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:
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
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.
Kenneth R. Farley
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’ HospitalAssociation Medicare Prescription Drug Plan. Next year, there will be some changes to the plan’s costs and benefits.
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.
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.
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.
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 atwww.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.
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"
During this stage, you pay the full cost of your drugs until you reach the deductible amount.
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.
You will stay in this stage until you reach the limit for the Initial Coverage 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:
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).
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:
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 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.
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
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.
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.
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. There are two basic kinds of help:
|Help 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
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 atwww.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).
Getting Help from Medicare
To get information directly from Medicare:
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.")
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