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About
Us |
  Medicare Prescription Drug Coverage Part D (Download Form as PDF)To: All Plan Participants Currently Enrolled in
our Health Plan
The Medicare program was expanded in 2006 to include
a prescription drug option, Part D. The attached notice will impact you
directly if you or your Spouse (or another dependent) are currently
eligible for Medicare. For
example:
1)
You (or your Dependent)
are age 65 or older, or
2)
You (or your Dependent)
are disabled, as defined
by the Social Security Administration and are receiving Social Security
disability payments.
NOTE: If you do not meet either of the
above criteria, there is absolutely no action needed on your part at this time.
We recommend that you simply keep this notice with your other important
paperwork about our health plan.
For those of you in either the first or second
category, the annual open enrollment period to apply for a Medicare Part D
prescription drug plan will commence from November 15, 2009 through December 31st,
2009. Just like Medicare’s Part B (medical care) coverage, there is a
separate premium cost associated with the purchase of prescription drug
coverage. In order to encourage people to sign up for a Part D plan when they
are first eligible, the regulations impose a surcharge (or penalty) if you wait
to enroll in the prescription drug plan at a later date.
Important: this late enrollment penalty is waived if
you are covered by another “creditable” prescription drug plan. Since you (or
your Dependent) are currently enrolled in our health insurance plan, in effect, you already have this “creditable” coverage. Therefore, you do not need
to immediately enroll in Part D to avoid a penalty.
Once you (or your Dependent) are no longer covered by
our health insurance, for example if you terminate your employment, retire, or
reduce your hours, the attached notice will be needed as proof of your
“creditable” coverage status. As long as you sign up for Part D within 63 days
after coverage with our plan ends, you will avoid the premium penalty.
It is therefore very important that you keep a copy
of this information for future reference. Otherwise, your application for
Medicare’s prescription drug coverage will be looked upon as being “late”, you
will be forced to wait until the next open enrollment period in November of
each year and your Medicare prescription drug coverage’s effective date will be
deferred until the following January 1st.
Please note that you are responsible for providing a
copy of the notice to your dependents that are covered under the group plan and
are eligible for Medicare. This
notice is available at any time upon request and can be obtained from Human
Resources.
Important
Notice from Lutheran Augustana Center About
Please read this
notice carefully and keep it where you can find it. This notice has information
about your current prescription drug coverage with Lutheran Augustana Center
and about 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.
There are two important
things you need to know about your current coverage and Medicare’s prescription
drug coverage:
1.
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.
2.
Lutheran Augustana Center has determined that the
prescription drug coverage offered by Medco 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 November 15th through December 31st.
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 Lutheran Augustana Center coverage will
not be affected.
For those Employees enrolled in a Medco plan, your current pharmacy benefits with Lutheran
Augustana Center are based on a three
tiered co-pay basis as follows:
$10 co-payment for generics, and $25
co-payment for formulary and $40 co-payment for non-formulary
medications. You may also use mail order for a 90 day supply.
If
you do decide to join a Medicare drug plan and drop your current Lutheran
Augustana Center coverage, be aware that you and your dependents may or may not
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 Lutheran Augustana Center 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 November
to join.
For More
Information About This Notice Or Your Current Prescription Drug Coverage…
Contact the person listed
below for further information. NOTE: You’ll get this notice each year. You will also get
it before the next period you can join a Medicare drug plan, and if this
coverage through Lutheran Augustana Center changes. You also may request a copy
of this notice at any time.
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).
Date: 10/20/2009
Name
of Entity/Sender: Lutheran
Augustana Center
Contact--Position/Office: Susan
Wittich, Director
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