Medicare pays for an Annual Wellness Visit (AWV). It’s an awesome free preventive service that so many Medicare patients have not been taking advantage of. Since the onset of COVID-19, the number of AWVs being performed has fallen drastically, as many people have chosen to put off elective services. However, it’s important for you to do what is best for your health. That also means it may be best to take the time to have this service. If you talk to your healthcare provider and they say that it’s safe for you to have an AWV, then it makes sense to consider doing so.
First off, what is an AWV?
An Annual Wellness Visit is a visit to develop or update a preventive services plan that is personalized to your needs and to perform a Health Risk Assessment (HRA). An AWV comes in two sizes: your initial AWV and your follow-up AWV. Your initial AWV sets the baseline for future visits. Before or during this visit, you will complete a Health Risk Assessment (HRA) questionnaire, which will collect at a minimum:
Your demographic data and a health status self-assessment
Your assessment of depression/life satisfaction, stress, anger, pain, fatigue, isolation or loneliness
Information on behavioral risks, including, but not limited to, if you smoke or use tobacco products, drink alcohol or use drugs, your physical activity and your nutrition
Information on your ability to do general activities of daily living, such as washing clothes, bathing, walking, ability to stand for periods of time, etc.
During an initial AWV, your provider will create a baseline of your medical and family history, capture information about your current list of doctors and medications that you take, and gather measurements of your height, weight, blood pressure and other routine measurements as they apply based on your medical and family history. Your provider may also perform a cognitive impairment assessment to check for Alzheimer’s disease or dementia, and for depression and other mood disorders.
Your healthcare provider will review all of the information you provided to them, along with what they have observed focusing on your ability to do general activities of daily living, your risk of falling, plus any hearing impairments or potential home safety issues that may come up during the visit.
From all of this, your provider will create a written schedule/checklist, for the next five to 10 years for future screening visits and preventive services. Your provider will also give you personalized referrals for health education, preventive programs or counseling services based on what the AWV data has shown them.
These recommended services or programs can help you reduce risk factors or promote wellness, such as increasing weight loss and physical activity, as well as preventing falls and improving your nutrition. Referrals can be made for programs to help you quit smoking. You can also work with your provider to produce Advanced Care Planning documents such as living wills, advanced directives and other documents that instruct others about your healthcare wishes in the event you are unable to do so due to injury or illness.
That’s the first AWV. The second type of AWV is considered a follow-up AWV, or just a plain AWV.
At this AWV visit, you will review and update your HRA and your provider will update your medical/family history, the list of your current providers and medications and your measurements – including weight and blood pressure. Your provider will then make any needed changes to your screening schedule and your personalized health plan, and make new referrals, if necessary, to keep current with your needs. It is important to have this service every year. Your body is constantly changing – every day, every week, every month, every year. You take care of your plants, your car, your family, and you need to remember to take care of yourself as well.
How often can you get an AWV?
You can receive an AWV if:
It has been more than 12 months since the effective date of your first Medicare Part B coverage period, and
You have not received an Initial Preventive Physical Examination (IPPE, or “Welcome to Medicare” exam ) or an AWV within the past 12 months.
Where can I get an AWV?
Many healthcare providers are authorized to perform AWV services. They include:
A medical professional (including a health educator, registered dietitian, nutrition professional or other licensed practitioners) or a team of medical professionals working under the direct supervision of a physician.
Teaching physicians in graduate medical education programs can perform these services in certain specific circumstances.
If you have a question about the AWV, please call Palmetto GBA’s toll-free Beneficiary Contact Center at 800-833-4455, from 8:30 a.m. until 7 p.m. ET Monday through Friday. They offer a TTY/TDD line at 877-566-3572. This line is for the hearing impaired with the appropriate dial-up service and is available during the same hours as customer service representatives are available. Palmetto’s website is www.PalmettoGBA.com/RR/Me, and offers access to a free self-service internet portal, MyRRMed. MyRRMed offers you access to your healthcare data.
At this time, you can use the portal to access:
Status and details of your Railroad Medicare Part B claims;
Historical Medicare Summary Notices (MSNs) for your Railroad Medicare Part B claims;
A listing of individuals you have authorized to have access to your private health information; and
You can also submit a request to add an authorized representative or to edit or remove an existing authorized representative.
While we are coming up to the one-year anniversary of the coronavirus being present in the United States, we are happy to report that Medicare is taking action with the administration of the coronavirus vaccine across the country.
As the vaccinations roll out, we are receiving questions about the process, and we would like to share them and the answers with you. They are:
What does the vaccine cost?
The vaccine is free. Medicare will pay your provider for administering the vaccine, and you will not be charged in any way. If a provider tries to collect co-pays or any other types of funds specific to the coronavirus vaccine (such as coinsurances or deductibles), please call our office and let us know.
How is the vaccine being distributed?
Every state has its own vaccine distribution plan, and you can access that information from each state’s health department. To find a listing of states and their health departments, their websites and phone numbers, please see the article “What You Don’t Know May Make A Difference” on the Palmetto GBA website at www.PalmettoGBA.com/RR/Me. You can also find a listing on the Centers for Disease Control and Prevention (CDC) website at www.CDC.gov.
Where can I find out more about the individual vaccines?
There are two vaccines being used. They are Pfizer-BioNTech COVID-19 vaccine and Moderna’s COVID-19 vaccine. Additionally, per the CDC, there are three large-scale (Phase 3) clinical trials in progress or being planned for three COVID-19 vaccines:
AstraZeneca’s COVID-19 vaccine
Janssen’s COVID-19 vaccine
Novavax’s COVID-19 vaccine
As each vaccine is approved and authorized, the CDC publishes information on who should or should not receive that particular vaccine based on health profiles. Additionally, the CDC will publish information to include the vaccine’s ingredients, its safety and its effectiveness. This information is located on the CDC website at www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines.html.
Can I get my shot sooner if I pay for that?
The vaccine is available based on each state’s distribution program. If someone contacts you and tells you that you can pay to either have your name put on a list to receive the vaccine (when you were not on the list yet to receive the shot) or tells you that you can pay to receive the vaccine sooner than you are scheduled for, do not believe them. These “opportunities” do not exist. And as always, do not share your personal and financial information with people who call, text or email you with any offer like this. Keep your private information private. The government will never call you and ask you for money.
If you have a question about Medicare’s coverage of the coronavirus vaccine, please call Palmetto GBA’s Beneficiary Contact Center at 800-833-4455, or for the hearing impaired, call TTY/TDD at 877-566-3572. Customer service representatives are available Monday through Friday, from 8:30 a.m. until 7 p.m. ET.
You are encouraged to visit the Palmetto GBA website at www.PalmettoGBA.com/RR/Me, as well as enrolling to use their free self-service internet portal, MyRRMed. MyRRMed offers you access to your healthcare data. At this time, you can use the portal to access:
Status and details of your Railroad Medicare Part B claims
Historical Medicare Summary Notices (MSNs) for your Railroad Medicare Part B claims
A listing of individuals you have authorized to have access to your private health information.
You can also submit a request to add an authorized representative or to edit or remove an existing authorized representative.
Palmetto GBA is the Railroad Specialty Medicare Administrative Contractor (RRB SMAC) and processes Part B claims for Railroad Retirement beneficiaries nationwide. Palmetto GBA is contracted by the independent federal agency Railroad Retirement Board (RRB), which administers comprehensive retirement-survivor and unemployment-sickness benefit programs for railroad workers and their families under the Railroad Retirement and Railroad Unemployment Insurance Acts.
The order implements President Joe Biden’s Executive Order 13998, Promoting COVID-19 Safety in Domestic and International Travel, “to save lives and allow all Americans, including the millions of people employed in the transportation industry, to travel and work safely.”
In an announcement of the order sent to Federal Railroad Administration stakeholders and partners on Jan. 31, an agency representative wrote the following: “Science-based measures are critical to preventing the spread of COVID-19. Mask-wearing is one of several proven life-saving measures including physical distancing, appropriate ventilation and timely testing that can reduce the transmission of COVID-19. Requiring masks will protect America’s transportation workers and passengers, help control the transmission of COVID-19, and aid in re-opening America’s economy.”
In addition to the CDC order, the Transportation Security Administration (TSA) anticipates issuing additional information and guidance.
The SMART Voluntary Short Term Disability Plan (VSTD) has temporarily suspended the elimination period for COVID-19 disabilities. Previously, the waiver of the elimination period began in the month of March and extended through May of this year and then was once again extended until November 2020.
SMART, in conjunction with Southern Benefit Administrators, is pleased to announce that the waiver of the elimination period is being extended through February 28, 2021. Effective with all diagnosed COVID-19 disabilities beginning in the months of March 2020 through February 2021, the Plan’s elimination period will be waived. A member must usually be disabled for 21 days before benefits will begin on the 22nd day. With the waiver of the elimination period, members who have tested positive for COVID-19 will have earlier access to benefits.
The waiting period will be reinstated for COVID-19 disabilities beginning on or after March 1, 2021.
The lifetime maximum benefit for the Railroad Employees National Early Retirement Major Medical Benefit (ERMA or GA-46000) Plan will increase from $171,100 to $175,700 beginning Jan. 1, 2021.
At the end of 2001, labor and management had agreed on various procedures to administer the annual changes in the amount of the lifetime maximum benefit under the ERMA Plan.
In conjunction with the formula established in 2001, a new lifetime maximum was calculated by utilizing the October 2020 consumer price index (CPI) data for Hospital and Related Services and Physician Services. The result is a lifetime maximum for 2021 of $175,700.
For individuals who have reached the lifetime maximum, the incremental maximum available is applied to eligible expenses submitted for dates of service on or after the effective date of the new maximum. For 2021, this amount will be $4,600.
This change will apply to all railroads and crafts participating in ERMA.
Private rail pensions may reduce supplemental annuities
Railroad Retirement beneficiaries are reminded that receipt of a private railroad pension may reduce the amount of a supplemental annuity payable by the Railroad Retirement Board (RRB). The following questions and answers provide information on this subject and how 401(k) plans are affected by the Railroad Retirement Act (RRA).
1. What are the eligibility requirements for a supplemental annuity?
Monthly supplemental annuities are payable to employee annuitants with 25 or more years of rail service, a “current connection” with the railroad industry, and at least one month of creditable rail service before October 1981. Individuals with 30 years or more of rail service may begin receiving a supplemental annuity at age 60, whereas individuals with 25-29 years of service may do so at age 65. (Disabled annuitants under full retirement age, which is gradually rising to age 67 for those born in 1960 or later, must relinquish employment rights in order for a supplemental annuity to be paid by the RRB.) Monthly supplemental annuity rates vary based on an annuitant’s years of rail service. The maximum monthly supplemental annuity rate is $43.
2. How does the receipt of a private railroad pension affect payment of a supplemental annuity?
If a retired employee also receives a private pension funded entirely, or in part, by a railroad employer, the supplemental annuity is permanently reduced by the amount of the monthly pension that is based on the railroad employer’s contributions. However, if the employer reduces the pension for the employee’s entitlement to a supplemental annuity, the amount by which the pension is reduced is restored to the supplemental annuity (but does not raise it over the $43 maximum). There is no reduction for a pension paid by a railroad labor organization.
3. What if an employee elects to receive the pension in a lump-sum payment instead of as a monthly benefit?
If a retired employee elects to receive his or her pension in a lump-sum payment instead of as a monthly benefit, the supplemental annuity is reduced in the same way as it would be if the employee was receiving the monthly benefit. (If the lump sum is paid in installments, the installment payments are not considered monthly benefit payments, but part of the single lump-sum payment.)
4. Does the receipt of a 401(k) plan distribution reduce the amount of a supplemental annuity?
No. In Legal Opinion L-2014-2, issued January 13, 2014, the RRB’s general counsel determined that 401(k) plans should not be considered supplemental pension plans as defined by the Railroad Retirement Act and, therefore, employee supplemental annuities should not be reduced due to the receipt of 401(k) distributions.
5. Are employee contributions to a 401(k) plan subject to Railroad Retirement Tier I and Tier II payroll taxes?
Yes. Federal budget legislation enacted in 1989 and effective January 1, 1990, provided that employee contributions to 401(k) plans are subject to Railroad Retirement payroll taxes and brought the treatment of 401(k) plans under Railroad Retirement law into conformity with the treatment of such plans under Social Security law. Consequently, employee contributions to a 401(k) plan are also treated as creditable compensation for Railroad Retirement benefit purposes. (For example, an employee earning $40,000 a year, but who has 10% of his earnings deferred under a 401(k) plan, would have only $36,000 reported to the IRS as earnings subject to federal income tax. However, the entire $40,000 would be subject to Railroad Retirement payroll taxes and therefore creditable as compensation under the Railroad Retirement Act.)
6. How can a person get more information about how private rail pensions and 401(k) plan payments affect supplemental annuities?
More information is available on RRB.gov or by contacting an RRB field office. It is important to know that while nearly all of the RRB’s 53 field offices are physically closed to the public until further notice because of the COVID-19 outbreak, they remain accessible by email and phone. Customers are encouraged to send a secure email to their local office by accessing the Field Office Locator and clicking on the link at the bottom of their local office’s page. Customers who prefer talking to an RRB employee can call the agency’s toll-free number (1-877-772-5772); however, they may experience lengthy wait times due to increased call volume caused by COVID-19 related issues.
Medicare Part B premiums for 2021
The Centers for Medicare & Medicaid Services (CMS) has announced that the standard monthly Part B premium will be $148.50 in 2021, an increase of $3.90 from $144.60 in 2020. Some Medicare beneficiaries will pay less than this amount because, by law, Part B premiums for current enrollees cannot increase by more than the amount of the cost-of-living adjustment for Social Security (Railroad Retirement Tier I) benefits.
Since the cost-of-living adjustment is 1.3% in 2021, some Medicare beneficiaries will see an increase in their Part B premiums but still pay less than $148.50. The standard premium amount will also apply to new enrollees in the program. However, certain beneficiaries will continue to pay higher premiums based on their modified adjusted gross income.
The monthly Part B premiums that include income-related adjustments for 2021 will range from $207.90 to $504.90, depending on the extent to which an individual beneficiary’s modified adjusted gross income exceeds $88,000 (or $176,000 for a married couple). The highest rate applies to beneficiaries whose incomes exceed $500,000 (or $750,000 for a married couple). CMS estimates that about 7% of Medicare beneficiaries pay the larger income-adjusted premiums.
Beneficiaries in Medicare Part D prescription drug coverage plans pay premiums that vary from plan to plan. Part D beneficiaries whose modified adjusted gross income exceeds the same income thresholds that apply to Part B premiums also pay a monthly adjustment amount. In 2021, the adjustment amount ranges from $12.30 to $77.10.
The Railroad Retirement Board withholds Part B premiums, Part B income-related adjustments and Part D income-related adjustments from benefit payments it processes. The agency can also withhold Part C and D premiums from benefit payments if an individual submits a request to his or her Part C or D insurance plan.
The following tables show the income-related Part B premium adjustments for 2021. The Social Security Administration (SSA) is responsible for all income-related monthly adjustment amount determinations. To make the determinations, SSA uses the most recent tax return information available from the Internal Revenue Service. For 2021, that will usually be the beneficiary’s 2019 tax return information. If that information is not available, SSA will use information from the 2018 tax return.
Railroad Retirement and Social Security Medicare beneficiaries affected by the 2021 Part B and D income-related premiums will receive a notice from SSA by the end of the year. The notice will include an explanation of the circumstances when a beneficiary may request a new determination. Persons who have questions or would like to request a new determination should contact SSA after receiving their notice.
Additional information about Medicare coverage, including specific benefits and deductibles, can be found at www.medicare.gov.
# # #
2021 PART B PREMIUMS
Beneficiaries who file an individual tax return with income:
Beneficiaries who file a joint tax return with income:
Income-related monthly adjustment amount
Total monthly Part B premium amount
Less than or equal to $88,000
Less than or equal to $176,000
Greater than $88,000 and less than or equal to $111,000
Greater than $176,000 and less than or equal to $222,000
Greater than $111,000 and less than or equal to $138,000
Greater than $222,000 and less than or equal to $276,000
Greater than $138,000 and less than or equal to $165,000
Greater than $276,000 and less than or equal to $330,000
Greater than $165,000 and less than or equal to $500,000
Greater than $330,000 and less than or equal to $750,000
$500,000 and above
$750,000 and above
The monthly premium rates paid by beneficiaries who are married, but file a separate return from their spouses and who lived with their spouses at some time during the taxable year, are different. Those rates are as follows:
Beneficiaries who are married, but file a separate tax return, with income:
Income-related monthly adjustment amount
Total monthly Part B premium amount
Less than or equal to $88,000
Greater than $88,000 and less than or equal to $412,000
Railroad Unemployment and Sickness Benefits Will See Slight Decrease in New Sequestration Reduction Rate
Under the Budget Control Act of 2011, and a subsequent sequestration order to implement mandated cuts, railroad unemployment and sickness insurance benefits are reduced by a set percentage that is subject to revision at the beginning of each fiscal year.
Starting October 1, 2020, the U.S. Railroad Retirement Board (RRB) will reduce railroad unemployment and sickness insurance benefits by 5.7%, down from the current 5.9% reduction, as required by law. The adjusted reduction amount is based on revised projections of benefit claims and payments under the Railroad Unemployment Insurance Act and will remain in effect through September 30, 2021, the end of the fiscal year. Reductions in future fiscal years, should they occur, will be calculated based on applicable law.
The current daily benefit rate for both unemployment and sickness is $80.00. Applying the sequestration rate of 5.7%, the maximum amount payable in a two-week period will be reduced from $800.00 to $754.40. Sickness benefits paid to an employee within six months from the date last worked for a reason other than an on-the-job injury are also subject to regular tier I railroad retirement taxes, resulting in a further reduction of 7.65%. Applying the 5.7% reduction to these sickness benefits will result in a maximum two-week total of $696.69.
In fiscal year 2019, the RRB paid about $13 billion in retirement and survivor benefits to about 535,000 beneficiaries, and net unemployment-sickness benefits of about $93.4 million to approximately 23,000 claimants.
Telehealth is a Medicare-approved healthcare service between a provider and a patient via a telecommunication system (such as by phone or video chat). It’s been a covered service for more than a decade, focusing on rural areas where appropriate care may be hard to come by. Patients would be “seen” via a communications medium at a Medicare-approved location (not their homes), and the provider and the facility they were “seen” at would receive payment for the service.
Let’s fast forward to today. The model has changed. As of March 6, 2020, providers can perform “office” visits and other expanded services via telecommunications to a beneficiary at their home. Regulations require that the provider (your doctor, a physician assistant, nurse practitioner, etc.) have an interactive audio and video communications system for use in this service. An “office visit” is another term for a “doctor’s visit;” however, visits completed through telehealth can also include emergency department visits, initial hospital and nursing facility visits and hospice visits. Telehealth services also include psychotherapy, services for substance use disorders, certain physical, occupational and speech-language pathology services and many others.
The expansion to allow for telehealth services in a patient’s home are part of Medicare’s response to the COVID-19 Public Health Emergency (PHE) starting on March 6, 2020. Many Medicare patients are more vulnerable to this disease, based on their medical conditions and age. As such, the expansion of telehealth services makes sense for both the provider and the patient. This has been especially important as many provider offices were closed or were not accepting in-person visits with beneficiaries. Providers are still required to perform the service in a Medicare-approved location, such as a physician’s office, skilled nursing facility or hospital.
Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS) and a member of the White House Coronavirus Task Force, said that this expansion of services “represents a seismic shift, initiating a new era of healthcare delivery in America,” per CMS. (To learn more about Administrator Verma’s comments, please visit the CMS website at www.CMS.gov/Newsroom).
If you have a telehealth service, Part B coinsurance and deductible apply. You pay 20% of the Medicare allowed amount after your Part B deductible has been met. These costs are the same as if you had an in-person visit. If you have a preventive or screening service, for which the Part B coinsurance and deductible do not apply, you will pay nothing.
Be sure to watch your quarterly Medicare Summary Notice (MSN) to be sure the charges are correct as many providers are learning how to bill for these services in real-time. If you notice any discrepancies, or you are asked to pay more than you would for an in-person visit, be sure to call Palmetto GBA’s Beneficiary Contact Center at 800-833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET when customer service representatives are available or visit Palmetto GBA’s website at www.PalmettoGBA.com/RR/Me.
Washington, D.C. (Aug. 7, 2020) — On August 5, 2020, 12 rail unions whose members and their families are covered by the NRC/UTU Plan and the Railroad Employees National Health and Welfare Plan filed suit against the nation’s Class I railroad carriers in the United States District Court for the District of Columbia.
The suit asks the court to force the carriers to bargain in good faith with the unions over mandatory subjects of bargaining. The involved issues have been the subject of collective bargaining for decades and are in fact part of the carriers’ bargaining notices served on November 1, 2019, pursuant to Section 6 of the Railway Labor Act (RLA). At issue are carrier attempts to restrict access to certain medications and to forcibly reconfigure health care networks.
The unions are: the American Train Dispatchers Association; the Brotherhood of Locomotive Engineers and Trainmen; the Brotherhood of Maintenance of Way Employes; the Brotherhood of Railroad Signalmen; the International Association of Machinists and Aerospace Workers; the International Association of Sheet Metal, Air, Rail and Transportation Workers, Mechanical Division; the International Association of Sheet Metal, Air, Rail and Transportation Workers, Transportation Division; the International Brotherhood of Boilermakers; the International Brotherhood of Electrical Workers; the National Conference of Fireman & Oilers District, Local 32BJ, SEIU; the Transportation Communications Union/IAM; and the Transport Workers Union.
The rail carriers are: BNSF Railway Company; Kansas City Southern Railway Company; CSX Transportation; Grand Trunk Western Railroad Company; Norfolk Southern Railway Company; Soo Line Railway Company; and Union Pacific Railway Company. Also named in the suit is the National Railway Labor Conference (NRLC), whose National Carriers’ Conference Committee (NCCC) is the designated bargaining agent of the railroads.
The unions have asked the court to:
issue a declaratory judgment that the carriers are obligated to bargain in good faith with the unions on proposed health and welfare changes in accordance with the collective bargaining procedures outlined under the RLA;
issue a declaratory judgment that health and welfare plan design changes are a mandatory subject of collective bargaining pursuant to the RLA;
issue a declaratory judgment that the NRLC may not force plan design changes upon its employees without the agreement of the unions, to be achieved through the mandatory dispute resolution process of the RLA;
issue an order enjoining the NRLC from trying to force these health and welfare changes via arbitration rather than addressing them in collective bargaining; and
issue an order requiring the NRLC to engage in good faith negotiations with the unions over their proposed health and welfare changes through the RLA’s major dispute resolution procedures.
The chief executives of the 12 unions issued the following statement concerning the lawsuit:
The railroads’ attempt to evade their legal obligation to bargain on these issues of great importance to our members has left us with no choice but to enforce these legal rights in court. If implemented without successfully negotiated application, the carriers’ proposals could be extremely harmful to our members and their families. Even more outrageous, the process they are attempting to impose would allow rail carriers to reduce employees’ access to medicines and doctors in the middle of a pandemic. When they should be rewarding the contributions of their essential employees with hazard pay, the rail carriers instead attempt to reduce medical benefits when they are needed most. Events like these are why railroad managers were labeled as “Robber Barons” over a century ago; their actions today are proof positive that the label still applies. Unfortunately for working class Americans, this is the way of many corporations across the country in Donald Trump’s America; essential employees are treated as expendable employees. We will not stand idly by while management attacks the core legal rights our members enjoy.
The Railroad Retirement Board (RRB) administers the Railroad Unemployment Insurance Act (RUIA), which provides two kinds of benefits for qualified railroaders: unemployment benefits for those who become unemployed but are ready, willing, and able to work; and sickness benefits for those who are unable to work because of sickness or injury. Sickness benefits are also payable to female rail workers for periods of time when they are unable to work because of health conditions related to pregnancy, miscarriage or childbirth. A new benefit year begins each July 1.
The following questions and answers describe these benefits, their eligibility requirements, and how to claim them. In addition, it details how the Coronavirus Aid, Relief, and Economic Security Act, or CARES Act, affects the RRB’s administration of benefits under the RUIA.
1. What are the eligibility requirements for railroad unemployment and sickness benefits in July 2020?
To qualify for normal railroad unemployment or sickness benefits, an employee must have had railroad earnings of at least $4,012.50 in calendar year 2019, counting no more than $1,605 for any month. Those who were first employed in the rail industry in 2019 must also have at least five months of creditable railroad service in 2019.
Under certain conditions, employees who do not qualify on the basis of their 2019 earnings may still be able to receive benefits in the new benefit year. Employees with at least 10 years of service (120 or more months of service) who received normal benefits in the benefit year ending June 30, 2020, may be eligible for extended benefits, and employees with at least 10 years of service (120 or more months of service) might qualify for accelerated benefits if they have rail earnings of at least $4,137.50 in 2020, not counting earnings of more than $1,655 a month. (Please see Question 4 for information on provisions for extended unemployment benefits under the CARES Act.)
In order to qualify for extended unemployment benefits, a claimant must not have voluntarily quit work without good cause and not have voluntarily retired. To qualify for extended sickness benefits, a claimant must not have voluntarily retired and must be under age 65.
To be eligible for accelerated benefits, a claimant must have 14 or more consecutive days of unemployment or sickness; not have voluntarily retired or, if claiming unemployment benefits, quit work without good cause; and, when claiming sickness benefits, be under age 65.
2. What if I’m not eligible for railroad unemployment benefits under the criteria listed in Question 1?
You may be eligible for benefits under a new temporary federal program called Pandemic Unemployment Assistance (PUA), which was created under the CARES Act. In general, PUA provides up to 39 weeks of unemployment benefits to individuals not eligible for regular unemployment compensation or extended benefits, including those who have exhausted all rights to such benefits. The PUA program is administered by individual states, not the RRB. For eligibility information, and to find the application process in each state, please visit careeronestop.org, and under the Find Local Help tab, select Unemployment Benefits Finder.
3. What is the daily benefit rate payable in the new benefit year beginning July 1, 2020?
Almost all employees will qualify for the maximum daily benefit rate of $80. Benefits are generally payable for the number of days of unemployment or sickness over four in 14-day claim periods, which yields $800 for each two full weeks of unemployment or sickness. Sickness benefits payable for the first 6 months after the month the employee last worked are subject to Tier I Railroad Retirement payroll taxes, unless benefits are being paid for an on-the-job injury.
Claimants should be aware that as a result of a sequestration order under the Budget Control Act of 2011, the RRB will reduce unemployment and sickness benefits by 5.9 percent through September 30, 2020. As a result, the total maximum amount payable in a 2-week period covering 10 days of unemployment or sickness will be $752.80. The maximum amount payable for sickness benefits subject to Tier I payroll taxes of 7.65 percent will be $695.21 over two weeks. It is expected that sequestration will force a 5.7 percent reduction in unemployment and sickness benefits beginning October 1, 2020. Future reductions, should they occur, will be calculated based on applicable law.
In addition, under the CARES Act, the amount of an unemployment benefit is increased by $1,200 per 2-week period. This increased amount, which is not subject to sequestration, is applied to any 2-week registration periods that began on or after April 1, 2020, through July 31, 2020. (Sequestration is not applied to benefit payments issued under the CARES Act.) The CARES Act includes a separate appropriation of $425 million to pay for this added “recovery benefit.” If this fund is exhausted, the new provision will no longer apply.
4. How long are these benefits payable?
Normal unemployment or sickness benefits are each payable for up to 130 days (26 weeks) in a benefit year. The total amount of each kind of benefit which may be paid in the new benefit year cannot exceed the employee’s railroad earnings in calendar year 2019, counting earnings up to $2,073 per month.
If normal benefits are exhausted, extended benefits are payable for up to 65 days (during 7 consecutive 14-day claim periods) to employees with at least 10 years of service (120 or more cumulative service months).
The CARES Act also authorizes payment of extended unemployment benefits to rail workers who received unemployment benefits from July 1, 2019, to June 30, 2020. Under the legislation, railroad workers with less than 10 years of service may be eligible for up to 65 days of extended benefits within 7 consecutive 2-week registration periods. Workers with 10 or more years of railroad service, who were previously eligible for up to 65 days in extended benefits, may now receive benefits for up to 130 days within 13 consecutive 2-week registration periods. No extended benefit period under this provision will begin after December 31, 2020.
5. What is the waiting period requirement for unemployment and sickness benefits?
There is a 7-day waiting period requirement, prior to any benefits becoming payable under the RUIA. During the first 14-day claim period, benefits are payable for every day claimed in excess of seven days. Subsequent claims are paid for the number of days of unemployment or sickness over four in each 14-day registration period. Initial sickness claims must also begin with four consecutive days of sickness. If an employee has at least five days of unemployment or five days of sickness in a 14-day period, he or she should still file for benefits in order to satisfy the waiting period for the current benefit year. Separate waiting periods are required for unemployment and sickness benefits. However, only one seven-day waiting period is generally required during any period of continuing unemployment or sickness, even if that period continues into a subsequent benefit year.
Under the CARES Act, the 7-day waiting period required before railroad workers can receive unemployment or sickness benefits is temporarily eliminated. This applies to any 14-day registration period that began on or after March 28, 2020, and ends on or before December 31, 2020. (Please note that this is the only provision of the CARES Act that applies to both unemployment and sickness benefits.) Employees who previously submitted claims during this time and were charged with the 7-day waiting period will receive retroactive payments of these additional monies once our systems are ready to pay them. The legislation provides $50 million to cover the cost of eliminating the waiting period, and, as with the recovery benefit paid under the CARES Act, if this fund is exhausted, the new provision will no longer apply.
6. Are there special waiting period requirements if unemployment is due to a strike?
If a worker is unemployed because of a strike conducted in accordance with the Railway Labor Act, benefits are not payable for days of unemployment during the first 14 days of the strike, but benefits are payable during subsequent 14-day periods.
If a strike is in violation of the Railway Labor Act, unemployment benefits are not payable to employees participating in the strike. However, employees not among those participating in such an illegal strike, but who are unemployed on account of the strike, may receive benefits after the first two weeks of the strike.
While a benefit year waiting period cannot count toward a strike waiting period, the 14-day strike waiting period may count as the benefit year waiting period if a worker subsequently becomes unemployed for reasons other than a strike later in the benefit year.
7. Can employees in train and engine service receive unemployment benefits for days when they are standing by or laying over between scheduled runs?
No, not if they are standing by or laying over between regularly assigned trips or they missed a turn in pool service.
8. Can extra-board employees receive unemployment benefits between jobs?
Yes, but only if the miles and/or hours they actually worked were less than the equivalent of normal full-time work in their class of service during the 14-day claim period. Entitlement to benefits would also depend on the employee’s earnings.
9. How would an employee’s earnings in a claim period affect his or her eligibility for unemployment benefits?
If a claimant’s earnings for days worked, and/or days of vacation, paid leave, or other leave in a 14-day registration period are more than a certain indexed amount, no benefits are payable for any days of unemployment in that period. That registration period, however, can be used to satisfy the waiting period.
Earnings include pay from railroad and non-railroad work, as well as part-time work and self-employment. Earnings also include pay that an employee would have earned except for failure to mark up or report for duty on time, or because he or she missed a turn in pool service or was otherwise not ready or willing to work. For the benefit year that begins July 2020, the amount is $1,605, which corresponds to the base year monthly compensation amount used in determining eligibility for benefits in each year. Also, even if an earnings test applies on the first claim in a benefit year, this will not prevent the first claim from satisfying the waiting period in a benefit year.
Earnings of $15 or less per day from work which is substantially less than full-time and not inconsistent with the holding of normal full-time employment may be considered subsidiary remuneration and may not prevent payment of any days in a claim. However, a claimant must report all full and part-time work on each claim, regardless of the amount of earnings, so the RRB can determine if the work affects benefits.
10. How does a person apply for and claim unemployment benefits?
Employees can apply for and claim unemployment benefits online or by mail. Individuals who have established an account through myRRB at RRB.gov can log in and file their applications and their biweekly claims online. Employees are encouraged to establish their accounts while still working to expedite the filing process for future unemployment benefits, and for access to other online services.
To apply by mail, claimants must obtain an Application for Unemployment Benefits (Form UI-1) from RRB.gov, or their labor organization or railroad employer. The completed application should be mailed to the local RRB office as soon as possible and, in any case, must be filed within 30 days from the date the claimant became unemployed, or the first day for which he or she wishes to claim benefits. Benefits may be lost if the application is filed late. Claimants who know in advance that they will be filing an unemployment application or claim late should include a signed statement explaining why they are unable to meet the required time frame.
Persons can find the address of the RRB office serving their area by visiting RRB.gov and clicking on Field Office Locator, or by calling the agency toll-free at 1-877-772-5772 and selecting the appropriate option from the automated menu.
The local RRB field office reviews the completed application, whether it was submitted online or by mail, and notifies the claimant’s current railroad employer, and base-year employer, if different. The employer has the right to provide information about the benefit application.
After processing the application, biweekly claim forms are made available on the RRB’s website, or are mailed to the claimant, as long as he or she remains unemployed and eligible for benefits. Claim forms should be signed and sent on or after the last day of the claim. This can be done online or by mail. The completed claim must be received by the RRB within 15 days of the end of the claim period, or within 15 days of the date the claim form was made available online or mailed to the claimant, whichever is later. Claimants mustnot file both an online and a paper claim form for the same period(s). Once an individual submits a claim online, all subsequent claim forms will be made available online only, and will no longer be mailed.
Only one application needs to be filed during a benefit year, even if a claimant becomes unemployed more than once. However, a claimant must, in such a case, request a claim form from the RRB within 30 days of the first day for which he or she wants to resume claiming benefits. These claims may then be filed online or by mail.
11. How does a person apply for and claim sickness benefits?
An Application for Sickness Benefits (SI-1a) can be obtained from RRB.gov, a railroad labor organization, or a railroad employer. Applications for sickness benefits must be submitted to the agency by mail, or by fax at 312-751-7185. Subsequent claims may be completed online by those with myRRB accounts.
An application including a doctor’s statement of sickness is required at the beginning of each period of continuing sickness for which benefits are claimed. Claimants should make a special effort to have the doctor’s statement of sickness completed promptly since claims cannot be paid without it.
The RRB suggests that employees keep an application for sickness benefits on hand, and that family members know where the form is kept and how to use it. If an employee becomes unable to work because of sickness or injury, the employee should complete the application and then have his or her doctor complete the Statement of Sickness (SI-1b). If a claimant receives sickness benefits for an injury or illness for which he or she is paid damages, it is important to be aware that the RRB is entitled to reimbursement of either the amount of the benefits paid for the injury or illness, or the net amount of the settlement, after deducting the claimant’s gross medical, hospital, and legal expenses, whichever is less.
If the employee is too sick to complete the application, someone else may do so. In such cases, a family member should also complete a Statement of Authority to Act for Employee (Form SI-10), which accompanies the statement of sickness.
After completion, the forms should be mailed to the RRB’s headquarters in Chicago within 10 days from when the employee became sick or injured. However, applications received after 10 days but within 30 days of the first day for which an employee wishes to claim benefits are generally considered timely filed if there is a good reason for the delay. Upon receipt, the RRB will process the application and determine if the employee is eligible for sickness benefits.
After processing the application, the RRB provides biweekly claims to the qualified employee as long as he or she is eligible for benefits and remains unable to work due to illness or injury. Biweekly claims are made available for completion online (by those with anaccount at myRRB) or mailed to the claimant. Completed claim forms must be received at the RRB within 30 days of the last day of the claim period, or within 30 days of the date the claim form was made available online or mailed to the claimant, whichever is later. Benefits may be lost if an application or claim is filed late. Claimants who know in advance that they will be filing a sickness application or claim late should include a signed statement explaining why they are unable to meet the required time frame.
As with claims for unemployment benefits, once a claim for sickness benefits is submitted online, all subsequent claims will be made available online only, and will no longer be mailed.
Claimants are reminded that while claim forms for sickness benefits can be submitted online, applications must be mailedto the RRB. Statements of sickness may be mailed with the sickness application or faxed directly from the doctor’s office to the RRB at 312-751-7185. Faxes must include a cover sheet from the doctor’s office.
12. Is a claimant’s employer notified each time a biweekly claim for unemployment or sickness benefits is filed?
The RUIA requires the RRB to notify the claimant’s base-year employer each time a claim for benefits is filed. That employer has the right to submit information relevant to the claim before the RRB makes an initial determination on the claim. Benefits may not be paid at this time but the employee will receive a notice and have the right to appeal. In addition, if a claimant’s base-year employer is not his or her current employer, the claimant’s current employer is also notified. The RRB must also notify the claimant’s base-year employer each time benefits are paid to a claimant. The base-year employer may protest the decision to pay benefits. Such a protest does not prevent the timely payment of benefits. However, a claimant may be required to repay benefits if the employer’s protest is ultimately successful. The employer also has the right to appeal an unfavorable decision to the RRB’s Bureau of Hearings and Appeals.
The RRB also conducts checks with other federal agencies and all 50 states, as well as the District of Columbia and Puerto Rico, to detect fraudulent benefit claims, and it checks with physicians to verify the accuracy of medical statements supporting sickness benefit claims.
13. How long does it take to receive payment?
Under the RRB’s Customer Service Plan, if a claimant files an application for unemployment or sickness benefits, the RRB will release a claim form or a denial letter within 10 days of receiving his or her application. If a claim for subsequent biweekly unemployment or sickness benefits is filed, the RRB will certify a payment or release a denial letter within 10 days of the date the RRB receives the claim form. If the claimant is entitled to benefits, his or her benefits will generally be paid within one week of that decision.
If a claimant does not receive a decision notice or payment within the specified time period, he or she may expect an explanation for the delay and an estimate of the time required to make a decision.
However, some claims for benefits may take longer to handle than others if they are more complex, or if an RRB office has to get information from other people or organizations, or under special circumstances such as the current pandemic.
Regarding the payments authorized under the CARES Act, after making necessary programming changes to claims processing systems, the RRB started paying extended unemployment benefits and unemployment recovery payments on May 11, and May 28, respectively. As for payment of the additional monies related to the elimination of the 7-day waiting period, the agency hopes to complete the needed programming changes for this provision in the near future. The RRB will initially make retroactive payments to individuals eligible for the payments listed above who had previously submitted unemployment claims before moving on to processing new claims.
Claimants who think an RRB office made the wrong decision about their benefits have the right to ask for review and to appeal. They will be notified of these rights each time an unfavorable decision is made on their claims.
14. How are payments made?
Railroad unemployment and sickness insurance benefits are paid by direct deposit. With direct deposit, benefit payments are made electronically to an employee’s bank, savings and loan, credit union or other financial institution. New applicants for unemployment and sickness benefits will be asked to provide information needed for direct deposit enrollment.
15. How can claimants get more information on their railroad unemployment or sickness claims?
Claimants with online myRRB accounts can log in to view their individual railroad unemployment insurance account statement. This statement displays the type and amount of the claimant’s last five benefit payments, the claim period for which the payments were made, and the dates that the payments were approved. Individuals can also confirm the RRB’s receipt of applications and claims.
In addition, claimants can call the agency toll-free at 1-877-772-5772 to access information about the status of unemployment and sickness claims or payments 24 hours a day, 7 days a week. Individuals with questions about unemployment or sickness benefits, or who need information about their specific claims and benefit payments, can send a secure email to their local office by accessing Field Office Locator at RRB.gov and clicking on the link at the bottom of their local office’s page. If a customer absolutely needs to talk to an RRB employee, they can call the agency’s toll-free number (1-877-772-5772). However, customers are asked to be patient because of the increase in call volume due to the closure to the public of RRB offices during the COVID-19 pandemic.
As many of you may recall, the SMART Voluntary Short Term Disability Plan temporarily suspended the Elimination Period for COVID-19 (Coronavirus) disabilities. In an announcement to you dated April 15, 2020, we communicated that the Elimination Period was being waived for any COVID-19 (Coronavirus) disabilities beginning in the months of March, April and May 2020.
We are pleased to announce that the Plan will be extending this waiver for three (3) more months through August 2020. So, effective with all diagnosed COVID-19 (Coronavirus) disabilities beginning in the months of March through August 2020, the Plan’s Elimination Period will be waived. Members must usually be disabled for 21 days before benefits will begin on the 22nd day. This is known as the Elimination Period or Waiting Period. We are waiving this Waiting Period for positive COVID-19 (Coronavirus) disabilities. This change will expedite and increase benefits for approved applicants so that you will have immediate access to money. The Waiting Period will be reinstated for COVID-19 (Coronavirus) disabilities beginning on and after September 1, 2020.
We are pleased that the Plan can take this action on your behalf. We wish you and your family health and wellness during these trying times.
Board of Trustees
Mr. Joseph Sellers Jr., General President SMART
Mr. Jeremy Ferguson, President-SMART Transportation Division
Mr. Joseph Powell, General Secretary-Treasurer SMART
The SMART Voluntary Short Term Disability Plan is administered by:
Southern Benefit Administrators, Incorporated
P.O. Box 1449
Goodlettsville, Tennessee 37070-1449
Toll-Free: (844) 880-1071, Fax: (615) 859-0201
SMART General President Joseph Sellers Jr. and SMART Transportation Division President Jeremy Ferguson as well as dozens of unions, business groups, economic justice organizations, and local transit advocates from across the nation wrote today to Vice President Mike Pence and Dr. Deborah Birx, coordinator of the White House Coronavirus Task Force, demanding better federal coordination to provide personal protective equipment (PPE) for transit workers.
As of this week, the coronavirus has claimed the lives of nearly 100 transit workers in the United States.
The victims include Scott Ryan, 41, a bus operator at Community Transit in Snohomish County, Washington; Patrick Patoir, 57, an MTA worker in New York for 33 years; Jason Hargrove, 50, a Detroit bus operator; Eugenia Weathers, a school bus driver in Lexington, Kentucky; and SMART-TD Local 61 member Michael Hill, a conductor and 30-year SEPTA veteran in Philadelphia.
The federal government can and must take stronger steps to prevent such loss of life.
Bus and train operators, maintenance workers, and cleaning staff at transit agencies around the country are putting their lives on the line as they enable essential travel for millions of Americans, ensuring the continued provision of food, medical care, and other basic goods and services during the COVID-19 pandemic. Without strong federal coordination to procure PPE for transit workers, they face needless risks on the job.
Based on guidance from infectious disease experts, the organizations demand the White House coordinate provision of N95 masks and other protective gear for frontline transit workers whose duties put them in close proximity to passengers, or require exposure to hazardous disinfectants. The groups also urge the CDC to issue stronger guidance for transit agencies, including recommendations on how to ventilate transit vehicles to minimize the risk of COVID-19 transmission.
These measures must be put in place to protect the transit workforce, which in turn will strengthen the overall effort to control the pandemic and minimize the spread of COVID-19. Nearly 3 million Americans classified as essential workers typically commute on transit, according to a TransitCenter analysis of U.S. Census data.
Protective gear for transit workers will have a strong multiplier effect, since reducing risk will increase the availability of the transit workforce, leading to greater provision of transit service, less crowding on transit vehicles, and lower rates of transmission among transit riders and thus the general population.
The alliance signing on to the letter reflects the broad public interest in protecting transit workers, encompassing labor, business, transportation, economic justice, environmental, and community-based organizations from dozens of states.
Supply chain issues affect every industry seeking protective gear. However, the need for transit workers is so urgent, and the consequences of further delay so dire, that federal action must be pursued as soon as possible. These protections will save the lives of transit workers, as well as the lives of nurses, doctors, food distribution workers, and other essential workers who rely on transit.
“Transit workers deserve every protection the government can muster,” said TransitCenter Executive Director David Bragdon. “Better coordination and provision of equipment will protect the health of hundreds of thousands of transit workers, and keep millions of other workers safe on their way to essential jobs.”