POST-RETIREMENT MEDICAL OPTIONS REVIEW

 

A phone conference was held between GE Salem Elfuns and the National Elfun insurance representatives. The following information was prepared to make our findings available to you. Our area is different from others in that we have very competitive health care available. Hopefully you will find the info below of value. My thanks to Bob Hody, Gerry Bijwaard, and Ron Nemura for their work to compile this.

 

5/6/03

GE retirees are extremely fortunate to have available medical care packages that provide the medical support they need and can afford in their retirement years. If there is a problem, it lies with which package to choose to best serve their family’s unique needs. The partial solution to this is for them is to first determine what they can “best guess” the needs will be for both themselves and their spouses. The needs that need to be addressed are typically reflected in 1) prescription drugs using 5 or more continuing prescriptions; 2) probability of major surgeries ; 3) probability of extended stays in the hospital or skilled nursing care facilities; 4) the frequency of physician visits. Most families wouldn’t have a clue as to what those needs are at the ripe, young age of 65. However, there are some families that have a very clear picture of what lies ahead because they are already beset with some very specific problems. At any rate, a “best guestimate’” must be made.

The good news is that all solid health plans are built on top of Medicare Parts A (hospital services) and B (physician services) as supplied by the federal government. The next step is to decide how much they wish to expand upon each of those two services and also decide upon any special needs. The base options from GE consisting of MCPP (Medical Care Plan for Pensioners), PHIP (Pensioners Hospital Indemnity Plan), and PPDP (Pensioners Pharmaceutical Drug Plan), added to Medicare, fortunately provide a core upon which all plans should be built. All that is needed at this point is to decide what supplemental plan needs to be added to the above base. This is where the unique family needs come into play.

There really are only three choices that can be made for the “supplemental” support: 1) the GE MIP (Medicare Insurance Plan), 2) A Medigap Policy available on the open market and 3) the Elfun Medical Care Plan available only to Senior Elfuns.

If your projected needs appear to require major surgical operations with a high dependence on physician services and facilities, and a high expectation of catastrophically high overall medical costs(over $300 K lifetime), a Plan A Medigap policy would be favored (and if not available, GE MIP). Anthem (Blue-Cross/Blue Shield) or some comparable Medigap policy would be satisfactory (although shopping for the policy can be tricky). Medigap Plans higher than Plan A would provide very little additional needed support, but should be investigated to satisfy the user. The GE PHIP option should also be purchased to maximize coverage ($8/month).

The Elfun Plan favors a situation where 1) drug/pharmaceutical needs are high (5 or more ongoing prescriptions) and/or 2) patient is using a physician or hospital that DOES NOT accept Medicare assignment. It is highly recommended that PHIP be purchased from GE (about $8/month) which will significantly reduce the financial risk for extended stays at the hospital or nursing home.

Whichever Supplemental Plan is chosen from the above three, you cannot go too far wrong. Most importantly is that all of the GE Plans identified in the second paragraph of this commentary be applied for. MCPP and PPDP are free to you as a GE retiree.