Important Information about OGB Prescription Benefits
Effective January 1, the Office of Group Benefits will move to a new Medicare Part D prescription drug plan for retired members age 65 or older who have Medicare Part A and/or B coverage and are enrolled in the PPO or HMO (Blue Cross) health plans. The change also applies to other PPO and HMO (Blue Cross) members who have Medicare Part A and/or B coverage.
OGB mailed the information below (printed on pink paper) to affected plan members on November 16. This information does not apply to other plan members, so OGB is not requesting that agencies forward this information to all employees.
Please take time to read ALL of the information below, which clearly explains the effects of the change, if any, on these plan members. And please encourage affected members who have additional questions to call Medco beginning December 1, 2012, at the toll-free phone number at the bottom of the notice: 1-866-808-5271 or 1-800-716-3231 (TTY/TDD).
The change may affect invoiced plan member costs due to the low-income premium subsidy and the late enrollment penalty. OGB will send additional information to agencies soon that explains how these issues may affect agency invoicing.
November 16, 2011
IMPORTANT INFORMATION ABOUT YOUR O.G.B. PRESCRIPTION DRUG COVERAGE
On January 1, 2012, the Office of Group Benefits will move to a new Medicare Part D prescription drug plan for many of our members. The change will affect retired members age 65 or older who have Medicare Part A and/or B coverage and are enrolled in OGB’s standard PPO or HMO (Blue Cross) health plans for 2012. It will also affect other members with Medicare Part A and/or B who are enrolled in our PPO or HMO (Blue Cross) plans for 2012.
The new OGB drug benefit for these members is called the Employer Group Waiver Plan (EGWP) Medicare Part D prescription drug plan.
Key points you need to understand
There are several things you need to know about OGB’s new EGWP Medicare Part D prescription drug coverage:
1 – OGB’s Medicare Part D plan includes supplemental coverage that continues to provide benefits in the coverage gap, or “donut hole.” This extra coverage means the OGB Medicare D prescription benefit include more drug coverage than standard Medicare Part D plans. This also means you will see very little, if any, change from your current drug plan.
2 – Your enrollment in OGB’s EGWP Medicare Part D prescription drug coverage will be automatic – you don’t have to do anything.
3 – OGB’s Medicare Part D coverage costs you nothing extra. The cost is covered by your standard health plan premiums.
4 – This program will be administered for by Medco, our new EGWP partner. With this partnership, you will see little – if any – change in your prescription benefits:
§ No change in drug co-insurance.
§ Continued availability of diabetic supplies at $0 co-pay.
§ Little or no change in the pharmacy network.
§ Little or no change in your drug coverage – with continued coverage for most prescription drugs now covered by Catalyst Rx, and coverage for some drugs not previously covered.
§ Prescription fill limits of up to 31, 62 and 93 days (instead of 30, 60 and 90 days).
§ Receive up to a 93-day fill at many network retail pharmacies – without a 31-day wait.
§ Prescription quantity limits may vary.
§ Prescriptions that now require prior authorization will require a new prior authorization.
5 – Members with OGB’s EGWP Medicare D prescription coverage will have two OGB ID cards – one for medical benefits and a second for prescription benefits only – starting January 1, 2012. Retirees in other health plans will not receive a Medco ID card.
§ Your new Medco ID card will be used ONLY for prescription drug benefits for the person named on the card.
§ You (and your covered spouse, if applicable) will continue using your PPO or HMO (Blue Cross) health plan ID card for all other medical benefits. (If you changed to a different OGB health plan for 2012, you will receive a new health plan ID card. If not, you will continue using your current health plan ID card.)
Who will be enrolled in OGB’s Medicare Part D prescription coverage?
Enrollment in our Medicare Part D prescription plan for 2012 will be automatic for plan members who:
· Are retired, at least 65 years of age and have Medicare Part A and/or B coverage (or otherwise have Medicare Part A and/or Part B coverage); and
· Are enrolled in the OGB PPO or Blue Cross HMO health plan for the 2012 plan year.
Enrollment also will be automatic for your covered spouse (if applicable), if he or she has reached age 65 and has Medicare Parts A and/or B.
Why OGB is making this change
OGB currently receives a federal Retiree Drug Subsidy (RDS) for providing prescription coverage to retired members with Medicare. This money helps OGB offset rising health care costs and future premium increases.
To continue to receive a meaningful subsidy, OGB will begin offering the new Medco Medicare Part D prescription drug coverage for the 2012 plan year, which begins January 1, 2012. This new Medicare D coverage qualifies OGB to receive the Employer Group Waiver Program (EGWP) subsidy.
Additional benefit for low-income members
OGB’s EGWP Medicare Part D drug coverage includes an additional benefit for low-income EGWP members.
If your annual income is less than $16,335 for an individual, or $22,065 for a family of 2, you may qualify for a Medicare subsidy that will help pay for your prescription co-payments and reduce the prescription portion of your health plan premiums.
More information coming soon from Medco – save it!
In a few days, you will begin receiving letters and other materials from Medco by mail about your OGB prescription drug benefits and OGB’s supplemental coverage.
It is very important for you to carefully read – and save– ALL information you receive, including this letter, for future reference.
Much of the information Medco will send you is required by the federal Centers for Medicare and Medicaid Services (CMS) and contains language that may be confusing and may not apply to your new OGB Medco Medicare Part D prescription drug coverage. For example, these materials refer to tiers of drug coverage and a Medicare Part D formulary (which is a list of covered drugs) – even though these do not apply to your OGB coverage!
The letters you receive in the mail from Medco will include federally-required CMS “opt-out” language that explains how to “opt out” of OGB’s Medco Medicare Part D drug coverage.
Consequences of opting out
Enrollment in OGB’s Medco Medicare Part D prescription coverage is automatic for eligible members … but your continued enrollment depends on you!
OGB strongly recommends you DO NOT OPT OUT of OGB’s Medicare Part D coverage.
If you opt out of the OGB’s EGWP Medicare D drug plan, you automatically opt out of all of your OGB health and prescription drug coverage – for you and your family members – FOREVER!
You can be enrolled in only ONE Medicare-type plan. Because you will be enrolled in OGB’s Medicare Part D prescription plan automatically effective January 1, OGB also strongly recommends you DO NOT purchase or enroll in:
§ An individual Medicare Advantage plan; or
§ A group Medicare Advantage plan not sponsored by OGB; or
§ Another Medicare Part D plan for drug coverage only.
Signing up for ANY individual Medicare plan cancels your current coverage – and could leave you and your covered family members without any OGB health and prescription coverage!