Medicare Part D Summary of Benefits

C and O Employees' Hospital Association

SUMMARY OF BENEFITS FOR 2010 COEHA MEDICARE PART D PRESCRIPTION DRUG PLAN

The C and O Employees’ Hospital Association ("COEHA") has a contract with the Federal Government to provide our members with an enhanced Medicare Part D Prescription Drug Plan. This Summary of Benefits gives you some features of your Plan. To get a complete list of our benefits, please refer to the C and O Employees’ Hospital Association Medicare Part D Prescription Drug Plan Evidence of Coverage for 2010. We have also developed a list of questions and answers to give you a better understanding of your Prescription Drug Plan.

Our Summary lists below what you pay under your COEHA Medicare Part D Prescription Drug Plan:

Monthly Premium for Plan Seven	$250 (This premium includes hospital, medical and prescription drug coverage)
Yearly Deductible	$150
Initial Coverage Limit	$5000
Copays	Generic – up to a 30-day fill @ local pharmacy - $10 Generic – 90-day fill mail order - $25 Brand – up to a $30-day fill @ local pharmacy - $35 Brand – 90 day fill mail order - $70
Out-of-Pocket Maximum	You pay 100% of your drug costs over $5000 until your out-of-pocket costs reach $4550
Catastrophic Coverage	After you have met your $4550 out-of-pocket costs, you pay the greater of the two: 5% of the drug cost or $2.50 copay for generic and $6.30 copay for brand

Who is eligible for this Plan? Current COEHA members will be automatically enrolled in this Plan and do not need to do anything. We have also extended our coverage to the following people:

Former COEHA members who discontinued membership in COEHA,

including those who were employees of the former C & O Hospitals

in Clifton Forge, VA and Huntington, WV

	Medicare spouse/widow(er) of COEHA member
	Medicare spouse/widow(er) of former COEHA member
	Medicare dependent child of COEHA member or former COEHA member
	Medicare parent or parent-in-law of COEHA member
	Medicare divorcee of COEHA member (as long as they have not remarried)
	Former employees of The Greenbrier Hotel
	Medicare retiree from any Railroad

When can I join? Anytime. We are an Employer/Union Medicare Part D Prescription Drug Plan and we do not have an open enrollment period.

Who is the Pharmacy Benefits Manager for this Plan? Informed RX will administer this Plan. You can reach Informed RX at 1-866-433-1095 or visit them at https://informedrx.rxportal.sxc.com/rxclaim/portal/preLogin .

How will I know which local pharmacies are in the Informed RX network? Most of the major pharmacies as well as a number of independent pharmacies are contracted with Informed RX. You can check with your pharmacy or call Informed RX at 1-866-443-1095.

Are there any local pharmacies through which I can get a 90-day supply without having to use mail order? Yes, all Walmart, Kroger, Rite Aid and Target Pharmacies will handle 90-day fills for mail-order copays. There are a few independent pharmacies that have also agreed to do this. You may call COEHA for information on the independent pharmacies.

What happens if I get my prescription filled at a pharmacy that is not in the Informed RX network? If you have met your deductible, you will pay the difference between the in and out of network pharmacy rates, as well as your copay. If you have not met your deductible, you will pay the full cost of the drug. In cases of emergency, you will pay the same rate as an in network pharmacy.

Will I lose coverage by moving to another state? No, your coverage is portable—you will never lose coverage by moving to another area of the country.

Does COEHA offer a plan for prescription drug coverage only? No.

Does COEHA offer a Medicare Supplemental Plan without prescription drug coverage? Yes—Plan Ten which costs $165 per month.

What happens to my prescription drug coverage if I am a Veteran? You can maintain both coverage through the VA and the COEHA. You will be able to get your prescriptions filled through the Department of Veterans Affairs or through the COEHA Prescription Drug Program since the VA is not a Medicare Part D Prescription Drug Plan.

What happens if I do not enroll in a Medicare Part D Prescription Drug Plan when I am first eligible? You will have to pay a higher premium if you choose to join later unless you currently have prescription drug coverage which offers the same or better coverage than the Standard Medicare Part D Plan. Example: The Veterans’ prescription drug coverage would be the same or better coverage than the Standard Medicare Part D Prescription Drug Plan.

Can I have two Medicare Part D Prescription Drug Plans? No. You can only join one Medicare Part D Prescription Drug Plan at a time.

How do I qualify for extra financial help under the Medicare Part D Prescription Drug Plan? The Social Security Administration can help you. This is based on your income and resources which includes your savings and stock, but not your home or car. You may qualify if your resources are less than $12,510 if you are single or $25,010 if you are married. (These amounts may change in 2010.) For more information, call the Social Security Administration at 1-800-772-1213 or visit your local Social Security Office.

For additional information, please call us at 1-800-679-9135 or local residents in the Clifton Forge, VA area call 862-5728. Our hours of operation are Monday through Friday, from 8:30 am to 5:00 pm, EST. You can also visit COEHA at www.coeha.com.

For more information about Medicare, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You can call 24 hours a day, seven days a week. You can also visit Medicare’s website at http://www.medicare.gov.

November 2009

COEHA

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