Public Employee Press

Health & Security Plan News
Drug plan expands to cover nursing homes

HIP/VIP sets limit for ’09 prescriptions
The annual prescription drug benefit for DC 37 retirees in the HIP/VIP Medicare plan is $2,405 for 2009.

After they exhaust the HIP/VIP coverage, eligible retirees can have their drugs covered by the DC 37 Health and Security Plan. For participants in HIP/VIP, the Medicare HMO is the primary provider of the drug benefit and the DC 37 plan is the secondary provider.

When participants reach the HIP/VIP annual limit, they should call the union’s drug unit at 212-815-1608 as soon as possible to avoid a gap in coverage.

Drug plan now covers members and retirees in nursing homes
The DC 37 Health and Security Plan will now cover prescription medication for members in nursing homes, extended-care residencies and assisted-living facilities.

In the fall, the DC 37 plan trustees voted to cover prescription drugs for members or retirees who live at those facilities. Previously, the plan terminated the drug benefit when participants moved into one of those facilities.

The trustees decided it was appropriate to provide the benefit because many members in these facilities who were not covered by Medicare or Medicaid had to pay out-of-pocket for drugs.

Since October, the DC 37 plan has been asking residents in those facilities to provide “coordination of benefits” infor­mation to identify their primary and secondary providers.

If a member has drug coverage from a federal, state or local program or private insurance company, DC 37 is the secondary provider. It will pick up coverage when individuals exhaust the coverage of their primary provider.

If the member has no other drug coverage, then theDC 37 drug benefit will be primary. In all instances, coverage will be based on plan rules and limitations.

8,000 owe Innoviant drug co-pays
Innoviant, the DC 37 Health and Security Plan’s prescription drug administrator, reports that many members have outstanding bills for drugs they ordered through the mail-order program. About 8,000 members owe co-pay balances averaging between $50 and $100. All told, Innoviant is owed about $500,000 for outstanding co-pays.

Recently, Innoviant has sent letters to the affected members requesting payment. Members can make lump-sum payments or enter into a payment schedule. If you have received a letter, the DC 37 plan urges you to contactInnoviant directly and resolve any balances due.

Plan recognizes tax benefit for married same-sex partners
The DC 37 Health and Security Plan will now provide benefits free from state and local income taxes to the spouses of members and retirees who were married in other jurisdictions that permit same-sex marriages.

For the partners to receive the H & S benefits untaxed, covered members and retirees must submit their marriage certificates to the plan.
When the plan receives the marriage certificate, it will classify the dependant as a “spouse,” which makes the value of the benefit exempt from city and state taxes.

Currently, Connecticut, Massachusetts and Canada recognize same-sex marriages. The value of the benefit will continue to be exempt from federal income taxes.

In November, voters in California approved a ballot proposition that bans same-sex marriages; that action is being challenged in court. Currently, the DC 37 plan will recognize same-sex marriages that occurred there before the ban.

In May, New York Gov. David Paterson ordered state agencies to provide gay and lesbian couples with the same benefits as straight couples. As a result of his directive, spousal benefits of same-sex partners married in otherjurisdictions are no longer taxable. After Paterson issued the directive, New York City acted similarly.

Following the lead of the state and city, DC 37 decided to recognize the tax benefit for the spouses of members and retirees in same-sex marriages.