Thursday, January 10, 2019
Dear Bay Shore Classroom Teachers' Association Members and Retirees:
As of January 1, 2019, Medicare Primary Retirees with individual coverage and Medicare Primary Retirees with family coverage whose only dependent is a spouse that is also Medicare Primary have both been enrolled in a Medicare Advantage PPO Plan with Extended Service Area (ESA). If you are a retiree who is not considered Medicare Primary, have a spouse that is not Medicare primary, or have dependent children, you will remain in the District's current health insurance plan (NYSHIP).
The Medicare Advantage PPO Plan with Extended Service Area will provide Medicare Parts A and B coverage along with Part D prescription coverage. You will still be enrolled in Medicare and pay the Part B premium. However, you will only use the Aetna card for all your doctors, labs, hospital and prescription drugs.
The Bay Shore Classroom Teachers' Association and Bay Shore Retired Teachers' Association are continuing to work with NYSUT to ensure that your rights and benefits are not impeded because of the district's unilateral move to an Aetna Medicare Advantage Plan. As you know, at our request, NYSUT has done plan benefit comparisons, reviewed surveys and survey responses, and been in contact with Aetna's benefit administrator, Benistar.
I want to thank all of you who came to the presentation on December 18, 2018, where our NYSUT LRS, Deborah Lloyd-Priest, Regional Staff Director, Associate General Counsel, and LRS-Assigned to Health Insurance provided us with an update. At that December 18, 2018 meeting, we listened to your questions and concerns, and stressed that we are monitoring the situation closely.
As we continue to do so, the BSRTA and BSCTA thought it was important to relay the following information to you:
1. The drug formulary for retirees in this plan is available electronically for any retiree that would like it e-mailed to them. Note that it is approximately 200 pages. If you would like a copy e-mailed, please contact the BSRTA or BSCTA and provide an email address. The formulary list is abridged, so in the event you do not see the medication you are looking for, please contact AETNA at 855-287-7406 or Benistar, the benefit administrator, to make the inquiry with AETNA.
2. Benistar has advised us that case workers from Aetna are reaching out to members that have inquiries about their providers concerning cancer treatments. Any member or retiree that is involved in a cancer fight can contact the BSRTA or BSCTA, and we will ensure that their name is forwarded to Benistar/Aetna to resolve questions.
3. The Medicare Advantage Plan implemented by the district is a Preferred Provider Organization (PPO) Plan with and Extended Service Area (ESA). Because it is a PPO, there are both in-network and out-of-network providers. However, because it has an ESA, out-of-network providers are treated identically as in-network providers. A member going to an out-of-network provider should incur identical costs as if they went to an in-network provider. The extra out-of-network costs will be paid by Aetna.
Prior to seeing a health care provider, ask if they will accept your insurance. Some (justifiable) confusion has arisen because some out-of-network health care providers respond by stating that they do not take Aetna. The key question is not whether they are in-network or out-of-network, but whether they will submit bills to Aetna (as an out-of-network healthcare provider). If they will do so, the member will incur identical (in some case, zero) costs as if they were going to an in-network provider.
For further clarification, do not hesitate to contact Benistar at 1-800-236-4782. Get the name of the person you are speaking to and, if at all possible, follow-up any conversation with an email. To assist the BSRTA and BSCTA in monitoring this change in the best way possible, it would be extremely helpful for you to forward copies of your emails (and any response from Benistar) to BSRTA President, Joe D'Antoni, at firstname.lastname@example.org and/or the BSCTA President, Mike Krieger, at email@example.com.
4. We have been advised that retirees can go to either Memorial Sloan Kettering or Stony Brook Hospital and have the appropriate treatment covered by the Aetna Medicare Advantage Plan.
We understand that this has been a trying time, and we will continue to monitor the change closely. We have also made explicit the BSRTA and BSCTA's frustration at the way the change was implemented by the District.
Had we been meaningfully involved earlier in the process, we could have avoided many of the problems we now face.