The Trustee is the official newsletter of the Kingston Trust Fund and is published every month of the school year.  The Trustee is distributed to members via ktfesp.org and email. Hard copies are mailed to retirees without email.  Active members who would like a hard copy, please contact the Trust and provide your name/school name.

​​​Copyright © Kingston Trust Fund Plan
Kingston Trust Fund


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​​​​​THE TRUSTEE 

January 2023
Vol XVI, No. 155
Happy New Year!

As of January 1, 2023, WithMe Health became our new pharmacy benefits manager (PBM). In December, all members were mailed new medical cards with the WithMe logo on the back. Also sent was a personalized pamphlet of information from WithMe Health with directions for accessing the pharmacy services. The pamphlet has instructions for registering with Withme, along with contact information for Manifest (mail order) and Lumicera (specialty). Members should download the Withme app, which gives members instant access to their digital IDs. Other features include the ability to chat directly with a pharmacist or pharmacy technician, find in- network pharmacies near them, find drug coverage details and do drug price checks, along with several other things. The app can be opened by scanning the QR code above, by searching “WithMe Health” in your app store, or visiting  go.withmehealth.com on your phone’s browser.

Please present your new card to your doctor(s) and pharmacy. If you have maintenance drugs and are currently using CanaRx, nothing has changed. You will continue to get your prescriptions from them. If you have a prescription that is on the CanaRx formulary, you can switch to CanaRx after one local fill.

Change is often difficult and can be confusing. In the past, our former PBM, Proact owned both the mail order and the specialty pharmacies we used. While this was convenient, it didn’t allow for transparent drug pricing. In our search for more transparent drug prices, we decided on a PBM that does not own a pharmacy.  Because of this, you will see the names of three different companies, which provide specific services. The information below will help clarify which services are provided by each company. 


When to call WithMe:

  • copays, deductibles, and max out-of-pocket expenses
  • pharmacy network
  • claims processing, submission, and payment issues
  • benefit coverage/eligibility
  • coverage decisions & appeals
  • any questions about your medications or treatment


When to call Manifest Pharmacy:

  • questions about a current or new mail order prescription
  • request to transfer prescription from retail to mail order

 
When to call Lumicera Pharmacy:

  • questions about current or new specialty medication prescription


*Specialty medications are limited to a one-month supply and are high cost/high complexity drugs.


As always, call the Compliance Office (844-583-3863, x5) with concerns/ complaints, or if you are having issues, you are unable to resolve directly with WithMe or the pharmacies. 


Retiree Medicare Reimbursement Part B

Retirees who are Medicare eligible are entitled to reimbursement from the district for their Medicare Part B premiums. In the fall, the district sent letters to all KTF retirees asking for proof of payment. Those who submitted were reimbursed members for their payments, including IRMAA. Reimbursement of Medicare Part B standard premium was a long-standing practice by the district. However, recently this practice has been challenged by other school districts and public entities. To protect our members, during the most recent negotiations of Kingston Teachers’ Federation contract, language was added to the contract to provide for Medicare part B and IRMAA reimbursement. This language included a board policy to include all prior retirees. Beginning in March of 2023, the district will request proof of payment amounts yearly and reimburse retirees in two payments. The first half will be reimbursed in June and the second half in December of each year.  Acceptable proof is your Social Security Benefits Verification Statement from the Social Security Administration or a copy of your SSA 1099. Contact Amanda Wells at the Kingston City School central offices for more information.


COVID Immunizations Payment from the District

The Kingston Teachers’ Federation contract language states:
“At such time as the Ulster County Health Department declares that the danger exists of any disease reaching epidemic proportions, the District shall, in the of those diseases for which there is immunization, provide such immunization free of charge to the members of the teachers’ unit who request it.”

At the request of the Trust, the KTF filed a grievance for reimbursement of monies spent by the Trust, for members who received COVID vaccines for a fee. The district and the KTF settled the grievance with the district agreeing to pay the cost for active members who received the vaccines that were charged to the Trust Fund, during the 2021-2022 school year.  The Trust is awaiting the payment from the district.


In Memoriam

Anna McGinnis