Medicare

For members and eligible dependents covered under the Relief PPO Medical Plan, there are adjustments made in premiums for those reaching the age of 65, who are no longer active duty. It is mandatory to sign up for Medicare.

You should begin the enrollment process with Medicare 90 days before your 65th birthday to allow sufficient time to process your application.

About Medicare's Three Parts

To sign up for Medicare:

Visit your local Social Security office or contact Social Security at (800) 772-1213. You can also obtain information on your Medicare eligibility, the latest deductible rates and premiums, by visiting medicare.gov. Once on the site, click “Enrollment” and use the Medicare Eligibility Tool for a step-by-step guide.

How to notify the Relief of your Medicare status:

Fax a copy of your Medicare card to (323) 259-5222 or (323) 259-5223.
You may also mail a copy to the Relief at:

Member Services
Los Angeles Firemen’s Relief Association
7470 N. Figueroa Street
Los Angeles, CA 90041

If you require additional information, contact Member Services at (323) 259-5200 or memberservices@lafra.org.

How Medicare Works with the Relief PPO Medical Plan, when Medicare is Primary:

For persons enrolled in Part “A” and “B” of Medicare:
The Relief Plan will pay the inpatient hospital deductible and coinsurance during the periods of extended confinement in which you or your eligible dependent is receiving Medicare Part “A” benefis. The Plan will reimburse the Part “B” deductible amount and pay 20% of the charges allowed by Medicare plus 80% of any unpaid balance, but not an amount that would exceed that which The Plan would pay in the absence of other insurance.

For persons enrolled in Part “B” only of Medicare:
The Plan will pay the current hospital benefits, less laboratory and x-ray charges covered under Part “B.” The Plan will reimburse the Part “B” deductible amount and pay 20% of the charges allowed by Medicare plus 80% of any unpaid balance, but not an amount that would exceed that which The Plan would pay in the absence of other insurance.

EXAMPLE

  1. If the rendering Physician accepts Medicare assignment, the Plan will reimburse 100% of your Medicare co-insurance amount.
  2. If the rendering Physician does not accept Medicare assignment, the patient is responsible for the total Charged Amount.When Physician Does Not Accept Medicare Assignment
  3. The Los Angeles Firemen’s Relief Association will reimburse in the absence of payment by the primary payor under the following situations:

a. if the Medicare approved amount is applied to the Medicare deductible; and/or
b. if Medicare denied services which may be covered by the Los Angeles Firemen’s Relief Association.

Contact HealthScope at (866) 995-2372 or medical@lafra.org for more information on The Plan’s reimbursement.

Payment of Claims:
You, your eligible Dependent, the Physician or Hospital must submit all expenses to Medicare for payment. A request for payment form is included with your Medicare handbook or you may obtain the forms from your local Social Security office.

In order to be reimbursed by the medical Plan, you, your eligible Dependent, the Physician or
Hospital must submit the “Explanation of Medicare Benefits” voucher and an itemized bill to the medical Plan. You may indicate on the voucher if you wish the reimbursement check to be issued to you, the Physician or to the Hospital. No vouchers will be returned. Please keep a copy of the voucher, for your records, before you mail it.

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