Frequently Asked Questions
Post-65 Insurance Options
Updated May 4, 2023
The ICSD is offering a second enrollment period for those who wish to return to The Hartford GRH Plan. The application deadline for the first enrollment period is May 15, 2023 (plan effective date July 1, 2023). The application deadline for the second enrollment period is October 15, 2023 (plan effective date January 1, 2024). Additionally, the district has updated the Retiree Plan Change Waiver Form and is hosting two Q&A sessions, one on May 10 and one on June 13. Click here for more details. |
Q |
UPDATED: There is so much to review, can there be an extension on the May 1 deadline? |
A |
Some retirees have asked for additional time to make decisions. Since the number of enrollees to ensure compliance with the Hartford contract has been reached by the May 1 deadline, we are able to extend the application deadline for the first enrollment period to May 15. However, in order to make the July 1 effective date, neither The Hartford nor the district will be able to extend the deadline past May 15. |
| The ICSD is now also offering a second enrollment period for those who wish to return to The Hartford GRH Plan. The application deadline for the second enrollment period is October 15, 2023 (plan effective date January 1, 2024). |
Q |
In the 2018 and 2020 Board of Education Retiree Healthcare Resolutions, the district not only affirmed that the Medicare/The Hartford and subsequently the Aetna coverage would be "equal or better" than the BCBS coverage available at the time of retirement, but that any shortfall would be covered by the district, out-of-pocket from its self-funded healthcare account. Will this still be the case for those electing the Option, noting of course that any item covered by BCBS but not covered by Medicare/The Hartford would no longer be considered a shortfall if it is now covered by Aetna (e.g., orthotics as of 2023)? |
A |
The district intends to comply with the New York Moratorium Law and with each retiree’s respective contractual rights. The district recognizes that it cannot reduce the health insurance benefits or increase the cost of the benefits that it affords to retirees unless it implements a corresponding reduction in benefits or increase in cost to active employees as well. The district is committed to continuing to offer retirees at least one plan option that is as robust as the coverage offered to active employees. At the current time, the Aetna Plan fulfills the district’s contractual obligations. The Hartford Plan is being offered as an alternative (and, in some respects, less robust) plan option for those retirees who prefer the structure of a Medicare Supplemental F Plan, as opposed to a Medicare Advantage Plan. |
Q |
What is the better plan if someone needed a nursing home after a hospital stay for either rehabilitation or long-term care? |
A |
Aetna: Nursing Home Coverage in general is not covered at all by Medicare, however, a skilled nursing facility would be covered. |
| The Hartford: Long-Term Care or Custodial Care is not covered. (Long-Term Care is assistance with activities of daily living.) When a covered person is confined in a skilled nursing facility, The Hartford will pay the benefit stated. It must be a Medicare-approved skilled nursing facility confinement. |
Q |
Will international travel coverage under The Hartford plan be the same? |
A |
No. Aetna has no limit on international coverage. The Hartford plan offers international emergency coverage, but it is limited to $250,000 benefit maximum within 60 days of travel. |
Q |
There is so much to review, can there be an extension on the May 1 deadline? |
A |
Some retirees have asked for additional time to make decisions. Since the number of enrollees to ensure compliance with the Hartford contract has been reached by the May 1 deadline, we are able to extend the deadline to May 15. However, in order to make the July 1 effective date, neither The Hartford nor the district will be able to extend the deadline past May 15. |
Q |
While the 2017 and 2023 Summary of Coverage documents have only a few differences, they are still only summaries. I have also looked at the more detailed 2017 GRI Plan document. Can you confirm that the Option plan is the same as the parameters specified in the district's previous Hartford plan (Policy Number AGP-003939 effective September 1, 2017), and if not, what are the differences? |
A |
The plan design is the same as the prior plan, AGP-3939. We are using the same benefit number as we did with AGP-3939, so WebTPA will pay claims as before. |
Q |
Can you confirm that there will not be any restriction or wait period related to prior conditions? |
A |
The pre-existing clause is satisfied with prior coverage. |
Q |
Can you confirm that the Express Scripts Medicare plan will waive any requirement for "step therapy"? |
A |
The Express Scripts Medicare utilization management programs, Step Therapy, Prior Authorization, and Quantity Level Limits are all turned off for this group’s four plan designs. However, there are certain CMS- and ESI-required medications that will need approval from the provider to process. Same as it was when they were with us before. There is a transition supply fill available for the first 90 days that new members are on the plan where they can get the medication filled and then work on what is needed for approval from their provider. Members can contact Benistar to assist with this process, and we will work with their provider and Express Scripts to ensure that all the applicable information is provided and where to provide it to. |
Q |
Can you confirm that a 90-day prescription supply will be available when prescribed, and the copay will be the same as a 30-day supply (unless the actual cost is lower)? |
A |
Most but not all medications are available in a 90-day supply. It also depends on the pharmacy you are using and if they have a 90-day supply available for you. |
| Except for the fourth plan design (5/35/70), which has 2X 60- and 90-day supply retail and mail-order copays, the copays are the same for 30- or 90-day supplies on all three other plan designs. |
Q |
Will Benistar again serve as the plan administrator, and if not, who would be the plan administrator to sort out any issues with The Hartford or Express Scripts? |
A |
Yes, Benistar will be the plan administrator. Members can contact Benistar for assistance on any issues with The Hartford or Express Scripts Medicare plans: 1-800-236-4782, M-F 8:30-5:30 EST. |
Q |
Will this choice be offered to new retirees? (I.e., we have a staff member retiring at the end of this year who is 65, and they want to know if they have a choice.) |
A |
The Board of Education’s resolution offering current Medicare retirees the option to return to The Hartford explicitly directed district administrators to “continue to listen and dialogue with Medicare-eligible retirees, retirees, and union leadership teams to explore whether the choice between such plans for future Medicare-eligible retirees would be supportable under the law, existing contractual obligations, and both short and long-term fiscal considerations.” We plan to begin these discussions as soon as we close the current process and can focus our attention on the future. |
Q |
Can a retiree choose one plan for themselves and the other plan for their spouse? |
A |
No, a spouse is on district insurance because of the retiree and will be enrolled in the same plan as the retiree. |
Q |
Should we insert AETNA in the section that asks if we have any other health plan on the Harford application? |
A |
Yes - please complete as indicated below, inserting your specific information: |
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Q |
On the Hartford Application, how do I answer Question #2? |
A |
#2 Check Yes and OTHER |
| Other (please specify) Former Employer offering other coverage |
Q |
There is no place to list my spouse’s name on the Express Scripts form. Do I have to complete two Express Scripts enrollment forms for my spouse and myself? |
A |
Yes, please complete two separate forms for Express Scripts - one for you and one for your spouse. The form is located on the district website: ithacacityschools.org/post65. |
Q |
If I change plans, when will The Hartford plan take effect? |
A |
The anticipated effective date is July 1, 2023. |
Q |
I am a newer retiree and was never on The Hartford plan previously. Will I have any issues if I make this change because of that? |
A |
No. The Hartford and ESI will be looking at everyone the same, new or past insured. |
Q |
I recently had a procedure and am still under care. If I choose to change to The Hartford and am still undergoing care for this procedure, will The Hartford cover my post-procedure care? |
A |
The Hartford would consider coverage for all services incurred after our effective date as long as the insured has consistently maintained insurance coverage (creditable coverage). Pre-existing condition limitations do not apply if an insured has maintained insurance coverage. |
Q |
Will I be able to fill my prescriptions from a local pharmacy or am I forced to do mail order now? |
A |
While mail order is encouraged, you will be able to pick up your prescriptions at your local pharmacy. |
Q |
I do not see an Aetna Policy Number on my card. What do I reference on The Hartford application? |
A |
We are reviewing the applications as they arrive and correcting or adding information as needed, including the policy numbers. The Aetna policy number is based on your Rx plan: PPO w/Rx 5/35/70 = Policy #AE467672 PPO w/Rx 5/10/10 = Policy #AE467675 PPO w/Rx 1/6/6 = Policy #AE467673 PPO w/Rx 10/25/40 = Policy #AE467676 |
Q |
I currently do not pay any premiums (0%) to the district. Because The Hartford plan costs more, will I have to start paying a percentage of the premium? |
A |
No, you remain at 0% premium cost. |
Q |
Do you need to complete separate forms for each enrollee if you change to The Hartford? |
A |
For a retiree and spouse, you only need to submit one Hartford application, one waiver signed by the retiree and notarized, and two Express Scripts applications (one for the retiree and the other for the spouse). |
Q |
For participating doctors, will pre-approval be needed on The Harford Plan? |
A |
The Hartford follows Medicare, and therefore, prior authorization will be needed if it is required by Medicare (some examples: power wheelchairs; MRIs; transplants; Part B drugs). |
Q |
What will the monthly cost be to change to the Hartford plan (23% of what)? |
A |
Premium rates for all plans will be set within the month. The estimated rate for The Hartford is expected to be a 23% increase to the Aetna premium (i.e., whatever you pay per month for Aetna + 23%). |
