C and O Employees' Hospital Association
C AND O EMPLOYEES’ HOSPITAL ASSOCIATION
511 MAIN STREET, 2ND FLOOR
CLIFTON FORGE, VIRGINIA 24422-1166
TELEPHONE (540) 862-5728/5729 (800) 679-9135 FAX (540) 862-3552/4958
1897-2016 MORE THAN 100 YEARS OF EXCELLENCE
C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan offered by C and O Employees’ Hospital Association ("COEHA")Annual Notice of Changes for 2017
You are currently enrolled as a member of C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan.Next year, there will be some changes to the plan’s costs and benefits. This booklet tells about the changes.
About C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan
Each fall, Medicare allows you to change your Medicare health and drug coverage during the Annual Enrollment Period. It’s important to review your coverage now to make sure it will meet your needs next year.
Important things to do:
If you decide to stay with C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan:
If you want to stay with us next year, it’s easy - you don’t need to do anything.
If you decide to change plans:
If you decide other coverage will better meet your needs, you can switch plans between October 15 and December 7. If you enroll in a new plan, your new coverage will begin on January 1, 2017. Look in Section 3.2 to learn more about your choices.
The table below compares the 2016 costs and 2017 costs for C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan in several important areas. Please note this is only a summary of changes. It is important to read the rest of this Annual Notice of Changes and review the enclosed Evidence of Coverage to see if other benefit or cost changes affect you.
If you do nothing to change your Medicare coverage by December 7, 2016, we will automatically enroll you in our Plan, C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan. This means starting January 1, 2017, you will be getting your prescription drug coverage through C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan. If you want to, you can change to a different Medicare prescription drug plan. You can also switch to a Medicare health plan. If you want to change, you must do so between October 15 and December 7.
The information in this document tells you about the differences between your current benefits in C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan and the benefits you will have on January 1, 2017 as a member of C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan.
Amounts you pay for your prescription drugs may depend on which pharmacy you use. Medicare drug plans have a network of pharmacies. In most cases, your prescriptions are covered only if they are filled at one of the Navitus network pharmacies.
Changes to Our Drug List
Our list of covered drugs is called a Formulary or "Drug List." A copy of our Drug List is in this envelope. The Drug List we included in this envelope includes many – but not all – of the drugs that we will cover next year. If you don’t see your drug on this list, it might still be covered. You can get the complete Drug List by calling COEHA Customer Service or visiting our website,http://www.coeha.com.
We have not made any changes to our Drug List for next year. The drugs included on our Drug List will be the same in 2017 as in 2016. However, we are allowed to make changes to the Drug List from time to time throughout the year, with approval from Medicare or if a drug has been withdrawn from the market by either the FDA or a product manufacturer.
Note:If you are in a program that helps pay for your drugs ("Extra Help"), the information about costs for Part D prescription drugs does not apply to you. We will send you a separate insert, called the "Evidence of Coverage Rider for People Who Get Extra Help Paying for Prescription Drugs" (also called the "Low Income Subsidy Rider" or the "LIS Rider"), which tells you about your drug costs. If you get "Extra Help" and didn’t receive this insert, please call COEHA Customer Service and ask for the "LIS Rider." Phone numbers for COEHA Customer Service are in Section 7.1 of this booklet.
There are four "drug payment stages." How much you pay for a Part D drug depends on which drug payment stage you are in. (You can look in Chapter 4, Section 2 of your Evidence of Coverage for more information about the stages.)
The information below shows the changes for next year to one of the first two stages – the Yearly Deductible Stage and the Initial Coverage Stage. (Most members do not reach the other two stages – the Coverage Gap Stage or the Catastrophic Coverage Stage. To get information about your costs in these stages, look at Chapter 4, Sections 6 and 7, in the Evidence of Coverage for 2017.)
No Changes to the Deductible Stage
Changes to Your Cost-sharing in the Initial Coverage Stage
To learn how copayments and coinsurance work, look at Chapter 4, Section 1.2, Types of out-of-pocket costs you may pay for covered drugs in your Evidence of Coverage.
Changes to the Coverage Gap and Catastrophic Coverage Stages
The other two drug coverage stages – the Coverage Gap Stage and the Catastrophic Coverage Stage – are for people with high drug costs. Most members do not reach the Coverage Gap Stage or the Catastrophic Coverage Stage.
For information about your costs in these stages, look at Chapter 4, Sections 6 and 7, in your Evidence of Coverage.
To stay in our planyou don’t need to do anything. If you do not sign up for a different plan by December 7, you will automatically stay enrolled as a member of our plan for 2017.
We hope to keep you as a member next year but if you want to change for 2017 follow these steps:
Step 1:Learn about and compare your choices
To learn more about Original Medicare and the different types of Medicare plans, read Medicare & You 2017, call your State Health Insurance Assistance Program (see Section 5), or call Medicare (see Section 7.2).
You can also find information about plans in your area by using the Medicare Plan Finder on the Medicare website. Go to http://www.medicare.govand click "Find health & drug plans." Here, you can find information about costs, coverage, and quality ratings for Medicare plans.
As a reminder, we offer two Medicare Supplemental Plans—one with Part D Prescription Drug coverage and one without prescription drug coverage.
If you want to change to a different prescription drug plan or to a Medicare health plan for next year, you can do it from October 15 until December 7. The change will take effect on January 1, 2017.
Are there other times of the year to make a change?
In certain situations, changes are also allowed at other times of the year. For example, people with Medicaid, those who get "Extra Help" paying for their drugs, those who have or are leaving employer coverage, and those who move out of the service area are allowed to make a change at other times of the year. For more information, see Chapter 8, Section 2.2 of the Evidence of Coverage.
The State Health Insurance Assistance Program (SHIP) is a government program with trained counselors in every state. SHIP is independent (not connected with any insurance company or health plan). It is a state program that gets money from the Federal government to give free local health insurance counseling to people with Medicare. SHIP counselors can help you with your Medicare questions or problems. They can help you understand your Medicare plan choices and answer questions about switching plans. You can call COEHA Customer Service to get the number for your state.
You may qualify for help paying for prescription drugs. Below we list different kinds of help:
|Help from your state’s pharmaceutical assistance program. Many
states have a program called State Pharmaceutical Assistance Program that
helps people pay for prescription drugs based on their financial need, age,
or medical condition. To learn more
about the program, check with your State Health Insurance Assistance
Program. To get the number for your state you can call COEHA Customer
Service.||Prescription Cost-sharing Assistance for Persons with HIV/AIDS. The
AIDS Drug Assistance Program (ADAP) helps ensure that ADAP-eligible
individuals living with HIV/AIDS have access to life-saving HIV medications.
Individuals must meet certain criteria, including proof of State residence
and HIV status, low income as defined by the State, and
uninsured/under-insured status. Medicare Part D prescription drugs that are
also covered by ADAP qualify for prescription cost-sharing assistance
through the State ADAP. For information on eligibility criteria, covered
drugs, or how to enroll in the program, please call National Medicare at
1-800-633-4227 to get the number for your state.|
Questions? We’re here to help. Please call COEHA Customer Service at 1-800-679-9135 or for local members, call 862-5728. (TTY/TTD users call 711 for all states). We are available for phone calls Monday through Friday, 8:30 am to 5:00 pm (EST). Calls to these numbers are free.
Read your 2017Evidence of Coverage (it has details about next year's benefits and costs)
This Annual Notice of Changes gives you a summary of changes in your benefits and costs for 2017. For details, look in the 2017Evidence of Coverage for C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan. The Evidence of Coverage is the legal, detailed description of your plan benefits. It explains your rights and the rules you need to follow to get covered services and prescription drugs. A copy of the Evidence of Coverage is included in this envelope.
Visit our Website
You can also visit our website at http://www.coeha.com. As a reminder, our website has the most up-to-date information about our pharmacy network (Pharmacy Directory) and our list of covered drugs (Formulary/Drug List).
To get information directly from Medicare:
Call 1-800-MEDICARE (1-800-633-4227)
You can call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
Visit the Medicare Website
You can visit the Medicare website (http://www.medicare.gov).It has information about cost, coverage, and quality ratings to help you compare Medicare prescription drug plans. You can find information about plans available in your area by using the Medicare Plan Finder on the Medicare website. (To view the information about plans, go to http://www.medicare.govand click on "Review and Compare Your Coverage Options.")
Read Medicare & You 2017
You can read Medicare & You 2017Handbook.
Every year in the fall, this booklet is mailed to people with Medicare. It has a
summary of Medicare benefits, rights and protections, and answers to the most
frequently asked questions about Medicare. If you don’t have a copy of this
booklet, you can get it at the Medicare website (http://www.medicare.gov)or
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-270-3877 (TTY: 711).
주의: 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다. 1-800-270-3877 (TTY: 711)번으로전화해주십시오.
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-270-3877 (TTY: 711).
(رقمهاتف800-270-3877-1 ملحوظة: إذاكنتتتحدثاذكراللغة،فإنخدماتالمساعدةاللغويةتتوافرلكبالمجان. اتصلبرقم الصم والبكم: 711)
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-270-3877 (TTY: 711)
ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-800-270-3877 (ATS : 711).
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-270-3877 (телетайп: 711).
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-800-270-3877 (TTY: 711).
Wann du Deitsch (Pennsylvania German / Dutch) schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-800-270-3877 (TTY: 711).
توجه: اگربهزبانفارسیگفتگومیکنید،تسهیلاتزبانیبصورترایگانبرایشمافراهممی باشد. با1-800-270-3877 (TTY: 711)تماسبگیرید.
ማስታወሻ: የሚናገሩትቋንቋኣማርኛከሆነየትርጉምእርዳታድርጅቶች፣በነጻሊያግዝዎትተዘጋጀተዋል፡ወደሚከተለውቁጥርይደውሉ 1-800-270-3877 (መስማትለተሳናቸው: 711).
خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال کریں1-800-270-3877 (TTY: 711).
XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-800-270-3877 (TTY: 711).
C and O Employees’ Hospital Association complies
with applicable Federal civil rights laws and does not discriminate on the basis
of race, color, national origin, age, disability or sex. C and O Employees’
Hospital Association does not exclude people or treat them differently because
of race, color, national origin, age, disability or sex. C and O Employees’
Hospital Association provides free aids and services to people with disabilities
to communicate effectively with us, such as: qualified sign language
interpreters and written information in other formats (large print, audio,
accessible electronic formats, other formats). C and O Employees’ Hospital
Association provides free language services to people whose primary language is
not English such as: qualified interpreters and information written in other
languages. If you need these services, contact the C and O Employees’ Hospital
Association Customer Care Center at800-679-9135. If you believe that C and O
Employees’ Hospital Association has failed to provide these services or
discriminated in another way on the basis of race, color, national origin, age,
disability, or sex, you can file a grievance. If you need help filing a
grievance, COEHA Grievance and Appeals is available to help you. You can file a
grievance in person or by mail, fax, or email:
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: