This Medicare plan is open to retirees
residing in the counties of Albany, Bronx, Broome, Columbia, Delaware, Dutchess,
Fulton, Greene, Kings, Montgomery, New York, Orange, Otsego, Putnam, Queens,
Rensselaer, Rockland, Saratoga, Schenectady, Schoharie, Sullivan, Ulster,
Warren, Washington, and Westchester in New York.
Retirees with both Medicare Parts A and B
and age 65 and older are eligible for GHI HMO Medicare Senior Supplement. This
plan provides the same comprehensive benefits of the standard GHI HMO program,
and includes coverage for deductibles, coinsurance, and services not covered by
Medicare Parts A and B, but not to exceed the standard coverage provided through
GHI HMO's program. To be covered in full, Medicare-eligibles must use GHI HMO's
participating physicians. If a non-participating physician is used, only
Medicare coverage is applicable and treatment is subject to deductibles,
co-payments and exclusions.
Prescription Drugs
There is a $265 annual deductible under this plan.
Member pays 25% of eligible prescription drug expenses between $265 and $2,400.
Member is responsible for 100% of the prescription drug cost between $2,400 and $5,451.25.
If member reaches an out-of-pocket
amount exceeding $3,850; copays will be the greater of 5% or $2.15 for
generic/$5.35 for brand-name drugs.
Cost
See rate page for pension deductions.
See the rate page
For More Information
Retirees with questions about this coverage may contact GHI
HMO Monday through Friday, 8:00 am - 6:00 pm, at (877) 244-4466 or (877)
208-7920 (TDD only). Or send your questions in writing to:
GHI HMO
PO Box 4181
Kingston, NY 12402
Attn: Customer Service
Visit the Plan Web site
Updated to reflect changes
to the Prescription Drug Benefit effective January 1,
2007.