The CSA Welfare Fund and the CSA Retiree Offices are open. However, they are NOT open for visitors. Call the CSA Welfare Fund at (212) 962-6061 and the Retiree Chapter at (212) 823-2020.
Stanley H Wilson, Editor
When do I opt out of this new plan to remain in Emblem Health Senior Care as a Supplement to Original Medicare?
You have until October 31, 2021. If you do not do anything you will be automatically put into the NYC Medicare Advantage Plan on January 1, 2022.
What do I do to opt out of the NYC Medicare Advantage Plus Plan and keep Emblem Health Senior Care as a supplement to Original Medicare?
You fill out and sign the opt out form located towards the back of the booklet you received entitled MEDICARE Group Plan-NYC Medicare Advantage Plus Enrollment Guide. EACH MEDICARE ELIGIBLE PARTICIPANT (i.e., retiree, spouse or dependent) MUST COMPLETE A SEPARATE OPT-OUT FORM. By signing and submitting this form you are agreeing to pay an additional $191.57 a month to remain in your current health plan for 2022. Please note that the additional $2.83 for 365 days of hospitalization will continue to be covered by the CSA Welfare Fund. If you opt out now you do not do it again if you want to stay with Senior Care.
If you can’t print the form or can’t locate the guide contact Stanley Wilson at unitleader@csa-rcmu.org or 917- 692-2942 and the form will be mailed to you.
What do I do if I am currently in HIP-VIP or any other plan that is not Emblem Health Senior Care and want to remain in that plan?
There is a different form to sign and submit if you want to stay in your current plan which is NOT Emblem Health Senior Care. You can get this form by going to the CSA Welfare Fund website which is csawf.org OR contact Stanley Wilson and a form will be mailed to you. If you have HIP-VIP or any plan which is not Emblem Health you can remain in your current plan by opting out of the new NYC Medicare Plus Plan. If you opt out of the new Medicare Advantage Plan you can continue with your current plan and be grandfathered into it since as of January 1, 2022, the only plans available to NYC municipal Medicare retirees to join or switch into will be the new MA Plan and Senior Care.
How can these opt-out forms be submitted?
The ways to submit the form are located at the bottom of the form. At our General Membership Meeting on October 1 Dr. Hathaway mentioned that using certified mail return receipt or priority mail and faxing the forms are good ways of submitting them. If you fax the form, make sure you have and keep the transmittal receipt. You can also email the form. If you do this, request both a delivery receipt and a read receipt to prove the email was delivered and read by the recipient. He does NOT recommend that you use the phone number listed as a way of submitting your opt-out form. The CSA Welfare Fund can’t submit the form for you.
What else should I know about opting out of the new Medicare Advantage Plan?
● Beginning in 2021, you may change plans every year. In 2021 you may only opt-out to your current plan. After 2022 you will only be able to opt out to Senior Care or the Medicare Advantage plan.
● You can switch between Senior Care and Medicare Advantage each year.
● If you are currently in Senior Care with the prescription drug benefit opting out of the Medicare Advantage plan you will keep your Senior Care prescription benefit.
● If a member turns 65 after October 31, they will be enrolled in their plan’s Medicare plan through the end of the year. If they wish to remain in that plan, they will need to file an opt out form with the Alliance and OLR. If they don’t file this form, they will automatically be placed in the NYC Medicare Advantage Plus Plan as of January 1, 2022.
● The cost to remain in Emblem Health Senior Care after January 1, 2022, will be $191.57 plus $125 for the prescription drug benefit. The cost of being in the new Medicare Advantage Plan will only be $ 125 a month for the prescription drug benefit.
What do I do if I want the new Medicare Advantage Plan as of 1-1-2022?
There is nothing to do right now. You should be getting a welcoming guide in December. When your new card arrives be sure to alert all your doctors that you will have a new plan on Jan. 1
What are some of the advantages of joining the new NYC Medicare Advantage Plus Plan?
● This is a $0 premium plan which is guaranteed for 5 years. The only cost is $125 a month for the prescription drug plan. The current cost under Senior Care is $150.30.
● There is an Annual Maximum Out of Pocket Medical Expense of $1470. There is no cap with Senior Care as a supplement to Original Medicare.
● This plan replaces both traditional Medicare and a Medicare Supplement Plan (Senior Care) with a single integrated program administered by an insurer approved by Medicare. You will now have one card and one EOB per medical service. Through a contract with Medicare, this plan provides all health care services previously covered by original Medicare and supplemented by Senior Care. The plan must follow Medicare rules and provide all benefits provided by Medicare.
● There is no co-pay for visits to your primary care physician
● Emergency care when traveling outside of the U.S.
● Transportation costs for 24 one-way trips to doctor’s offices
● Home meals delivery for patients after they are discharged from the hospital
● Silver Sneakers Fitness Program
● Wearable health and fitness tracker
● Live Health Online
● 24/7 Nurse Line
● House Call Program
You can read about these features on pages 4 to 11 of the guide to the new plan.
● There is a dedicated number to call if you have any questions, problems, or concerns. That number is 833-325-1190.
What are the concerns people have expressed about the NYC Medicare Advantage Plan?
The first concern is about networks. About 640, 000 of the approximately 850,00 Medicare
doctors in the US are in the plan. These doctors are contractually bound to see NYC
Medicare Advantage Plan patients. Medicare providers that are not contracted with the plan
bill the NYC Medicare Advantage Plus Plan to get reimbursed, like
they do for traditional Medicare. It doesn’t make a difference if that provider is in the insurer’s network or not. If the provider takes payment from Medicare, they can bill the NYC Medicare Advantage Plus Plan and be paid the same amount as traditional Medicare pays. This includes all the hospitals in NYC including Memorial-Sloan Kettering which recently officially joined the network. As of this writing, while the Hospital for Special Surgery will see patients from the plan, they are not officially in the network. They are expected to join very shortly.
What if the provider does not agree to accept payment from the NYC Advantage Plan?
Some people have expressed consternation about a doctor refusing to take the plan. There is a definite method to follow. First, contact the concierge service of the plan. The plan can work with the provider to make sure they understand it is the same payment schedule and billing protocol and answer any questions the provider may have. If that doesn’t work, the member can pay the provider and then submit the claim(s) to the plan for reimbursement. So long as the service is a Medicare covered benefit and the Medicare fee schedule is followed, the member will only be responsible for his or her copays/coinsurance as defined by the plan. You should receive this reimbursement within 30 days.
Please look at the document you received in the CSA Welfare Fund eblast on October 4. You are urged to give this document to a provider reluctant to accept the plan.
What services require pre-authorizations?
Just like plans for active City employees, certain medical procedures will require pre-authorization under the NYC Medicare Advantage Plus Plan. As found in the guide to the new plan the following are some of the most common services that require prior authorization:
● Inpatient hospital admissions
● Skilled nursing facility
● Rehabilitation including, physical, occupational, and speech therapy
● Complex radiology – MRI, CT, and PET scans
● Prosthetics/orthotics
● Transplants
Also please refer to the additional information about prior authorization contained in the October 4 email blast from the CSA Welfare Fund. The complete list of pre-authorizations is listed. You can also find this document by going to www.csawf.org and look for Medicare Advantage Plan Update Presentation-September 30, 2021. If you can’t access this information, Stanley and it will be mailed to you.
While Original Medicare has an increasing number of pre-authorizations for items like durable medical equipment and physician services, it has far less than the new NYC Medicare
Advantage Plus Plan. Original Medicare uses ABN’s (Advance Beneficiary Notification) in which the patient signs a form saying they know that the service to be performed might not be approved and, if that is the case, they will have to pay for the service. If the provider didn’t have you sign an ABN, you can’t be billed. The NYC Medicare Advantage Plus Plan does not use ABNs.
What else should we know about prior authorizations?
The plan has told us they take from 3 to 5 days. It is the provider’s responsibility to ask for prior authorization. If the doctor is not in the network, remind them about this. You can appeal a denial of service. The representatives of the new plan estimate that only about 3 to 4 percent of approvals will be denied.
What happens when the retiree or spouse is under 65 and the other one is 65 or older?
As they currently do, they must choose an insurer that offers both an over 65 option and an under 65 options. The over 65 members will be automatically enrolled under the NYC Advantage Plus Plan and the under 65 will be in the Empire GHI CBP plan, both with a zero premium. If the retiree chooses to pay to remain in another pay up plan, the under 65 spouses will pay up to remain with the same insurer.
Where do I go for more information and clarification?
● Call the new plan at 833-325-1190
● Go to their website which is empireblue.com/nyc-ma-plus. If you want to know if your doctor is in the network, you can use this site. You must know the doctor’s zip code.
● Email Dr. Hathaway at dhathaway@csawf.org
● Email Mark Brodsky at mark@csa-nyc.org
● Email Stanley at shw29@verizion.net or call at 917-692-2942
CSA CONVENTION-Saturday, October 30 at the midtown NY Hilton-6th Ave. between 53rd &54th Streets. If you plan to attend, you must show proof of vaccination and photo ID. As Mark Cannizzaro has stated only do what you are comfortable doing. The Retiree Chapter will have their own program including breakfast. Although this part is free, you must register. The full day conference is $100 which includes lunch. You will get a $25 rebate from the Manhattan Unit if you are paying this. Please let Stanley Wilson know if you are paying the $100. To register go to csa-nyc.org/conference.
ELECTION DAY - NOVEMBER 2, 2021
by Richard Oppenheimer
The CSA is endorsing Eric Adams for Mayor, Brad Lander for Comptroller, Jumaane Williams for Public Advocate, Alvin Bragg for Manhattan DA and Mark Levine for Manhattan Borough President. Early voting is from 8AM to 5PM on Oct. 23, 24 and 30. It is from 7AM to 4 PM on Oct. 25 and 29. It is from 10 AM to 8 PM on Oct. 26, 27 and 28. Voter registration deadline is Oct. 8. Request for absentee ballots deadline is Oct. 18. To find your poll site go to VOTE.NYC.
MEDICARE ADVANTAGE EDITION
On July 14, 2021, the Municipal Labor Committee approved the NYC Medicare Advantage Plan which will take effect on January 1, 2022. This customized plan is run by Alliance. You should have received a package in the mail from the CSA Welfare Fund describing this plan in detail. If you have not received it, call the Welfare Fund at 212-962-6061. Listed below are some frequently asked questions.
Will I be able to keep GHI Emblem Health Senior Care?
If you choose to remain in your current plan, you must opt out of the Alliance Advantage Plan during the opt out period between September 1 and October 15. If you opt out of the Advantage Plan and choose to keep Emblem Health Senior Care, the cost will be an estimated $200 a month. Information about this goes out in mid-August.
Will I be able to opt in or out of the new plan?
Yes, your choice of a NYC health plan can always be changed during the annual Fall Open Enrollment Period as well as by invoking your once-in-a lifetime change.
How does the new Alliance Medicare Advantage Plan work?
This plan replaces both traditional Medicare and a Medicare Supplement Plan (Emblem Health Senior Care) with a single program administrator approved by Medicare. The plan is a Group Medicare PPO which does not restrict access to providers. This program provides access to all doctors that take Medicare. It does not make a difference if a provider is in the insurer’s network or not. As long as the provider takes payment from Medicare, they can bill the NYC Medicare Alliance Advantage Plan and be paid the same amount as traditional Medicare pays. There are no referrals to see a specialist in this program. You will be able to go to the doctors and hospitals of your choice as long as they accept Medicare. Hospitals that accept Medicare should accept this new plan including Memorial Sloan-Kettering and The Hospital for Special Surgery.
What if the provider I am seeing does not agree to accept payment from the Alliance NYC Medicare Advantage Plan?
You should first contact the Alliance Concierge Service so that the plan can work with the provider to make sure they understand it is the same payment schedule and billing protocol and answer any questions the provider may have. If the provider still refuses, the member can pay the provider and then submit the claims to the plan for reimbursement.
Will Medicare B and IRMAA reimbursements continue?
Yes as long as you stay in a City Health Plan like the new Alliance Advantage Plan or Emblem Health Senior Care or VIP HIP.
How does the prescription drug benefit work under the new plan?
It works the same way. The Part D plan, which your high option rider pays for and is expected to be lower under the new plan, remains the same.
Are there copayments under the Alliance Advantage Plan?
There will be new $15 copayments for seeing specialists, having diagnostic procedures, rehabilitation services, eye/hearing exams, urgent care centers and mental health/substance use services. Emblem Health Senior Care will also be adopting these copayments effective January 1, 2022. Emblem Health Senior Care will be adopting a $15 Primary Care Physician (PCP) copayment on January 1, 2022. Alliance will NOT have a copayment to see a PCP. Also, the max out of pocket yearly cost under the new plan is $1470, while it is unlimited under Emblem Health Senior Care. The $1470 does not include prescription drug and diagnostic copayments.
Will this plan create an administrative paperwork burden on doctors when they submit claims in order to get paid?
No, unlike the current GHI Emblem Health Senior Care program, doctors will submit claims to one organization. Members also will have one ID card and receive one Explanation of Benefits.
ON FRIDAY OCTOBER 1 at 1 PM WE ARE HAVING A MANHATTAN UNIT ZOOM MEETING, AT WHICH TIME DR. HATHAWAY WILL BE OUR GUEST SPEAKER. HE WILL ANSWER YOUR QUESTIONS ABOUT THE NEW PLAN.
Please send questions to ask Dr. Hathaway to unitleader@csa-rcmu.org
Our Union, CSA has endorsed Scott M. Stringer as their number one vote in the new rank choice voting for Mayor. UFT has also endorsed him. Stringer is highly qualified to lead the DOE out of the pandemic. Currently as comptroller he has kept Union pensions, not only safe, but well invested. Previously, in his capacity as Manhattan Borough President, he was faced with many challenges and proved his leadership ability. During his time in office, Manhattan prospered.
Primary Election – Rank Choice Voting
The Primary election will be held on June 22. Polls open from 6 AM – 9 PM
Early voting will be from June 12 – June 20
There will be Rank Choice Voting for Mayor, Public Advocate, Comptroller, Borough President and members of the City Council
Pick your first choice and completely fill in the oval next to the candidate under first choice
It is not necessary to make five choices as long as you vote for at least one in order for your vote to count
To find your assigned early voting site, early voting hours, check your registration, request an absentee ballot or view a sample ballot, visit VOTE.NYC or call 866-VOTE-NYC.
This meeting has been scheduled to provide you with up-to-date information about the proposed changes in the City’s Health Plan for Medicare Retirees. There have been many rumors and it is important that you have accurate information.
Dr. Douglas Hathaway will answer questions about the prospective modifications and the impact these will have on CSA retiree members.
You can email your questions to Stanley at unitleader@csa-mcru.org and he will forward them to Doug.
You can also ask him questions at the meeting by putting them in CHAT which can be found at the bottom of your computer screen. Tap the screen with the cursor to access this feature. Then press “return” on your keyboard to send your questions. On the smartphone, go to “more” and click the three dots to access “chat.”
We will try to give you the opportunity to ask questions directly. You can do this by going to RAISE HAND which can be found by accessing PARTICIPANTS on your computer or smartphone. You must wait to be recognized. Then you UNMUTE yourself by clicking the “microphone” on your device. If the “microphone” has green at the bottom, it means you can be heard. A red line through it means you are muted. We will mute everyone at the beginning of the meeting and unmute you when you are recognized.
Doug will answer your questions at the end of his presentation.
The invitation and link for this meeting will be sent on Tuesday, May 11.
During these tumultuous times your union and unit are always there to help you.
From understanding and obtaining your CSA Welfare Fund and other benefits to helping you with medical plan, IRMAA and TRS concerns to assisting you in your quest to obtain a Covid vaccine please contact Stanley Wilson at shw29@verizon.net or 917-692-2942.You can also contact our Manhattan Unit Outreach Coordinator Juanita Johnson at juanita10025@yahoo.com or 212-316-4287 or leave her a text at 917-975-3223.
Letters concerning membership dues for the period from May 1, 2021 to April 30, 2022 will go out this May. The yearly dues remain at $15.00. Checks should be made out to “Manhattan Unit CSARC” and are mailed to Stanley H Wilson, Unit Leader at 400 East 56 Street, 8M New York NY 10022. We are resuming collecting dues after suspending collection for one year due to the pandemic.
Medicare Part B Deductibles - As you start to visit your Medicare doctors in 2021, you will have to pay deductibles again since they reset January 1, 2021.The deductible increased from $198 to $203. GHI remains at $50. The portion of the $ 203. deductible that you pay when you visit a doctor will depend on the doctor’s service and what Medicare allows for the service. The likelihood is that it will be less than the full amount of the deductible. You will pay the amount that is left at future doctor visits. Remember that the deductible is determined by the first doctor who submits the bill to Medicare and is not necessarily the first doctor you visited in 2021.Therefore, do not to make a payment to the doctor on the date of your visit and let the doctor bill you after their bill is submitted to Medicare.
Medicare Part B Premiums- For 2021 the standard Medicare B premium increased from $144.60 to $148.50. But some people who enrolled in Medicare in 2020 or earlier will pay slightly less (about $145 per month) because of a hold harmless provision that doesn’t allow Social Security payments to be reduced from year to year for Medicare premiums. If your monthly 2019 taxable income was greater than $88,000 if you filed individually or $176,000 if you filed jointly, you will also pay a surcharge known as the IRMAA. Both the 2021 standard and IRMAA amounts are still reimbursable. The Office of Labor Relations should automatically reimburse you the standard amount. You have to apply for the IRMAA.
Emblem Health -GHI Senior Care-The pension deduction for those enrolled in the GHI Enhanced Medicare Part D plan increased from $142.50 to $150.30 per person per month.
Medicare Part D Drug Costs- The “donut hole” has been eliminated. You will pay 25 % of the cost of generic and name brand medications until you reach the Catastrophic Stage which means your prescription drug expenses exceed $6,550 in true-out-of-pocket costs which is known as TROOP. In this stage your co-payment continues as it was in 2020 at 5 % of the drug cost. Medicare pays 80 % and the plan pays the remaining 15 percent. The CSA Welfare Fund offers an added benefit in this stage by reimbursing you the 5 percent cost up to $5,000. There is no deductible. Just send your Monthly Prescription Drug Summary to the CSA Welfare Fund. These statements should be sent at the end of the calendar year.
Medicare D Surcharge- If you are subject to a Medicare B surcharge in 2021 you will also have a Medicare D surcharge. The amount ranges from $12.30 per month to $77.10 per month depending on your 2019 income. This is the amount deducted from your Social Security and is in addition to the amount deducted from your pension if you have the high option rider with Emblem Health providing for prescription drugs. The Medicare Part D surcharge is NOT reimbursable.
If you are eligible for 2020 IRMAA reimbursement, the application will become available in May of 2021according to the OLR. Then it will be
on the CSA Welfare Fund website, www.csawf.org or you can have an IRMAA application mailed to you by contacting Stanley Wilson at shw29@verizon.net or 917-692-2942.When you get the application, you must check which year you are applying for reimbursement. You can apply separately for the years 2019 and 2018 if you never did so and are eligible. It is critical that you sign the application, or else it will not be accepted.
There are two documents that must be included with the application you are submitting for reimbursement. These documents are:
1. The letter Social Security (SSA) sent you, dated November 2019, indicating how much your Medicare B premium was going to be in 2020. Do not confuse this letter with the one you received this past November, which indicated your 2021 Medicare Part B premium. Put that away in a safe place.
2. The SSA-1099 you should have received in January 2021, including the total amount you paid for your Medicare Part B premium in 2020.
If your spouse or domestic partner is Medicare eligible and a city retiree who has his/her own medical coverage he/she must fill out and sign a separate application and submit it along with the required documents.
If your spouse or domestic partner is Medicare eligible and is your dependent, complete the Eligible Dependent Information section on your application (one
application for both of you) and submit it along with your proper documents as well as your spouse’s or domestic partner’s documents. This procedure is to be
followed whether or not your spouse or domestic partner is a city retiree.
If you or your Medicare spouse are not receiving Social Security, you will not receive a 1099 form. Instead, you will have to send a copy of each month’s
SSA billing statement for Medicare B and proof of payment for the IRMAA premium which can be a copy of a check, credit card statement or bank statement.
If you are providing a credit card or bank statement black out the account information before submitting the information.
Send your completed application to the CSA Welfare Fund at 40 Rector Street,-12th Floor, New York NY 10006. The Fund will check your application to
determine that you submitted the correct documents. They also will scan your documents to their archives, and, log at submit them to OLR.
Do not submit original documents. Only submit copies.
Once again our thanks to Norm Sherman for providing the information above.
If you are on Medicare and have Emblem Health (GHI Senior Care) in November of 2020 you should have received your 2021 Cost Sharing Guide. This guide gives the tier 4 levels which are Tier 1-Generic Drugs, Tier 2-Preferred Brand Drugs, Tier 3-Non- Preferred Drugs and Tier 4-Speciality Drugs. Tier 1 drugs are the cheapest and Tier 4 are the most expensive.
Until you reach the Catastrophic Stage (which means that in 2021you have spent $6,550 in true out of pocket expenses) you pay 25% of the cost of the drug for a 30, 60, or 90-day supply, except for drugs in Tier 4, where a 60- or 90-day supply is unavailable.
In the Catastrophic Coverage Stage, the copayment is the greater of $3.70 or 5% of the cost for generic drugs and the greater of $9.20 or 5% of the cost of brand
name drugs.
Drug tiers are the main way drug companies inform you how much a specific drug will cost. Based on the tier the drug is in, it will have a specific copayment.
You can get more information by going to the Emblem Health website which is https://emblemhealth.com/Medicare or calling 800-585-5786.
Many of us are receiving numerous calls from people claiming to be Medicare Advisors, Medicare Consultants, Medicare Advocates or Medicare Discount Agents. Some of them even say they are offering you a free “cost analysis” of your medical expenses. They often promise to lower your Medicare costs and provide you with free dental, eyeglass, hearing aid and prescription drugs. What they are really attempting to sell you is a Medicare Advantage Plan. Most of us have Original Medicare with a GHI/Emblem Health Senior Plan as supplemental coverage. In Original Medicare you can go to any doctor or hospital that takes Medicare, anywhere in the US. Furthermore, in most situations you do not need a referral see a specialist.
This is not the case with Medicare Advantage Plans. You often must use doctors and other providers in the plan’s network and service area for the lowest costs. Some plans will not cover services from providers outside of the plan’s network and service area. Also, you may have to obtain a referral to visit a specialist. Some of the information listed above comes from “Medicare and You 2021”. More information about Original Medicare and Medicare Advantage Plans can be found in this most useful resource guide. If you need a copy call Medicare at 800-633-4227.
Remember that Medicare Advantage plans are offered by private insurance companies contracted with the Medicare program to provide benefits covered by Part A and Part B. According to the Center for Medicare Advocacy, “over the last several years, legislative and regulatory policy changes have continued to tip the scales in favor of Medicare Advantage over Traditional Medicare”. Thanks to Manhattan Unit member Ada Letelier for bringing this information to light.
In addition, the people calling you do NOT know the benefits that you already have with the City of New York and the CSA Welfare Fund and CSA Retiree Chapter. If you do decide to change your Medicare plan, please contact Dr. Doug Hathaway (CSA Welfare Fund Administrator) at dhathaway@csawf.org or 212-962-6061.
There seems to be an endless amount of unwanted and in many cases unethical phone calls. A common scam is a call referring to something charged on Amazon. Another is a call stating that there is something wrong with your computer. There are the calls about your extended car warrantee and terminating the contract on the time share that you never owned in the first place. These callers are up to no good. NEVER respond to their questions and NEVER give them any information.
HANG UP!
An even more pernicious call comes from someone pretending to be from Social Security or IRS. They often state that there has been fraud committed on your Social Security account and your SS payments will cease or you owe money to the IRS. Please be assured that neither Social Security nor the IRS will call you. If you have any concerns you can contact Social Security at 800-772-1213 and IRS at 800-829-1040.
As stated in the pamphlet “Phone Scams by the Federal Trade Commission” If you answer the phone and hear a recorded message instead of alive person, it’s a robocall. Recorded messages are often trying to sell you something. If you get a robocall:
Hang up the phone. Don’t press 1 to speak to a live operator or any other key. If you respond by pressing any number, it will probably just lead to more robocalls.
Consider asking your phone company whether they charge for blocking phone numbers. Remember, that telemarketers change Caller ID information easily and often, so it may not be worth paying a fee to block a number that will change.
Report your experience to the Do Not Call Registry at 888-382-1222.
In recent years, CSA has received increasing inquiries for support or advice when members needed a last will and testament, information on student loan assistance programs, and more. For many throughout our nation, the pandemic has caused people to realize the need for estate planning, a living will, health care proxy, and powers of attorney. CSA is pleased to announce that our union has contracted with a well-established law firm, Feldman, Kramer and Monaco (FKM) to offer all members new, comprehensive legal benefits commencing March 1, 2021.
The Legal Service Plan provides all CSA Retirees with access to attorneys in connection with real estate transactions, preparation of wills, providing legal advice, drafting letters and reviewing documents relating to personal legal matters as well as providing representation for other matters. There is no charge for the plan although discounted fees are charged for some more complicated matters handled by plan attorneys.
In addition to the Retiree Plan participants, the Plan covers their spouses or domestic partners who are living with the Plan participant; Parents, Grandparents, unmarried dependent children under the age of 19 or under the age of 25 if the child is wholly dependent upon the Plan participant for support and maintenance and is enrolled as a full - time student.
The initial point of contact for every active participant is the toll-free number of The Office of Feldman, Kramer and Monaco, PC which is 800-832-5182. If necessary, the Legal Office will then make referrals to local participating attorneys.
A Summary of Legal Plan Benefits are listed below:
Free Telephone Advice and Consultation-Each participant can call a toll-free number for unlimited telephone and Zoom sessions for advice and consultation.
Free Office Consultation-Each calendar year, participants are entitled to
three sessions concerning any new legal matter with a Legal Office attorney or local referral attorney.
Toll-free 24-hour hotline for emergencies.
Free Letter Writing-Plan attorneys will write as many legal letters or place as many telephone calls as needed to assist the participants. In matters such as protection and credit resolution, a telephone call from a Plan attorney often resolves the problem.
Free Document Review- Plan attorneys will review documents such as apartment and car leases, promissory notes, retail sales agreements, and other contracts limited to 15 pages per document.
Wills or Trusts-Participants are entitled to the preparation of a Will, Living Will, Health Care Proxy and Power of Attorney annually without any additional charge. Reciprocal Wills are also prepared at no extra charge for spouses/domestic partners. Certain trusts are also prepared with limitations.
Estate Planning Seminars or “Will Days”- Plan attorneys are available to conduct Estate Planning Seminars or sponsor “Will Days” via zoom or in person upon request.
Referral Attorneys-These attorneys have contracted to provide legal representation at a rate of $285 per hour or at a 30% discount from their usual fee, whichever is the lower amount.
Identity Theft- Plan attorneys can be a tremendous resource in helping to both avoid becoming an identity theft victim and reclaiming one’s identity.
This may include advising on the laws governing this crime, the appropriate course of action, and the proper entities to contact to place a fraud alert, and assistance with formulation of the appropriate dispute letters to the agencies and creditors involved.
Foreclosure-Plan attorneys can assist with steps that can be taken to avoid mortgage foreclosure by analyzing the financial situation, reviewing loan documents and discussing options such as lender payment workouts, short sale options and, in some cases, Chapter 13 bankruptcy payment plan alternatives.
Bankruptcy-Plan attorneys can offer advice on alternatives such as creditor “workout” in situations of overwhelming debt, including suspension of interest, budget review and in extreme circumstances, Chapter 7 and Chapter 13 bankruptcy alternatives.
Veterans Benefits- Assist members in obtaining “Aid and Assistance” for a loved one who is a veteran or the veteran’s spouse.
Student Loan Reduction- Members can review their student loan issues and have access to assistance and advice in connection with student loan assistance programs.
Traffic Matter Assistance- Legal Representation with a consultation in matters concerning any traffic violation and representation in court in all instances where, in connection with the operation of a motor vehicle, a traffic ticket was issued.
Benefit is limited to moving violations within the State of New York where conviction will result in points on license. Representation in court under this benefit is available once in a 12-month period beginning the day you first consult with the Plan attorneys concerning a traffic related matter. This benefit includes trial if necessary.
Elder Law-A plan attorney will provide representation and advice regarding Elder Law at a reduced fee.
Stockbroker Arbitration- Financial abuse is on the rise and we will provide a reduction of the contingency fee.
Real Estate Transactions-Legal representation with regard to purchase of a primary residence, sale of a primary residence and refinancing of a primary residence at flat rates.
Reduced Fee Benefit- Representation is available from Plan attorneys at $285. per hour for matters that are specifically covered by the Legal Plan but require payment for contested matters under the terms of the plan.
Criminal Defense-The plan provides a consultation in connection with matters concerning any misdemeanor or felony. Representation is available at $285. per hour. This benefit includes a free consultation and the availability of representation at trial or in court at the reduced hourly rate described herein or at a 30% reduction from the flat fee.
Personal Injury Benefit-Representation on a contingency fee at a reduced rate from the standard contingency fee from the standard contingency percentage of the recovery.
Estate Administration Benefit-Representation in an uncontested probate or administration proceeding at a 25% reduction in the percentage contingencies used to calculate the statutory fiduciary commissions.
In many legal matters the Legal Plan has guaranteed maximum fees in addition to reduced hourly rates.
If you and your Medicare-eligible dependent spouse/legal partner are NOT eligible for 2019 IRMAA reimbursement, and paid $135.50 monthly for Medicare Part B, you should complete a 2019 Reimbursement Differential Request form to collect the Differential reimbursement of $318.00. This applies to people who joined Medicare before 2016. If you have not done so already it is not too late to file. The application can be downloaded from the CSA Welfare website, www.csawf.org. You can also obtain this application by contacting Stanley Wilson via email or via phone at 917-692-2942. When filing, you must include a copy of your 2019 SSA-1099 letter. If you do not collect Social Security, you must include proof of payment for the Medicare Part B premium. Credit card statements or copies of canceled checks are acceptable proof.
You should receive this reimbursement in March of 2021.
Thanks to Norm Sherman, Florida Outreach Coordinator and Doug Hathaway, CSA Welfare Fund Administrator for the information in the above articles.
As Medicare retirees, you and your Medicare eligible spouse/partner were automatically reimbursed for your basic Medicare Part B premium for 2019.
This reimbursement took place on April 16, 2020. However, if you went on Medicare prior to 2016 you did not receive the correct amount. The amount owed to you, which is $318.00, is known as the Differential Reimbursement. You should have received this on November 13, 2020.
IRMAA reimbursements were made on October 16, 2020. Please be aware that the Office of Labor Relations has been closed since mid-March. The CSA Welfare Fund did develop the capacity to receive mail while the OLR did not.
Any IRMAA documentation mailed to the Office of Labor Relations, even if it was pre-pandemic, has not been processed.
If you submitted your IRMAA documents to the Fund, either electronically or by mail, they have been received, reviewed and those that are correct, have been delivered to the OLR. Additional submissions are being made weekly as additional forms are received and reviewed.
Many members received the correct amount, meaning that their 2019 documents were received and processed.
The OLR reimbursed those whose forms were not yet processed at their 2018 level. So, if you were in the first level of IRMAA for 2018, then you were reimbursed according the first tier in 2019. There are 5 levels of IRMAA payments. As the OLR processes these forms, they will issue additional reimbursements due to members.
If your 2019 IRMAA level was less than the 2018 level, you were likely overpaid, and the overpayment will be deducted from the 2020 reimbursement.
If you are eligible for 2019 IRMAA reimbursement but have NOT yet applied, you can still do so. Just submit a completed 2019 IRMAA form to the CSA Welfare Fund at:
CSA Welfare Fund, 40 Rector Street 12th Floor, New York NY 10006
You can download the form from the CSA Welfare Fund website, www.csawf.org. You can also request a form by contacting Stanley Wilson via email or phone at 917-692-2942. When submitting the form, be sure to include a copy of your Social Security Benefits Letter which you received on or about November 26, 2018 for the 2019 calendar year. Also include your SSA-1099 for 2019. If you do not yet collect Social Security, you must include proof of payment for the Medicare Part B premium. Credit card statements or copies of canceled checks are acceptable proof.
Look at the Social Security Benefits Letter that you received in November of 2018, telling you what your Medicare B premium would be in 2019. If the monthly premium is GREATER than $135.50, it means that you had an additional premium and thus have an IRMAA deduction. Therefore, you should apply for an IRMAA reimbursement. If you cannot find that letter, look at the SSA-1099 letter you received in January 2020 for the 2019 calendar year. If the amount was GREATER than $1626 you are eligible for an IRMAA reimbursement.
You must provide both the Social Security Benefits Letter and SSA -1099 for 2019 to obtain your IRMAA reimbursement.
Call Social Security at 800-772-1213 if you are missing either or both documents.
Manhattan Unit Executive Board members Dee Dee Goidel, Harriett Fortson, Juanita Johnson, Terry Goldstein and Connie Testa have volunteered to reach out to our members to see how they are doing in these perilous times.
If you are or will be on Medicare in 2021 you should have received the 2021 Edition of “Medicare and You”. This book provides up-to-date information about Medicare. Call Medicare at (800) 633-4227 if you have not received it.
The Basic Medicare B Monthly Premium for 2021 will be $148.50. If your gross adjusted income from 2 years ago was above $88,000 single or $176,00 joint return, you will pay the standard premium plus a surcharge per the IRMAA.
The Medicare B deductible for 2021 will be $203.00. The GHI/Emblem Health deductible will remain at $50.00.
If you are on Medicare and GHI/Emblem Health is your secondary insurance, you should have received the “Annual Notice of Change for 2021”. Other documents can be reviewed at the Emblem Health website emblemhealth.com/medicare. These documents include your Evidence of Coverage.
You can find which Medicare Part D prescriptions are covered by going to emblemhealth.com/medicare-formulary.
You can find the list of network pharmacies by going to emblemhealth.com/medicare-pharmacy. If you have any questions call Emblem Health at 800-585-5786.
Social Security will increase benefits by 1.3% as of January 2021.
Effective January 1, 2021, Medicare will cover up to 12 acupuncture visits in a 90 day period for chronic lower back pain providing:
The pain is lasting 12 weeks or longer
The pain is not related to spreading cancer, inflammatory or infectious disease
The pain is not associated with pregnancy or surgery
Medicare will also cover an extra 8 sessions if your doctor indicates that your chronic back pain shows improvement. If the doctor indicates there is no improvement or your condition is getting worse, then Medicare will not cover the additional sessions. Medicare covers no more than 20 treatments yearly. These treatments may only be used for chronic lower back pain.
Once you have exhausted your allotted 20 treatments, you can turn to the CSA Retiree Welfare Fund and the CSA Retiree Chapter for additional coverage.
CSA Welfare Fund and Retiree Chapter acupuncture benefits are less restrictive than Medicare benefits for acupuncture, and of course these are for Medicare and non-Medicare members alike. For the Welfare Fund, you are allowed a maximum of 36 visits a year. The maximum allowable charge is $100.00 per visit. After the annual deductible you will be reimbursed 80% of the cost. The CSA Retiree Chapter will give you an additional 20% reimbursement of whatever the Fund reimburses you. You do not have to apply for it, as the process is a seamless operation. The reimbursement should come approximately 2 weeks after the Fund reimbursement.
Several of our members have reported that they had to submit 18 months of COMPLETE documents from Medicare and GHI/Emblem Health when they made a claim to collect Catastrophic Insurance benefits. For example, if a document says 5 of 5 pages you need to submit all 5 pages. Most members have purchased this insurance through AFSA, CSREA or NYSUT and should keep their affiliation with the organization from which they purchased their Catastrophic Insurance. Your coverage depends on which organization you used to purchase this insurance. For more information call Mercer at 800-503-9230. They will need to know your certificate number.
Dr. Doug Hathaway was the presenter at our October meeting on Zoom. Listed below are some of the key points he made:
-The CSA Welfare Fund gives members a choice of dental plans. Most members choose SIDS which is now enhanced by the Carrington Dental Plan. Go to ASOnet.com to find a list of SIDS participating dentists.
-The Welfare Fund has a home health aide benefit. After a $100.00 annual deductible, coverage is 80% up to an annual maximum of $10,000 and a lifetime limit of $30,000. The CSA Retiree Chapter supplements 20% of the payment made by the Welfare Fund. A physician’s certification of medical necessity is required, as is proof that the home health aide is certified. Forms to log the date and hours the aide provided service can be obtained by calling the Welfare Fund. You must also show proof of payment. You need a copy of credit card or check payment. Cash payment is not acceptable.
-Regarding the catastrophic/stop loss Welfare Fund benefit for members on Medicare, the Welfare Fund gets the procedure code from the Medicare opt-out doctor. Then the Fund looks at what Medicare provides and pays the member 25% of the allowable Medicare charge. The payment is made at 80% after a $1,000.00 deductible. After $1,000. is paid to the member, payment is made at 100%. The Chapter provides 20% of what the Welfare Fund pays.
-The CSA Welfare Fund covers orthotics. The maximum per pair is $400. There is a 2 pair maximum. Medicare does not cover orthotics.
-The Welfare Fund benefit for the $300.00 hospital deductible is 80% after a $100.00 annual deductible. The Chapter will then reimburse you an additional 20%.
-Regarding your expense for cataract lenses or glasses, submit a copy of your Medicare EOB and a copy of the bill you paid to the Welfare Fund. The lifetime benefit is $500.00 per eye.
-Physical Therapy is covered up to $2,000.00 annually by the Welfare Fund. Apply after your Medicare coverage is exhausted.
- Regarding the Prescription Drug Benefit for Medicare members, the Welfare Fund reimburses members after they have spent $6,350.00 in true out of pocket expenses in 2020.The annual maximum for this benefit is $5,000.00. To obtain this benefit, members must submit copies of Emblem Health Monthly Drug Summaries showing that they have paid $6,350.00 in out of pocket expenses as well as documentation of their drug expenses after they have paid the $6,350.00.
For more information about your Welfare Fund benefits call the CSA Welfare Fund at 212-962-6061. You can email Dr. Hathaway at dhathaway@csawf.org.
As stated in a May 2020 letter from TRS Executive Director Patricia M Reilly, “Your TRS pension is a guaranteed, defined benefit, protected by the New York State constitution. Whatever else may be uncertain these days, your benefits from TRS are not. You can count on TRS’ ability to meet its pension obligations.”
Visit the TRS website at www.trsnyc.org
Visit www.trsnyc.org/memberportal/COVID-19 for news on TRS operations during the pandemic.
Email TRS at AskTRSNYC@trs.nyc.ny.us and a TRS representative will respond by phone or email. Include your phone number in your message.
Fax TRS at 212-918-9253 if you need to submit documents to TRS.
Mail correspondence to TRS at 55 Water Street, New York NY 10041.
Call TRS at 888-869-2877.
Paperwork can be dropped off at the TRS entrance at 55 Water Street. However, TRS is still closed to visitors.
Due to the CARES Act the TDA Required Minimum Distribution is suspended for 2020. Of course, you can always withdraw money from your TDA account and pay the appropriate tax on your withdrawal.
Due to the SECURE Act when distribution requirements resume in 2021, if you have not reached the age of 70 and a half by the end of 2019, you will not be subject to the RMD rules until the year in which you reach 72.
TRS 1099 Forms for 2020 should be sent out in January of 2021.
I was rushed to the hospital on January 25, 2020. It has been my experience that you are attended to much more quickly if you arrive by ambulance. I was diagnosed as having two flus which compromised my breathing and I was put on oxygen. I was considered contagious for five days. On the sixth day, my doctor decided since I was still using oxygen, to have me remain. On the eighth day, I was to be discharged with the temporary use of oxygen at home.
The Hospital Case Coordinator began the discharge procedures. At noon, when I asked why I did not have a specific discharge time. I was told that Medicare still had not approved the payment for oxygen at home. I could not understand this, since my doctors had prescribed the need. At 3:45 PM, Medicare said they could not agree to pay for the oxygen because I did not have a diagnosis of COPD or asthma. In order to go home, I had to pay for the oxygen. A week later, I visited my pulmonary doctor and told him what happened. He told me he felt that the hospital processed the oxygen incorrectly. I subsequently realized that due to a technical problem, I wound up paying for the oxygen.
The problem was that the hospital claim for my home oxygen was rejected. It should have been up to the hospital to challenge this rejection. If I had realized that, I would not have agreed to the hospital’s discharge plan.
On November 16, 2020 you should have received an email blast from Mark Brodsky. It included the information that the city recently informed CSA that it intended to withhold the final installment of the retroactive lump sum payments that our members are owed in February 2021, pursuant to our 2014 contract. CSA immediately set out to protect this retroactive pay, and the City has agreed to pay half of the lump sum payment in February 2021, and the remaining half in November 2021. This arrangement is in line with the deferral pattern for the final lump sum established earlier in October by the City and UFT. With this new agreement, the City also officially acknowledges what we previously announced in a member update last month, which is that CSA members who were owed lump sum payments of retroactive pay in October, earned during their time as teachers, will be paid the remaining half of that lump sum payment in July 2021 (given that the first half was paid in October). You will recall that it was CSA’s negotiations in 2014 that won the UFT portion of the retroactive payment for those promoted into CSA, since that issue was unaddressed in the teacher negotiation. CSA members who joined our union from November 2009 forward have been paid lump sums on both the UFT and CSA schedules, representing the time spent in each union for the relevant time period.
OUR FALL MEMBERSHIP MEETING WILL BE HELD ON FRIDAY, OCTOBER 30 AT 1 PM VIA ZOOM WITH DR. HATHAWAY AS OUR GUEST SPEAKER
If you have not already done so download the free Zoom app from the App store (Apple/Mac) or Google Play store (Android/PC devices) or for Windows & sign up for a free Zoom account at Zoom.us. You need a computer with a camera and a microphone. Most have them built in already. A smartphone or tablet (iPad or Android) can also be used.
The link will be sent to you via email by Mark Brodsky about one week before the meeting. It will be sent to you again the day before the meeting.
Click the link to join the meeting. You will see two prompts. They are “Join with Video”-say yes and “Join with Audio”-say yes.
If you have a question, go to “chat” and write your question. Chat can be found at the bottom of the screen on the computer. Tap the screen to access this. On the smart phone go to “more” and click the three dots to access “chat”. After you write your question press the return button on your keypad. Mark Brodsky will ask Dr. Hathaway to answer these questions. This will be done after Dr. Hathaway’s presentation.
We will try to give you the opportunity to ask questions directly. You do this by going to “raise hand” which is found by accessing “participants” on your computer or smartphone. You must wait to be called on. Then you must “unmute” yourself by clicking the “microphone” on your computer or smartphone. If the microphone has green at the bottom it means you can be heard. A red line through it means that you are muted. We will mute everyone at the beginning of the meeting.
If you do not have a computer or smartphone, you can try to “call in” by calling (646)876-9923.The meeting ID is 947 4173 0361.
If you would like to know more about Zoom, go to Zoom.us/about.
At this meeting Dr. Hathaway will remind you of all your benefits and how to access them.
Registered voters will have three ways to cast their ballots in the November General Election.
Vote on Election Day, Tuesday, November 3.
Vote early at an early voting site beginning on Saturday, October 24 through Sunday, November 1. If you choose to vote early you must cast your ballot at the early voting site designated for your address. Call your County Board of Elections to find out your site for early voting. The Manhattan Board of Elections phone number is 212-886-2100.
Vote by mail by requesting an Absentee Ballot Application. If you are voting by mail due to the risk of contracting the coronavirus, check “temporary illness or physical disability” for the first question on the Application Form.
You may request an Absentee Application Form in one of the following ways:
CALL-866-VOTE-NYCFAX
212-487-5349
EMAIL- apply4absentee@boe.nyc
WRITE a letter to your County Board of Elections requesting an absentee ballot. The address of the Manhattan office is:
Board of Elections of the City of New York Manhattan Office200 Varick Street- 10th Floor New York NY 10014
You must postmark, apply online, email or fax a completed application for the General Election by October 27. You may apply in -person by November 2.
If applying by mail for an absentee ballot, the Postal Service recommends you apply at least 15 days before Election Day.
Returned ballots must be postmarked by Election Day, November 3 and received by the Board no more than 7 days after Election Day to be counted under the law.
The Postal Service recommends mailing returned ballots at least 7 days before Election Day. You may drop off your ballot in a secured ballot box at any NYC Board of Elections Voting Site or Election Day Poll Site no later than 9 PM on Election Day.
If you return an Absentee ballot, you can still vote in person. ONLY the in-person vote will count.
UNIT DUES - Due to the circumstances under which we are living, the $15.00 unit dues will not be collected for the period from May 1, 2020 until April 30, 2021.Dues will resume on May 1, 2021 for the 2021-2022 year. If you have already paid dues for 2020-2021, you will be credited.
MANHATTAN UNIT EVENTS - Due to the need to maintain social distancing, the Manhattan Unit will not plan any gatherings at the present time. We will be sending out more special editions of Manhattan Matters. To update your email address, please email us at admin@csa-rcmu.org or click here. Also, please remember that you can contact Stanley Wilson 24/7 at unitleader@csa-rcmu.org .
NATTER CALENDAR - At the CSARC Executive Board meeting, we were informed that the Natter Calendar will NOT be published this year. The DOE has not issued a school calendar and therefore, the CSA will not be able to distribute a calendar.
THE 2020 CENSUS-New York City has been losing funds for schools, hospitals, roads, and more because only 62% of New Yorkers filled out the 2010 census. We need 100%. If you have not replied to the 2020 Census, please call 844-330-2020 or go to Census.gov immediately.
NEW MEDICAL CARDS FROM EMBLEM HEALTH - You should be receiving new cards with new numbers which take effect on July 1, 2020. In one mailing you will receive a new Emblem Health card with an 11 digit number starting with the letter K(if you are on Medicare your card will say GHI Senior Care), as well as a new Empire Blue Cross/Blue Shield card with a 9 digit number starting with the letter K.
If you or your spouse currently have an Emblem Health Medicare prescription drug plan, your cards will come in a separate mailing. The member ID number for your prescription drug plan is the same as your Senior Care member ID number. The ID number for your dependent is different. Your dependent has their own ID number. It is an 11-digit number that begins with the letter R.
For more information and /or if your cards have not arrived by June 22 please call Emblem Health at 212-501-4444, Blue Cross at 800-433-9592 and Express Scripts (Prescription Card) at 800-585-5786.