Important Notice from the Catholic Health East Employee Prescription Plan

About Your Prescription Drug Coverage and MedicarePart D

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Catholic Health East (CHE) and prescription drug coverage available for people with Medicare. It also explains the options you have under Medicare prescription drug coverage and can help you decide whether or not you want to enroll. At the end of this notice is information about where you can get help to make decisions about your prescription drug coverage. If you or your family members are not covered by Medicare and won’t become covered by Medicare in the next 12 months, this notice doesn’t apply to you.

What you Need to Know

  • Medicare prescription drug coverage is available to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All Medicare prescription drug plans will provide at least a standard level of coverage set by Medicare. Some approved plans may offer more coverage for a higher monthly premium.
  • Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from November 15th through December 31st.
  • Catholic Health East (CHE) has determined that your prescription drug coverage throughCHE is, on average for all plan participants, expected to provide benefits that are at least as great as will be provided by the standard Medicare prescription drug benefit and is considered Creditable Coverage.
  • Because your existing coverage is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay extra if you later decide to enroll in Medicare prescription drug coverage.
  • You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the Medicare prescription drug plans offered in your area. If you decide to enroll in a Medicare prescription drug plan and you are an active employee or family member of an active employee, you may also continue your employer coverage. In this case the CHE plan will continue to pay primary or secondary as it had before you enrolled in a Medicare prescription drug plan. If you decide to enroll in a Medicare prescription drug plan now and discontinue your CHE plan coverage be aware that Medicare will be your only payer of health benefits, including prescription drugs and that your ability to reenter the CHE plan may be limited. You can re-enroll in the CHE plan at annual enrollment of if you have a special enrollment event for the CHE plan.

A Summaryof Medicare Part D Prescription Drug Benefits

  • You must meet a $310annual deductible before Medicare Part D benefits are paid.
  • When your total annual prescription costs are between $310and $2,830, Medicare Part D pays 75% of the cost of your prescriptions.
  • When your total annual prescription costs are between $2,840 and $4,550, Medicare Part D does not pay any benefit. Part D enrollees will receive a 50% discount on the total cost of their brand-name drugs but the full retail cost of the drugs will still apply. Enrollees will pay a maximum of 93% Copay on Generic drugs.
  • Once your total annual prescription costs are above $4,550, Enrollees pay the greater of 5% or $2.50 for generic or preferred drugs and 5% or $6.50 for other drugs.
  • If you discontinue or lose your coverage throughCHE and don’t enroll promptly in a Medicare prescription drug plan, you may have to pay more to enrolllater in Medicare Part D. If you go 63 days or longer without prescription drug coverage that is at least as good as Medicare’s prescription drug coverage, your monthly premium will go up at least 1% for each month that you did not have comparable coverage. For example, if you go nineteen months without such coverage, your premium will always be at least 19% higher than what other Medicare subscribers pay for the same benefits. You’ll have to pay this higher premium as long as you have Medicare Part D coverage. In addition, you may have to wait until the following November to enroll in a Medicare prescription drug plan.

Name/Number:______Date: ______

This individual is covered under Prescription Drug Coverage that is Creditable

from ______to ______or present.

For more information please contact:

RHC______

Contact Name & Position/Office:______

Address:______

Phone Number:______

Other Important Information

  • More detailed information about Medicare Part D prescription drug benefits is available in the “Medicare & You” handbook. You should receive a copy of this handbook in the mail each year directly from Medicare.
  • You may be contacted directly by Medicare prescription drug plan sponsors with detailed information about your enrollment options.
  • You can also get more information about Medicare prescription drug plans from these sources:

On the internet, visit

Call your state Health Insurance Assistance Program (see your copy of the “Medicare & You”

handbook for the telephone number).

Call 1-800-MEDICARE (1-800-633-4227) for personalized assistance. (TTY users should call

1-877-486-2048.)

  • For people with limited income and resources, assistance may be available to help payfor a Medicare prescription drug plan. Information about this assistance can be obtained from the Social Security Administration (SSA). You can visit SSA online at or by phone at 1-800-772-1213. (TTY users should call 1-800-325-0778.)
  • You will receive this notice annually and at other times in the future, such as before the next period you can enroll in a Medicare prescription drug plan, if your prescription drug coverage through CHEchanges, or upon your request. REMEMBER TO KEEP THIS NOTICE. If you enroll in a Medicare prescription drug plan, you may need to provide a copy to show that you are not required to pay a higher premium amount.
  • For more information about this notice, to request a copy, or ask questions about your current Catholic Health East prescription drug benefits, you should contact the Human Resources office of the CHE organization through which you obtain your medical benefit coverage. For general information about your CHE prescription drug benefits, you can call Caremark Customer Care toll free at 1-866-243-7526 (1-866-CHE-PLAN).
  • Written questions about this notice can be addressed to:

Manager, System-wide Benefits

Catholic Health East

Human Resources

3805 West Chester Pike, Suite 100

Newtown Square, Pennsylvania 19073

November 5, 2018