THE SENIOR CITIZEN HEALTH PROGRAM — A PROGRAM TO COMPLEMENT YOUR MEDICARE COVERAGE
The Senior Citizen Health Program provides health care coverage to those:
The Senior Citizen Health Program provides health care coverage to those:
- who have reached age 65;
- whose covered earnings during four consecutive quarters are insufficient to qualify them for active coverage under the Plan; and
- who meet the necessary requirements based on their history of AFTRA covered earnings.
The types of benefits provided through the Senior Citizen Health Program are generally those provided under the Individual and Family Plan (whichever is applicable). They include the Hospital, Major Medical, Wellness, Mental Health and Chemical Dependency, and Prescription Drug Programs. In addition, dental benefits are provided for the retiree but not for the retiree's spouse or dependents. Life, Accidental Death and Dismemberment Insurance and Loss of Voice Benefit coverage is not provided. However, you may qualify for the Senior Citizen Death Benefit.
The benefits provided under the Program are coordinated with Medicare benefits so that while total reimbursement from both plans may equal 100% of the Medicare allowable charge, it will never exceed that amount. However, the AFTRA Health Plans also provide benefits for services not covered by Medicare such as prescription drugs, dental, wellness and private duty nursing. In these instances, the payment of charges will be governed by the terms of the Individual and Family Plan, whichever is applicable.
The benefits provided under the Program are coordinated with Medicare benefits so that while total reimbursement from both plans may equal 100% of the Medicare allowable charge, it will never exceed that amount. However, the AFTRA Health Plans also provide benefits for services not covered by Medicare such as prescription drugs, dental, wellness and private duty nursing. In these instances, the payment of charges will be governed by the terms of the Individual and Family Plan, whichever is applicable.
| IMPORTANT DEFINITIONS |
| A "Base Year" is the twelve‑month period measured from December 1 through November 30. A "Qualifying year" is any Base Year in which your covered earnings are at least $2,000 or the amount required for Individual Health Plan eligibility as of the last day of that Base Year, whichever is greater. A "Family qualifying year" is any Base Year in which your covered earnings were at least $2,000 or the amount required for Family Health Plan eligibility as of the last day of that Base Year, whichever is greater. |
