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Questions About County Retiree Benefits

Q:  I plan on retiring from service with the county.  Will I need to pay for continuation of my health insurance coverage?
A:  Currently, County Ordinance employees, hired on/or after January 1, 2002, must contribute 5% of the cost of the premium towards individual coverage and 10% towards family coverage. College Ordinance employees hired after June 1, 2002 must contribute 10% of the cost of the premium towards individual and family coverage.  Please note that if a retiree (including ALL union and Ordinance retirees) chooses a HMO health insurance coverage plan that is more costly than the County’s contribution to the NYSHIP Empire Plan, the retiree is also responsible for the premium portion in excess of The Empire Plan premium.   

Q:  As a retiree, is my primary medical carrier Medicare or Empire?
A:  If you qualify for Medicare and you are not an active employee, Medicare is your primary carrier.  The county will reimburse you for the cost of your Medicare Part B premium through checks issued twice a year.

Q:  I am a Medicare Primary subscriber. Why aren't my bills being automatically forwarded from Medicare to United Healthcare?
A:  You must call NYSHIP at 1-877-7-NYSHIP (1-877-769-7447) to find out if you have crossover coverage.

Q:  Why haven't I received my Medicare Part B reimbursement check?
A:  If your address has recently changed, you must send the Comptroller’s Office a signed letter with the change of address information.  If it is not an address problem, please contact the Comptroller’s Office, Health Benefits Unit by e-mail or by phone at 516-571-2679. 

Q:  I recently received information from the state regarding the Medicare Part D program for drug coverage.  Does this program benefit me if I already have drug coverage under The Empire Plan?
A:  As an Empire Plan enrollee or covered dependent eligible for Medicare, you should consider joining a Medicare prescription drug plan ONLY if you are currently contributing to your health insurance premium and are eligible for extra help provided by the Medicare Part D Low Income Subsidy.  The prescription drug benefits provided under your Empire Plan coverage will, in most cases, give you better coverage and lower out-of-pocket costs than the coverage offered under a Medicare Prescription Drug Plan.

Q:  What is the Medicare Part D Low Income Subsidy Program and what are the eligibility requirements?
A:  Under the Low Income Subsidy, individuals with limited incomes and resources are eligible for extra help with drug plan costs under Medicare Part D.  If you qualify for this extra help from Medicare, your out-of-pocket cost for prescription drug coverage may be lower through Medicare than under The Empire Plan.  For more information on eligibility requirements and/or to apply for the Low Income Subsidy, call Social Security at 1-800-772-1213 or visit www.socialsecurity.gov.

Q:  If I currently pay for a portion of my health insurance premium and I find that I do qualify for the Low Income Subsidy under Medicare Part D, what will happen to my drug plan under Empire?
A:  At present, if you choose to enroll in a Medicare Drug program such as Medicare Part D, your prescription drug coverage under The Empire Plan will become secondary to your Medicare prescription drug coverage and you will continue to be billed your full share of The Empire Plan monthly premium.  The Medicare prescription drug plan will be primary, or paid first, for your prescription drugs.  Your out-of-pocket costs under your Empire Plan prescription drug coverage may then be higher and you will have to submit a claim form for reimbursement under your Empire Plan coverage.  There will be no automatic coordination of benefits, and therefore, a retiree would have to manually submit a claim form to Empire’s drug carrier for secondary benefits.

For more information about how Medicare prescription drug coverage relates to your Empire Plan drug coverage call 1-877-7-NYSHIP (1-877-769-7447), and select Option 1.

Q:  Can I still use my NassauRx prescription drug discount card in addition to my county prescription drug coverage or my Medicare prescription plan and get additional discounts?
A:  No.  You may present either your county health insurance card, your Medicare prescription plan card, or your NassauRx prescription drug discount card.  Only use the NassauRx prescription discount card when purchasing medications not covered by your prescription drug insurance or Medicare prescription plan.

Q:  If my prescription drug plan has a gap period, should I use my NassauRx prescription drug discount card during the gap to reduce the cost of medications that would usually be covered by my plan?
A:  It depends.  If your prescription drug plan has a gap period, such as the Medicare “doughnut hole,” that requires you to pay a certain amount of prescription drug costs out of pocket before coverage resumes, and you are sure you will not meet that spending threshold before the calendar year ends, you may want to use the NassauRx card to reduce your out-of-pocket costs.  If you are not sure, you should continue purchasing your medication through your prescription plan.

Q:  I do not see my question answered here and I need help.  How do I proceed?
A:  For answers to questions not covered here, please send your inquiry via mail or email, along with pertinent details to the Comptroller’s Office, Health Benefits Unit, 240 Old Country Road, Mineola, New York, 11501.