National Coverage Determinations (NCD)
Implementation Policy on Medicare covered Preventive Services
12/01/11 - CARE is in receipt of information from the Centers for Medicare & Medicaid Services (CMS) regarding the responsibilities of Medicare Advantage Organizations and Cost Plans (such as CARE) regarding medical preventative services that will now be offered to our membership with no cost sharing responsibility.
There are four services included in this implementation those being, Screening and Behavioral Counseling Interventions to reduce Alcohol Misuse and Screening for Depression in Adults, these were effective October 14, 2011. Effective November 8, 2011, Screening for Sexually Transmitted Infections (STI’S) and High Intensity Behavioral Counseling to Prevent STI’s and Intensive Behavioral Therapy for Cardiovascular Disease are included. In the near future CMS will be advising of an additional preventative service.
It is the responsibility of CARE to notify our members of these changes to your membership coverage.
CARE 2012 BENEFIT CHANGES
Plan #4000 - Prescription Drug Benefit Change
THE FOLLOWING INFORMATION INCLUDES THE APPLICABLE COPAYMENTS,
DEDUCTIBLES AND ANNUAL MAXIMUMS
CARE PLAN #4000 - 2012 PRESCRIPTION DRUG BENEFIT (PART D)
We are pleased that we can continue to offer an enhanced, creditable prescription drug benefit for 2012! With the CARE Plan #4000 Part D prescription drug benefit, there is NO annual deductible and we have increased your annual benefit level (Stage 2/Initial Coverage Stage) to $4,200! Keep in mind however that the $4,200 now includes not only the amount that CARE pays toward your benefit, but it also includes the amount YOU have paid toward the $4,200. Once you reach $4,200 in total drug spend, you then move into Stage 3/Coverage Gap Stage or Donut Hole. In Stage 3, you are responsible for 50% of the cost for brand name drugs and 86% of the cost for generic drugs. You remain in Stage 3 until your Out-of-Pocket costs (co-payments/coinsurance) reach $4,700. You then go into Stage 4/Catastrophic Coverage and pay only 5% or less of the costs of drugs until the end of the year.
The CARE open enrollment is from November 15th through December 31st. The benefit period for Plan #4000 is January 1 through December 31. As stated above, there are four stages to your Medicare Part D Prescription Drug Plan. Please see chart below for further explanation of the four stages plus your copayments for 2012.
For questions regarding your prescription drug benefit contact the CARE Customer Service/Benefits Department at 800-334-1330.
SEE THE CHART BELOW FOR THOSE CHANGES.
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STAGES |
2011 |
2012 |
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Stage 1 Yearly Deductible Stage Because there is no deductible for the plan, this payment stage does not apply to you. |
No Annual Deductible |
No Annual Deductible |
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Stage 2 Initial Coverage Stage The stage where you pay a co-payment or coinsurance for your drugs.
You stay in this stage until the total cost of your Part D drugs reaches the limit for the Initial Coverage Stage.
Once you reach this limit, you move on to the Coverage Gap Stage. |
$3,000 When total plan costs for your Part D drugs reaches this amount, you move on to the Coverage Gap Stage. |
$4,200 When the total costs (drug costs paid by you and the plan) for your Part D drugs reaches this amount, you move on to the Coverage Gap Stage. |
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Stage 3 Coverage Gap Stage You stay in this stage until your True Out-of-Pocket Costs (TROOP) reach a total of $4,700.
Your TROOP costs are the total amount you have paid (co-payments and/or coinsurance) since January 1. |
During this stage, you pay 50% of the price (plus the dispensing fee) for brand name drugs and 93% of the price for generic drugs. |
During this stage, you pay 50% of the price (plus the dispensing fee) for brand name drugs and 86% of the price for generic drugs. |
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Stage 4 Catastrophic Coverage Stage During the Catastrophic Coverage Stage, the plan will pay most of the cost for your Part D drugs.
You will stay in this stage until the end of the calendar year. |
During this stage, you will pay:
The greater of 5% coinsurance or $2.50 for generics (or drugs treated as generic) and $6.30 for all other drugs. |
During this stage, you will pay:
The greater of 5% coinsurance or $2.60 for generics (or drugs treated as generic) and $6.50 for all other drugs. |
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CARE PLAN #4000 MEDICARE (PART D) PRESCRIPTION DRUG BENEFIT CO-PAYMENTS FOR 2012 |
RETAIL |
MAIL ORDER |
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Up to 34-Day Supply |
34 to 90-Day Supply |
90-Day Supply |
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Tier 1 - Generic Drugs |
$ 10.00 |
$ 30.00 |
$ 15.00 |
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Tier 2 - Preferred Brand Name Drugs |
$ 25.00 |
$ 75.00 |
$ 30.00 |
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Tier 3 - Non-Preferred Name Brand Drugs |
$ 40.00 |
$120.00 |
$120.00 |
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Tier 4 - Specialty Drugs |
Higher of $50 or 33% of drug costs.
Maximum Co-payment $150 |
Higher of $150 or 33% of drug costs.
Maximum Co-payment $450 |
Higher of $100 or 33% of drug costs.
Maximum Co-payment $300 |
CARE 2011 BENEFIT CHANGES
CARE PLAN #4000/#4100 CHEMOTHERAPY/ANTI REJECTION DRUGS BENEFIT CHANGE FOR 2011
The Chemotherapy / Anti Rejection Drug Benefit will be removed from the medical portion of CARE Plans #4000 and #4100.
Plan #4000 members will receive these types of medications through their CARE Medicare Part D Prescription Drug Plan. Plan #4100 members will lose this portion of their medical benefit unless they are enrolled in a Part D Plan elsewhere. Current Plan #4100 members have the option of switching to Plan #4000 or another Part D Plan during the open enrollment period.
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Medicare will continue to pay for immunosuppressive drugs after transplant under Medicare Part B. CARE will supplement on Medicare approved charges. |
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CARE PLAN #4000 - PRESCRIPTION DRUG BENEFIT CHANGE FOR 2011
MEDICARE PRESCRIPTION DRUG PLAN (EMPLOYER PDP) EFFECTIVE JANUARY 1, 2011
In the coming weeks, Plan #4000 members will be receiving further information regarding the 2011 prescription drug plan. You will receive new identification cards and phone numbers for all your pharmacy questions.
For questions regarding your prescription drug benefit contact the CARE Customer Service/Benefits Department at (800) 334-1330
Effective January 1, 2011, prescription drug benefits will be administered through informedRx. CARE members are able to purchase medications at a local participating pharmacy or by mail order effective January 1, 2011. You may continue utilizing your current pharmacy without disruption of your service.
Your Plan now pays for all Medicare Part D eligible Drugs!
PURCHASING PRESCRIPTIONS USING YOUR informedRx PRESCRIPTION DRUG CARD
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Present your prescription drug card to one of the participating pharmacies to guarantee maximum benefits from your prescription card program. |
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Present your informedRx prescription drug card to any pharmacy that uses a computer to access third-party Rx plans (most modern pharmacies). All the information needed to process your prescription is on the front and back of your card. |
The benefit period for Plan #4000 is January 1 through December 31. There is no annual deductible for Plan year 2011. Members in Plan #4000 will be responsible for the applicable copayment during the $3,000 initial coverage limit. There are four stages to your new Medicare Part D Prescription Drug Plan. Please see chart below for an explanation of these four stages.
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CONSOLIDATED ASSOCIATIONS OF RAILROAD EMPLOYEES (CARE) MEDICARE PRESCRIPTION DRUG PLAN (Employer PDP) Administered by informedRx®
SUMMARY OF PHARMACY BENEFITS FOR 2011 FOR CARE PLAN #4000 |
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STAGE 1 - NO ANNUAL DEDUCTIBLE |
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STAGE 2 Initial Coverage
Up to $3,000 in total drug costs. |
STAGE 3 Coverage Gap
After $3,000 in total drug costs, up to $4,550 in True-Out-of-Pocket costs. |
STAGE 4 Catastrophic Coverage
After $4,550 True-Out-of-Pocket costs. No limit. |
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You pay a copay for each prescription filled.
The Plan pays the rest until total costs reach $3,000. |
You pay about 50% of the cost of most brand-name drugs and 93% of the cost of generic drugs until you reach $4,550 in year-to-date True Out-of-Pocket (TrOOP) costs.
Your TrOOP costs are the total amounts you have paid since January 1 excluding premiums. |
You pay 5% of drug costs.
Copayments:
$2.50 Generic/Preferred
$6.30 for all others
The Plan pays the rest of the costs for each covered drug until the end of the year.
There is no limit. |
FOUR TIER COPAYMENT STRUCTURE
Effective January 1, 2011, CARE is implementing a Four-Tier copayment structure for your prescription drug benefit. This plan divides coverage for prescription drugs into four tiers with a different copayment applying to each tier. In addition to Generic, Preferred Brand Name and Non-Preferred Brand Name drug copayments, a new fourth level copayment is being introduced for Specialty drugs.
Also beginning January 1, 2011, in an attempt to save you and the plan money we are implementing a mail order component to the prescription drug benefit. When an eligible prescription drug is filled by mail order, you will save money due to lower copayments. You will receive information on this new feature in the coming weeks.
Please see Retail and Mail Order copayment chart below:
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CARE PLAN #4000 MEDICARE (PART D) PRESCRIPTION DRUG BENEFIT COPAYMENTS |
RETAIL |
MAIL ORDER |
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Up to 34-Day Supply |
34 to 90-Day Supply |
90-Day Supply |
|
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Tier 1 - Generic Drugs |
$ 10.00 |
$ 30.00 |
$ 15.00 |
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Tier 2 - Preferred Brand Name Drugs |
$ 25.00 |
$ 75.00 |
$ 30.00 |
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Tier 3 - Non-Preferred Name Brand Drugs |
$ 40.00 |
$120.00 |
$120.00 |
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Tier 4 - Specialty Drugs |
Higher of $50 or 33% of drug costs.
Maximum Copayment $150 |
Higher of $150 or 33% of drug costs.
Maximum Copayment $450 |
Higher of $100 or 33% of drug costs.
Maximum Copayment $300 |
CARE 2010 BENEFIT CHANGES
PLAN #4000 - INCREASE IN ANNUAL MAXIMUM FOR PRESCRIPTION DRUG BENEFIT
The annual prescription drug maximum for Plan #4000 increased to $3,275 for Plan Year 2010. By increasing the annual maximum this allows CARE to provide creditable prescription drug coverage to its Medicare members for 2010.
PLAN #4000 - CHANGE IN COPAYMENT STRUCTURE
Effective January 1, 2010, CARE is implementing a Three-Tier copayment structure for your prescription drug benefit. This plan divides coverage for prescription drugs into three tiers with a different copayment applying to each tier. In addition to generic and brand name drug copayments currently offered under your prescription drug program, a new third level copayment is being introduced for non-preferred brand name drugs.
** Also beginning January 1, 2010, in an attempt to save you and the plan money we are implementing a "zero copayment" to the international mail order component. When an eligible prescription drug is filled by mail order, we will waive all copayments for all medications filled while "in-benefit."
THREE TIER COPAYMENT STRUCTURE (AFTER ANNUAL DEDUCTIBLE SATISFIED)
** Mail-Order $ 0.00 copayment per 90-day fill (change to your current benefit)
Tier 1 (Generic drugs) $ 5.00
copayment per 30-day fill
(no change from your current benefit)
Tier 2 (Brand name drugs) $ 10.00 copayment per 30-day fill
(no change from your current benefit)
Tier 3 (Non-preferred brand name drugs) $ 30.00 copayment per 30-day fill
CARE 2009 BENEFIT CHANGES
LIFETIME MAXIMUM INCREASED UNDER UNITED HEALTHCARE GA46000
As of January 1, 2009, the lifetime maximum benefit for each individual covered under the Railroad Employees National Early Retirement Major Medical Benefit Plan (United Healthcare's GA46000) will increase from $107,700 to $113,000. Additional benefits payable apply to expenses incurred on or after January 1.
PLAN #1000 - CHANGE IN EXISTING ANNUAL MAXIMUM & LIFETIME MAXIMUM FOR 2009
ANNUAL MAXIMUM FOR 2009
$ 500,000 for services provided In-Network
$ 250,000 for services provided Out-of-Network
LIFETIME MAXIMUM FOR 2009
$ 1,000,000 for services provided In-Network
$ 500,000 for services provided Out-of-Network
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PLAN #4000 - INCREASE IN ANNUAL MAXIMUM FOR PRESCRIPTION DRUG BENEFIT
The annual prescription drug maximum for Plan #4000 increased to $3,000 for Plan Year 2009. By increasing the annual maximum this allows CARE to provide creditable prescription drug coverage to its Medicare members for 2009.
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PLAN #7000 - CHANGE IN EXISTING ANNUAL MAXIMUM & LIFETIME MAXIMUM FOR 2009
ANNUAL MAXIMUM FOR 2009
$ 500,000 for services provided In-Network
$ 250,000 for services provided Out-of-Network
LIFETIME MAXIMUM FOR 2009
$ 1,000,000 for services provided In-Network
$ 500,000 for services provided Out-of-Network
CARE 2008 BENEFIT CHANGES
CHANGE IN EXISTING PRECERTIFICATION & UTILIZATION COMPANY FOR 2008:
Effective January 1, 2008, Spectrum Review Services, Inc. will be the new Precertification & Utilization Review company for all primary plans, including Plan #1000, Plan #2000, Plan #5500, Plan #5100 and Plan #7000 under the CARE Health Plan. The new telephone number to call and obtain precertification will be (800) 258-5055. Prior to the end of the year, members in the primary plans previously mentioned will be receiving a new CARE identification card with updated information for precertification.
Also, effective January 1, 2008, members in Plan #1000, Plan #2000, Plan #5500, Plan #5100 and Plan #7000 will no longer be required to obtain precertification and/or preauthorization on outpatient physical therapy.
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PLAN #3000 - INCREASE IN DEDUCTIBLE AND COPAYMENT REIMBURSEMENT
The annual limit for Plan #3000 is being increased from $1,600 to $2,200 as a result of deductible, out-of-pocket, and copayment changes recently made to the Health & Welfare Plan for Railway employees currently covered under the Managed Medical Care Plan* (MMCP) and Comprehensive Health Care Benefit** (CHCB). Therefore, beginning January 1, 2008, Plan #3000 will reimburse you up to $200.00 of your deductible in full for covered services, with the remainder of your deductible (if applicable) being reimbursed at 20%. In addition, the Association will reimburse you for the difference between the Amount Allowed and the Amount Paid by your primary carrier, NOT TO EXCEED 20% up to the CARE annual limit of $2,200.
*Managed Medical Care Plan (MMCP)
Office Visit copayment increased from $15 to $20; Office Visit copayment for Specialist increased from $15 to $35; Urgent Care copayment increased from $15 to $25; Emergency Room copayment increased from $30 to $50.
**Comprehensive Health Care Benefit (CHCB)
Annual Deductible increased from $100 to $200; Annual Out-of-Pocket increased from $1,500 to $2,000.
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PLAN #4000 - INCREASE IN ANNUAL MAXIMUM FOR PRESCRIPTION DRUG BENEFIT
The annual prescription drug maximum for Plan #4000 increased to $2,500 for Plan Year 2008. By increasing the annual maximum this allows CARE to provide creditable prescription drug coverage to its Medicare members for 2008.
PLAN #5100 - CHANGE IN ELIGIBILITY REQUIREMENTS FOR 2008:
As information, Plan #5100 is now being extended to include dependents of early retirees who retired at 60 years of age and 30 or more years of service and/or 61 years of age and 30 or more years of service.
Also, this plan is now available to dependents of railway employees who have exhausted benefits under the National Health and Welfare Plan (GA23000) due to disability. Eligible dependents of disabled employees may apply for membership in Plan #5100 when the dependent loses coverage under the National Health and Welfare Plan (GA23000).
The disabled employee or disability annuitant would be required to enroll in Plan #3000 as a supplement to his/her GA23000 coverage for the remainder of the time they qualify. Disabled employees or disability annuitants who become eligible for Medicare must be enrolled or enroll in a Medicare supplement with CARE in order for dependents to qualify for Plan #5100.
Eligible dependents include:
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wife or husband |
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unmarried children* under age 19 |
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unmarried children* between the ages of 19 and 25 who are registered students in regular full-time attendance (12 hours**) at school |
*Children include: Natural or adopted children and stepchildren
**Full-time hours may vary depending on school type and institution.
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PLAN OUTLINE
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80/20 Plan |
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$150,000 Lifetime Maximum |
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$150,000 Lifetime Maximum |
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No Annual Maximum |
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$100 Annual Deductible |
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Percertification/Preauthorization Required on certain procedures |
For additional information regarding this plan contact our
Benefits / Customer Service Department at 1-800-334-1330.
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**LIFETIME MAXIMUM INCREASED UNDER GA46000** As of January 1, 2008, the lifetime maximum benefit for each individual covered under the Railroad Employees National Early Retirement Major Medical Benefit Plan (United Healthcare's GA46000) will increase from $101,200 to $107,7000.
Additional benefits payable apply to expenses incurred on or after January 1. |
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Attention former members of the Santa Fe Employees Hospital Association, Atchison, Topeka and Santa Fe Employees’ Benefit Association and Consolidated Associations of Railroad Employees
Open Enrollment for Plan #4000 and Plan #4100 Medicare Secondary Coverage has been extended indefinitely The plan year for CARE Medicare members is January 1 through December 31. New members enrolling in either Plan #4000 or Plan #4100 must remain enrolled in their selected Plan through December 31.
If you have any questions regarding our Medicare Supplemental Plans or to request additional information please contact our Benefits/Customer Service Department at 1-800-334-1330.
Please feel free to discuss this Open Enrollment opportunity with your friends who might qualify for this plan. Also, if you know of a surviving spouse of a BNSF deceased retired employee, please pass this information on inasmuch as we have no record of them and cannot notify them individually. |
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CARE Open Enrollment For New Members Extended Indefinitely!
The Open Enrollment for Plan #3000, Plan #4000, Plan #4100, Plan #5000 and Plan #5100 have been extended indefinitely.
Plan #3000 is currently available to Active or Retired employees and/or dependents who have coverage with Aetna US Healthcare, Cigna, Highmark, United Healthcare GA23000, United Healthcare Plan 0690100, United Healthcare GA107300 or United Healthcare GA23111-E.
Plan #4000 and Plan #4100, both Medicare supplemental plans, are available to retired railroaders, their spouses or surviving spouses who are currently on Medicare. The plan year for CARE Medicare members is January 1 through December 31. New members enrolling in either Plan #4000 or Plan #4100 must remain enrolled in their selected Plan through December 31.
Plan #5000 is a supplemental plan available to retired employees and spouses who currently have primary coverage with United Healthcare Plan GA46000.
Plan #5100 a replacement plan for those dependents not wishing to continue GA46000 Cobra coverage upon the early retiree reaching 65 years of age or for dependents who have exhausted their GA46000 Cobra coverage.
If you qualify for any of these plans or know of someone who may be interested in receiving information on one of these plans contact the Membership/Customer Service Department at (800) 334-1330.
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NARVRE MEETINGS IN TOPEKA, KANSAS ATTENTION TOPEKA CARE MEMBERS!!! REMEMBER THAT NARVRE UNIT 140--TOPEKA, KANSAS MEETS EVERY 2ND TUESDAY OF THE MONTH AT 9:15 A.M. AT COYOTE CANYON LOCATED AT 1251 S.W. ASHWORTH PLACE (ACROSS FROM HOME DEPOT)
For more information, you may contact Mr. Fred Shaw at 785-228-0676
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