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Medicare Part D

Guide to Medicare Part D

  • Reimbursement of the 5% out of pocket expenditures in excess of the catastrophic level.

Medicare Part D Catastrophic Reimbursement

Who is covered?

Retirees and their eligible spouse/domestic partner who have enrolled in, and purchased, a Medicare Part D Prescription Drug Program and have reached the annual 5% catastrophic coverage threshold are covered. Other dependents are not covered.

What is the benefit?

This benefit will reimburse the 5% out of pocket co-payments incurred in the catastrophic coverage portion of the Medicare Part D plan. 

To qualify for the Fund’s benefit, an eligible claimant must reach the “catastrophic stage” of their Medicare Part D coverage, by incurring real and true out-of-pocket expenses, equal to the annual out-of-pocket spending threshold set by Medicare. The Fund’s program does not consider any subsidies, payments or other forms of “extra help” (including, but not limited to, Medicare’s coverage gap discount program) received by a Medicare Part D enrollee, in determining if he/she has reached the Medicare out-of-pocket threshold. In processing claims, the Fund will only consider the amount in the “You Paid” column of your Medicare Part D plan’s Explanation of Benefits, in determining whether you have incurred the required amount of out-of-pocket costs to be eligible for catastrophic reimbursement benefits. If the “You Paid” column does not equal the requisite Medicare out-of-pocket threshold, you will not qualify for Fund benefits.

How are benefits obtained?

You must complete a Medicare Part D Reimbursement Claim Form and submit it to the Welfare Fund no later than February 1 in the year following the calendar year in which you incurred the 5% copayment charges, along with the letter and Explanation of Benefits (EOB) received from your Health Insurance carrier.

Note: If you have not reached the catastrophic threshold of your Medicare Part D plan, you do not qualify for the benefit and you should not file a claim form.

At the end of every year, the health plan that you are enrolled in for the Medicare Part D program will send you an Explanation of Benefits (EOB).

Where can I get the Reimbursement Claim Form?

You can obtain the form in any of the following ways:

Important Information

You can reach the Welfare Fund Forms Hotline at 212-539-0539.