Health Benefits Retired Members

Health Benefits Retired Members (17)

DRUG PROGRAM – RETIREES -- Mandatory Generic Reimbursement

The member, his or her spouse, and children (up to their 23rd birthday) can use the Benecard PBF drug card at participating pharmacies with a co-payment schedule as follows:

$10 or less for generic prescriptions (not to exceed the cost of the medication);

$10 or 30% for single source brands;

$10 or 30% for multi-source brands, plus the difference between the cost of the brand and generic drugs.


There is an annual plan year deductible (July 1st through June 30th) of $50 per individual and $150 per family prior to plan benefit coverage.

There is an $15,000 cap for a family per year. Prescription drugs that have an over-the-counter equivalent are not covered under our drug plan.

Asthma and psychotropic drugs have a 45% co-pay.

Children from the ages of 19 to the date of their 23rd birthday (who have proper student verification on file with the DEA) will now be eligible to use the Benecard PBF card to obtain their prescriptions, and simply pay the co-payment. Student verification must be submitted to the DEA twice each year for the fall and spring sessions. Please remember to submit student verification for the fall semester (which covers the time period between 9/1 and 2/28), and the spring semester (which covers the time period between 3/1 and 8/31).Click here for the DEA Student Verification Form.


Mail order -- The maintenance (continuous medication) drug program entitles you to a three (3) month supply with a co-payment schedule per prescription as follows:

$10 or 30% for generic prescriptions;

$10 or 30% for single source brands;

$10 or 30% for multi-source brands, plus the difference between the cost of the brand and generic drugs.

Asthma and psychotropic drugs have a 45% co-pay.

You may contact Benecard PBF directly at 1-888 DEA NYPD or the DEA health benefits office should you have any questions regarding your prescription drug benefits.

The City of New York is covering certain prescriptions (injectibles and chemotherapy drugs) under the PICA program. This program is available to all non-Medicare members who are enrolled in a City-sponsored Health Plan and is administered by Express Scripts. Contact the DEA health benefits office or telephone Express Scripts at (800) 467-2006 for more information. You may also visit Express Script's Web site at www.express-scripts.com .

Click on PDF's for Forms.

A member must select from one of the following dental plan options: 

PLAN ONE – COMPREHENSIVE PANEL PROGRAM

An enrollment card is needed for this program. The member selects a panel dentist whom the entire family is required to use. You must use this dentist only. There are no dental forms to submit.

Please note that enrollments for this plan are done monthly. If the application is received by the 15th of the month, it will be effective the first of the following month.

 
 
PLAN TWO – FEE SCHEDULE PLAN

Participating Dental Providers

Choose a dentist from the DEA participating provider listing.  These dentists have agreed to accept Healthplex’s DEA schedule as payment in full for covered services.  Healthplex will pay these providers directly.  You are not responsible to pay these participating dentists for covered services.

* * * * * OR * * * * *
 
Non Participating Dental Providers

The member may choose any dentist he or she prefers and pay the dentist directly for services. The member is reimbursed for covered services only according to the DEA fee schedule of allowances.

Please note:  DEA members who are enrolled in the Comprehensive Panel Program are not permitted to use the providers under the Fee Schedule Plan. 
 

Member, spouse and eligible dependents are entitled to an eye exam and eye glasses every 12 months.

Effective January 1, 2010 two vision vendors are available for retirees who reside in New York or New Jersey, Vision Screening and Davis Vision.  Vision Screening will provide a vision exam, frames/lenses or contacts at no charge in New York State and for a $15 co-payment in New Jersey.  Davis Vision will provide a vision exam, frames/lenses or contacts for a $25 co-payment in New York State.  For out of state (non-New York) retirees, Davis Vision is the sole vendor and will provide an exam, frames/lenses or contacts for a $67 co-payment ($25 basic eyewear + $42 basic exam).  You may choose from the selection of Davis Vision “Designer” frames at any participating Davis Vision provider.  Should you wish to upgrade your frames to Davis Vision’s “Premier” frame selection, you may do so for an additional $25.

As of January 1, 2010 optical certificates are no longer required as eligibility is maintained by both Vision Screening and Davis Vision.  Appointments can be scheduled directly at the participating provider’s office by providing your DEA unique ID number.
Lastly, in addition to the elimination of the vision voucher requirement, the new retiree vision benefit replaces the previous $32.50 eye examination/eye glass benefit and $10 examination only benefit, effective January 1, 2010.

GHI and HIP announcement letters that Emblem Health will be mailing out

Page 1 of 3