The eligibility and enrollment rules for the U

More documents

Recommendations

Info

Retiree Health Care SPD Effective January 1, 2012 If your dependent’s coverage option is the UHC plan and (s)he enrolls in a Medicare Part D prescription drug plan, Medicare will automatically terminate your dependent’s UHC coverage and (s)he will no longer be enrolled in the U.S. Bank Retiree Health Care Program. Vaccines: If you are enrolled in UnitedHealthcare or Medica, vaccines that are covered by Medicare Part D are not covered by these medical carriers. However, these vaccines (such as the vaccine for Shingles), will be covered by Medco if the prescription is filled at a participating network retail pharmacy. You should inform your physician that the vaccine is not covered by your medical carrier (UnitedHealthcare or Medica). You will need to coordinate with both your physician and the pharmacist at the retail pharmacy to ensure that the pharmacy stocks the particular vaccine, and has someone onsite that can administer the medication. (See the “Vaccines Covered By Medicare Part D” section in this SPD). 62
Retiree Health Care SPD Effective January 1, 2012 PHARMACY Note: If you are enrolled in Kaiser Colorado, this information does not apply to you. Please see the separate Kaiser materials. Medco Health Solutions (Medco) is the Claims Administrator for the pharmacy benefits included in the Early Retiree Medical, Comprehensive, Medica and UnitedHealthcare options. The information stated throughout the entire “Pharmacy” section relates to all of these options (unless otherwise noted). Refer to the section “How Coverage Works If You Are Age 65 Or Older Or Pre-65 And Medicare Eligible” in this SPD for information about Medicare Part D prescription drug coverage. You need to be sure to show your Medco ID card when receiving prescriptions and Medco will track your claims for you. Once your combined pharmacy/medical deductible for the Early Retiree Medical option or the pharmacy deductible for the Comprehensive, UnitedHealthcare and Medica options has been satisfied you will only be charged the applicable copayment or coinsurance for eligible prescriptions, until you reach your combined pharmacy/medical out-ofpocket maximum for the Early Retiree Medical option and the pharmacy out-of-pocket maximum for the Comprehensive, UnitedHealthcare and Medica options. Coverage includes two prescription drug-dispensing methods: • Mail order using the Medco Pharmacy or Accredo (a division of the Medco Pharmacy for specialty drugs); and • Retail Pharmacy. Pharmacy Deductibles, Coinsurance and Maximums Note: This section only applies to you if you are enrolled in the Comprehensive, Medica or UnitedHealthcare options. If you are enrolled in the Early Retiree Medical option see the “Deductibles, Coinsurance and Maximums” section in this SPD, for information on the combined medical/pharmacy deductibles, coinsurance and maximums. Deductible A deductible is the per plan year amount you must pay toward eligible expenses before you and the health care option begin to share covered expenses. The deductible is applied to the out-ofpocket maximum. The deductible for the Comprehensive, UnitedHealthcare and Medica options is an embedded deductible. Under the health care and pharmacy care options, there are two different types of deductibles. They are: pharmacy and medical deductible. For a definition of each of these deductibles, refer to the “Glossary of Terms” section in this SPD. Deductibles are designed as per person and per family (i.e., the Retail Pharmacy deductible is $250 per person or $750 per family). Family deductibles apply to a participant with two or more covered dependents. If you have selected Family coverage but have only one covered dependent, you and the dependent will each be responsible for the per person deductible. 63
Page 1 and 2:
Retiree Health Care SPD Effective J
Page 3 and 4:
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12: Retiree Health Care SPD Effective J
Page 61: Retiree Health Care SPD Effective J
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
show all

The eligibility and enrollment rules for the U

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?