Maine-Endwell Central School District

Can I add new dependents to my plan after I retire?
If you retire with a family health insurance plan you may add a new dependent as long as they qualify as dependent.  If you retired with an individual policy you MAY NOT add anyone to your policy.

What happens to my benefits if I retire and I am under 65 years old?
You will be placed in the retiree group and remain on the plan applicable to active employees until you reach the age of 65.  Members contribute the amount as indicated in the contract they retire under.  Dental for retirees is not covered by the District:  you will be offered COBRA if you wish to continue dental coverage.  

What happens to my benefits if I retire and I am over 65 years old?
You should already be enrolled in Medicare Part A thru the Social Security Administration.  In order to continue health insurance coverage through the District you must be enrolled in both Parts A and B.  You will need to contact the Social Security Administration in order to sign up for Part B.  

What happens to my benefits if I retire and I am over 65 years old and my spouse is under 65?
You should already be enrolled in Medicare Part A thru the Social Security Administration.  In order to continue health insurance coverage through the District you must be enrolled in both Medicare Part A and B.  You will need to contact the Social Security Administration to sign up for Part B.  You will then have the Medicare Advantage Plan (HUMANA) which will take the place of your Medicare Plan.  Your spouse may remain in the Excellus plan until they reach 65 years old. Your spouse will need to complete the enrollment form for Excellus and will be enrolled in an Individual Policy.  Once they reach 65, they will need to purchase Part B and will then will be offered coverage under the District’s Medicare Plan.  The Personnel Office can give you the enrollment form for Part B upon request. 

What happens if I have more than one dependent on my plan once I have reached 65?
Because of the cost of holding a family plan and an individual plan, you would be required to stay on the Excellus Plan until such time as your children dependents come off your plan.  

What happens to my benefits if I retire and I am under 65 years old and my spouse is over 65?
You and your spouse will remain on the Excellus Plan.  Your spouse should already be enrolled in Medicare Part A thru the Social Security Administration.  In order to continue health insurance coverage through the District they must be enrolled in both Medicare Part A and B.  Your spouse will need to contact the Social Security Administration to enroll in Part B once you retire.  Medicare will be your be your spouse’s primary coverage and Excellus would be their secondary policy.  The Personnel Office can give you the enrollment form for Part B upon request. 

What happens to my benefits if I move?
Your benefits remain the same. You must contact the Personnel Office any time you have a change of address, phone number, or change to marital/dependent  status. 

How long does the COBRA dental insurance last and what do I do once it ends?
You can continue the COBRA dental for up to 18 months from the date you retire if you continue to pay the premiums.  Once the 18 months finishes your coverage in the District’s dental plan ends. The District does not contribute toward this dental plan.  

What happens if my spouse or I become disabled and become Medicare eligible?
If you or your spouse becomes disabled, Medicare may be offered.  If Medicare is offered, you must enroll in the Medicare Parts A and B. Medicare Part B covers 80% of services.  Excellus would cover 20% of the services.  If you are not enrolled in Medicare Part B, there may be additional costs to you as the District Plan does not pay the 80% cost of services that Medicare would cover so the cost would be passed on to you. 
It is very important that if you or your spouse becomes Medicare eligible due to a disability, that the Personnel office is notified as soon as possible.  At that time, the Advantage plan will be offered to continue coverage. 

What happens when my spouse or I turn 65 and become Medicare eligible?
When you or your spouse reaches the age of 65, you become Medicare eligible.  You must be enrolled in Medicare Parts A and B and choose the District’s Advantage Plan in order to continue your coverage in the District’s Retiree group.  Approximately 6  weeks prior to turning 65, you will receive a packet from the Personnel Office that will provide you with the necessary information.  Paperwork must be returned to the Personnel Department at least two weeks prior to the first of the month that age 65 is reached.

What happens to my spouses’ benefits if I pass before my spouse does?
Upon your passing, your spouse has the option to continue on the coverage. Your spouse will be billed at the full cost of the plan.

What options do my children have once they are no longer eligible for coverage because they have hit the maximum age of coverage?
Any dependent who ages off your plan has the option of 36 months of medical COBRA coverage and 18 months of Dental COBRA coverage.  

Pro-Flex FAQ

Q:  What are the important things for members to know about Pro-Flex?
-The plan year runs with the calendar year, from 01/01 to 12/31.
-Funds may be used for medical, dental, vision, and pharmacy expenses (same guidelines as an FSA).
-Members have 30 days after the plan year ends to submit manual claims for that year’s dates-of-service. 
-Funds are accessible by the debit cards, which were sent to the members’ home addresses.
- Funds may be accessed at point-of-service with the debit card, or after with a manual claim.
-Members may use their funds to purchase eligible OTC items at www.fsastore.com, www.my-healthshopper.com, or in Amazon’s FSA/HSA eligible items shop.

Q:  What should members know about submitting Pro-Flex claim forms?
-Funds may be accessed at point-of-service with the debit card, or after with a manual claim.
               ~Manual claims may be submitted via the website, mobile app, mail, email, or fax. Claim form required.
               ~Proof of payment is not required to be reimbursed – only an itemized statement/invoice/prescription tag.
               ~Reimbursement may go to the member or directly to the provider.
-Members may receive reimbursements by check or direct deposit.