Page 32 - 2022 DPR Construction Benefit Guide_Craft Employees

prescription drug coverage pays and is therefore For more information about Medicare prescription
considered Creditable Coverage. Because your existing drug coverage:
coverage is Creditable Coverage, you can keep this • Visit www.medicare.gov
coverage and not pay a higher premium (a penalty) if you • Call your State Health Insurance Assistance Program
later decide to join a Medicare drug plan.
(see the inside back cover of your copy of the “Medicare
& You” handbook for their telephone number) for
When Can You Join A Medicare Drug Plan?
personalized help
You can join a Medicare drug plan when you first become • Call 1-800-MEDICARE (1-800-633-4227). TTY users should
eligible for Medicare and each year from October 15th to call 1-877-486-2048.
December 7th. However, if you lose your current creditable
prescription drug coverage, through no fault of your own, you Remember: Keep this Creditable Coverage notice. If you
will also be eligible for a two (2) month Special Enrollment decide to join one of the Medicare drug plans, you may
Period (SEP) to join a Medicare drug plan. be required to provide a copy of this notice when you join
to show whether or not you have maintained creditable
What Happens To Your Current Coverage If You coverage and, therefore, whether or not you are required
Decide to Join A Medicare Drug Plan? to pay a higher premium (a penalty).

If you decide to join a Medicare drug plan, your current DPR Today’s Date: 01/01/2022
Construction coverage will be affected. You can keep this Name of Entity/Sender: DPR Construction
coverage if you elect part D and this plan will coordinate with Contact—Position/Office: Anne Anderson
Part D coverage. Address: 1450 Veterans Blvd, Redwood
City, CA 94063
If you do decide to join a Medicare drug plan and drop your Phone Number: 650-306-7700
current DPR Construction coverage, be aware that you and
your dependents will not be able to get this coverage back. HIPAA Notice of Special Enrollment
If you are declining enrollment for yourself or your
When Will You Pay A Higher Premium (Penalty) To dependents (including your spouse) because of other health
Join A Medicare Drug Plan?
insurance or group health plan coverage, you may be able
You should also know that if you drop or lose your current to enroll yourself or your dependents in this plan if you or
coverage with DPR Construction and don’t join a Medicare your dependents lose eligibility for that other coverage (or
drug plan within 63 continuous days after your current if the employer stops contributing towards your or your
coverage ends, you may pay a higher premium (a penalty) dependents’ other coverage). However, you must request
to join a Medicare drug plan later. If you go 63 continuous enrollment within 30 days after your or your dependents’
days or longer without creditable prescription drug coverage, other coverage ends (or after the employer stops contributing
your monthly premium may go up by at least 1% of the toward the other coverage).
Medicare base beneficiary premium per month for every In addition, if you have a new dependent as result of marriage,
month that you did not have that coverage. For example, if birth, adoption, or placement for adoption, you may be able
you go nineteen months without creditable coverage, your to enroll yourself and your dependents. However, you must
premium may consistently be at least 19% higher than the request enrollment within 30 days after the marriage, birth,
Medicare base beneficiary premium. You may have to pay adoption, or placement for adoption.
this higher premium (a penalty) as long as you have Medicare
prescription drug coverage. In addition, you may have to wait Special enrollment rights also may exist in the
until the following October to join. following circumstances:
• If you or your dependents experience a loss of eligibility for
For More Information About This Notice Or Your Medicaid or a state Children’s Health Insurance Program
Current Prescription Drug Coverage… (CHIP) coverage and you request enrollment within 60
For further information, call Anne Anderson at 650-306-7700. days after that coverage ends; or
NOTE: You’ll get this notice each year. You will also get it • If you or your dependents become eligible for a state
before the next period you can join a Medicare drug plan, and premium assistance subsidy through Medicaid or a state
if this coverage through DPR Construction changes. You also CHIP with respect to coverage under this plan and you
may request a copy of this notice at any time. request enrollment within 60 days after the determination
of eligibility for such assistance.
For More Information About Your Options Under Note: The 60-day period for requesting enrollment applies
Medicare Prescription Drug Coverage… only in these last two listed circumstances relating to

More detailed information about Medicare plans that offer Medicaid and state CHIP. As described above, a 30 day
prescription drug coverage is in the “Medicare & You” period applies to most special enrollments.
handbook. You’ll get a copy of the handbook in the mail every
year from Medicare. You may also be contacted directly by
Medicare drug plans.
32