PLAN OUTLINE
PLAN #4000 - SUPPLEMENT TO MEDICARE PARTS A & B
WITH MEDICARE (PART D) PRESCRIPTION DRUG COVERAGE
PLAN #4100 - SUPPLEMENT 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
MEDICARE (PART D) PRESCRIPTION DRUG COVERAGE
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.
This plan is available to retired railroaders, their spouses or surviving spouses who are currently on Medicare. Plan #4000 will continue to offer its supplement to Medicare Part A (Hospital) and Part B (Medical). This plan includes a Medicare Part D Prescription Drug Plan. The dues rate for this plan for plan year 2012 will be $267.00 per member per month.
Click here for informedRx® comprehensive formulary
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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 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 |
As information, for the year 2012, the Medicare Part A deductible will be $1156.00 and the Part B deductible will be $140.00. There is no annual deductible with CARE and you are not responsible for any copayments.
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 2012, the Medicare Part A deductible will be $1156.00 and the Part B deductible will be $140.00. 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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