C and O Employees' Hospital Association

C and O Employees’ Hospital Association

Medicare Part D Prescription Drug Plan

Annual Notice of Changes for 2012

                                                               COEHA

                                         1897      

This booklet tells you how your benefits and costs will change next year if you stay in the          C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan. These changes will take effect on January 1, 2012.

To decide what’s best for you, compare this information with the benefits and costs of other Medicare prescription drug plans in your area, as well as the benefits and costs of Medicare health plans.

This plan, the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan, is offered by the C and O Employees’ Hospital Association (“COEHA”). (When this Annual Notice of Changes 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.) 

Our Plan has a contract with the Federal Government.

COEHA Medicare Part D Prescription Drug Plan Customer Service:

For assistance or information, please call COEHA Customer Service or go to our plan website at www.coeha.com.   Calls to these numbers are free:

                        1-800-679-9135

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

                        TTY/TTD users call 711 for all states

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

Section 1. Important things to know

You are currently enrolled in the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan (PDP)

You are currently enrolled as a member of the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan. This plan is a Medicare prescription drug plan (PDP).

Like all Medicare prescription drug plans, this Medicare plan is approved by Medicare and run by a private company. We are pleased to be providing your Medicare prescription drug coverage.

If you stay enrolled in the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan, there will be some changes to your benefits and to what you pay

Each year, Medicare prescription drug plans may decide to change the premiums, cost-sharing amounts, and benefits they offer. These changes may include increasing or decreasing premiums, increasing or decreasing cost-sharing amounts, and adding or subtracting benefits.

We’re sending you this Annual Notice of Changes to tell you how your benefits and costs as a member of the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan will change next year from your current benefits. The changes will take effect on January 1, 2012. Medicare has approved these changes.

This Annual Notice of Changes is only a summary (see your Evidence of Coverage for the details)

This Annual Notice of Changes gives you a summary of the changes in your benefits and what you will pay for these services in 2012. This notice is a brief summary, not a comprehensive description of benefits. For more information, contact the plan or look in your Evidence of Coverage.

What should you do?

We want you to know what’s ahead for next year, so please read the rest of this document very soon to see how the changes in benefits and costs will affect you if you stay enrolled in the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan for 2012.

To decide what’s best for you, compare this information about the 2012 benefits and costs for    C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan to what your benefits and costs would be if you switched to a different Medicare prescription drug plan or to a Medicare health plan.

If you have access to the Internet, you can find information about plans available in your area by using the Medicare Plan Finder on the Medicare website at http://www.medicare.gov. The Plan Finder helps you compare your choices by giving you information about plans’ benefits and costs and showing you how Medicare rates the plans. For example, these ratings let you compare how well plans are doing in different categories that include member satisfaction and customer service. (To view the information about plans, go to http://www.medicare.gov. Click on the “Health & Drug Plans” button on the left and then choose “Compare Drug and Health Plans.”)

To get information about Medicare plans available in your area, you can also call Medicare or your State Health Insurance Assistance Program.

We value your membership in the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan and hope to keep you as a member.  If you want to make a change for 2012, see “When can you change to a different plan?” in Section 4 for time periods when you can make a change.

There are programs to help people with limited resources to pay for their prescription drugs

You might qualify to get help in paying for your drugs. There are two basic kinds of help:

What if you are currently getting help to pay for your drugs?

If you already get help paying for your drugs, some of the information about premiums and Part D drug costs in this Annual Notice of Changes is not correct for you. We will be sending you a separate insert, called the “Evidence of Coverage Rider for People Who Get Extra Help Paying for Prescription Drugs” (LIS Rider), which tells you about your drug coverage. If you don’t have this insert, please call COEHA Customer Service and ask for the “Evidence of Coverage Rider for People Who Get Extra Help Paying for Prescription Drugs” (LIS Rider). Phone numbers for COEHA Customer Service are on the front page of this Notice.

Section 2. Changes to your monthly premium

Exceptions:

Section 3.  Part D prescription drugs:  Changes to your out-of-pocket costs

There are no changes to our “List of Covered Drugs (Formulary)”

The C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan has a “List of Covered Drugs (Formulary)” or “Drug List” for short. It tells which Part D prescription drugs are covered by the plan. (Chapter 3, Section 1.1 of your Evidence of Coverage explains about Part D drugs.)

The drugs included on our Drug List and the amount you will pay for covered drugs will be the same in 2012 as in 2011. However, we are allowed to make changes to the plan’s Drug List from time to time throughout the year, with approval from Medicare.

Changes to your “out-of-pocket” cost

Changes to the plan’s Drug Payment Stages

The chart below summarizes changes to the plan’s Drug Payment Stages. These changes affect Part D prescription drugs only.

Section 4. Do you want to stay in the plan or make a change?

Do want to stay with the C and O Employees’ Hospital Association Medicare    Part D Prescription Drug?

If you want to keep your membership in the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan for 2012, it’s easy. You don’t need to tell us or fill out any paperwork. You will automatically remain enrolled as a member if you do not sign up for a different plan.

Do you want to make a change?

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.  If you decide to leave the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan, you can switch to a different Medicare prescription drug plan or to a Medicare health plan (either with or without Medicare prescription drug coverage). You can also cancel your enrollment and keep Original Medicare without a Medicare prescription drug plan. (If you disenroll from Medicare prescription drug coverage and go without creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. See Chapter 4, Section 9 for more information about the late enrollment penalty.)

If you want to change to a different plan, there are many choices. If you have access to the Internet, 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.gov and click on the “Health & Drug Plans” button on the left. Then choose “Compare Drug and Health Plans.”) You can also get information about plans from Medicare or from your State Health Insurance Assistance Program.

When can you change to a different plan? 

During the yearly enrollment period (called the “annual coordinated election period”) from October 15 through December 7, 2011, you can change to another Medicare prescription drug plan or to a Medicare health plan (either with or without Medicare prescription drug coverage). You can also cancel your enrollment and keep Original Medicare without a Medicare prescription drug plan. Your new coverage will begin on January 1, 2012. (If you disenroll from Medicare prescription drug coverage and go without creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. See Chapter 4, Section 9 for more information about the late enrollment penalty.)

Is this the only time of the year to choose a different plan?

For most people, yes. Certain individuals, such as those with Medicaid, those who get Extra Help paying for their drugs, or those who move out of the service area, can make changes at other times. There may be other situations in which you are allowed to change plans. For more information, see Chapter 8, Section 2.2 of the Evidence of Coverage.

How do you make a change?

See Chapter 8 of the Evidence of Coverage. It tells what you need to do to make a change from            C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan to another plan.

Check on these things before you make a change

·      Are you a member of an employer or retiree group? If you are, please check with the benefits administrator of your employer or retiree group before you change your plan. This is important because you may lose benefits you currently receive under your employer or retiree group coverage if you switch plans.

·      Are you getting help with paying for your drugs from a State Pharmaceutical Assistance Program (SPAP)? If you are, please check with this program before switching to another plan. The phone number for your State Pharmaceutical Assistance Program is listed in Chapter 2, Section 7 of the Evidence of Coverage.

Section 5. Do you need some help? Would you like more information?

We have information and answers for you

To learn more, read the information we sent in the same package with this Annual Notice of Changes. This is the Evidence of Coverage.

If you have any questions, we are here to help. Please call our COEHA Customer Service at 1-800-679-9135 or for local residents in the Clifton Forge, VA area call 862-5728. (TTY only, 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.

You can get help and information from your State Health Insurance Assistance Program (SHIP)

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.  For more information on SHIP, see Chapter 2 of the Evidence of Coverage.

You can get help and information from Medicare

Here are three ways to get information directly from Medicare:

·         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 (http://www.medicare.gov).

·         Read Medicare & You 2012 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 website (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.