C and O Employees' Hospital Association

 

 

 

December 1, 2012

 

Dear C and O Employees’ Hospital Association ("COEHA") Member:

Here are four documents with important information for you regarding your C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan:

  1. Please start by reading the Annual Notice of Changes for 2013. It gives you a summary of changes to your benefits and costs for next year. These changes will take effect on January 1, 2013. Please review this notice within a few days of receiving it to see how the changes might affect you.
  2. The Evidence of Coverage for the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan is the legal, detailed description of your benefits and costs for 2013 if you stay enrolled in our Plan. It also explains your rights and rules you need to follow when using your coverage for prescription drugs. Please look through this document so you know what’s in it and keep it handy for reference.
  3. In October 2012, we sent notices to our membership regarding the change in our Pharmacy Benefits Manager, effective January 1, 2013, to Navitus Health Solutions ("Navitus"). We are enclosing a listing of the Navitus network pharmacies (national and regional chains). Navitus is contracted with the same retail pharmacies currently utilized by our membership. The Navitus network also includes the independent pharmacies utilized by our membership such as: Stultz, Big Four Drug Store, Owens and Brothers & Brown. You will not have to get new prescriptions for the retail pharmacies.
  4. Navitus offers a mail-order service for your convenience. We have enclosed the WellDyne Rx Prescription Drug Program Mail Service Form. You will need new prescriptions for the mail-order program.

Your new C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan ID card will be mailed to you under separate cover. If you have not received your new ID card by December 15, 2012, please let us know.

 

If you have any questions, we are here to help.

Call COEHA Customer Service toll-free at: 1-800-679-9135

For local residents in the Clifton Forge, VA area: 862-5728

TTY/TTD users: 711 for all states

Hours of Operation are Monday - Friday: 8:30 am to 5:00 pm (EST)

Visit our web site at: www.coeha.com

Effective January 1, 2013, you can contact Navitus, after our weekday hours and 24 hours on Saturday and Sunday at:

Call Navitus Customer Care toll-free at: 1-866-333-2757

Hours for Monday-Thursday: 5:01 pm to 8:29 am (EST)

Hours for Friday, Saturday & Sunday: 5:01 pm Friday until 8:29 am

Monday (EST)

Visit their web site at: www.navitus.com

We value your membership in the C and O Employees’ Hospital Association and look forward to providing you a high level of service.

Sincerely,

Kenneth R. Farley

 

 

                    COEHA

                                                                                                                 

   1897

 

 

 

 

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 2013

You are currently enrolled as a member of C and O Employees’ Hospital Association Medicare Prescription Drug Plan. Next year, there will be some changes to the plan’s costs and benefits.

Additional Information:

bulletPlease contact our Customer Service number at:

1-800-679-9135

862-5728 (for local residents in the Clifton Forge, VA area)

TTD/TTY users call 711 for all states

Hours of Operation: 8:30 am to 5:00 pm (EST), Monday through Friday

About C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan:

bulletOur Plan is a Medicare approved Part D Sponsor.
bulletWhen this booklet says "we," "us," or "our," it means COEHA. When it says "plan" or "our plan," it means C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan.

 

Think about Your Medicare Coverage for Next Year

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:

bulletCheck the changes to our benefits to see if they affect you. It is important to review benefit changes to make sure they will work for you next year. Look in Section Two for information about benefit and cost changes for our plan.
bulletCheck the changes to our prescription drug coverage to see if they affect you. Will your drugs be covered? Are they in a different tier? Can you continue to use the same pharmacies? It is important to review the changes to make sure our drug coverage will work for you next year. Look in Section Two for information about changes to our drug coverage.
bulletThink about your overall costs in the plan. How much will you spend out-of-pocket for the services and prescription drugs you use regularly? How much will you spend on your premium? How do the total costs compare to other Medicare coverage options?
bulletThink about whether you are happy with our plan.

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 don’t make a change by December 7, you will automatically stay enrolled in our plan.

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, 2013. Look in Section Three to learn more about your choices.

 

 

SECTION 1 Unless You Choose Another Plan, You Will Remain Enrolled in C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan

If you have not done anything to change your Medicare coverage by December 7, 2012, you will remain enrolled in our Plan, C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan. You have choices about how to get your Medicare coverage. If you want to, you can change to a different Medicare prescription drug plan. You can also switch to a Medicare health plan.

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, 2013 as a member of C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan.

SECTION 2 Changes to Benefits and Costs for Next Year

 

Section 2.1 – There are No Changes to the Monthly Premium

 

 

2012 (this year)

2013 (next year)

Monthly premium

 

(You must continue to pay your Medicare Part B premium.)

$285.00

$285.00

bulletYour monthly plan premium will be more if you are required to pay a late enrollment penalty.
bulletIf you have a higher income, you may have to pay an additional amount each month directly to the government for your Medicare prescription drug coverage.
bulletYour monthly premium will be less if you are receiving "Extra Help" with your prescription drug costs.

Section 2.2 – Change to a Different Pharmacy Benefits Manager

 

Effective January 1, 2013, your prescription drug coverage will be managed by Navitus Health Solutions, LLC ("Navitus") instead of Informed Rx.

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 Health Solutions’ network pharmacies. Navitus is contracted with the same retail pharmacies that you currently utilize.

We included a copy of the Navitus Pharmacy Directory in the envelope with this Notice. It includes the national and regional chains. An updated Pharmacy Directory is located on the Navitus web site at www.navitus.com. You may also call COEHA Customer Service for updated pharmacy information or to ask us to mail you a Pharmacy Directory. Please review the 2013 Pharmacy Directory to see which pharmacies are in the Navitus network.

Section 2.3 – Changes to Part D Prescription Drug Coverage

There are No Changes to Our Drug List

Our list of covered drugs is called a Formulary or "Drug List." You can call COEHA Customer Service to find out if a particular drug is on our plan’s drug list. You can also visit our web site at www.coeha.com or the Navitus web site at www.navitus.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 2013 as in 2012. However, we are allowed to make changes to the Drug List from time to time throughout the year, with approval from Medicare.

Changes to Prescription Drug Costs

There are four drug payment stages. Which "Drug Payment Stage" you are in affects how much you pay for a Part D drug.

The information below shows the four drug payment stages. You can also look in Chapter 4 of your Evidence of Coverage for more information about the stages.

Note: If you are in a program that helps pay for your drugs ("Extra Help"), the information about costs for Part D prescription drugs may 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 coverage. If you don’t receive this insert, please call COEHA Customer Service and ask for the "LIS Rider." Phone numbers for COEHA Customer Service are on the front page of this document.

Stage 1

Yearly Deductible Stage

Stage 2

Initial Coverage Stage

Stage 3

Coverage Gap Stage

Stage 4

Catastrophic Coverage Stage

You begin in this payment stage.

During this stage, you pay the full cost of your drugs.

You stay in this stage until you have paid your deductible amount.

During this stage, the plan pays its share of the cost of your drugs and you pay your share of the cost.

You stay in this stage until your total drug costs reach the limit for the Initial Coverage Stage.

Most people do not reach the Coverage Gap Stage. If you do reach this stage, your share of the costs for your drugs will change.

You stay in this stage until your total "out-of-pocket costs" (your payments) reach the limit for the Coverage Gap Stage.

Most people do not reach the Catastrophic Coverage Stage. If you do reach this stage, we will pay most of the cost of your drugs for the rest of the calendar year (through December 31, 2013).

 

Stage 1: "Yearly Deductible Stage"

During this stage, you pay the full cost of your drugs until you reach the deductible amount.

bulletIn 2013, the yearly deductible is $150.00 (it was $150.00 in 2012).
bulletOnce you reach the deductible amount, you move to the "Initial Coverage Stage."

Stage 2: "Initial Coverage Stage"

The "Initial Coverage Stage" starts once you reach the deductible amount. In this stage, how much you pay for a drug depends on which "tier" the drug is in.

 

 

 

 

 

 

 

The table below shows your costs for drugs in each of our three drug tiers. These amounts apply only during the time when you are in the Initial Coverage Stage.

2012 (this year)

2013 (next year)

Drugs in Tier One

(generic drugs)

Cost for a one-month (up to a 30-day supply) of a drug in tier one that is filled at a network pharmacy

Cost for a long-term (up to a 90-day supply) when filled through the mail-order program, WellDyne Rx or at participating retail pharmacies that fill a 90-day supply for the same price as the mail-order copay

 

 

 

 

$10.00

 

 

 

 

 

$20.00

 

 

 

 

 

 

 

$10.00

 

 

 

 

 

$20.00

Drugs in Tier Two

(preferred brand medications)

Cost for a one-month (up to a 30-day supply) of a drug in tier two that is filled at a network pharmacy

Cost for a long-term (up to a 90-day supply) when filled through the mail-order program, WellDyne Rx or at participating retail pharmacies that fill a 90-day supply for the same price as the mail-order copay

 

 

 

 

$35.00

 

 

 

 

 

$70.00

 

 

 

 

$35.00

 

 

 

 

 

$70.00

 

 

 

 

Drugs in Tier Three

(non-preferred medications)

 

Cost for a one-month (up to a 30-day supply) of a drug in tier one that is filled at a network pharmacy

 

Cost for a long-term (up to a 90-day supply) when filled through the mail-order program, WellDyne Rx or at participating retail pharmacies that fill a 90-day supply for the same price as the mail-order copay

 

 

 

 

 

 

 

 

$50.00

 

 

 

 

 

$90.00

 

 

 

 

$50.00

 

 

 

 

 

$90.00

You will stay in this stage until you reach the limit for the Initial Coverage Stage:

bulletIn 2013, the limit for the Initial Coverage Stage is $5,000.00 (this year the limit is $5,000.00. You stay in the Initial Coverage Stage until your total drug costs reach $5,000.00.
bulletOnce you reach this limit, you move on to the Coverage Gap Stage.

Stage 3: "Coverage Gap Stage"

Once you reach the Coverage Gap stage, your costs for Part D drugs will change (the three drug tiers no longer apply).

In 2013, your costs for drugs in the Coverage Gap Stage will be:

bulletBrand name drugs: You pay 47.5% of the total cost (plus a portion of the dispensing fee) (this year, 2012, you pay 50% of the total cost for brand name drugs).
bulletGeneric drugs: You pay 79% of the total cost (this year, 2012, you pay 86% of the total cost for generic drugs).

You will stay in the Coverage Gap Stage until you pay $4,750.00 out-of-pocket for Part D drugs (this year it is $4,700.00).

bulletOnce you reach this total amount, you move on to the "Catastrophic Coverage Stage."

Stage 4: "Catastrophic Coverage Stage"

The Catastrophic Coverage Stage is the last of the Drug Payment Stages. Once you are in this stage, you stay in it until the end of the calendar year.

Medicare requires all plans to have the same coverage in the Catastrophic Coverage Stage. So in this stage, all people with Medicare pay the same amount, no matter which plan they are in. In the Catastrophic Coverage Stage, we pay most of the cost for your Part D drugs. You pay the greater of:

bullet5% of the total cost
bullet-- or -- $2.65 copay for generic (including brand drugs treated as generic) and a $6.60 copay for all other drugs (this year, 2012, you pay a $2.60 copay for generic drugs and a $6.50 copay for other drugs.)

 

SECTION 3 Deciding Which Plan to Choose

 

Section 3.1 – If you want to stay in the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan

To stay in our plan you 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 2013.

Because we are an Employer/Union Medicare Part D Prescription Drug Plan, you may leave our Plan at any time; however, you may not be able to join another plan at any time.

Section 3.2 – If you want to change plans

We hope to keep you as a member next year but if you want to change for 2013 follow these steps:

Step 1: Learn about and compare your choices

bulletYou can join a different Medicare prescription drug plan,
bullet-- OR-- You can change to a Medicare health plan. Some Medicare health plans also include Part D prescription drug coverage,
bullet-- OR-- You can keep Original Medicare without a separate Medicare prescription drug plan.

To learn more about Original Medicare and the different types of Medicare plans, read Medicare & You 2013, 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 Web site. Go to http://www.medicare.gov and click "Compare Drug and Health 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.

Step 2: Change your coverage

bulletTo change to a different Medicare prescription drug plan, enroll in the new plan. You will automatically be disenrolled from the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan.
bulletTo change to a Medicare health plan, enroll in the new plan. You will automatically be disenrolled from the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan.

 

SECTION 4 Deadline for Changing Plans

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, 2013.

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, 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 2.3 of the Evidence of Coverage.

 

 

SECTION 5 Programs That Offer Free Counseling about Medicare

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.

SECTION 6 Programs That Help Pay for Prescription Drugs

You may qualify for help paying for prescription drugs. There are two basic kinds of help:

bullet"Extra Help" from Medicare. People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not have a coverage gap or late enrollment penalty. Many people are eligible and don’t even know it. To see if you qualify, call:
bullet1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
bulletThe Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
bulletYour State Medicaid Office.
bulletHelp from your state’s pharmaceutical assistance program. Many states have a 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. Each state has different rules to provide drug coverage to its members. To get the number for your state, you can call National Medicare at 1-800-633-4227.

 

 

SECTION 7 Questions?

 

Section 7.1 – Getting Help from the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan

Questions? We’re here to help. Please call COEHA Customer Service toll free at 1-800-679-9135 or for local members, call 862-5728. TTY/TTD users should 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 2013 Evidence 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 2013. For details, look in the 2013 Evidence of Coverage for the 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 was included in this envelope.

Visit our Web site

You can also visit our web site at www.coeha.com. As a reminder, our web site has the most up-to-date information about the Navitus pharmacy network (Pharmacy Directory) and our list of covered drugs (Formulary/Drug List).

Section 7.2 – Getting Help from Medicare

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 Web site

You can visit the Medicare Web site (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 Web site. (To view the information about plans, go to http://www.medicare.gov and click on "Compare Drug and Health Plans.")

Read Medicare & You 2013

You can read Medicare & You 2013 Handbook. 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 Web site (http://www.medicare.gov) or by calling
1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call
1-877-486-2048.

 

COEHA

                                                                                             

 

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