Page 15 - 2020 Goodwill Benefits Guide
P. 15
2020
Legal Notices
When Will You Pay A Higher Premium (Penalty) To Join A Report Eligibility
Medicare Drug Plan? Changes In a Timely
You should also know that if you drop or lose your current coverage with Goodwill Manner
and don’t join a Medicare drug plan within 63 continuous days after your current It is your responsibility to notify the
coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug Beneits Department when a dependent
plan later. If you go 63 continuous days or longer without creditable prescription drug becomes eligible or ceases to be eligible
coverage, your monthly premium may go up by at least 1% of the Medicare base for coverage under our beneit plans. All
beneiciary premium per month for every month that you did not have that coverage. eligibility changes should be reported
For example, if you go nineteen months without creditable coverage, your premium within 31 days of the event. Failure
may consistently be at least 19% higher than the Medicare base beneiciary premium. to report changes in a timely manner
You may have to pay this higher premium (a penalty) as long as you have Medicare can impact your ability to add newly
prescription drug coverage. In addition, you may have to wait until the following eligible dependents or discontinue pre-
October to join. tax premium contributions on ineligible
For More Information about This Notice or Your Current dependents. In addition, failure to
report a loss of eligibility due to legal
Prescription Drug Coverage separation or divorce or a dependent
Contact the person listed below for further information. NOTE: You will get this notice that has otherwise ceased to be eligible,
each year. You will also get it before the next period you can join a Medicare drug such as a child reaching the maximum
plan, and if this coverage through Goodwill changes. You also may request a copy of dependent child age limit, can impact
this notice at any time. your dependent’s rights for group health
plan coverage under the federal law
For More Information about Your options Under Medicare known as COBRA. If you fail to report
Prescription Drug Coverage the loss of eligibility within 60 days of
More detailed information about Medicare plans that ofer prescription drug coverage the event, your dependents may be left
is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the with no continuation coverage under our
mail every year from Medicare. You may also be contacted directly by Medicare plan. Please see your COBRA notice or
drug plans. For more information about Medicare prescription drug coverage: Visit your group health plan summary plan
www.medicare.gov; Call your State Health Insurance Assistance Program (see the description for additional information.
inside back cover of your copy of the “Medicare & You” handbook for their telephone
number) for personalized help; Call 800-MEDICARE 800.633.4227).TTY users
should call 877.486.2048. If you have limited income and resources, extra help
paying for Medicare prescription drug coverage is available. For information about this
extra help, visit Social Security on the web at www.socialsecurity.gov, or call them
at 800.772.1213 (TTY 800.325.0778).
Remember:
Keep this creditable coverage notice. If you decide to join one of the Medicare drug
plans, you may be required to provide a copy of this notice when you join to show
whether or not you have maintained creditable coverage and, therefore, whether or
not you are required to pay a higher premium (a penalty).
Date: October 2019
Name of Entity/Sender: Goodwill Industries of Middle Tennessee, Inc.
Contact—Position/Oice: Human Resources
Address: 937 Herman Street, Nashville TN 37208
Phone Number: 615.346.1677
15
Legal Notices
When Will You Pay A Higher Premium (Penalty) To Join A Report Eligibility
Medicare Drug Plan? Changes In a Timely
You should also know that if you drop or lose your current coverage with Goodwill Manner
and don’t join a Medicare drug plan within 63 continuous days after your current It is your responsibility to notify the
coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug Beneits Department when a dependent
plan later. If you go 63 continuous days or longer without creditable prescription drug becomes eligible or ceases to be eligible
coverage, your monthly premium may go up by at least 1% of the Medicare base for coverage under our beneit plans. All
beneiciary premium per month for every month that you did not have that coverage. eligibility changes should be reported
For example, if you go nineteen months without creditable coverage, your premium within 31 days of the event. Failure
may consistently be at least 19% higher than the Medicare base beneiciary premium. to report changes in a timely manner
You may have to pay this higher premium (a penalty) as long as you have Medicare can impact your ability to add newly
prescription drug coverage. In addition, you may have to wait until the following eligible dependents or discontinue pre-
October to join. tax premium contributions on ineligible
For More Information about This Notice or Your Current dependents. In addition, failure to
report a loss of eligibility due to legal
Prescription Drug Coverage separation or divorce or a dependent
Contact the person listed below for further information. NOTE: You will get this notice that has otherwise ceased to be eligible,
each year. You will also get it before the next period you can join a Medicare drug such as a child reaching the maximum
plan, and if this coverage through Goodwill changes. You also may request a copy of dependent child age limit, can impact
this notice at any time. your dependent’s rights for group health
plan coverage under the federal law
For More Information about Your options Under Medicare known as COBRA. If you fail to report
Prescription Drug Coverage the loss of eligibility within 60 days of
More detailed information about Medicare plans that ofer prescription drug coverage the event, your dependents may be left
is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the with no continuation coverage under our
mail every year from Medicare. You may also be contacted directly by Medicare plan. Please see your COBRA notice or
drug plans. For more information about Medicare prescription drug coverage: Visit your group health plan summary plan
www.medicare.gov; Call your State Health Insurance Assistance Program (see the description for additional information.
inside back cover of your copy of the “Medicare & You” handbook for their telephone
number) for personalized help; Call 800-MEDICARE 800.633.4227).TTY users
should call 877.486.2048. If you have limited income and resources, extra help
paying for Medicare prescription drug coverage is available. For information about this
extra help, visit Social Security on the web at www.socialsecurity.gov, or call them
at 800.772.1213 (TTY 800.325.0778).
Remember:
Keep this creditable coverage notice. If you decide to join one of the Medicare drug
plans, you may be required to provide a copy of this notice when you join to show
whether or not you have maintained creditable coverage and, therefore, whether or
not you are required to pay a higher premium (a penalty).
Date: October 2019
Name of Entity/Sender: Goodwill Industries of Middle Tennessee, Inc.
Contact—Position/Oice: Human Resources
Address: 937 Herman Street, Nashville TN 37208
Phone Number: 615.346.1677
15
