Page 13 - 2017-18 Ed 1st CU Benefits & Notices

Education First CU 2017-18

Notice of Creditable Coverage for Medicare Rx

Important Notice from Education First Credit Union
About Your Prescription Drug Coverage and Medicare

Please read this notice carefully and keep it where you can find it. This notice has information about your
current prescription drug coverage with Education First Credit Union and about your options under
Medicare’s prescription drug coverage. This information can help you decide whether or not to join a
Medicare drug plan. Information about where you can get help to make decisions about your prescription
drug coverage is at the end of this notice.

(1) Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You
can get this coverage if you join a Medicare Prescription Drug Plan (PDP) or join a Medicare
Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug
plans provide at least a standard level of coverage set by Medicare. Some plans may also offer
more coverage for a higher monthly premium.

(2) Education First Credit Union has determined that the prescription drug coverage offered by the
Education First Credit Union Aetna POS 250 plan, is, on average for all plan participants, expected
to pay out as much as standard Medicare prescription drug coverage pays and is considered
Creditable Coverage.

Because this drug coverage is, on average, at least as good as standard Medicare prescription drug
coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join
a Medicare drug plan.

2017-18 Education First CU Prescription Drug Coverage
30-DAY SUPPLY 90-DAY SUPPLY 30-DAY SUPPLY

(Retail) (Mail Order) (Specialty Drug)
Your Lowest-Cost Option – Tier I $ 15 copay $ 37.50 copay $15 copay

Your Midrange-Cost Option – Tier II $ 45 copay $112.50 copay $100 copay
Your Highest-Cost Option – Tier III $ 75 copay $187.50 copay $300 copay

Additional High-Cost Option – Tier IV Not applicable Not applicable Not applicable

Salus Group © Copyright 2017 Page | 13