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.

You have from October 15 until December 7 to make changes to your Medicare coverage for next year.

 

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

C and O Employees’ Hospital Association Medicare Part D Prescription Drug is a Medicare-approved Part D sponsor. Enrollment in our plan depends upon contract renewal.
When 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:

Check the changes to our benefits and costs to see if they affect you. It is important to review benefit and cost 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.
Check 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.
Think about your overall health care costs. 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?
Think 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 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.

 

Summary of Important Costs for 2017

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.

Cost

2016 (this year)

2017 (next year)

Monthly plan premium*

*There are no changes to your

premium

$285.00

$285.00

Part D prescription drug coverage

(See Section 2.3 for details)

 

 

 

Copayments (no changes)

Deductible:$200.00

Copayment during the Initial Coverage Stage for a 30-day supply:

Drug Tier 1:$10.00
Drug Tier 2: $35.00
Drug Tier 3: $55.00

Deductible: $200.00

Copayment during the Initial Coverage Stage for a 30-day supply:

Drug Tier 1: $10.00
Drug Tier 2: $35.00
Drug Tier 3: $55.00

 

 

 

 

SECTION 1 Unless You Choose Another Plan, You Will Be Automatically Enrolled in the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan in 2017

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.

SECTION 2 Changes to Benefits and Costs for Next Year

Section 2.1 – There Are No Changes to the Monthly Premium

Cost

2016 (this year)

2017 (next year)

Monthly premium

(You must also continue to pay your Medicare Part B premium unless it is paid for you by Medicaid.)

$285.00

$285.00

 

Your monthly plan premium will be more if you are required to pay a lifetime Part D late enrollment penalty for going without other drug coverage that is at least as good as Medicare drug coverage (also referred to as "creditable coverage") for 63 days or more.
If 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.
Your monthly premium will be less if you are receiving "Extra Help" with your prescription drug costs.

Section 2.2 – There Are No Changes to the Pharmacy Network

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.

Section 2.3 – Changes to Part D Prescription Drug Coverage

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.

Changes to Prescription Drug Costs

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

Stage

2016 (this year)

2017 (next year)

Stage 1: Yearly Deductible Stage

During this stage, you pay the full cost of your drugs until you have reached the yearly deductible.

The deductible is $200.00

The deductible is$200.00

.

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.

 

Stage

2016 (this year)

2017 (next year)

Stage 2: Initial Coverage Stage

Once you pay the yearly deductible, you move to the Initial Coverage Stage. During this stage, the plan pays its share of the cost of your drugs and you pay your share of the cost

The costs in this row are for a one-month (up to a 30-day supply) when you fill your prescription at a Navitus pharmacy that provides standard cost-sharing. For information about the costs for a long-term supply (up to a 90-day supply), look in Chapter 4, Section 5 of your Evidence of Coverage.

We changed the tier for some of the drugs on our Drug List. To see if your drugs will be in a different tier, look them up on the Drug List.

Your cost for a one-month supply filled at a network pharmacy with standard cost-sharing:

Tier 1 - Generic:

You pay $10.00

Tier 2 – Preferred Brand:

You pay $35.00

Tier 3 – Non-Preferred Brand:

You pay $55.00

______________

Once your total drug costs have reached $3500.00, you will move to the next stage (the Coverage Gap Stage).

Your cost for a one-month supply filled at a network pharmacy with standard cost-sharing:

Tier 1 - Generic:

You pay$10.00

Tier 2 – Preferred Brand:

You pay$35.00

Tier 3 – Non-Preferred Brand:

You pay $55.00

______________

Once your total drug costs have reached $3700.00, you will move to the next stage (the Coverage Gap Stage).

 

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.

SECTION 3 Deciding Which Plan to Choose

Section 3.1 – If You Want to Stay in 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 2017.

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 2017 follow these steps:

Step 1: Learn about and compare your choices

You can keep your COEHA Medicare Supplemental Health Plan with Original Medicare (which would be Plan Ten) and join a different Medicare prescription drug plan,
-- OR-- You can change to a Medicare health plan. Some Medicare health plans also include Part D prescription drug coverage,
-- OR--You can change to another Medicare Supplemental Health Plan and another Medicare Part D Drug Plan.

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.

Step 2: Change your coverage

To change to a different Medicare prescription drug plan, enroll in the new plan. You will automatically be disenrolled from C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan.
To change to a Medicare health plan, enroll in the new plan. Depending on which type of plan you choose, you may automatically be disenrolled from C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan.
You will automatically be disenrolled from C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan if you enroll in any Medicare health plan that includes Part D prescription drug coverage. You will also automatically be disenrolled if you join a Medicare HMO or Medicare PPO, even if that plan does not include prescription drug coverage.
If you choose a Private Fee-For-Service plan without Part D drug coverage, a Medicare Medical Savings Account plan, or a Medicare Cost Plan, enrollment in the new plan will not end your membership in our plan. If you are enrolling in this plan type and want to leave our plan, you must ask to be disenrolled from C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan. To ask to be disenrolled, you must send us a written request.

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, 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.

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. Below we list different kinds of help:

"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 75%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:
1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
The 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 (applications); or
Your State Medicaid Office (applications).
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.

SECTION 7 Questions?

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

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).

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 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 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.

Additional Resources

Please contact our COEHA Customer Service number at 1-800-679-9135 or local residents call 862-5728 for additional information. (TTY users should call 711). Hours are Monday through Friday, 8:30 am to 5:00 pm EST.
Language Assistance:

 

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-270-3877 (TTY: 711).

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-800-270-3877TTY71

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(رقمهاتف 800-270-3877-1 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 کریں 1-800-270-3877 (TTY: 711).

注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。1-800-270-3877TTY:711)まで、お電話にてご連絡ください。

 XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-800-270-3877 (TTY: 711).

 

Non-Discrimination Statement:

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:

Co-Administrators, COEHA

511 Main St., 2nd Floor

Clifton Forge, VA 24422

Phone: 800-679-9135

Email: coeha1@aol.com

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:

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD)

 

                                                                                         

                                                            COEHA 1897-2016