Benefits News

May 22, 2014

Two new specialty drugs, Sovaldi and Olysio, have recently come to market in pill form that are claimed to be effective against Hepatitis C.  Sovaldi costs one thousand dollars a pill, and must be taken daily, typically over a twelve week period at a cost of $84,000.00 a patient.  Olysio is also extremely expensive and may be prescribed to be taken in combination with Sovaldi.

The  cost of these drugs, if continued, now appear poised to drive the Security Benefits Fund into insolvency, thereby leaving no money to provide prescription drugs or other benefits for any participants or their families.  Therefore, in order to preserve the benefits for all members of the Security Benefits Fund, the Trustees determined the following:

1)      Commencing  August 1, 2014, Sovaldi and Olysio will not be covered drugs under the CWA Local 1180 Security Benefits Fund’s plan of benefits.

2)      Participants who have been prescribed and approved for Sovaldi and/or Olysio prior to August 1, 2014 will be “grandfathered” and permitted to complete the course of treatment with Sovaldi and/or Olysio, up to a total of 84 days. Participants who are first prescribed Solvadi or Olysio on or after August 1, 2014 will be denied coverage by the Fund.


 Participants for whom Sovaldi and Olysio are prescribed and denied coverage by the Fund may contact the Patient Assistance Program. The contact person is:

Grayson Frank, CPhT
Certified Pharmacy Technician
Orchard Specialty
(330) 491-4280, e-mail:  gfrank@orchardrx.com  
Fax: 877-309-0687

This program will help those referred to apply for financial help from the drugs’ manufacturer and facilitate the acquisition of Sovaldi and/or Olysio.  

Please refer to our web site to consult the listing of our drug formulary.  It will reflect all the prescription drugs that are covered. No new drug that arrives on the market, whether a specialty drug or not, will be covered by the Local 1180 Security Benefits Fund unless and until it is approved for coverage by the Trustees.

Very truly yours,
Dwight R. Kearns
Fund Administrator

Benefits News

Major restructuring of the CWA Local 1180
Security Benefits Fund’s plan of benefits to conform with the
Patient Protection & Affordable Care Act
Beginning January 1, 2014

The Trustees of the CWA Local 1180 Security Benefits Fund (“SBF”) announce a major restructuring of the Plan of benefits as of January 1, 2014 that will provide significant new benefits to you and your family. The changes were made so that the Plan complies with the Federal Affordable Care Act requirements. Read More......

 

Benefits News
IMPORTANT NOTICE ON                
THE DEPENDENT(S) ELIGIBILITY VERIFICATION AUDIT

Since the Audit process began, numerous problems have resulted, one problem being that individuals have never received a form due to multiple people having the same name. The second situation occurs when the initial City mail is sent back to the City because it was undeliverable (i.e. person does not live at the noted address). There are at least 2,400 cases citywide of this occurring as of now.

Our agreement with the City provides that no one will be dropped until after the appeal process has been resolved:

PROVIDED THAT YOU SEND BACK YOUR FORM
BY THE OCTOBER 4, 2013 DEADLINE!

AGAIN, PROVIDED YOU SEND BACK THE FORM NO ONE WILL BE DROPPED FROM COVERAGE ON OCTOBER 1, 2013 AND COVERAGE WILL CONTINUE UNTIL THE APPEAL(S) ARE RESOLVED.

Documentation requirements

COPIES of Tax returns are optional. But you may choose to use them after blocking out income information. COPIES of Marriage and birth certificates including those from foreign government agencies are acceptable. COPIES of Passports, Utility bills and other documents listed on the form remain acceptable.
If you do not have documentation, you may submit an affidavit explaining why the dependent is eligible but the city can challenge the affidavit and you must appeal within 30 days. The dependent remains eligible until the appeals process is completed.

Please remember:
1. If you need a form or there are any problems, you should call the City's consultant AON at (855) 596-7454.

2. Members and retirees over 80 years old need not file.

BACKGROUND

The Health Insurance Dependent Verification Audit, ("Audit"), the City sent out to
employees and retirees was challenged by the Municipal Labor Committee, ("MLC"), because the City failed to negotiate with the MLC over certain mandatory subjects of collective bargaining. The MLC obtained a Temporary Restraining Order from the New York Supreme Court against the City prohibiting further implementation of the Audit. Thereafter the City and the MLC met and an Agreement was achieved to permit the Audit to continue under the following conditions:

I . The deadline to provide proof of eligibility of dependents must be submitted by
October 4, 2013. This was extended from September 20, 2013.

2. If an employee or retiree self report dependents who must be removed by October 4, 2013 that employee or retiree will not be subject to:
    A)  Recoupment of monies from premiums or claims incorrectly paid; or
    B)  Disciplinary charges.


3. If an employee or retiree submits proof of dependent eligibility by the October 4, 2013 deadline and their dependent's eligibility is denied there is a three step appeal process that ends with an expedited arbitration. During the appeal process no dependent will lose coverage. If after the appeal process, a dependent is ultimately deemed ineligible the City has indicated that it would not seek recoupment when there was reasonable disagreement or a misunderstanding(s) to eligibility.

4. Further the confidentiality and privacy of the proof that is submitted is protected in that once the proof is accepted it will be destroyed and the City's consultant will verify the destruction of the submitted proof. If there is any breach of confidentiality or privacy the MLC, the individual or his/her employee representative will have a right to file a lawsuit against the City's consultant or its subcontractors that will be receiving the submitted proof.

5. In addition the City will support legislation that will ensure no criminal charges will be
brought against any employee/retiree if that employee/retiree self reports dependents who must be removed by October 4, 2013.

In Unity,

Arthur Cheliotes, President

About Your Benefits

Welcome to Benefits

The CWA Local 1180 Security Benefits, Education Benefits, Legal Benefits and Member’s Annuity Benefits Funds are separate trusts maintained for the purpose of providing covered members with supplemental health, education benefits, legal services benefits and annuity benefits. The supplemental health benefits provided by the Security Benefits Fund are intended to augment basic health insurance and hospitalization benefits administered by employers.

The Funds are separately administered by Boards of Trustees.

The benefits provided by these Funds are the result of collective bargaining agreements between the City of New York and related public employers, the Board of Education of the City of New York, the State of New York and the Communications Workers of America, AFL-CIO on behalf of its Local 1180. These collective bargaining agreements provide for annual contributions to the Funds on behalf of each employee in a covered title in accordance with the applicable collective bargaining agreement.

The benefits provided by the Funds are made possible by the Funds’ assets which are derived from employer contributions. All of the Funds’ assets are used to provide your benefits and to defray reasonable administrative expenses   On behalf of the trustees and staff of the CWA Local 1180 Security Benefits Fund. We are pleased to provide you with this updated Summary Plan Description that describes all the benefits provided to you through the Communications Workers of America, Local 1180 Security Benefits Fund, Legal Benefits Fund, Education Fund, and Members’ Annuity Fund.

To the extent that this hand booklet describes an insured benefit (e.g., life insurance/accidental death and dismemberment), the group insurance contract specifies the exact benefits provided and the language of the insurance contract will govern in the event of any inconsistency between it and the language of this Summary Plan Description.

Every effort has been made to present this information in clear, straightforward language. Please read this Summary Plan Description carefully. If you have any questions about your benefits, the Fund Office will be pleased to answer them.

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