The CSA Retiree Welfare Fund has established a Home Health Care Benefit for members or dependents who require such services as certified by a physician. The purpose of this benefit is to provide necessary home care for members and/or eligible dependents who became incapacitated as result of injury or illness and who, as a result of that injury or illness, cannot perform at least two activities of daily living without assistance as certified by the patient’s primary care physician. Services must be provided by a licensed home care agency or certified home health aide who is not related to the patient. No reimbursement will be made if the service provider is paid in cash unless there is a receipt signed by the provider. The benefit provides reimbursement up to an annual maximum of $10,000 with a lifetime maximum of $30,000. Claims are paid at 80% after the annual Home Health Aide Benefit deductible of $100 is met and will be based upon the CSA Retiree Welfare Fund’s determination of reasonable and customary charges. A copy of the certified aide or agency’s state certification and Taxpayer ID Number (TIN), either Federal employer number or individual social security number is required with the initial claim submission.
Members are encouraged to review the specific conditions for this benefit in their CSA Retiree Welfare Fund Benefits Booklet.
Home Health Aide Claims Procedures
Home Care Claim Form
Home Health Aide Provider Record
Acupuncture Benefit
The CSA Retiree Welfare Fund will reimburse 80% of out-of-pocket costs, for up to 36 treatments provided by a licensed acupuncturist. Requests for reimbursement must be submitted on a receipt showing the provider’s name and address and state license number, as well as an itemized description of the service(s) provided, including procedure code and description, and amount charged for each service. If the provider is not state licensed (or lives in a state which does not license acupuncturists), he or she must be accredited by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) and produce proof of accreditation. A maximum charge of $100 per visit is allowed.
Hospitalization Coverage
Coverage for hospitalization is provided by the Basic City Health Plan for members enrolled in HIP/HMO or any of the other HMO plans offered by the City to its active or retired employees.
The City coverage for members enrolled in Empire Blue Cross and GHI/CBP provides hospitalization coverage for 365 days in full for retirees under 65 years of age. For retirees over 65 years of age covered by Medicare, extended coverage for 365 days plus other additional benefits such as coverage for prescription drugs is offered only through the purchase of an optional benefits rider. The CSA Retiree Welfare Fund has assumed the cost to the City to provide CSA Retirees enrolled in either GHI/CBP or GHI Type C with 365 days of hospitalization coverage. Members enrolled in either of these plans will automatically be covered for this benefit. Members who purchase the optional benefits rider will not be charged for the cost of the extended hospitalization part of the rider. They will only pay for the other benefits, such as prescription drugs.
Note: The CSA Retiree Welfare Fund’s coverage for extended hospitalization for the member and his/her eligible dependent can only be applied if the Basic Health Plan (GHI/CBP or C) is in the name of the CSA Retiree.
