80/20 Plan for Retirees
The 80/20 Plan for Retirees provides coverage for retirees who are age 65 or older (endowed retirees under age 65 remain in either the 80/20 Plan, Aetna PPO or HealthNow).
- Eligibility
- Medco Three-Tier Prescription Drug Plan $5/$20/$40
- Reimbursement Schedule for 80/20 Plan for Retirees
Eligibility
To be eligible for Cornell's endowed retiree health coverage you must:
- be an endowed retiree age 65 or older;
- be eligible for Medicare;
- have 10 or more years of benefits-eligible service at the time of retirement;
- have been at least age 55 at the time of retirement;
- be participating in one of the endowed health care plans at the time of retirement.
In general, the same expenses are eligible for reimbursement under the
80/20 Plan for Retirees as are eligible under the 80/20 Plan for faculty
and staff. Retirees and spouses/same-sex partners (if retired and age
65 or older) are required to enroll in Medicare Parts A & B. Annual
deductibles and out-of-pocket maximums also match the 80/20 Plan for active
employees. Once your deductible is met, the 80/20 Plan for Retirees will
pay up to 80% of eligible medical expenses (including the amount Medicare
pays), and you pay 20%, up to an annual out-of-pocket maximum. Medicare
provides coverage for prescription drugs, called Medicare Part D, effective
January 1, 2006. Your coverage under the Retiree 80/20 Plan is better
than the standard Medicare part D Plan. Most retirees should not enroll
in Part D. If you do enroll in Part D, then Medicare is primary for your
prescription drugs and Medco (through Cornell) is secondary.
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Important: If you decide not to continue your health insurance at any time and cancel your coverage or fail to pay your premiums, you will not be able to re-enroll at a later date.
There are a few differences in coverage for the 80/20 Plan for Retirees:
- private duty nursing is covered at 50%
- you are not required to pre-certify inpatient hospital stays.
Reimbursement Schedule for 80/20 Plan
for Retirees:
The 80/20 Plan for Retirees calculates the amount payable as 80% of eligible
expenses, after the annual deductible has been met. Medicare's payment
is subtracted from that 80% and the 80/20 Plan will pay the difference.
If Medicare has already paid 80% of the eligible expenses, (which occurs
in an assigned claim) Aetna will not make a payment under the 80/20 Plan
for Retirees. Once you have paid $3,000 (individual) or $6,000 (family)
out-of-pocket in a calendar year, the Plan reimburses at 100%.
Remember, all eligible expenses must be submitted to Medicare before they can be considered by Aetna under the 80/20 Plan for Retirees. Once Medicare has processed the claim, you can attach a copy of the Medicare Explanation of Benefit statement and the bill to an Aetna "Medical Benefits Request" form. Send it to:
Aetna
P.O. Box 981109
El Paso, Texas 79998-1109
Although Cornell University and the Board of Trustees of the university
expect and intend to continue offering health coverage to retirees, they
reserve the right to modify, suspend or terminate the program at any time
by action of the Board of Trustees.
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