Misc Benefits Active

The Consolidated Omnibus Budget Reconciliation Act (Public Law 99-2721, Title X), also known as COBRA, was enacted April 7, 1986. This law requires that, effective July 1, 1987, in addition to offering normal conversion opportunities, the City and the union welfare funds must offer employees and their families the opportunity for an extension of group health and welfare fund coverage (called “continuation of coverage”) at 102% of the group rates in certain situations where a member’s benefits, or his/her eligible dependents’ benefits, under either City basic or the applicable welfare fund, would be reduced or terminated. 

The SOC Fund provides continuation of coverage based on the same criteria spelled out in the Consolidated Omnibus Budget Reconciliation Act. Under the Fund, qualified beneficiaries who elect Continuation of Coverage pay for this coverage (exceptions may apply – see Surviving Spouse/Dependent(s) SOC Health and Welfare Fund Benefit). You or your dependents may be required to pay the necessary premium for the following benefits:  

• Prescription Drug Benefit  
• Dental Benefit  
• Optical Benefit 

A federal law, the Health Insurance Portability and Accountability Act (HIPAA), requires the Superior Officers Council Health and Welfare Fund (“the Fund”) to protect the confidentiality of your private health information. A complete description of your rights under HIPAA can be found in the SOC Fund’s privacy notice, which was distributed to all current members of the SOC Fund prior to April 14, 2003 and is distributed to all new members upon enrollment, a copy of which is available from the SOC Fund Office 

The SOC Fund will not use or further disclose information that is protected by HIPAA (“protected health information”), except as necessary for treatment, payment, operations of the Fund, or as permitted or required by law. By law, the SOC Fund has required all business associates to also observe the Fund’s privacy rules. In particular, the SOC Fund will not, without authorization, use or disclose protected health information for employment-related actions and decisions. 

The Board of Trustees may change the benefits provided by this SOC Fund. The Board of Trustees adopts rules and regulations for the payment of benefits and all provisions of this handbook are subject to such rules and regulations and to the Trust Agreement, which established and governs the Fund operations. 

All rules are uniformly applied by the SOC Fund Office. The action of the SOC Fund Office is subject only to review by the Board of Trustees. A member or beneficiary may request a review of action by submitting notice in writing to the Board of Trustees at the following address: 

Superior Officers Council  

40 Peck Slip  

New York, NY 10038 

The Trustees shall act on the appeal within a reasonable period of time and render their decision in writing, which shall be final and conclusive and binding on all persons. 

The SOC Fund has the right to recoup overpayments that were caused by an error in the processing of a claim, or if additional information comes to the attention of the Fund after the claim has been paid. Furthermore, the SOC Fund has the right to suspend one or more benefits if you have received overpayments or have in any way abused the SOC Fund’s benefit program. 

If the SOC Fund finds it has overpaid you, or an otherwise ineligible dependent, for a particular benefit, it has the right to recoup the excess amount from you, the member. The SOC Fund may bill you for overpayments made, and/or, it may also reduce future benefit payments to offset the overpaid amounts or it may suspend your benefits until the overpayment is recouped. 

Medicare is health insurance for the following:
   • People 65 or older
   • People under 65 with certain disabilities
   • People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) 

DIFFERENT PARTS OF MEDICARE
The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)
• Helps cover inpatient care in hospitals
• Helps cover skilled nursing facility, hospice, and home health care
Medicare Part B (Medical Insurance)
• Helps cover doctors’ services, hospital outpatient care, and home health care
• Helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse
Medicare Part D (Medicare Prescription Drug Coverage)
• A prescription drug option run by Medicare-approved private insurance companies
• Helps cover the cost of prescription drugs
• May help lower your prescription drug costs and help protect against higher costs in the future

NOTE: In most cases we do not recommend members subscribe to a Medicare Part D Prescription Plan. The SOC Prescription Plan will under most circumstances provide you and your family with sufficient prescription drug coverage. However, there may be occasions where the prescription benefits offered by Medicare Part D are more cost efficient than those offered by the SOC. If you need further assistance, contact the SOC Fund Office at (212) 964-7500, option 1.

COST OF MEDICARE

Medicare Part A
You don’t pay a monthly premium for Medicare Part A coverage. The taxes you paid to Medicare while working will cover the cost of your Medicare Part A coverage.
Medicare Part B
You pay the Part B premium each month. Most people signing up for Medicare Part B will pay the standard amount of $170.10 for 2022. However, if your modified adjusted gross income as reported on your IRS tax return from two years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount, you may pay more.
Each year Social Security will notify you if you must pay more than the standard premium. Whether you pay the standard premium or a higher premium can change each year depending on your income. For more information regarding Medicare premium rates visit www.medicare.gov.
The Medicare monthly premium is deducted from your Social Security check. If you are not currently receiving a Social Security Check, Medicare will send you a bill for your Part B premiums every three months.
If you don’t sign up for Part B when you’re first eligible, you may have to pay a late penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it.
Medicare Part D
For information regarding Medicare Part D premiums, visit www.medicare.gov.

HOW TO ENROLL IN MEDICARE
Medicare has different guidelines for eligibility. It is important that you know when and how to enroll in Medicare.
If you already get benefits from the Social Security Administration you will automatically be entitled to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) starting the first day of the month that you turn 65. You do not need to do anything to enroll. You will receive a Medicare card approximately 3 months before your 65th birthday.
If you are not receiving Social Security you can enroll in Medicare up to three months before your 65th birthday and no later than three months after the month of your birthday. This is called the initial enrollment period. You will need to submit an application to the Social Security Administration. You can also sign up for Part B at your local Social Security office. They will determine your eligibility and send you a Medicare card.
If you wait until you are 65, or sign up during the last three months of your initial enrollment period, your Medicare Part B start date will be delayed.
If you are under age 65 and disabled, and have been entitled to disability benefits under Social Security for 24 months, you will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement. You do not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you approximately three months before your Medicare entitlement date.
For more information, visit www.medicare.gov or call 1(800)MeDiCare (1(800) 633-4227), 24 hours a day, seven days a week for assistance.

GETTING YOUR AFFAIRS IN ORDER
The Trustees of the Superior Officers Council hope the information contained in the following pages will serve as a useful tool to you and your family to help prepare for the inevitable.

THINGS TO CONSIDER
You should give consideration to making pre-death arrangements. This should be discussed by couples and by parents with their families. You should also give consideration to having a “Family Durable Power of Attorney” (someone to take over your finances if you become incapacitated or incompetent). Following are two checklists, one for the member to use as a guide in order to have your affairs in order beforehand, and one for your family to help guide them through some of the things that will need to be done after your death.