Employer Group, Union and Retiree Health Plans
Active Employer or Union Group Health Coverage
What is an Employer or Union Group Health Plan (GHP)?
An Employer or Union Group Health Plan (GHP) is health coverage provided by an employer or union to its current, active employees or members, their spouses, and their eligible dependents.
Are there different types of Group Health Plans?
Group Health Plans are classified by size. Each type must follow different regulations that could affect your coverage depending on your circumstances.
Group Health Plans with fewer than 20 employees must follow different regulations than those for 20 up to 100 employees. Plans for 100 or more employees are known as Large Group Health Plans (LGHP) and have additional requirements they must follow in certain situations.
Contact HICAP at 1-800-434-0222 to schedule an appointment for more information.
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What should I consider before dropping or changing my Group Health Plan?
It is extremely important that you talk with your employer, benefits administrator, or insurer before you make any changes to your Group Health Plan. If you drop your plan, you and your dependents may never be able to re-enroll.
If you are thinking about dropping your Group Health Plan and changing to a Medicare plan, here are a few questions to consider before making a change:
- Does your current plan have creditable prescription drug coverage that meets or exceeds that of Medicare Part D?
- Will you reach the Part D "donut hole" or gap in coverage if you change plans?
- What are the premiums, deductibles, and co-payments for each plan?
- Which plan provides the most comprehensive coverage?
- Does your current plan provide coverage for dental, hearing, and vision care that Medicare plans may not?
- Which plan has the largest selection of doctors and hospitals?
- If you change plans, will you need to change doctors?
- Will you still have coverage if you move or travel to another area?
Contact HICAP at 1-800-434-0222 to schedule a one-on-one appointment about your options.
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Should I sign up for Medicare Part A if I have an Employer or Union Group Health Plan?
If you are entitled to Part A without a premium, it is beneficial to enroll even if you have an Employer or Union Group Health Plan. Contact Social Security at 1-800-772-1213 or www.ssa.gov for more information.
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I am no longer actively employed. When do I enroll in Medicare Parts B and D?
If you or your spouse delayed Medicare Part B enrollment due to group health coverage based on active employment, you only have an 8 month Special Enrollment Period (SEP) to sign up for Part B without a penalty when the employment ends.
If you or your spouse delayed Part D enrollment because your Group Health Plan has creditable prescription drug coverage (coverage considered at least equivalent to Medicare Part D benefits), you will have a limited, 63 day Special Enrollment Period (SEP) to join a Medicare drug plan without penalty when the employment ends.
Contact HICAP at 1-800-434-0222 to schedule a one-on-one appointment about your options.
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Retiree Health Plans
What is a Retiree Health Plan?
A Retiree Health Plan is coverage offered by some employers and unions to their retired employees. An employer or union's Retiree Health Plan is often different from the Group Health Plan they offer to active employees.
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What do Retiree Health Plans cover and cost?
There are no set standards for Retiree Health Plans. The details of coverage and cost for each individual plan are determined by the employer or union and may be changed at any time. Many Retiree Plans notify members of changes in the fall around the Medicare Annual Election Period.
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What do I need to ask my benefits administrator about my Retiree Health Plan?
Retirement is a big step, and it is important to have sufficient health coverage in place. Here are a few questions you may want to discuss with your employer or union benefits administrator about your Retiree Health Plan:
- Do I have a choice of Retiree Health Plan options?
- Does the Retiree Health Plan have a premium, deductible, or copayments? If so, how much are they?
- How will Medicare coordinate with my Retiree Health Plan benefits?
- Will the Retiree Health Plan have creditable prescription coverage that meets or exceeds the benefits of Medicare Part D?
- Are there additional services covered under the plan that are not covered by Medicare?
- Will I still have coverage when I travel or move?
- What will happen to my spouse's coverage in the event I drop my coverage or pass away?
Call HICAP at 1-800-434-0222 to schedule a one-on-one appointment for more information.