SUMMER 2015
BENEFITS TOOLBOX
A publication of the New York City District Council Of Carpenters Benefit Funds
NEW OUT-OF-POCKET MAXIMUM TO LIMIT YOUR COVERED PRESCRIPTION DRUG EXPENSES
I
n accordance with the Affordable Care Act (ACA), the NYCDCC Welfare Fund Plan has set a limit on the annual out-ofpocket costs you could pay for covered services. This limit is referred to as your “Out-of-Pocket maximum.� Once you have reached your Out-of-Pocket maximum for the year, the Plan pays 100% of your covered prescription drug claims. As stated in the Summary of Material Modifications (SMM) recently sent to eligible participants, the Out-ofPocket maximum became effective July 1, 2015, and will be prorated through the end of the year. Therefore, for the period beginning July 1, 2015 through December 31, 2015, the prescription drug Out-of Pocket maximum will be $1,500 if you have single coverage, and $3,750 if you have family coverage. Effective January 1, 2016, the Out-of-Pocket maximum will be $3,000 per year if you have single coverage and $7,500 per year if
Benefits Toolbox / Summer 2015
you have family coverage. (*NoteIf you are a Retiree, these numbers vary. Please refer to your SMM for more details.) Please note that only copayments for in-network covered expenses will accumulate toward your annual Out-of-Pocket maximum. You are still responsible for the full cost of non-covered expenses, as well as the difference in cost when you purchase a brand name which has a generic equivalent.
Also note that the Out-of-Pocket maximum for prescription drugs is separate from the Out-of-Pocket maximum for medical and hospital benefits. The medical and hospital Out-of-Pocket maximum remains unchanged. If you have any questions on how these changes affect your coverage, please call the Member Services Department at (800) 529-FUND (3863).