CALIFORNIA - Pacificare Health Systems

PART B
156
Section 2 – Eligibility, Enrollment
Periods and Effective Date
information regarding your Effective Date,
please contact the University of California.
n Special Election Period (SEP) – Special
periods of time in which you can
discontinue enrollment in a Medicare
Advantage Plan and change your
enrollment to another Medicare Advantage
Plan or return to Medicare. In the event
of the following circumstances, a Special
Election Period is warranted: the Medicare
Advantage Plan in which you are enrolled
is discontinued in the Service Area in
which you live; you move out of the
Service Area of the Medicare Advantage
Plan; the Medicare Advantage Organization
offering the plan violated a material
provision of its contract with you; or you
meet such other material conditions as
CMS may provide.
As a Group Retiree Plan Member, the
information below does not apply to you
because you are allowed to make enrollment
changes at times designated by the University
of California ( see above). Also, please note
that your Secure Horizons Group Retiree
Medicare Advantage Plan through the
University of California does include Medicare
Part D prescription drug coverage. However,
if you ever choose to discontinue your
employer-sponsored health care coverage
through the University of California, the
information below will apply to you.
Starting in 2006, there are limits on when
and how often you can change the way that
Medicare beneficiaries get Medicare coverage
and what choices they can make when they
make the change.
For Medicare beneficiaries who currently
have Medicare coverage, the following
dates are important:
From November 15, 2005 through May 15,
2006, all Medicare beneficiaries may choose
Medicare Part D prescription drug coverage.
Medicare beneficiaries may choose to join a
Medicare Advantage Plan that offers Medicare
Part D prescription drug coverage, or they
may choose to add a Prescription Drug Plan
to their Original Medicare coverage. Medicare
Part D prescription drug coverage is voluntary,
and Medicare beneficiaries may choose not
to enroll in a plan that offers Medicare Part D
drug coverage. Medicare beneficiaries who
do not want Medicare Part D prescription
drug coverage may join a “medical only”
Medicare Advantage Plan, which does not
offer Medicare Part D prescription drug
coverage, or they may remain with Original
Medicare. (If a Medicare beneficiary does
not enroll in a Medicare Part D drug plan by
May 15, 2006, they will be subject to a late
enrollment penalty. If a Medicare beneficiary
waits until after May 15, 2006 to enroll in
a Medicare Part D plan, they will have to
pay the late enrollment penalty for as long
as they have Medicare Part D prescription
drug coverage. The amount of the penalty
will increase every month the Medicare
beneficiary waits to enroll in a Medicare Part
D prescription drug plan.)
From January 1, 2006 through June 30,
2006, Medicare beneficiaries have a chance
to change the way they get their health care
coverage. However, they are limited in when
they may change benefit plans and the type
of plan that they may join. For example, if
they are in a plan that offers Medicare Part D
prescription drug coverage, they may only
choose to join another plan that offers a
Medicare Part D prescription drug coverage,
or choose to return to Original Medicare
and join a Prescription Drug Plan. If they
are not in a plan that offers Medicare Part
D prescription drug coverage, they may not
use this time period to get Medicare Part D
prescription drug coverage.
From November 15, 2006 through
December 31, 2006, Medicare beneficiaries
may switch from one way of getting their
health care coverage to another for 2007.
During this period, they may add Medicare
Part D drug prescription drug coverage
by joining a plan that offers Medicare Part
D prescription drug coverage or add a
Prescription Drug Plan to their Original
Medicare coverage.