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.
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.
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.