PLAN OUTLINE
Plan #4000 - Secondary to Medicare Parts A & B with
Creditable Prescription Drug Coverage
Plan #4100 - Secondary to Medicare Parts A & B Only
Both Medicare supplemental plans are available to retired railroaders, their spouses or surviving spouses who are currently on Medicare.
As a reminder, the plan year for current CARE Medicare members is January 1 through December 31. Current CARE members must remain enrolled in their selected Plan through December 31. CARE members will be given the opportunity to make a plan selection from November 15 through December 31 of each year to be effective January 1 of the following year.
Eligible Retiree/Or Spouse with Medicare Parts A & B
This Plan applies to an eligible railroad retiree or the spouse of a retiree who becomes eligible for Medicare. Individuals must be enrolled in Hospital (Part A) and Medical (Part B) coverage under Medicare to be eligible for our Medicare supplements (Plan #4000 or Plan #4100). This Plan is designed to supplement Medicare benefits. When Medicare benefits are exhausted, secondary benefits cease.
An eligible retiree or spouse becomes eligible under Medicare:
1. On the basis of age on the first day of the month in which he/she attains age 65 (if an individual's birthday is on the first day of the month, he is considered to reach 65 the first day of the previous month).
2. On the basis of disability, on the first day of the month following receipt of disability waiting period of 5 full calendar months of disability before disability benefits begin. To be eligible for Medicare, a Railroad Retirement beneficiary must meet the disability qualification of the Social Security Act which requires that an individual be totally disabled (unable to perform the duties of any occupation).
Eligible persons without a current connection may apply for membership during an Open Enrollment. Persons interested in applying for membership should contact the CARE Health Plan.
If you are eligible for Medicare and are NOT employed, the CARE Health Plan would be secondary to your Medicare Parts A & B coverage. The CARE Health Plan has a contract with the Health Care Financing Administration (HCFA) to make payment as the Medicare Intermediary for Part B services.
If you are eligible for Medicare and are employed, or your spouse is employed and has you covered for health care benefits under his or her employer plan, the employer plan is primary; Medicare is secondary; and the CARE Health Plan is third payor.
If you are eligible for Medicare, are regularly employed by the Burlington Northern and Santa Fe Railway Company, and have chosen the CARE Health Plan as your primary coverage, Medicare Parts A & B would be secondary to the Consolidated Associations of Railroad Employees.
Dependent Spouse with Medicare Parts A & B
The dependent spouse of a retired Burlington Northern and Santa Fe Railway Company employee is eligible for membership in the CARE Health Plan under Plan #4000 or Plan #4100. The eligible dependent spouse MUST be enrolled in Medicare Parts A & B and remain enrolled in order to receive benefits from the CARE Health Plan under Plan #4000 or Plan #4100. Failure of the individual to remain enrolled in Medicare Parts A & B will deprive the individual of valuable benefits and result in the individual being responsible for a large part of the medical bills incurred. The eligible dependent spouse with Medicare may enroll for membership in Plan #4000 or Plan #4100 by making application direct to the CARE Health Plan. The application for membership must be accompanied by a copy of his or her Medicare Parts A & B card.
Surviving Spouse with Medicare Parts A & B
The spouse of a deceased Burlington Northern and Santa Fe Railway Company employee is eligible for membership in this CARE Health Plan under Plan #4000 or Plan #4100.
The eligible spouse MUST be enrolled in Medicare Parts A & B and remain enrolled in order to receive benefits from the CARE Health Plan under Plan #4000 or Plan #4100. Failure of the individual to remain enrolled in Medicare Parts A & B will deprive the individual of valuable benefits and result in the individual being responsible for a large part of the medical bills incurred.
The eligible spouse with Medicare may enroll for membership in this Plan #4000 or Plan #4100 by making application direct to this CARE Health Plan. The application for membership must be accompanied by a copy of his or her Medicare Parts A & B card.
Plan #4000 - Supplement to Medicare Parts A & B with Creditable Prescription Drug Coverage
Plan #4000 will continue to offer its supplement to Medicare Part A (Hospital) and Part B (Medical) but will increase the prescription drug maximum from $3000 to $3275 annually for plan year 2010. Plan #4000 will pay your Medicare Part A & B deductibles and coinsurance on approved, allowed charges.
As information, for the year 2010, the Medicare Part A deductible will be $1100 and the Part B deductible will be $155.00. There is no annual deductible with CARE and you are not responsible for any copayments.
PRESCRIPTION DRUG BENEFIT FOR 2010:
$200.00 Annual Deductible / $3275.00 Annual Maximum
Effective January 1, 2010, CARE is implementing a Three-Tier Copayment 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.
**In another attempt to encourage you to save yourself and the Plan money, effective 01-01-2010, we will waive all in-benefit copayments on mail order medications (drugs received outside of the United States)! Given the deep cost discounts (sometimes as much as 60%!) on mail order eligible products, such change could save the Plan tens of thousands of dollars which in turn will allow us to keep your dues rates affordable.
THREE TIER COPAYMENT STRUCTURE (AFTER ANNUAL DEDUCTIBLE SATISFIED)
**Mail-order $ 0.00 copayment per 90-day fill
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 (change
to your current benefit)
By purchasing your Tier 2 or Tier 3 medications locally, you will still be responsible for the cost difference between the brand name drug and any generic equivalent. Members pay the least for a generic drug, a higher amount for a brand name drug, and the most for a non-preferred brand name drug. The Tier 3 increased copayment is intended to encourage you to either switch to a generic equivalent, if available, a less costly Tier 2 brand name drug, or better yet, purchase your brand name drugs by international mail-order saving you and CARE money. A listing of Tier 3 drugs and their generic equivalents or less costly brand name drugs may be obtained by contacting Employer Health Options (EHO) at (800) 650-1817.
CARE members are able to purchase medications at a local participating pharmacy. "Maintenance" drugs identified and recommended by Employer Health Options (EHO) may be purchased with one applicable copayment for a 90-day supply. All other 90-day prescriptions not on the EHO Maintenance drug list would be subject to an applicable copayment for each 30-day fill.
Plan #4000 will continue to allow members the flexibility of an "open formulary" in which they would be able to receive most any medication they desire paying the appropriate copayment and would continue to have access to international sources for drugs (both are features lacking in the Medicare Part D prescription plan). As a reminder, members will still be eligible to use international sources for prescription drugs, however, these purchases will not be applied toward their CARE prescription drug benefit. CARE Medicare members who exhaust their prescription drug maximum can use their EHO prescription drug card which would allow them to continue receiving the discounted retail network price for prescriptions drugs.
Because the prescription drug coverage offered under this plan is considered to be "creditable" coverage for plan year 2010 according to Medicare’s current guidelines, you can keep this coverage and not pay a penalty if you later decide to enroll in a Medicare prescription drug plan.
Plan #4100 - Supplement to Medicare Parts A & B Only
This plan will only act as a supplement to Medicare Part A (Hospital) and Part B (Medical) but will offer NO prescription drug coverage. This plan is available to those members who opt to enroll in a Medicare prescription drug plan or for members who do not use a high volume of prescription drugs. Plan #4100 will pay your Medicare Part A & B deductibles and coinsurance on approved, allowed charges. As information, for the year 2010, the Medicare Part A deductible will be $1100.00 and the Part B deductible will be $155.00. There is no annual deductible with CARE and you are not responsible for any copayments.
Although Plan #4100 members will NOT have a prescription drug benefit through CARE, members in this plan can continue to access international sources for prescription drugs. Plan #4100 members may also use the EHO prescription drug card which would allow them to obtain the discounted retail network price for prescription drugs. However, for Plan #4100 members who enroll in a Medicare prescription drug plan, these purchases will not count toward the member’s Medicare prescription drug Out-of-Pocket maximum.
Because Plan #4100 does not offer a prescription drug plan please be aware if you sign up for this plan and go 63 days or longer without creditable prescription drug coverage, you may incur a penalty should you try to enroll in a prescription drug plan at a later date. It is your choice whether or not you choose to enroll in a prescription drug plan, however, remember you may pay more to enroll in a Medicare prescription drug plan later.
The Consolidated Associations of Railroad Employees (CARE) has a contract with the Centers for Medicare and Medicaid Services (CMS), the agency of the Federal Government that administers Medicare, to make payment as the Medicare Part B intermediary. This means under certain circumstances, CARE can pay the 80% that Medicare normally pays. This authorizes us to pay both your primary and secondary Medicare Part B claims at one time to participating physicians and other Medicare Part B providers. By doing so, the physician does not have to bill Medicare and then bill CARE for your copay (secondary billing). Thus, CARE can make the complete Medicare payment for the following services:
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Doctor Office Visits / Consultations |
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Hospital Visits |
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X-rays and Surgical Procedures |
Providers that bill their charges at Medicare’s designated profile can bill direct to CARE for both Assigned and Non-Assigned claims.
Providers that do not bill the fee profile designated by Medicare must bill Medicare first. CARE will then supplement the Part B Deductible and 20% remaining Co-Insurance amount. CARE will pay for certain charges not covered by Medicare Part B provided the charges fall within the CARE benefit structure.
Click here for the Medicare Supplement Application.
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