Answers about the Retiree Medical plan, including eligibility, options, enrollment, customer service and more.
What is not covered under this plan?
The Plan does not cover: any expenses that are not Medicare Eligible Expenses, or beyond the limits imposed by Medicare for such expenses, or excluded by name or specific description by Medicare, except as specifically provided in the policy; any portion of a covered expense to the extent paid by Medicare; benefits payable under one benefit of the policy to the extent covered under another benefit of the policy; and covered expense incurred after coverage terminates, except as stated in the extension-of-benefits provision of the policy.
How will Medicare know if I chose to enroll in the Medicare Options US Retiree Benefit Plan?
Once your application is processed and you’ve provided your Medicare ID number to Gilsbar, LLC, Gilsbar will electronically notify Medicare of your enrollment in the plan.
Do I have to enroll in the Medical/prescription drug plan to enroll in the dental plan?
You can enroll in the dental plan without enrolling in the medical and/or prescription drug plan.
Do I have to worry about pre-existing conditions?
This plan has no pre-existing condition restrictions as long as you are coming from an approved insurance program.
Do I have to change doctors?
No. With this Medical Plan, you and your eligible spouse can use your current doctor or any doctor(s) you choose who accept Medicare patients.
Will I have to file claims?
There is usually no need to file medical claims. In most areas, your doctor or pharmacy submits your claims directly. Medicare will then submit the balance of any claim to this Plan for processing. Simply present your ID Card to your health care provider at the time services are received. Should you need to file a paper claim, you can direct them to the address on the back of your ID Card.
Can my coverage be cancelled if I file too many claims?
No. Your coverage cannot be cancelled because of claims incurred as long as the Master Policy remains in force.
Do I have to enroll in the medical/prescription drug plan to enroll in the vision plan?
Yes. You must enroll in the medical/prescription drug plan to enroll in the vision plan.
What if I am hospitalized for treatment that will last through the effective date of the new plan?
Typically, the coverage you had when admitted to the hospital would remain in effect until you are discharged. After your release from the hospital, your new Medicare Options US Retiree Benefit Plan coverage will begin.