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PLAN #5100

CLASSIFICATION OF MEMBERSHIP

REPLACEMENT PLAN FOR DEPENDENTS LOSING COVERAGE UNDER THE

NATIONAL HEALTH & WELFARE PLAN (INCLUDING PLANS GA23000 AND/OR GA46000)

 

This is a replacement plan for those dependents not wishing to continue GA23000 and/or GA46000 COBRA coverage. This plan has its own Schedule of Benefits and pays benefits at 80% and has an annual deductible of $100. The lifetime maximum for this plan is $150,000.

Also, this plan is now available to dependents of railway employees who have exhausted benefits under the National Health and Welfare Plan (GA23000) due to disability. Eligible dependents of disabled employees may apply for membership in Plan #5100 when the dependent loses coverage under the National Health and Welfare Plan (GA23000).

The disabled employee or disability annuitant would be required to enroll in Plan #3000 as a supplement to his/her GA23000 coverage for the remainder of the time they qualify. Disabled employees or disability annuitants who become eligible for Medicare must be enrolled or enroll in a Medicare supplement with CARE in order for dependents to qualify for Plan #5100.

Eligible dependents of early retirees** may apply for membership in Plan #5100 when the early retiree reaches, or in the case of a widow(er), would have reached 65 years of age. In order for dependents to qualify for this plan, the retiring employee upon reaching 65 years of age, must be enrolled or enroll in a Medicare supplement with CARE.

MEMBERSHIP AVAILABILITY

Eligible dependents include:

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wife or husband

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wife or husband

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unmarried children* under age 19

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unmarried children* under age 19

*Children include: Natural or adopted children and stepchildren

**Full-time hours may vary depending on school type and institution.

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PLAN OUTLINE

 

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80/20 Plan

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$150,000 Lifetime Maximum

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No Annual Maximum

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$100 Annual Deductible

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Percertification/Preauthorization Required on certain procedures