2013 Benefit Enrollment Guide - Troy University

26.01.2015 Views
important notices Medicare Part D Notice: Prescription Drug Coverage and Medicare This notice has information about your current prescription drug coverage with Troy University and your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. Please note: If you are not Medicare eligible, and none of your covered family members are Medicare eligible, no action is required on your part. There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: • Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare 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. • Troy University has determined that the prescription drug coverage offered by The Troy University medical plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When can you join a Medicare Drug Plan You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 through December 7. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What happens to your current coverage if you decide to join a Medicare Drug Plan If you decide to join a Medicare drug plan, your current Troy University medical coverage will not be affected. Participants may keep this coverage if they elect Part D and this plan will coordinate with Part D coverage. If you decide to join a Medicare drug plan and drop your current Troy University medical plan coverage, be aware that you and your dependents will be able to get this coverage back. When will you pay a higher premium (penalty) to join a Medicare Drug Plan You should also know that if you drop or lose your current coverage with Troy University medical plan and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For more information about this notice or your current Prescription Drug Coverage: Contact the benefits department for further information, 334-670-3338. NOTE: You may receive this notice at other times in the future such as before the next period you can enroll in Medicare prescription drug coverage, and if this coverage changes. You also may request a copy. For more information about your options under Medicare Prescription Drug Coverage: More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: • Visit www.medicare.gov. • Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778). Please call 1-866-688-9727. Troy University 2013 Benefits Enrollment Guide 18

Troy University-54395/000 Coverage Period: Beginning on or after 01/01/2012 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Plan Type: PPO This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsal.org or by calling 1-800-292-8868. Important Questions Answers Why this Matters: What is the overall deductible Are there other deductibles for specific services Is there an out–of–pocket limit on my expenses What is not included in the out–of–pocket limit Is there an overall annual limit on what the plan pays Does this plan use a network of providers Do I need a referral to see a specialist $500 person. Does not apply to preventive services, physician, inpatient, drugs, noncovered services, most copays, balance-billed charges and pre-certification penalties. Yes. $300 person Per Admission. $400 person per admission inpatient deductible for out of network. There are no other specific deductibles. Yes. $400 person. Premium, balance-billed charges, health care this plan doesn't cover, copays, out of network coinsurance, most coinsurance, pre-certification penalties and pharmacy copays. No. Yes, this plan uses in-network providers. For a list of in-network providers, see www.bcbsal.com or call 1-800-810-BLUE. No. You don't need a referral to see a specialist. You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use. Check your policy or plan document to see when the deductible starts over (usually, but not always, January 1st). See the chart starting on page 2 for how much you pay for covered services after you meet the deductible. You must pay all of the costs for these services up to the specific deductible amount before this plan begins to pay for these services. The out-of-pocket limit is the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses. Even though you pay these expenses, they don’t count toward the out-of-pocket limit. The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits. If you use an in-network doctor or other health care provider, this plan will pay some or all of the costs of covered services. Be aware, your in-network doctor or hospital may use an out-of-network provider for some services. Plans use the term in-network, preferred, or participating for providers in their network. See the chart starting on page 2 for how this plan pays different kinds of providers. You can see the specialist you choose without permission from this plan. Questions: Call 1-800-292-8868 or visit us at www.bcbsal.org. If you aren’t clear about any of the bolded terms used in this form, see the Glossary. You can view the Glossary at www.dol.gov/ebsa/pdf/SBCUniformGlossary.pdf or call 1-800-292-8868 to request a copy. 1 of 7

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