Frequently Asked Questions

Who is eligible to participate in Open Enrollment?

Police and Fire Retirees who separated from active service with the City of Detroit on or before December31, 2014, and are currently in receipt of pension benefits from the Police and Fire Retirement System of the City of Detroit are eligible to participate in the VEBA. Additionally, spouses that were married to an eligible Police or Fire retiree at the time of retirement are also eligible to independently participate in the VEBA’s Medicare Advantage plans or HRA, even if the retiree elects not to participate in any of the VEBA’s benefit offerings. Similarly, if you are a spouse and were married after the member retired, but prior to August 26, 2009, and you and your retiree spouse are both members of the Weiler Class as provided under the Weiler v. City of Detroit settlement agreement, you may also be eligible for your own HRA or Medicare Advantage Plan from the VEBA.

Can I make changes to my coverage during the year?

No, as is common in most group insurance plans, once the coverage period begins, you cannot switch to another plan, terminate coverage, add or remove dependents or otherwise make changes during the coverage year unless a verifiable life event occurs. (Examples of life events include, death, divorce, enrollment in Medicare Part A and Part B, permanent address change in instances where your current healthcare plan is not available in the new area.) 

Can I make changes to my dental and/or vision coverage during the year?

You cannot switch to another dental or vision plan during the coverage year. But if you wish to terminate your dental or vision plan during the coverage year you are permitted to do so. However, please note, if you terminate your dental and/or vision coverage during the plan year, you will not be eligible to re-enroll for dental/vision coverage for two years.

Am I required to be enrolled in Medicare to qualify for VEBA medical coverage?

Yes, all persons enrolled in the Medicare Advantage plans offered through the VEBA must be enrolled in Medicare Part A and Part B and continue paying their Medicare Part B premiums.

When should I enroll in Medicare?

You, your spouse and other eligible dependents seeking VEBA medical coverage should enroll in Medicare Part A and Part B as soon as you become eligible. Most people become eligible for Medicare at age 65. It is your responsibility to contact the local Social Security Administration (SSA) office to apply for Medicare. To allow sufficient time to process your application it is recommended that you apply three (3) months prior to reaching age 65. Please note if you fail to enroll in Medicare Part B when first eligible you may be subject to a financial penalty which will increase your monthly Medicare Part B premiums. Also note, if you are entitled to Social Security disability benefits, have end-stage renal disease, or undergo a kidney transplant, you may be eligible for Medicare coverage prior to age 65, and should contact your local SSA office to have your case evaluated for Medicare eligibility.

Note: When you receive your Medicare Card, you MUST notify BeneSys, call (833) 725-5336.

Is documentation required when adding a dependent?

Yes, when adding dependents to your healthcare coverage you will be required to submit documentation to substantiate eligibility for coverage. Examples of documentation that may be required include, but are not limited to: birth certificate, marriage certificate (a marriage license is not accepted), legal guardianship papers (stating full and permanent custody), proof of residency, and the last Federal 1040 filed.

Providing False Information:

Retirees, spouses or eligible dependents who submit false information intended to provide health care coverage for alleged dependents not eligible for such coverage will be held financially responsible for all claims filed and will be required to reimburse the VEBA for any payments made on behalf of or for the benefit of an ineligible person claimed as a dependent. Also, be aware that even if you had been in a long period of marriage while you were actively employed, if that former marital partner is now divorced from you (is your ex-spouse) then he/she is NOT eligible for our retiree healthcare benefits even though you are.

Audits:

Periodic audits will be conducted to ensure that retirees, spouses and dependents currently enrolled in VEBA healthcare plans are eligible for coverage. During these audits, the terms and conditions of your retirement will be examined. In addition, retirees will be required to provide documentation to substantiate that their covered dependents continue to be eligible for coverage. If you receive a notice of audit, you must provide the documentation within the time period specified in the notice or the coverage for your dependent will be terminated. If it is determined that a retiree and/or his/her dependent is not eligible for healthcare the coverage will be immediately terminated.

Note: It is the responsibility of the retiree/beneficiary to notify BeneSys when covered dependents are no longer eligible for healthcare coverage. Events that can make a dependent ineligible for coverage include, but are not limited to, marriage, divorce, age or no longer being a dependent of the retiree/beneficiary (i.e., can no longer be claimed as a dependent on his/her federal income tax return). In general, the termination of coverage becomes effective at the end of the month in which the disqualifying event occurs. However, the coverage termination date for an ex-spouse is the date of the divorce decree. Please note that you will be financially responsible for all claims and premiums associated with an ineligible dependent.

How do I pay for my healthcare plans?

The required monthly payment for your medical, dental and/or vision plan will be automatically deducted from your monthly pension check. The amount being deducted appears on your pension check stub. You are responsible for monitoring your pension check stubs to verify that the deductions are proper. If an incorrect amount is being deducted, you must immediately report it to BeneSys.

My pension will not cover the cost for my healthcare, how do I pay?

If you are eligible for healthcare, but do not receive a pension check or the amount of your pension is insufficient to cover the cost of the monthly premium(s), you will need to contact BeneSys to set up a direct payment plan at no. If you are on a direct pay plan but fail to submit your payments in accordance with the pay schedule, your coverage will be terminated.

Who do I contact to change my address?

It is important to keep your address updated in two places, the City of Detroit Pension Office and BeneSys. You are required to notify BeneSys of your address change so that you will continue to receive information from the VEBA and other mailings regarding healthcare benefits. To change your address for healthcare purposes please contact BeneSys Troy office at (833) 725-5336 or TMR Detroit office at (313) 963-1135.

I purchase health insurance on a public healthcare exchange and receive federal tax subsidies. Will the HRA affect these subsidies?

Please be aware that HRAs are considered to be group health plans within the meaning of Internal Revenue Code § 9832(a); Section 733(a) of the Employee Retirement Income Security Act of 1974 (ERISA); and section 2791(a) of the Public Health Service Act. If you are currently purchasing health insurance on a public healthcare exchange, HRA coverage through the RHC Trust will be considered "other health coverage" and may result in your ineligibility for federal tax credits on the public exchanges. Therefore, if you are currently receiving federal tax credits, you may want to opt-out of coverage under the RHC Trust in order to preserve your eligibility for such tax credits on the public health exchanges.

What expenses are eligible for reimbursement under my Health Reimbursement Account?

A Health Reimbursement Arrangement (HRA) can cover a wide variety of expenses. We've assembled a list of common expenses that are eligible for reimbursement. Not all eligible items are on this list. For a more exhaustive list, visit our website at www.irs.gov/pub502.

Items marked with an asterisk (*) are considered over-the-counter (OTC) medicines or drugs and require a prescription for reimbursement.

 Healthcare Premiums - Medicare Supplemental, Medicare Advantages, and Medicare Part D.

 Additional Documentation Required

Certain medical expenses are not reimbursed under a Health Reimbursement Arrangement (HRA) unless a licensed health care practitioner states that the service or product is medically necessary. 

Ineligible Health Care Expenses

The following expenses are not eligible under a Health Care Reimbursement (HRA). Under no circumstance will the following items be reimbursed. Please do not submit claims for these items.

I want to opt-out of the HRA plan so I can continue to receive federal tax credits on the public exchanges. What do I do?

You may elect to opt-out at any time, by providing written notifications of your election to opt-out to the Benefits Administration Office. Your opt-out notification should be directed to Benefits Administration as follows: 

BeneSys
Suite 300 
700 Tower Drive
Troy, Michigan 48098
(833) 725-5336
(248) 641-9898 fax

Note that verbal requests to opt-out of the HRA will not be accepted.   

What is the RHC Trust?

The RHC Trust was established under the Plan for the Adjustment of Debts of the City of Detroit to provide health benefits to certain eligible former City of Detroit employees. The RHC Trust is established as a tax-exempt voluntary employees beneficiary association (VEBA) under Section 501(c)(9) of the Internal Revenue Code, as amended. Pursuant to Section 501(c)(9) of the Internal Revenue Code and Section 2.1 of the RHC Trust Agreement, the RHC Trust is limited to providing health and welfare type benefits to eligible retirees and their beneficiaries.

The Board of Trustees for the Police & Fire RHC Trust are:  

Leadership

Chet Opolski               Tracy Shippy             Greg Trozak

Chair                             Vice Chair                  Trustee 

Floyd Allen                  Brian Roehl               Rick Kosmack

Trustee                         Trustee                       Trustee

Dan Bojalad                 Aaron Castle   

Secretary                      General Counsel