health Center except for pharmacy co-pays.
• Prescriptions are provided by the Health Center through a mandatory generic program: $5 co-pay for generic drugs on formulary; $15 co-pay for brand-name drugs on formulary but not available generically. 90-day supplies of certain generic drugs are $12 or less. 90-day formulations and dosages may vary and are at the discretion of the pharmacy. Use of an outside pharmacy is not reimbursed. Drugs not on formulary may be provided at the actual cost to the Fund.
• With a Health Center referral, a Retiree Health Plan participant will not have the standard deductibles or 20% co-pays for outside Part B medical services.
• You must maintain your monthly Medicare Part B premiums to remain in the Retiree Health Plan.
• Hospital benefits are not covered by the Retiree Health Plan. Medicare Part A services are paid by Medicare and all related deductibles and co-insurances are the responsibility of the Retiree, Retiree’s spouse or other covered dependent.
• EPO coverage is not available under the Retiree Health Plan.

Using Outside Providers

After you retire, you may still choose any outside providers that accept Medicare — as long as you are not eligible through Covered Employment. However, in these cases you will be responsible for all deductibles, co-insurances and any other related charges.

If you are eligible through Covered Employment after retirement, services at an outside provider will not be covered by Medicare. These services will only be covered through a referral from one of our Health Centers.

Returning to Covered Employment After Retirement »

Termination due to Medicare Part D, HMO or Medicare Advantage enrollment »

Eligibility

To Continue Health Coverage After Retirement, You Must:

• Be a “Hotel Industry Retiree”

This means that you must work for a Contributing Employer until you’re eligible for a Pension benefit that will begin with the calendar month after your last day of Covered Employment.

• Have been part of the Health Benefits Fund Plan for at least 36 months during your career

You must be enrolled in the Health Benefits Fund Plan and be part of the plan for at least 36 months during your career prior to your date of retirement. You must also have medical coverage in the three consecutive calendar months prior to your retirement date.

In cases of disability, Workers’ Compensation or a Family Medical Leave (FMLA) prior to retirement, you still must be covered by the Plan on your retirement date. (This means you must be within the maximum 6 months of paid disability or coverage under the statutory FMLA law.)

• Assign Your Medicare Part B Benefits to the Health Center

You must enroll in the Retiree Health Plan by bringing your Medicare card to the Funds office. This will designate the Health Center as a Part B (medical) provider. See election deadlines.

Spouses and Dependents

Under the Retiree Health Plan, all spouse and dependent eligibility is subject to the Retiree keeping medical coverage. In addition, your spouse and/or dependent(s) must also keep medical coverage in order to continue any form of Retiree coverage. If a Retiree’s spouse loses medical coverage, the Retiree and any other eligible dependents may still retain coverage.

Dependent children are covered according to the regular rules of the Health Benefits Fund Plan. This means that they may remain eligible until the day they reach age twenty-six.
New spouses or dependents cannot be enrolled once the member is covered by the Retiree Health Plan.

Surviving Spouse Terms

If a spouse takes a Pre-Retirement Surviving Spouse Pension Benefit or the lump sum cash payment, this spouse is not eligible for the Retiree Health Plan or any retiree coverage.

Election Deadlines »