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Article 6, #3 of the Collective Bargaining Agreement (page 9) states “Any employee who has terminated employment with the District and elects to retire under the provisions of the Public School Employees’ Retirement System may, at the employee’s option, and with the approval of the insurance carrier, retain membership in the District’s group hospitalization program, up to age 65, by direct payment of premium by the individual.”

This is allowable under PA Act 110 (1988) which requires school employers in PA to give retirees and their dependents the right to continue coverage in the group health plan to which they belonged as employees. The coverage may continue until they are eligible for Medicare benefits (usually age 65) or until they are covered by another group health insurance plan.

 Act 43 (1989) amended Act 110 by defining those retirees eligible for continuation of group coverage as those who

  • Took superannuation (normal) retirement on or after age 62 OR

  • Retired with thirty (30) years of service, OR

  • Were receiving PSERS disability benefits

     

The Acts stipulated that the purchase of the continuation of coverage shall equal the cost of the program for active employees and dependents (plus 2% administrative fee).

For reference purposes, premium costs monthly/yearly for 2017-2018 are as follows:

  • Individual:             $   619 / $  7,427

  • Parent/Child:         $1,270 / $15,249

  • Parent/Children:    $1,381 / $16,573

  • Husband/Wife:      $1,581 / $18,969

  • Family:                  $1,691 / $20,293

     

    Continuation coverage will be terminated before the end of the maximum period if:

  • any required premium is not paid in full on time;

  • a qualified beneficiary becomes covered, after electing continuation coverage, under another group health plan that does not impose any pre-existing condition exclusion for a pre-existing condition of the qualified beneficiary;

  • a qualified beneficiary becomes entitled to Medicare benefits (under Part A, Part B, or both) after electing continuation coverage; or

  • the employer ceases to provide any group health plan for its employees.

     

    Continuation coverage may also be terminated for any reason the Plan would terminate coverage of a participant or a beneficiary not receiving continuation coverage (such as fraud).

     

    See “Premium Assistance” information from PSERS

    http://www.psers.state.pa.us/premiumasst.htm

     

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