Explanation of COBRA verses Retiree Plans

PFT Health and Welfare Fund COBRA for Prescription, Vision and Dental

Note: this is not for Medical Coverage. Medical is through the School District.

COBRA coverage and co-pays are exactly the same as active member coverage.

  • Currently these are $9.50 for Brand and $6.75 for Generic.
  • Mail order provides a 90 day supply for one co-pay.
  • Retail provides a 30 day supply for one co-pay.
  • Retirees and eligible dependents may enroll in COBRA for up to 18 months.
  • A letter will be sent from the PFT H&W Fund office detailing the benefits and costs and how to enroll.
  • Remember, while the retiree may chose the Retiree Rx plan, dependents can only enroll in the COBRA plan.
  • Rates:
    • Prescription only – single coverage $154.76
    • Prescription, dental and vision – single coverage $175.96
    • Prescription only – 2 or more people $386.90
    • Prescription, dental and vision – 2 or more people $439.90

Eligible retirees can chose between COBRA and the Retiree Plan. The COBRA plan is $154.76 per month for prescription only verses the Retiree plan cost of $69.00 per month.  Why would someone take COBRA over the Retiree plan, at least for the first 18 months of retirement?  The co-pays are lower with the COBRA ($9.50 and $6.75) plan ($40.00 and $11.25 Retiree) and mail order provides a 90 day supply verses the 60 day supply with the Retiree plan.  You’d have to do the math to see which option is more cost effective for you.

Also, the COBRA plan is $386.90 for two or more people, so if you have at least two other family members who need prescription coverage, it may make sense for you to enroll in COBRA with them, at least for the 18 month period, since the monthly cost of $386.90 is the same for two or more people.

Note: The amounts above are for prescription only.  Single COBRA coverage for dental, vision and prescription is $175.96.  Family coverage for dental, vision and prescription (2 or more people) is $439.90.

 *When the COBRA coverage expires the retiree would then enroll in the Retiree plan*.

Two PFT Health &Welfare Fund Retiree Benefits are available:

  1. UNDER AGE 65 – CVS/Caremark Co-pays are $40.00 for Brand and $11.25 for Generic.
    Mail order provides a 60 day supply for one co-pay.
    Retail provides a 14 day supply for one co-pay.
  2. AGE 65 OR OLDER- or- Medicare Eligible due to disability – Express Script Medicare Rx Plan Co-pays are $60.00 for Brand and $15.00 for Generic.
    Mail order and retail provides a 90 day supply for one co-pay.
    Retail provides a 30 day supply for one co-pay. ($40 brand and $10 generic).

Definition of Eligibility:

  1. Those who retire under a State Early Retirement Plan (30 years of service or more) – no age requirement;
  2. A person who has retired from a PFT bargaining unit and is at least 65 years of age.
  3. Approved PSERS Disability Retirement and/or the Health and Welfare Fund’s Long Term Disability benefit.
  4. A person who has retired from a PFT bargaining unit and is at least age 55 with a combination of age and years of service that equal 65 or more.
    • Cost is $69 per month, billed on or about January 1 for the 6 month period starting March 1st.
    • For the 6 month period starting September 1, 2017, the cost is $69 per month for September – December and then increases to $84 per month effective January 1, 2018. Therefore, retirees will be billed $444 for the Sept 1 – Feb 28, 2018 cycle.
    • Retirees age 65 or older or Medicare eligible must enroll within 2 months of retirement in accordance with Medicare regulations, or within 6 months if under age 65 and enrolling in the CVS/Caremark plan.
    • A retiree who drops out of the plan will have two months to reenter and will be charged for the two missed months.
    • A retiree who drops out of the plan more than once will not be readmitted.

To receive Retiree Rx Benefits, fill out the following two forms which will be mailed to you:

  1. PHILADELPHIA FEDERATION OF TEACHERS HEALTH AND WELFARE FUND RETIREE BENEFIT APPLICATION.
  2. RETIREMENT PRESCRIPTION APPLICATION – check the box next to the month that coverage is to begin.
  3. Return forms and a check payable to PFT Health & Welfare fund in the enclosed pre-addressed envelope.

PFT Health & Welfare Fund Retiree Dental Plan

Retirees and eligible dependents may enroll.

Rates:

  • Individual—$20.69 per month – billed by United Concordia quarterly ($62.07)
  • Two People—$40.04 per month – billed by United Concordia quarterly ($120.12)
  • Family—$53.04 per month – billed by United Concordia quarterly ($159.12)

PFT Health & Welfare Fund Vision Care Program:

  • If you elect to use one of the participating optometrists, ophthalmologists, or opticians, there is a basic charge for:
    • Examination – Up to $25.00
    • Administrative fee – $6.69
    • Regular lenses (two) – Up to $28.00
    • Bifocal (two) – Up to $39.00
    • Trifocal (two) – Up to $48.00
    • Any frame which the wholesale cost is $24.00 or less
    • The $24.00 basic charge is applied to the wholesale cost of the frames. These typically sell for approximately $48.00.
    • If you pick more expensive frames, you pay the difference between the $24.00 and the actual wholesale cost, plus 20% of this difference.
  • There is no monthly premium. Instead, you will be billed by Health and Welfare if you use the Plan.
  • How does an eligible person use the PFT Retirees N.V.A. Vision Program?
    • Obtain a list of eligible providers from the Fund office
    • Make an appointment and notify the NVA participating provider that our coverage is administered by NVA and sponsored by The Philadelphia Federation of Teachers.
    • You pay the provider for listed extras when you pick up your glasses.
    • After you order your glasses you will receive a bill for the basic portion of your order from the Fund office. Pay the bill within 30 days.
    • Remember, failure to pay the Fund bill could result in loss of the Prescription Benefit.