What is Medicare?
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)

The 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, their may be occasion 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.

Visionworks/Davis Vision Optical BeneFit
Benefits provided by Vision Works/Davis Vision is an In-Network only plan and are subject to applicable co-payments. With 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?
The Davis Vision Program features an in-network benefit that offers the opportunity to obtain services for an eye examination with dilation, as professionally indicated, as well as obtain eyeglasses or contact lenses at fixed copayments.

• Eye examination – (including dilation as professionally indicated) is covered at a par-ticipating network provider with the applicable copayment. basic copayments

In-Network providers within New York State:
$25 for exam
$0 for glasses

In-Network providers outside of New York State:
$50 for exam
$15 for glasses

• Spectacle lenses (one pair) – including single vision, bifocal, or trifocal lenses, in any prescription range with applicable copayment.
• Frames – you may choose any Fashion, Designer or Premier level frame from the Visionworks/Davis Vision collection, covered in full. If the member selects a frame other than one provided by the plan, a credit of $65 will be applied toward the frame purchase.
• Contact lenses (in lieu of eyeglasses) – Every 12 months you may select contact lenses. Any contact lenses from Davis Vision’s Contact Lens Collection will be covered in full per the number indicated below, your evaluation, fitting and follow up care will also be covered. he plan covers most popular types of contact lenses including standard, soft, daily-wear (available with no co-payment Contact Lens Collection (includes evaluation, fitting and follow up):

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.

The Superior Officers Council currently sponsors three dental plans for our retired members. The Healthplex Indemnity/PPO Plan, the Healthplex Comprehensive Plan (Dentcare Delivery System) and the Compbenefits Plan, administered by Humana (Florida residents only).

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

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; full-time 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 $4,000 per year. (Out-ofpocket 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 still has a minimum of at least $4,000 of 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 $6,000. The member is responsible for and pays the remaining $4,000 of the balance and is now eligible to receive $1,000 from the SOC’s Catastrophic Reimbursement Benefit.

When are benefits payable?

Benefits are payable at:

• Retirement (restrictions/penalties apply based on age, see page 80 of benefits book)
• Upon your death
• If you become disabled, (must cease employment to receive this benefit)
• Upon separation from employment (see page 80 “Notice to Separated Participant” summarizing your distribution options)

Distribution Guidelines
When you are eligible to receive a distribution, you may elect one of the following:

• Lump Sum
• Substantially equal installments
• Direct Rollover

How Distributions Affect Your Account
Your account shall be valued for distribution purposes as soon as administratively possible following the date your Distribution Election Form is approved by the SOC Fund Office.

Most withdrawals/distributions are subject to taxation and required withholding. Generally, distributions paid from the Plan to a participant are exempt from New York City and New York
State income taxes (Federal income taxes apply). By “rolling-over” your account to another qualified plan, you may lose this tax-favored status in whole or in part.

The Principal is required by the IRS to withhold 20% of any distribution eligible for rollover if it is not directly rolled over to another eligible retirement plan, including an IRA, or is paid in installments over a minimum period of the lesser of 10 years or the participant’s life expectancy. Any withholding will offset a portion of federal income taxes you owe on the distribution.

Pension Protection Act
A special rule allows you to make an election to exclude up to $3,000 a year from income taxes if such amount is applied by the Plan to pay for qualified health insurance premiums for the retiree, the retiree’s spouse or dependents for that year. The amount to be used to pay for qualified health insurance premiums will need to be elected annually, by completing a Special Election Form for Public Safety Officers Electing Distributions. For more detailed information on the “Pension Protection Act” see page 87.

Note: You should consult your financial/tax advisor on the applicable tax rules and how best to receive your distribution.