The Healthplex Indemnity/PPO (Preferred Provider Organization) Plan gives our members the flexibility to visit any dentist of their choice in or out of the Healthplex network.

In-Network PPO Plan
To receive the advantages of In-Network benefits, visit the Healthplex web site at www. healthplex.com to review the Directory of Preferred Providers who participate in the dental plan. The network of participating dentists will treat eligible active members and their eligible dependents with minimal or no out-of-pocket expense for covered services. When services are rendered from participating dentists in the Healthplex PPO Plan, you will only be responsible for the copayment, if any.

Out-of-Network Reimbursement Plan
Eligible active members and their eligible dependents may receive services from dentists who do not participate in the Healthplex PPO Plan. You are free to receive dental care from any licensed dentist not participating in Healthplex. When services are received from an out-of-network dentist, Healthplex will pay for all covered services according to the Out-of-Network Schedule of Allowances. For the most current Out-of-Network Schedule of Allowances, you can visit the SOC web site. You will be responsible to your dentist for all charges not covered or not paid in full by the plan.

The Healthplex Comprehensive Plan (Dentcare Delivery Systems) is a preventive dental program. Covered services can only be rendered by participating dentists. Members must select one participating dentist (per family) to provide general dental services. These primary dentists will provide all covered services according to the Schedule of Benefits/Copayments. Many preventive services are provided at no cost. Other services may require patients to make copayments directly to the dentist. For a copy of the Schedule of Benefits/Copayments, visit www.nypdsoc.com.

• General covered services can only be rendered by the member’s assigned dentist.
• Each member selects one participating dentist (per family) to provide general dentist services.
• Patients must receive referrals from their assigned dentist in order to have services covered for special procedures.
• Your Dentcare Identification Card will show your assigned participating dental provider.
• Provider changes can be made by completing and submitting a Dentcare Change Form.

The Healthplex/Dentcare Buy-Up Dental Plan is a member cost share plan. This enhanced dental plan has low monthly premiums paid through an authorized payroll deduction. Some of the highlights of the plan include:

• No co-payments for covered procedures when utilizing one of Healthplex’s National Panel Network Providers.
• Allows you to visit any dentist in the expanded Healthplex National PPO Network.
• Utilizes the Healthplex National Network with over 500,000 access points.
• An annual maximum of $3000 per individual (January to December).
• Low co-pays for a standard In-Network 24-month Orthodontic case (restrictions apply).

With Visionworks/Davis Vision you have access to licensed providers in both private practice and retail locations who are extensively reviewed and credentialed to ensure stringent standards for quality and service is maintained.
What are MY benefits?

• Eye Examination – Every 12 months (including dilation as professionally indicated) is covered at a participating network provider with no co-payment.
• Spectacle Lenses (one pair) – including single vision, bifocal, or trifocal lenses, in any prescription range with no co-payment.
• Frames – you may choose any Fashion, Designer or Premier level frame from the Visionworks/Davis Vision collection, covered in full. Or, if you select another frame in the network provider’s office a $65 credit will be applied.
• Contact Lenses (in lieu of eyeglasses) – Every 12 months the plan covers most popular types of contact lenses including standard, soft, daily-wear (available with no co-payment) or disposable type contact lenses (at either a $25 co-payment for an approximate three month supply or a $45 co-payment for an approximate six-month supply).

A $45 credit will be applied toward the purchase of non-plan contact lenses, fitting fees, and follow-up care. Your provider will determine your co-payment or credit based on the type of contact lenses required.

Prescription drug benefits are available for our members through the Superior Officers Council Health and Welfare Fund Prescription Plan administered by OptumRx. Certain specialty drugs not covered by the Fund’s Prescription Drug Plan may be available through the City Health Benefits Plan, commonly referred to as PICA, which is explained in more detail on page 19. Also in this section you will find information on guidelines pertaining to diabetes medication on page 22.

Note: Medications prescribed as a result of a Line-of-Duty Injury (LODI) are covered in FULL through the New York City Police Department’s Line-of-Duty Prescription Drug Program. Information regarding the NYPD LODI Prescription Drug Program is included in this section.

Benefit Overview
The Superior Officers Council Active Health and Welfare Fund Prescription Drug Plan does not have an annual maximum. The member is responsible for 35% of brand name medication costs and 5% of the cost of generic medications for the first $10,000 in drug spend. Beyond the $10,000 in drug spend the member is responsible for a 55% co-payment of the cost of all brand name medications. The SOC Prescription Plan is a mandatory generic plan. Mandatory generic means the Plan eliminates coverage for all brand name medications that have a direct generic available. Should you or your doctor insist on receiving a brand name medication where there is a generic equivalent available, you will be responsible for the full Cost of the medication.

PICA Drug Plan Benefit Overview
The PICA Program is a prescription drug benefit that is provided to all NYC employees, non-medicare retirees, and eligible dependents who are enrolled in a health plan offered by the City’s Health Benefits Program. It is made available through the joint efforts of the City of New York Office of Labor Relations and the Municipal Labor Committee.

PICA covers medications in two specific drug categories:

• Injectable — Most injectable medications not requiring administration by a health care professional (self administered).
• Chemotherapy — Medications used to treat cancer and/or to treat the side effects of chemotherapy

Co-payments Retail Pharmacy (up to a 30-day supply)

• $10 for generic medications
• $25 for preferred brand (formulary) medications
• $45 for non-preferred brand (non-formulary) medications

Mail Order Pharmacy (up to a 90-day supply)

• $20 for generic medications
• $50 for preferred brand (formulary) medications
• $90 for non-preferred brand (non-formulary) medications

Note: The Superior Officers Council Prescription Plan does not cover medications covered by the City of New York Office of Labor Relations PICA Program. However, if you choose a non-preferred brand name medication that has a generic equivalent, you will be charged the difference in cost between the non-preferred brand name drug and the generic drug plus the non-preferred brand name drug co-payment. See Generics Preferred section for additional information.

Who are Eligible Dependents? Family members eligible for benefits are:

• Spouses
• Registered domestic partners
• Dependent children up to the age of 19 years old
• Legally adopted children
• Stepchildren
• Children for whom the member has legal guardianship
• Developmentally disabled or physically handicapped children determined to be disabled/ handicapped prior to attaining the age of 19 years
• Dependent children enrolled as a full-time student in an accredited institution up to the age of 23 years old
• Adult children up to age 26 years old (prescription drug benefit only)

The GHI Catastrophic Rider (GHI members only) was established to assist our members and their eligible dependents (includes spouses, registered domestic partners, and eligible dependent  children; fulltime students ages 19–23) to defray some of the non-covered medical and surgical expenses incurred for services rendered by non-participating or out-of-network providers and to provide coverage for catastrophic illness.

• Members must incur out-of-pocket expenses of more than $3,000 per year. (Out-of-pocket expenses are those medical and hospital charges that are considered reasonable and customary by GHI and are not reimbursed by either the City Health Plan or private insurers).
• Members must produce a statement of services, Explanation of Benefits Form (EOB) and cancelled checks for expenses submitted.
• Reimbursement is based on a contract year (January – December) 100% of GHI reasonable and customary charges, based on the current profile.
• The maximum lifetime benefit is $2 million (limitations apply).

Limitations
The first $25,000 is covered for private duty nursing care, and thereafter 50% of the remainder, with a lifetime cap of $50,000 per person. The cap for in-hospital mental health charges is $10,000 individual lifetime maximum.

$1,000 SOC Catastrophic Benefit
The SOC provides a self-funded $1,000 direct reimbursement payable to the member after the member has submitted the required documentation and has qualified under the GHI Catastrophic Rider outlined above. The member must have incurred the minimum of at least $3,000 out-of-pocket to qualify. The exclusions and restrictions of the SOC Catastrophic Reimbursement are the same as the  requirements outlined above for the GHI Catastrophic Benefit.

The benefit does not cover prescription drug charges. Ineligible charges such as experimental procedures or services not approved by GHI/CBP and/or Empire Blue Cross Blue Shield are likewise not eligible for this benefit.

Example: You paid $10,000 in out-of-pocket expenses, but GHI’s reasonable and customary payment for those services is deemed to be $7,000. The member is responsible for and pays  the remaining $3,000 of the balance and is now eligible to receive $1,000 from the SOC’s Catastrophic Reimbursement Benefit.

The SOC Annuity Trust Fund is administered by Principal Financial. The old SOC Annuity Fund was liquidated in March 2009. $109 million in assets was transferred to our current SOC Annuity Fund, administered by Principal Financial Group (“The Principal”). As of September 2019, the SOC Annuity Fund asset balance exceeded $500 million. This is the highest recorded balance in our Fund’s history.

The Superior Officers Council Annuity Fund’s (the “Plan”) purpose is to help you accumulate the funds you will need for retirement. The Plan is one of the best ways for you to accomplish that goal. Your personal financial security is one of life’s most important objectives. Chances are, you are hoping for a long and fulfilling retirement. A significant part of how rewarding your retirement experience will be depends on how well you have planned for it. Your respective Union shares your concerns and offers the Plan to help you build a stronger financial future for you and your family.

FUND HIGHLIGHTS

• Fund’s retirement age changed from 55 1/2 to age 50 effective January 1, 2016 (you must have retired in the year you turned 50). For distributions prior to January 1, 2016 you must have reached the age of 55 1/2 in the year you retired.
•  Allows Distributions (withdrawals) to be paid in installments. (periodic, monthly, etc.)
• Allows beneficiaries to maintain an account with full member privileges in the event of a member’s death.
• Ability to accept rollovers from other government N.Y. tax-exempt retirement plans (Police Pension Fund “Final Loan” distribution and Banked Variable Supplement Fund).
• Designation as a government sponsored 401a Retirement Plan that allows the Plan to distribute withdrawals exempt from NYS and NYC income taxes.
• Allows retirees in their 40s to elect a “72t Distribution” (calculated at the Federal Midterm Rate) that is free from New York Income Tax and without the 10% early withdrawal Federal penalty.
• Provides for daily account valuation and quick turnaround for distribution requests (5-10 business days).
• Allows for Required Minimum Distributions to be paid at age 70½.