Retiree Forms


pdf nyc_office_of_labor_relations_information_form.pdf



pdf nyc_office_of_labor_relations_change_of_address_form.pdf



pdf Retiree_procedures.pdf




Retiree Fund Medicare “D” Information  
Important Notice from the Retiree Health and Welfare Fund of the Patrolmen’s Benevolent Association of the City of New York About Your Prescription Drug Coverage and Medicare.
Please read this notice carefully and keep it where you can find it.
This notice has information about your current prescription drug coverage with the Retiree Health and Welfare Fund of the Patrolmen’s Benevolent Association of the City of New York (“the Fund”) and prescription drug coverage available for people with Medicare. It also explains the options you have under Medicare prescription drug coverage and provides information about where you can get help to make decisions about your prescription drug coverage.  
Medicare prescription drug coverage became available in January of 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
An actuary has determined that the prescription drug coverage offered by the Fund is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage.
Because your existing coverage is as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay extra if you later decide to enroll in Medicare prescription drug coverage.
Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from November 15th through December 31st. Beneficiaries leaving employer/union coverage may be eligible for a Special Enrollment Period to sign up for a Medicare prescription drug plan. You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area.  
If you do decide to enroll in a Medicare prescription drug plan, you will still be covered by the Fund. Your prescription drug coverage through the Fund will be secondary to your Medicare prescription drug coverage.
You may contact the Funds Office at 212-349-7560 for more information.