Operating Engineers Health & Welfare Fund

Plan "M"
Home Page
Health & Welfare Main Page
Claims Status
Check Eligibility
General Information
Eligibility
Important Basics About the Plan
Affiliated Health Funds (AHF)
Medical Benefits
Maternity Benefits
Surgery Benefits
Hospital Benefits
Expenses Not Covered by the Plan
Prescription Drug Programs
Vision Care Plan
Dental Plan
Life, Accidental Death & Disability
Frequently Asked Questions
Forms Page
Links Main Page
Notice of Privacy Practices

 
Plan "M" Information

The Board of Trustees currently offers Plan “M” for Medicare Retirees only.

Plan “M” allows you to select, and enroll in, any Medicare HMO of your choice in the area where you live. The Fund will then provide benefits only for:

Hearing Aids

Chiropractic Care

Dental Care

Death Benefits

At this time you can participate in Plan “M” at a lower monthly fee of $45.00 per person ($90.00 per couple). You must also pay the Medicare HMO’s fee, if there is any fee, directly to the HMO.

 

Important: If you join a Medicare HMO in your area and enroll in Plan “M”, you must obtain all your medical and hospital care from the Medicare HMO. The Fund’s Plan “M” will cover only those benefits listed above.


You cannot enroll in a Medicare HMO if:

You reside outside the service area of the HMO

You have End-Stage Renal Disease (ESRD)

You do not have Part B Medicare

You are currently receiving Medicare Hospice benefits

If you want to select Plan “M”, you must complete an Authorization Form and return it to the Fund Office with written confirmation from the Medicare HMO of the effective date of your coverage with them. Your monthly fee will be reduced on the first day of the month following receipt of your authorization form and the written HMO confirmation.
Plan "M" Questions and Answers

1. How can I find a Medicare HMO in my area?
You can get the names of the HMO plans in your area that have Medicare contracts
by calling any Social Security Administration office or by calling Medicare at (800)
MEDICARE (633-4227). All plans that contract with Medicare have an open enrollment period at least once a year.

2. What if I cannot locate a Medicare HMO which serves my area of the country?
If there are no Medicare HMOs available in your area, you cannot select Plan “M”.
You would have to remain in the Fund’s fee-for-service plan.

3. I want to enroll in a Medicare HMO. When should I terminate my coverage in
the Fund’s fee-for-service plan?
You should not ask the Fund Office to change your monthly fee until you have been
formally approved by the HMO and have an effective date for your new coverage.

4. I am a Medicare Retiree and want to join an HMO but use a lot of prescription
drugs. I am concerned about the HMO annual drug maximum.
The Fund’s Plan “M” would provides unlimited prescription drug coverage after you
use up the drug benefit available through the HMO.  Plan “M” would cost
$45.00 compared to the $128.00 per month you pay now.

5. I am a Medicare retiree and want to join an HMO but my spouse is not
Medicare age.
You may join the HMO and enroll in Plan “M” for $45.00 per month. Your spouse
may join an HMO or remain in the Fund’s fee-for-service plan but the monthly fee for
her coverage would be $167.00. The total monthly fee would be $212.00, a reduction
of $83.00 per month.

6. I am a Medicare retiree and I have serious medical problems. What are my
options?
You could join a Medicare HMO and enroll in Plan “M” for $45.00 per month.  However, you would be limited to the physicians in the HMO and any exclusions or
limitations of the HMO.
If you require specialized medical care and you like your current physicians, you may
prefer to remain in the Fund’s fee-for-service plan at the cost of $128.00 per month.

7. With my serious medical problems, can a Medicare HMO refuse to enroll me?
HMO plans under contract with Medicare generally cannot refuse to enroll you because
of any health problem you may have or delay your coverage for a pre-existing condition.

8. I have end-stage renal disease (ESRD) requiring kidney dialysis. Can I still
enroll in a Medicare HMO?
No, you cannot enroll in the HMO if you currently have ESRD. However, if, after
joining the HMO, you are determined to have ESRD, the HMO is required to
provide or arrange for your care.

9. What happens if I enroll in Plan “M”, join a Medicare HMO and later find I
want to change to another Medicare HMO?
You may simply enroll in the other Medicare HMO. You will then be
automatically dis-enrolled from the first Medicare HMO Plan.

10. What if I enroll in Plan “M”, join a Medicare HMO but don’t like the HMO
and want to return to the Fund’s fee-for-service plan?

Once you have enrolled in Plan “M” you have 90 days to change your mind. Once
the 90 days is over, you must remain in that plan until the Health & Welfare Fund’s
Open Enrollment which is held once each year in December.


To return to the Fund’s fee-for-service plan, you must do both of the following:

  1. Provide a written statement that you want to withdraw from the HMO to your local Social Security Office or the HMO administrative office.

  2. Provide a written statement to the Fund Office of your intentions so you can be removed from Plan “M” and your monthly fee can be increased.

The change would take effect the first day of the month following the month your
request is received by the Fund office and the HMO or Social Security Office.

11. What happens to my Medicare card if I join an HMO?
By enrolling in a Medicare HMO, you transfer the administration of your Medicare
benefits to the HMO. You will use the I.D. card the HMO provides. Should you
decide to drop out of the HMO, the HMO will transfer you back to Medicare.