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PLAN OUTLINE

Medicare Supplements

 

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.

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2014 Medicare Deductibles

Part A deductible:  $1216.00

Part B deductible:  $ 147.00

 

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.

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PLAN #4000 - SUPPLEMENT TO MEDICARE PARTS A & B WITH MEDICARE (PART D) PRESCRIPTION DRUG COVERAGE

Plan #4100 will pay your Medicare Part A & B deductibles and coinsurance on approved, allowed charges. There is no annual deductible with CARE and you are not responsible for any copayments. 

PRESCRIPTION DRUG BENEFIT FOR 2014: For Plan Year 2014, Express Scripts Medicare (PDP) will administer pharmacy benefits for our Plan #4000 members. CARE will continue to provide you with an "enhanced" Part D prescription drug benefit. Your copayments and a brief summary of your prescription drug benefit for Plan Year 2014 are listed below.  Your prescription drug benefit has been increased from $4,200 to $4,550. You will continue to have no deductible and will only be responsible for any applicable copayment and/or coinsurance throughout the plan year. Due to the additional coverage provided by CARE, the coverage gap known as the "Donut Hole" will not impact you as in the past.

EXPRESS SCRIPTS MEDICARE CUSTOMER SERVICE IS NOW AVAILABLE TO ADDRESS YOUR PHARMACY PLAN QUESTIONS

24 HOURS A DAY, 7 DAYS A WEEK AT 1.866.725.2511.

TTY USERS SHOULD CALL 1.800.716.3231.

Open enrollment is from October 15th through December 7th. 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 2014.

For questions regarding your prescription drug benefit contact the CARE Customer Service/Benefits Department at 1.800.334.1330.

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 2014 will be $267.00 per member per month.

Click here for the 2014 Express Scripts Medicare (PDP) comprehensive formulary

CARE PLAN #4000 RX BENEFIT FOR 2014

DEFINITIONS

Total Drug Costs - Drug costs paid by you and the plan.

Out-of-Pocket Drug Costs - Copayment and/or coinsurance paid by you and payments made for your drugs by any of the following programs or organizations: "Extra Help" from Medicare, Medicareís Coverage Gap Discount Program, etc.

Does NOT include payments made for a) plan premiums, b) drugs not covered by your plan, c) non-Part D drugs (such as drugs you receive during a hospital stay), d) and drugs obtained at a non-network pharmacy that does not meet out-of-network pharmacy access policy.

Deductible

None

Initial Coverage Stage

(0 - $2,850)

You will pay the applicable copayment and/or coinsurance listed below until your total drug costs reach $2,850.

Coverage Gap Stage

$2,851 - $4,550

After your total drug costs reach $2,850, you will continue to pay the same applicable copayment and/or coinsurance listed below as in the Initial Coverage Stage until you reach $4,550.

 

Copayments

RETAIL

HOME DELIVERY

Tiers

Up to 34-Day Supply

35 to 90-Day Supply

90-Day Supply

Tier 1: Generic Drugs

$15

$15

$15

Tier 2: Preferred Brand Drugs

$30

$50

$50

Tier 3: Non-Preferred Brand Drugs

$45

$120

$120

Tier 4: Specialty Drugs

33% of drug costs.

$150 Maximum

33% of drug costs.

$450 Maximum

33% of drug costs.

$450 Maximum

Reminder: If the cost of the generic drug is less than the $15 copayment, you will pay the lesser price. Examples: If the cost of the generic drug is $7.50, you will ONLY pay $7.50, NOT the $15 copayment. If the cost of the generic drug is $25, you will ONLY pay the $15 copayment.

 

Catastrophic Coverage

Stage

> (Greater than) $4,550

After your out-of-pocket drug costs reach $4,550, you will pay the greater of 5% coinsurance or $2.55 for generics (or drugs treated as generic) and $6.35 for all other drugs. The plan will pay the rest.

 

 

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. 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 memberís 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 dues rate for this plan for plan year 2014 will be $142.00 per member per month.

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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 Medicareís 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 Supplemental Application and Disclosure.

If you don't have Acrobat Reader, click here.

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