This section summarizes the various types of benefits available to you as a Medicare eligible participant in the Goodyear Retiree VEBA Health Care Plan.
A complete description of the Plan benefits is contained in the Plan Document. In the event of any conflict between the summarized version of these benefits in this Trust Benefits section of the website and the Plan Document, the terms of the Plan Document shall govern.
Your medical benefits are provided through the Highmark Blue Cross Blue Shield National PPO Program. Under the PPO program you are not required to select a primary care physician and you have access to a large network of physicians, hospitals and other medical care providers throughout the country, including all providers who participate in Medicare.
The PPO program offers both In-Network and Out-of-Network benefits. For a higher level of coverage, you need to receive care from a network provider. However, you can go outside the network and still receive care at the lower level of coverage. To locate a network provider near you, or to learn whether your current physician is in the network, call 1-800-810-BLUE (2583) or log onto Highmark’s Web site, www.highmarkbcbs.com.
Another important feature of the PPO program is that the plan encourages you to stay healthy by covering preventive care at 100%. Preventive care plays a key role in identifying potentially serious health risks at an early, more easily treatable stage. You are covered for a range of preventive care, including physical examinations and selected diagnostic tests. Preventive care is a proactive approach to health management that can improve your health status and save medical expenses down the road. For more information on preventive care, please visit the Wellness and Prevention section under Trust Participant Resources.
Medicare Parts A & B Medical Coverage
You must enroll in both Medicare Parts A and B as soon as you become eligible in order to receive the maximum benefits under the Plan. When you are eligible for Medicare, the Plan pays claims as if you are enrolled in Medicare, whether or not you are actually enrolled. This means that if you are eligible for Medicare but are not enrolled, you will have significantly higher out-of-pocket medical expenses.
Filing a Claim
If you receive services from a network provider, you will not have to file a claim.
If you receive services from an out-of-network provider, you may be required to file the claim yourself. If you need to file a claim yourself, you must request a claim form. These forms are available from the Trust Administration Office at 1 (866) 694-6477, or by calling the Highmark Member Service Department at 1 (888) 334-5027. Once you complete the claim form, you should attach all itemized bills to the claim form and mail everything to Highmark Blue Cross Blue Shield, PO Box 1210, Pittsburgh, PA 15230.
Explanation of Benefits (EOB) Statement
Once your claim is processed, you will receive an Explanation of Benefits (EOB) statement from Highmark. This statement lists: the provider’s charge; allowable amount; copayment; deductible and coinsurance amounts, if any, you are required to pay; total benefits payable; and the total amount you owe.
For information on how to read your Explanation of Benefits statement, click here.
If you have questions about your medical plan, need to request a new identification card, have an issue with a medical claim or need to locate a participating provider, the Highmark Members Services team can assist you. To reach a Highmark Member Services representative, please call 1 (888) 334-5027. This number is printed on the back of your identification card.
Freedom Blue PPO Plan
The Freedom Blue PPO Plan is a Medicare Advantage PPO specifically designed for the Goodyear Retiree Healthcare Trust and administered by Highmark Blue Cross Blue Shield. Under this Plan, your Medicare coverage and the additional coverage available through the Trust are combined into a single program. It uses the national Blue Cross and/or Blue Shield Medicare Advantage PPO provider network.
You may go to health care providers and hospitals of your choice – inside and outside of the network – without referrals. See the attached network brochure that explains your coverage, while you are on the go.
If you go to network providers or hospitals in locations that are part of the national Medicare Advantage network service area, eligible services you receive will generally be covered subject to a co-payment or participant co-insurance.
On the other hand, if you go to non-network providers or hospitals in locations that are within the national Medicare Advantage network service area, eligible services you receive with generally be subject to a higher participant co-insurance.
If you go to Medicare-eligible providers or hospitals in locations that are not part of the national Medicare Advantage network service area, eligible services you receive will be covered at the more beneficial in-network level.
Additional Benefits are offered through the Freedom Blue plans that are not available on the National PPO plan. Please click here for a chart comparing the two plans.
Lower Out-of-Pocket Maximum
Silver Sneakers – You will have access to a free basic gym membership at participating facilities at no additional cost. Click here for additional information on the Silver Sneakers program
Hearing Aid Benefit
Coverage for an Eye Examination
If you have questions about your medical plan, need to request a new identification card, have an issue with a medical claim or need to locate a participating provider, the Highmark Freedom Blue Members Services team can assist you. To reach a Highmark Freedom Blue Member Services representative, please call 1 (866) 670-5847. This number is printed on the back of your identification card.
Prescription Drug Coverage
Your prescription drug benefit is called the SilverScript Employer Prescription Drug Plan (PDP). The SilverScript Employer PDP is an approved Medicare Part D prescription drug plan with additional coverage provided by the Goodyear Retiree Health Care Trust to supplement the Part D benefits.
If you fill your prescription at a participating SilverScript network pharmacy, your claim will be processed automatically and you will be required to pay only the applicable copayment amount, depending on whether you obtain a brand name drug or a generic version.
If you use a pharmacy that is not part of the SilverScript network, you may have to pay the full cost of the drug at the pharmacy. In this case, you must complete a paper claim form and submit it to SilverScript Employer PDP within three (3) years of the date you filled your prescription. You will not be reimbursed for the difference between the discounted rate and the cost you paid.
SilverScript Mail Order Service
You may obtain up to a 90 day supply of maintenance medications through the mail using the SilverScript Mail Order service. Your copayment amount will be less, compared to obtaining these medications at a retail pharmacy.
The Maintenance Choice program provides participants who are taking maintenance medications the opportunity to purchase 90-day supplies through a CVS pharmacy, but with the same lower copayment amounts as the Mail Order Service.
To locate a CVS pharmacy near you, go to www.cvs.com and click on Store Locator.
Medicare Prescription Drug Coverage Choices
You have choices in your Medicare prescription drug coverage. The Goodyear Retiree Health Care Trust is offering you a plan that is not available to the public. As a Medicare beneficiary, you can choose from different Medicare prescription drug coverage options. One option is to get prescription drug coverage through a Medicare Part D PDP, like SilverScript Employer PDP. Another option is to get your prescription drug coverage through a Medicare Advantage Plan that offers prescription drug coverage. It is up to you to make the choice.
If you decide to enroll in a Medicare Part D PDP other than the SilverScript Employer PDP offered through the Trust or a Medicare Advantage plan which includes prescription drug benefits, please be aware that you will lose your Trust prescription drug coverage, but you will still be required to pay the full monthly premium to the Health Care Trust.
If you have any questions about your prescription drug plan, please contact SilverScript Employer PDP Customer Care at 1 (855) 479-3654 or visit goodyearretireetrust.silverscript.com. TTY users should call 1 (866) 236-1069.
The Trust provides you with coverage for a limited range of dental services through Delta Dental. Your dental plan provides coverage for services such as:
- Periodontic Services – to treat gum disease
- Endodontic Services – includes root canals
- Oral Surgery Services – extractions and dental surgery
- TMJ Treatment – treatment of the disorder of temporomandibular joint
- Other Radiographs – other x-rays
Benefits for temporomandibular joint disorders (TMJ) are limited to those services normally provided by a dentist to relieve oral symptoms associated with malfunctioning of the temporomandibular joint, including appliance therapy and surgical correction. This does not include services that would normally be provided under medical care. Predetermination is required when TMJ treatment will exceed $250 or no coverage will be made.
All oral surgery services performed by a dentist are Covered Services, including IV sedation and general anesthesia when performed in conjunction with periodontic, endodontic, and oral surgery services.
Selecting a Dentist
To verify that a Dentist is a Participating Dentist or a Premier Dentist, you can use Delta Dental’s online Dentist Directory at www.deltadentaloh.com or call 1 (800) 524-0149.
If you have any questions regarding your dental benefits or need assistance with filing a dental claim, please contact Delta Dental at 1 (800) 524-0149.
Medicare Part B Premium Reimbursement
The Trust provides a $50 per month Medicare Part B premium reimbursement to all Medicare eligible Trust participants, including dependent children. This premium reimbursement is paid to eligible participants on a quarterly basis, with the first quarterly payment made in April.
Your Medicare Part B reimbursement benefit will be deposited electronically into your checking or savings account.
In order to ensure that you receive your Medicare Part B premium reimbursement, the Trust Administration Office must have an accurate Authorization for Automatic Deposit on file for you.
If you have any questions regarding your Medicare Part B premium reimbursement or if you have made a change to your banking information, please contact the Trust Administration Office at 1 (866) 694-6477. You may download the form by clicking here.
Summary Plan Description
For more information about your benefits, please refer to the appropriate Summary Plan Description.