GENERAL FAQs

MEDCO PRESCRIPTION DRUG PLAN 

I lost my Medco prescription drug plan card. How do I replace it? 

    Call the Welfare Fund (212-354-5230) and give us your SS#; we’ll ask Medco to send a new card. 

How long will it take to get my first mail-order fill of a new prescription? 

    Because it can take up to three weeks for the first mail-order fill, you should buy your first 30-day supply from a retail pharmacy, then mail-order a 100-day supply.  

What do I do if my medications are late? 

    Call the Welfare Fund (212-354-5230). We can place a two-week emergency  retail fill for you at no extra cost. 

Why is the cost of my drugs higher at the start of each year? 

    For all retirees, at the beginning of each new year, a $50 deductible is applied to all prescription drug orders, whether new or refills. 

I am a retiree and not purchasing Medicare Part B. Can I get drug coverage from the Welfare Fund/ Medco plan? 

    Only until age 65. New York City employee policy requires retirees who reach age 65 to apply for Medicare B, which becomes their primary health insurance coverage. Their insurance under the New York City Health Benefits Program (NYCHBP) becomes their secondary coverage.  

    Likewise, The PSC-CUNY Welfare Fund follows the NYCHBP policy. To enroll in the Medco prescription drug program, retirees who reach age 65 are required to enroll in Medicare Part B.  

How does the Medicare Part D Prescription Drug Plan work? 

    Click here for a basic description of Medicare Part D. 

Can I use my Medco card even if I am enrolled in the Medicare Part D prescription drug plan? 

    No. You cannot be enrolled in two drug plans simultaneously. If you enroll in Medicare Part D, you will be dropped from the Medco plan. 

If I’m out of the country and need medication, can I use my Medco card? 

    No. You will have to pay for the medication out-of-pocket, and submit a reimbursement form to Medco upon your return home. Medco will factor the foreign exchange rate. 

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What is MyMedicare.gov?

It's a very useful service for getting your personal Medicare information. Read about it here.

PAYROLL DEDUCTIONS  

I've forgotten what insurance benefits my deductions are paying for. How can I find out?

The Welfare Fund, 212-354-5230, can provide information on payroll deductions for Extended Disability insurance and the John Hancock Long Term Care Program. Information on other deductions is available from NYSUT at 1-800-626-8101.

 

OPTICAL BENEFIT 

Do I need a card to get my optical benefit? What do I bring to the provider’s office?

    You don’t need a card or ID. If you are using General Vision, you don't need to call the Welfare Fund; the General Vision Services provider will call the Welfare Fund office to verify your eligibility.

    If you choose Davis Vision as your provider, please call the Welfare Fund (212-354-5230) before your first appointment to activate your eligibility. After that, you don't need to call the Fund to make an appointment unless you need to check your eligibility (i.e., when you last used the biannual benefit).

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CLAIMS AND REIMBURSEMENT 

How long does it take to be reimbursed for services?

    Please allow 4 to 6 weeks to receive reimbursement for optical, dental and/or prescription drug claims. 
     

How much time do I have to send in claims for reimbursement?

    Claims must be filed within 90 days of service for optical, hearing or prescription drug purchase. Dental claims may be submitted within one year of treatment.

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WELFARE FUND COVERAGE WHILE ON LEAVE

Will my benefits continue if I take a leave of absence?

Plan participants who go on employer-approved leave with or without pay are covered for up to 24 months for the following supplemental benefits:

  • Prescription Drugs
  • Dental
  • Optical
  • Hearing Aid
  • Disability
  • Death
  • Extended Medical (if basic health coverage is GHI-CBP)

The Extended Medical benefit is available only if the basic GHI coverage is in place. If CUNY does not provide basic health coverage for any portion of the 24-month period, it must be obtained via COBRA or other direct payment in order to qualify. The most common leave with pay is sabbatical.

Benefits are available to participants during a leave of absence to the same extent as they were prior to a leave. Benefits continue to apply to eligible dependents.

FAMILY AND MEDICAL LEAVE

We're having a baby! How do I apply for Parental Leave?

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TEACHING ADJUNCT BENEFIT ELIGIBILITY 

Do I have to teach 6 hours in three consecutive semesters to be eligible for benefits?

    Yes.  That is the minimum—6 hours in 2 consecutive semesters before the current one. 

What happens if I don’t teach one semester but start up again the following one?

    You lose your coverage for the semester you don’t teach 6 hours, but you will be reinstated if you resume 6 hours the next semester.  If you do not teach for a semester in each of two out of three consecutive academic years, you will have to re-establish your eligibility by teaching 6 hours in 3 consecutive semesters. 

Can I qualify by combining the hours I teach at different colleges?

      Yes. 

Can my non-teaching and teaching hours be combined to qualify me for benefits?

      Yes. Contact your campus HR office for details. 

Can I qualify by working at the Research Foundation?

      No. 

Do summer or winter semesters count for eligibility?

      No. 

Do teaching adjuncts have dental benefits?

      HIP includes basic dental benefits for adjuncts; Empire does not.

    Note: HIP coverage is not available to New Jersey residents 

 

JOHN HANCOCK LONG TERM CARE INSURANCE

I got a letter saying that Hancock is changing its name to "John Hancock USA," and the company is no longer licensed in New York. How will this affect my policy? What do I need to do?

Nothing about your policy or services will change. You do not need to do anything at all.

 

CHANGING YOUR INSURANCE CARRIER 

Can I switch from one insurance plan to another?

    You are able to transfer insurance plans during open enrollment time, which is usually in October, with a January 1 effective date. 
     

    Retiree Restriction: Retirees may transfer or add an Optional Rider only during enrollment periods in even-numbered years. However, retirees who have been retired for at least one year can take advantage of a once-in-a-lifetime provision to transfer or add an optional rider at any time. Once-in-a-lifetime transfers become effective on the first of the month following the date that the Health Benefits Application is processed. 

PROSPECTIVE RETIREE FAQS 
 

Will my health insurance coverage continue into retirement?

Yes, and your insurance coverage will continue to be offered in the same two parts. The basic health plan for hospitalization and major medical insurance (such as GHI-CBP/Empire Blue Cross, for example) remains available to eligible retirees participating in the New York City Health Benefits Program. Retirees also continue to receive the supplemental health insurance benefits (dental, optical, prescription drugs, etc.) provided by the PSC-CUNY Welfare Fund.  
 

What are the eligibility requirements for continuing coverage in retirement?

  • You must be collecting a pension through a CUNY-related program
  • You must be eligible for Welfare Fund benefits at the point of retirement
  • You must be eligible for basic coverage through the NYC retiree health program.

  
Who do I contact with questions about my health insurance/prescription drug coverage after I retire?

You can contact the New York City Health Benefits Program at 212-513-0470 if you have a TRS pension. If you have a TIAA pension the number to call is 212-306-7378. You can visit their website at www.nyc.gov/html/olr. You can also call the Welfare Fund at 212-354-5230, or e-mail us at communications@psccunywf.org 

If I predecease my covered spouse after retirement, can my spouse continue health insurance coverage under my plan?

The Welfare Fund provides a package of benefits for the surviving covered spouse / covered domestic partner / and dependent child(ren) of an active covered employee who dies. The extent of the coverage depends upon length of service and it may fully or partially replace federally–mandated COBRA coverage.  
 

The benefits are the following, as described in the Summary Plan Description on our website here. 

  • Prescription Drugs
  • Dental
  • Optical
  • Hearing Aid
  • Major Medical (if applicable)

Does my retiree health insurance coverage change when I or my covered dependent reach age 65?

New York City policy requires retirees who reach age 65 to apply for Medicare B, which becomes their primary health insurance coverage. Their City benefits insurance plan (GHI, HIP, etc.) becomes their secondary coverage. Likewise, The PSC-CUNY Welfare Fund follows the NYCHBP policy. To enroll in the Medco prescription drug program, retirees who reach age 65 are required to enroll in Medicare Part B.

Once I enroll in Medicare, is my spouse/partner still covered by my City benefits plan, such as GHI? 

Yes. Likewise, when a dependent spouse/partner reaches age 65, enrollment is Medicare Part B is mandatory. The City benefit plan, such as GHI, becomes secondary coverage.

When and how do I apply for Medicare B?

Approximately three months before you and/or your covered dependent reach age 65, contact your local Social Security Administration to apply (1-800-772-1213). If your dependent is under the age of 65 but is receiving Social Security Disability payments for 24 months or more, your dependent must also apply for Medicare B.  

Is there a cost associated with Medicare B?

Yes. The monthly cost of Medicare B usually changes each year on January 1 and is automatically deducted each month from your social security check. Please contact the Social Security Administration to determine the current cost of Medicare B coverage.  

Will I be reimbursed for the cost of Medicare B? 

 TRS/ERS Retirees 

The City will reimburse TRS/ERS retirees and their eligible dependents on Medicare for a portion of the monthly premium for Medicare Part B. You must be receiving a City pension check and be enrolled as the contract holder for City health benefits in order to receive reimbursement. 

You must notify the NYC Health Benefits Program (40 Rector Street, 3rd floor, New York, NY, 10006) in writing immediately upon receipt of your and your dependent’s Medicare card.  Medicare Part B reimbursements will be made to retirees who elect Medicare as primary coverage.    

TIAA-CREF Retirees 

TIAA-CREF retirees are eligible to receive a partial reimbursement of the monthly Medicare Part B premium if you meet all of the following requirements: 

  1. You must be receiving a TIAA-CREF retirement annuity check; and be
  2. Enrolled in the New York City Health Benefits Program as the contract holder; and be
  3. Enrolled in and paying premiums for Medicare Part B

Your spouse/domestic partner and/or disabled dependent may be eligible to receive Medicare Part B reimbursement in the year in which you retire (or in the year they become eligible for Medicare Part B following your retirement date) if they are: 

    1. Enrolled in Medicare Part B; and
    2. Covered under your retiree health benefits plan

TIAA-CREF retirees must submit a Medicare Part B Application for Reimbursement form, available here or from your College Human Resources Office.  

Complete and forward the application to the University Benefits Office, 535 East 80th Street, New York, NY 10021.  You must include a copy of the Health Insurance and Medicare Part A and Part B cards for yourself and eligible spouse/domestic partner and/or disabled dependent(s).  Reimbursements are not permitted for retirees who live outside of the United States. 

Medicare Part B reimbursement checks are processed in the year following your retirement.  The City will generally process the payments once a year for those who retired during the previous calendar year.  As a result, the application approval process may take six (6) months or more depending on the application submission date. 

Detailed information and advice about Medicare is available from the Medicare Rights Center (MRC), http://www.medicarerights.org/ 

Through its Consumer Hotline (800-333-4114), MRC provides counseling to individuals who need answers to Medicare-related questions or help getting care. Hotline counselors are available Monday through Friday, 9AM - 6PM.

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Some things to remember 

Between the time you go off payroll deduction and the time you go on pension deduction there is a period of self-pay for: 

  • Marsh Catastrophic Medical
  • John Hancock Long Term Care
  • NYSUT Life Insurance

During this time you must have direct pay arrangements, such as: 

  • Automatic Bank Withdrawals (will be continued if already in place)
  • Direct Premium remittance (e.g., by personal check)

The insurance carrier can bill you, but ... 

  • This is not %100 reliable
  • You may overlook the bill or mistake it for a general solicitation

Serious Consequences of Non-Payment 

  • Possible permanent cancellation of coverage
  • More likely: You may have to provide medical qualification, which could lead to cancellation

Verify that each insurance carrier has your correct mailing address, phone number and e-mail address. 

You may not be wholly aware of what coverage you have. Before you retire, make sure that you check your pay stub and understand each deduction. You can also consult the bi-annual communication from NYSUT for clarification. 

If you have valuable information and advice that isn’t included here, please feel free to share it by writing to communications@psccunywf.org.

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