uawtrust.org/otc Benefit : UAW Retiree Medical Benefits Trust
The Medicare Advantage (MA) PPO plan is the primary plan for Medicare-enrolled Trust members (those over age 65, or on Medicare because of a disability). Medicare-enrolled members are automatically enrolled in the MA PPO plan on January 1, following the year they qualify for Medicare. Certain Medicare members, such as Protected members and those enrolled in an HMO plan may not be automatically enrolled in the MA PPO plan but have the option to select the plan, if they meet all other eligibility criteria.
If you are an eligible retiree or surviving spouse covered under another plan you can enroll in the Trust in the future. When you notify RHCC, your coverage will begin the first of the following month.
However, note that under the Affordable Care Act (ACA), individuals are required to provide evidence of “minimum essential health coverage” or be subject to a penalty when they file their income tax return.
MA PPO plans provide Medicare members with greater value than other plan offerings while preserving coverage levels and access to doctors and hospitals. These plans also have lower cost share than the Traditional Care Network (TCN) plan!
The MA PPO plan provides access to additional programs at no extra cost:
- Rewards for health activities – Gift cards when you complete certain important health care activities such as getting an annual checkup.
- Personalized nurse support – Resources to help manage chronic conditions.
- Healthy home visit – Home visit from a licensed doctor or nurse to assess health and safety needs.
- Virtual doctor visits – Phone or video consult with a board-certified doctor (the office visit copay applies).
- Nurse help line – Speak with a registered nurse any time, night or day.
Over-the-Counter (OTC) Program
The Trust added an over-the-counter (OTC) benefit giving eligible members an annual allowance to order approved non-prescription medications and health-related items—such as bandages, aspirin, cold and sinus medicine, and vitamins and minerals—up to twice per calendar year. The dollar value of the allowance depends on your health plan.
Skilled Nursing Facility Care Expanded for All Medical Plans
Beginning January 1, 2023, the Skilled Nursing Facility (SNF) benefit will be expanded for in-network care under all Trust-sponsored medical plans. A SNF is a facility outside of the hospital that provides nursing care 24 hours a day under the supervision of a physician and/or registered nurse. There will no longer be a limitation on the allowed amount of days of care provided per benefit period. Additionally, there will no longer be a non-confinement period required to reset the benefit (when it is determined to be medically necessary because the medical criteria and guidelines are met).
Medicare Part B Premium Subsidy
For Ford Retirees retiring after October 1, 1979, a Medicare Part B Premium Subsidy is provided to help Retirees, Surviving Spouses, and Surviving Same Sex Domestic Partners pay for Medicare Part B. Those enrollees receiving a Retirement Plan due to a deferred vested benefit or a pre-retirement survivor benefit are not eligible. The enrollee must be receiving a pension from the pension plan in order to be eligible; those receiving survivor’s insurance are not eligible.
A Ford Retiree cannot also receive this benefit as a Surviving Spouse or Surviving Same-Sex Domestic Partner. The Medicare Part B Premium Benefit is $76.20 per month. Enrollees eligible for Medicare Part B must enroll and remain enrolled in Part B to be eligible to receive this benefit. Retirees under age 65 who are disabled or have End Stage Renal Disease are also eligible for this benefit, provided they have enrolled in Part B. If eligible, the Medicare Part B Premium Benefit will be included in the enrollee’s pension check.