Pre-Medicare Retirees
Pre-Medicare Retirees
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- Pre-Medicare Retirees
This page outlines the benefits you are eligible for as a pre-medicare retiree or spouse.
Overview
The Pre-Medicare Benefits page is for RIT Retirees or their spouses who are not eligible for Medicare, which usually occurs at age 65; unless they are disabled before age 65.
Retirees or spouses who are enrolled in Medicare can find more about their benefits on the Medicare Retirees page.
Within 31 days of your or your spouse retirement date, the Change Benefits for Retirees service request should be submitted. The form confirms for RIT the benefits that will be continued in retirement.
If you will be covering eligible family members and you have not submitted proof of their eligibility (e.g., copy of marriage certificate for your spouse, copy of birth certificate for a child), you should submit that proof with the service request.
Cost Sharing Group 2
Employees who were hired before January 1, 2004 and were age 35 or over on January 1, 2008.
In 2024 and after, retiree contributions will be double the employee contributions.
2024 Group 2 Medical Plan Rates
2025 Group 2 Medical Plan Rates
Cost Sharing Group 3
Employees who were hired on or after January 1, 2004 OR hired before January 1, 2004 and under age 35 on January 1, 2008.
In 2024 and after, retiree medical contributions will 10% higher than Cost Sharing Group 2.
Plan |
Level Of Coverage |
Monthly Contribution |
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Dental-Standard Plan |
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Dental-Enhanced Plan |
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Vision Care - See 2025 Information |
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Legal Services - See 2025 Information |
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Identity Theft Protection-Ultra Secure |
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Identity Theft Protection-Ultra Secure + Credit |
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RIT has retained the services of Lifetime Benefit Solutions (LBS) to administer billing for retirees and surviving spouses. LBS sends an invoice to pre-Medicare retirees with medical coverage on or about the 15th of each month for the next month’s coverage and the payment is due by the 1st of the month.
LBS offers several payment options:
- payment by check,
- money order,
- electronic funds transfer (EFT - automatic withdrawal from your bank account), and
- by credit card with a fee.
If payments are not made in a timely basis, coverage will be cancelled. LBS will send details about the payment options and deadlines with the first bill.
Each year, RIT holds a retiree Open Enrollment period in the late fall. Open Enrollment materials will mailed to retirees home addresses.
This is a retiree's annual opportunity to enroll, change or cancel any benefits they have through RIT.
Pre-Medicare Medical
Four medical plan options are offered and administered through Excellus BlueCross BlueShield: POS A, POS B, POS D and PPO (available to those living out of area). The prescription drug benefit is administered by OptumRx.
It is important to compare your health needs along with the coverage of the medical plans and the premium costs to determine which plan is best for you.
The Pre-Medicare medical plans are for retirees or their spouses who are not eligible for Medicare, which usually occurs at age 65; unless they are disabled before age 65. Retirees can cover their dependent children through age 26.
In-Network Medical Coverage | POS A | POS B and POS B No Drug | POS D | |||
RRH(1) | Other In-Network | RRH(1) | Other In-Network | RRH(1) | Other In-Network | |
Annual Deductible (individual/family) | Not Applicable | $250/$500 | $300/$600 | |||
Coinsurance (patient pays/plan pays) | Not Applicable | 10%/90% | 10%/90% | |||
Annual Patient Maximum Out-of-Pocket (individual/family) | $5,250/$10,500 | $6,250/$12,500 | $6,600/$13,200 | |||
Telemedicine with MD Live | N/A | $10 | N/A | $10 | N/A | $10 |
RRH On-Campus Practice | $20 | N/A | $20 | N/A | $20 | N/A |
Primary Care Physician | $30 | $35 | $35 | $40 | $40 | $45 |
Specialist | $35 | $50 | $40 | $55 | $45 | $60 |
Physical Therapy | $50 | $55 | $60 | |||
Urgent Care | $55 | $60 | $65 | |||
Emergency Room | $115 | $140 | $140 | $190 | $165 | $215 |
Hospital Inpatient | $150 | $200 | 10% coinsurance after deductible | 10% coinsurance after deductible | ||
Hospital Outpatient or Ambulatory Surgical Center | $70 | $140 | 10% coinsurance after deductible | 10% coinsurance after deductible | ||
Laboratory and Pathology | Covered in Full | Covered in Full | Covered in Full | |||
X-ray | $50 | $55 | $60 | |||
Advanced Imaging (CT, MRI, etc.) | $75 | 10% coinsurance after deductible | 10% coinsurance after deductible |
(1)The lower RRH copays do not apply to tests, treatments or any other services (e.g., allergy shots, chiropractic services, physical therapy, etc.).
Prescription Drug Coverage | POS A | POS B Only | POS D | |||
Wegmans | Other Retail(2) | Wegmans | Other Retail(2) | Wegmans | Other Retail(2) | |
Annual Deductible (individual/family) | Not Applicable | Not Applicable | $1,250 per person, then copays | |||
Annual Patient Maximum Out-of-Pocket (individual/family) | $2,350/$4,700 | $2,350/$4,700 | $2,500/$5,000 | |||
Up to 30-Day Supply at Retail | ||||||
Tier 1: Generic | $15.00 | $17.00 | $15.00 | $17.00 | $25.00 | $30.00 |
Tier 2: Brand Name-Formulary (preferred) | $35.00 | $40.00 | $35.00 | $40.00 | $70.00 | $80.00 |
Tier 3: Brand Name-Non-Formulary (preferred) | $50.00 | $60.00 | $50.00 | $60.00 | $130.00 | $150.00 |
Up to 90-Day Supply at Wegmans or OptumRx Mail Order | ||||||
Tier 1: Generic | $37.50 | Not Available | $37.50 | Not Available | $62.50 | Not Available |
Tier 2: Brand Name-Formulary (preferred) | $87.50 | Not Available | $87.50 | Not Available | $175.00 | Not Available |
Tier 3: Brand Name-Non-Formulary (preferred) | $125.00 | Not Available | $125.00 | Not Available | $325.00 | Not Available |
Each person covered by a POS plan (A, B or D) should have a Primary Care Physician (PCP) listed at Excellus. The specialist copay will apply for any visit to a primary care physician who is not listed as the PCP. You can change your PCP at any time by logging into your online account with Excellus or contacting customer service at 1-877-253-4797.
A PCP is not required for those covered by the Blue PPO.
For a full comparison of the POS plans, please see the current Medical Benefits Comparison Book for specifics.
Rochester Regional Health (RRH)
Located right on the RIT Henrietta campus, Family Medicine at RIT provides complete medical care in a convenient location. All RIT employees and their family members are welcome at this practice. More information about this location can be found at Rochester Regional Family Medicine at RIT.
The practice is in the Clinical Health Sciences Center located at the north end of Louise Slaughter Hall. The office hours of operation are Monday through Friday, 8:00 AM to 5:00 PM.
Adjacent to the practice is the Rochester Regional Health Outpatient Lab, where you can have blood drawn or provide a urine sample. The hours of operation are Monday through Friday 7:00 AM to 4:00 PM (closed for lunch 12-1 PM). The lab is open to the public and no appointment is required, but you will need to bring a lab request from your medical provider.
In support of the strategic alliance between RIT and Rochester Regional Health (RRH), there are two ways for medical plan participants to save money on their medical care:
- If a POS plan member has an appointment at Rochester Regional Family Medicine at RIT, they will have a lower $20 copay for the PCP
- There is an “RRH Copay Option” within our point of service medical plans. Under this option, there is a slightly lower copay when you obtain the following medical services from the Domestic Network of RRH providers:
- office visit to primary care physician (PCP)
- office visit to specialists
- emergency room visits
- Under POS A only, there is a lower copay for Inpatient Hospitalization and Outpatient Services.
- The lower copays do not apply to tests, treatments or any other services (e.g., allergy shots, chiropractic services, physical therapy, x-rays, etc.). These lower copays are outlined.
See the current Domestic Network listing for participating providers.
Dental Care
Eligibility
Pre-Medicare retirees and their Pre-Medicare spouses are eligible for the Dental Care plan until they become Medicare eligible. Coverage will end the last day of the month prior to the month the enroll in Medicare. For dependent children of retirees, coverage can continue through the end of the month in which they turn 26.
Claims Administrator
The Dental Care benefits are administered by Excellus BC/BS of Rochester.
Participating Providers
Search for a local participating dentist (select Dental Blue Options)
Alternative Benefits Allowance
All covered procedures are subject to an alternative benefit allowance.
When there is more than one technique or material type for a dental procedure, the dental plan will reimburse for the procedure that has the lesser allowance. When alternate benefit is enforced, the subscriber’s benefits are not intended to interfere with the treatment plan recommended by the dentist. The subscriber and dentist should discuss which treatment is best suited for the patient, and may proceed with the original treatment plan regardless of the benefit determination. If the more expensive treatment is chosen, the subscriber is liable for the balance up to the billed amount.
Predetermination of Benefits
A Predetermination of Benefits is a written estimate from the insurance company of the amount your dental plan will pay for a specific service based on the treatment plan provided by your dentist. Predetermination of benefits should be requested when using the Basic Restorative, Major Restorative or Orthodontia benefits,
Out of Network Services
The Dental Plans allow you to see any dentist you choose. However, nonparticipating dentists are not obligated to accept Excellus BCBS’s allowed amounts as payment in full and will balance bill any amount in excess of these allowed amounts.
Other Important Information
Priced according to the Blue Shield Schedule of Allowances. Dentists who participate with Blue Shield agree to accept the Schedule of Allowances. Subscribers who go to a non-participating dentist will be liable for balances over the Schedule of Allowances.
NOTE: All rules, limits, and exclusions apply regardless of plan (e.g., you would still have a 5-year wait to replace a crown even if you change plans).
Category |
Standard Plan |
Enhanced Plan |
---|---|---|
Annual Deductible (applies to Basic and Major Restorative Services combined) | $25 per individual, $75 family maximum | None |
Annual Maximum (applies to Basic and Major Restorative Services combined) | $1,250 per individual per year | $2,500 per individual per year |
Orthodontia Maximum (per person) | $1,250 per lifetime for children under age 19 | $2,500 per lifetime for adults and children |
Category |
Standard Plan |
Enhanced Plan |
---|---|---|
Cleaning (twice per calendar year) | Covered at 100% | Covered at 100% |
Oral Exam (twice per calendar year) | Covered at 100% | Covered at 100% |
Topical Fluoride application for members under age 16 (twice per calendar year) | Covered at 100% | Covered at 100% |
Emergency Palliative Treatment to relieve pain | Covered at 100%, when no other services are rendered | Covered at 100%, when no other services are rendered |
Sealants (once per tooth in 36 consecutive months for first and second unrestored permanent molars) | Covered at 100%, for members under age 16 | Covered at 100%, for members under age 16 |
Space maintainers | Covered at 100% | Covered at 100% |
X-rays (full mouth 1 in 3 years, bitewings 1 in 12 months) | Covered at 100% | Covered at 100% |
(All services subject Blue Shield Schedule of Allowances and to the annual deductible and annual maximum)
Category |
Standard Plan |
Enhanced Plan |
---|---|---|
Endodontics (Nerve and Pulp) Root Canal Treatment |
Covered at 80% | Covered at 80% |
Apicoectomy | Covered at 80% | Covered at 80% |
Fillings – Silver/amalgam and anterior composite restorations for treatment of cavities (once per tooth per year) | Covered at 80% | Covered at 80% |
Oral Surgery Routine Extraction |
Covered at 80% | Covered at 80% |
Non-routine Extraction (Surgical, Soft tissue, Impactions) | Covered at 80% | Covered at 80% |
IV Sedation for extraction of impacted 3rd molars (wisdom teeth) | Covered at 80% | Covered at 80% |
Periodontics (Gum and Tissue) Surgical Procedures: gingivectomy, osseous surgery or mucogingival surgery (allowed once in 36 months) |
Covered at 80% | Covered at 80% |
Non-Surgical Procedures: Periodontal Root Planning/Scaling (allowed once in 24 months) | Covered at 80% | Covered at 80% |
Periodontal Maintenance following Surgery | Covered at 80%, allowed twice per calendar year | Covered at 80%, allowed twice per calendar year |
Category |
Standard Plan |
Enhanced Plan |
---|---|---|
Dental Implants | Covered at 50% | Covered at 80% |
Removable Prosthetics | Allowed once every 5 years, combined with fixed prosthetics | |
Complete Dentures | Covered at 50% | Covered at 80% |
Partial Dentures | Covered at 50% | Covered at 80% |
Denture Repair/Adjustment | Covered at 50% | Covered at 80% |
Fixed Prosthetics | Allowed once every 5 years, combined with removable prosthetics | |
Crowns, Inlays/Onlays, Bridges | Covered at 50% | Covered at 80% |
Orthodontia Services | Covered at 50%, subject to the lifetime maximum (children under age 19) | Covered at 50%, subject to the lifetime maximum (adults and children) |
Vision Care
Provider Information
The Vision Care plan is offered through VSP. You can find participating providers at VSP Vision Care or by calling VSP at (800) 877-7195/v and (800) 428-4833/TTY Monday – Friday 8 a.m. to 10 p.m., Eastern Time.
Vision Care along with RIT Medical Insurance
RIT’s medical coverage under POS A, POS B, POS B No Drug, and POS D covers routine eye exams with a copay. If you want to continue using your same eye doctor who is not a VSP provider, use your medical ID card at the eye doctor. Then you can take your prescription for eyeglasses or contacts to a VSP provider.
Online Account with VSP
You can set up an member account on the VSP website to manage your coverage. Click on Members then Member Log In to log in or create an account. Enter you University ID number (UID) for the Member ID along with the other required information.
Once your account is set up, you will be able to see information about your coverage. From your account, you will also be able to print a Member ID Card to keep in your wallet; the card does not have the VSP ID on it.
Non-Participating Providers
If you or a covered family member receives coverage from a non-VSP provider, you should pay the provider’s full fee at the time of service and then submit an itemized bill to VSP for reimbursement according to the schedule of allowances. Discounts do not apply for vision care benefits obtained from non-VSP Providers, so your cost is likely to be higher if you receive services from a non-VSP Provider.
You can print a Member ID card from the VSP website. You will not receive an ID card from VSP. And, when you go to a VSP provider, you simply let them know you are a VSP member and they will take care of the rest (no claim forms to file). The ID number will be your RIT University ID (UID) number.
Member will receive the below in-network benefits when they go to a participating provider.
Service |
Coverage Information |
---|---|
Eye Exam |
A routine eye exam is covered once per calendar year with a $15 copay. A diabetic eye exam has a $20 copay (see details below about the VSP Diabetic Eyecare Plus ProgramSM. |
Lenses |
VSP’s standard lenses are covered in full, every calendar year, after a $20 copay, including glass or plastic single vision, bifocal, trifocal, progressive, or other more complex lenses necessary for the patient’s visual welfare. There is an additional cost for various coatings (e.g., anti-reflective, scratch, etc.), but VSP does provide a discount on these optional items. |
Frames | $150 allowance toward frames, every calendar year. If you select a frame that costs more than $150, VSP offers a 20% discount off the amount over the retail allowance. Some frames qualify for a $170 featured frame brands allowance. |
Contact Lenses | You may choose contacts instead of glasses (lenses and frame). There is a $150 allowance applied to the contact lens exam (fitting & evaluation) and the contact lenses. You also receive a 15% discount off the contact lens exam before the allowance is applied. |
Note: RIT’s medical coverage under POS A, POS B, POS B No Drug, and POS D covers routine eye exams with a copay. If you want to continue using your same eye doctor who is not a VSP provider, use your medical ID card at the eye doctor. Then you can take your prescription for eyeglasses or contacts to a VSP provider.
The VSP Diabetic Eyecare Plus ProgramSM provides coverage of additional eyecare services specifically for members with diabetic eye disease, glaucoma or age-related macular degeneration (AMD). Eligible members can receive both routine and follow-up medical eyecare from their VSP doctor—the doctor who already knows their eyes best. A summary of the coverage is as follows:
- The VSP Diabetic Eyecare Plus ProgramSM provides coverage of additional eyecare services specifically for members with diabetic eye disease, glaucoma or AMD, including:
- medical follow-up exams,
- visual field and acuity tests,
- specialized screenings and diagnostic tests,
- diagnostic imaging of the retina and optic nerve,
- retinal screening for eligible members with diabetes.
- The program also provides supplemental1 coverage for non-surgical medical eye conditions such as diabetic retinopathy, abnormal blood vessel growth on the eye (rubeosis), and diabetic macular edema.
- Members can self-refer2, visit their VSP Provider as often as needed, and pay only a copay for services.
1 The VSP Diabetic Eyecare Plus Program pays secondary to other medical eye insurance coverage.
2 Unless referral by a primary care physician is required by the health plan.
Low Vision Services are a plan benefit when specific benefit criteria are satisfied and when prescribed by the covered person’s VSP Preferred Provider. Professional services for severe visual problems not correctable with regular lenses are covered as follows:
- Supplemental Test: Covered in full*
- Supplemental Aids: 75% of VSP Preferred Provider’s fee, up to $1,000*
*maximum benefit for all Low Vision services and materials is $1,000 every two (2) years and a maximum of two supplemental tests within a two-year period.
Some brands of spectacle frames may be unavailable for purchase as Plan Benefits, or may be subject to additional limitations. You may obtain details regarding frame availability from the VSP Member Doctor or by calling VSP’s Customer Care Division at (800) 877-7195.
This Plan is designed to cover visual needs rather than cosmetic materials. If you or a covered family member selects any of the following extras, the Plan will pay the basic cost of the allowed lenses, and you will pay the additional costs for the options.
- Optional cosmetic processes
- Anti-reflective coating
- Color coating
- Mirror coating
- Scratch coating
- Cosmetic lenses
- Laminated lenses
- Oversize lenses
- Photochromic lenses, tinted lenses except Pink #1 and Pink #2
- UV (ultraviolet) protected lenses
- Certain limitations on low vision care
Not Covered
There are no benefits for professional services or materials connected with:
- Orthoptics or vision training and any associated supplemental testing
- Plano lenses (less than a ±.50 diopter power)
- Two pair of glasses in lieu of bifocals
- Replacement of lenses and frames furnished under this plan that are lost or broken, except at the normal intervals when services are otherwise available
- Replacement of lost or damaged contact lenses, except at the normal intervals when services are otherwise available.
- Medical or surgical treatment of the eyes
- Local, state and/or federal taxes, except where VSP is required by law to pay
- Services associated with Corneal Refractive Therapy (CRT) or Orthokeratology
- Corrective vision treatment of an experimental nature, unless approved by an external appeal agent
- Plano contact lenses to change eye color cosmetically
- Artistically-painted contact lenses
- Contact lens insurance policies or service contracts
- Additional office visits associated with contact lens pathology
- Contact lens modification, polishing, or cleaning
- Costs for services and/or materials above Plan Benefit allowances
- Services or materials of a cosmetic nature
- Services and/or materials not indicated on this Schedule as covered Plan Benefits
Liability in Event of Non-Payment
In the event VSP fails to pay a VSP preferred provider, you will not be held liable for any sums owed by VSP other than those not covered by the plan.
Other Benefits
Plan Contact
Website: MetLife Legal Plan (access code: 570005)
Phone: 800-821-6400/V or 800-821-5995/TTY
Covered Services
- Advice and Consultation
- Consumer Protection
- Debt Matters
- Civil Lawsuit Defense
- Document Preparation
- Family Law
- Immigration
- Personal Injury
- Real Estate
- Traffic and Criminal Matters
- Will and Estate
The available benefits are very comprehensive, but there are limitations and other conditions that must be met. **See Exclusions in the Legal Plan Services Summary for details regarding matters not covered by MetLife Legal.
How to Use the Plan
You must call MetLife Legal Plans, as described below, prior to contacting any attorney. Plan benefits will be denied if you do not call first.
To begin, call MetLife Legal Plans' Client Service Center at 800-821-6400 between Monday - Friday, 8am – 7pm; Eastern Time. You will need to identify yourself as a participant in the Plan and to give the last four digits of your Social Security Number and Zip Code. If your spouse/partner or a child is calling, they will need this information to provide to the representative.
During the call, the Client Service representative will:
- verify your eligibility for services;
- make an initial determination of whether and to what extent your case is covered (the Plan Attorney will make the final determination of coverage)
- provide you a Case Number (you will need a new Case Number for each new case you have);
- give you the telephone number of the Plan Attorney most convenient to you; and
- answer any questions you have about the Plan.
Contacting the Plan Attorney
Contact the Plan Attorney provided by MetLife and identify yourself as a legal plan member referred to them by MetLife Legal Plans to request an appointment for a consultation. Be prepared to give them your Case Number, the name of the legal plan (Hyatt Legal Services) and the type of legal matter you are calling about.
If you wish, you may choose an out-of-network attorney. In a few areas, where there are no Participating Law Firms, you will be asked to select your own attorney. In these circumstances, you must call MetLife Legal Plans, as described above, prior to contacting any attorney. MetLife Legal Plans will reimburse you for these non-Plan attorneys' fees based on a set fee schedule.
Reminder - Plan benefits will be denied if you do not call first!
For more details about the Legal Services plan, see the Legal Services Summary Plan Description.
Plan Contact Information
Website: Identity Force Phone: 877-697-3367
Plans
UltraSecure - provides continuous monitoring of your personal information, Rapid alerts, comprehensive recovery services and a $1 million identity theft insurance policy.
UltraSecure+ Credit - all of the benefits of the UltraSecure Plan plus robust credit report monitoring and credit reports and scores from all 3 bureaus.
Covered Services
Prevention
- Fraud Monitoring
- Online Protection Tools
- Identity Threat Alerts
- Fraud Alert Reminders
Detection
- Identity Monitoring
- Identity Health Score
- DeleteNow
- Change of Address Monitoring
- Court Record Monitoring
- Sex Offender Report & Monitoring
- Pay Day Loan Monitoring
- Medical ID Fraud Protection
- Junk Mail Opt-Out
Restoration
- Lost Wallet Assistance
- Identity Restoration Specialists
- $1 Million Identity Theft Insurance
Credit
- Free annual credit report
ChildWatch (Available for children under the age of 18 with the purchase of an employee policy.)
- Identity Monitoring
- Fraud Monitoring
- Identity Restoration Specialists
- $1 Million Identity Theft Insurance
Activating Coverage
When retirees elect coverage and their enrollment is processed, an email will be sent from ID Theft to their email address on file as well as to their spouse/partner if they elected coverage. Additional personal information needs to be provided directly to ID Theft in order to provide full theft protection.
Benefit Plan Contacts
Plan | Vendor | Contact info |
---|---|---|
Medical Coverage | Excellus BlueCross BlueShield | 800-724-1675/V and 585-454-2845/TTY |
Prescription Drug | OptumRx | (855) 209-1300 |
Prescription Drug | Wegmans | 800-934-6267 (call transferred to local store) |
Dental | Excellus BlueCross BlueShield | 800-724-1675/V and 585-454-2845/TTY |
Vision | VSP | 800-877-7195/V and 800-428-4833/TTY |
Retiree Billing | Lifetime Benefit Solutions (LBS) | (800) 828-0078 |
Legal Services Plan | MetLife Legal Plans (access code: 570005) | 800-821-6400/V and 800-821-5955/TTY |
Identity Theft Protection | Identity Force | 877-694-3367 |
Education Benefits
Retirees and their eligible family members continue to be eligible for tuition waivers (courses taken at RIT) in retirement. Waivers for the retiree are automatic - retirees just need to register for the class. A Tuition Waiver for Retiree Family Member needs to be completed for an eligible family member. This form must be completed once per academic year.
Tuition Assistance, Tuition Scholarship and Tuition Exchange are not available in retirement.
Other RIT Privileges & Programs
Check out the BetterMe website for more information about programs and benefits.
- Retirees receive a FREE fitness membership at the Student Life Center and Better Me Wellness Center. You will need an RIT Retiree ID card to access these locations; for more information, please refer to their website at https://www.rit.edu/~w-criw/. You can obtain an Retiree ID card from the Registrar’s Office, 1st floor, Eastman Hall.
- Access to weight room, pool, track, tennis courts, basketball courts, racquetball/squash/pickleball courts
- Access to recreation sports (golf league, pick up soccer, lunchtime basketball, racquet sports list, cycling group, Tough Tigers, volleyball)
- Retirees have access to the following free Better Me services:
- Weight room orientations
- Student Life Center tours
- Retirees have access to the following Better Me services that have an additional fee:
- Personal fitness training
- Class pass
- Nutrition coaching (fee for service only)
- Occupational athletic training
- Massage therapy
You may obtain a Retiree ID card at the Registrar’s Office located on the first floor of George Eastman Hall.
By showing your RIT Retiree ID card, you have access privileges to RIT Facilities and services, including the Student Life Center and Wallace Library.