PPO II - EmblemHealth

2013 Evidence of Coverage for PPO II) II
SECTION Chapter 5: 3 Using What the benefi plan’s ts are coverage not covered for your by the Part plan? D prescription drugs
Section 9.3 What if you’re also getting drug coverage
from an employer or retiree group plan?
Do you currently have other prescription drug coverage through your (or your spouse’s) employer
or retiree group? If so, please contact that group’s benefi ts administrator. He or she can help you
determine how your current prescription drug coverage will work with our plan.
In general, if you are currently employed, the prescription drug coverage you get from us will be
secondary to your employer or retiree group coverage. Th at means your group coverage would pay fi rst.
Special note about ‘creditable coverage’:
Each year your employer or retiree group should send you a notice that tells if your prescription drug
coverage for the next calendar year is “creditable” and the choices you have for drug coverage.
If the coverage from the group plan is “creditable,” it means that the plan has drug coverage that is
expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.
Keep these notices about creditable coverage, because you may need them later. If you enroll in a
Medicare plan that includes Part D drug coverage, you may need these notices to show that you have
maintained creditable coverage. If you didn’t get a notice about creditable coverage from your employer
or retiree group plan, you can get a copy from the employer or retiree group’s benefi ts administrator or
the employer or union.
SECTION 10 PROGRAMS ON DRUG SAFETY
AND MANAGING MEDICATIONS
Section 10.1 Programs to help members use drugs safely
We conduct drug use reviews for our members to help make sure that they are getting safe and
appropriate care. Th ese reviews are especially important for members who have more than one provider
who prescribes their drugs.
We do a review each time you fi ll a prescription. We also review our records on a regular basis. During
these reviews, we look for potential problems such as:
• Possible medication errors
• Drugs that may not be necessary because you are taking another drug to treat the same medical
condition
• Drugs that may not be safe or appropriate because of your age or gender
• Certain combinations of drugs that could harm you if taken at the same time
• Prescriptions written for drugs that have ingredients you are allergic to
• Possible errors in the amount (dosage) of a drug you are taking.
If we see a possible problem in your use of medications, we will work with your provider to correct the
problem.
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