Page 43 - Phil Chai - Benefit Guide Queen Sweet Jane R1

Medicare Part D Notice: Prescription

Drug Coverage and Medicare

This notice has information about your current prescription drug When will you pay a higher premium (penalty) to join a
coverage with Queen Sweet Jane, LLC and your options under Medicare Drug Plan? You should also know that if you drop or
Medicare's prescription drug coverage. This information can help lose your current coverage with Queen Sweet Jane, LLC medical
you decide whether or not you want to join a Medicare drug plan. If plan and don't join a Medicare drug plan within 63 continuous
you are considering joining, you should compare your current days after your current coverage ends, you may pay a higher
coverage, including which drugs are covered at what cost, with the premium (a penalty) to join a Medicare drug plan later. If you
coverage and costs of the plans offering Medicare prescription drug go 63 continuous days or longer without creditable prescrip-
coverage in your area. Information about where you can get help to tion drug coverage, your monthly premium may go up by at
make decisions about your prescription drug coverage is at the end least 1% of the Medicare base beneficiary premium per month
of this notice. for every month that you did not have that coverage. For ex-
ample, if you go nineteen months without creditable coverage,

Please note: If you are not Medicare eligible, and none of your
your premium may consistently be at least 19% higher than
covered family members are Medicare eligible, no action is required
the Medicare base beneficiary premium. You may have to pay
on your part.
this higher premium (a penalty) as long as you have Medicare
There are two important things you need to know about your prescription drug coverage. In addition, you may have to wait
current coverage and Medicare's prescription drug coverage: until the following October to join.
• Medicare prescription drug coverage became available in 2006 to For more information about this notice or your current
everyone with Medicare. You can get this coverage if you join a Prescription Drug Coverage: Contact your HR department for
Medicare Prescription Drug Plan or join a Medicare Advantage Plan further information, 712-239-4582. NOTE: You may receive this
(like an HMO or PPO) that offers prescription drug coverage. All notice at other times in the future such as before the next
Medicare drug plans provide at least a standard level of coverage period you can enroll in Medicare prescription drug coverage,
set by Medicare. Some plans may also offer more coverage for a and if this coverage changes. You also may request a copy.
higher monthly premium.
For more information about your options under Medicare
• Queen Sweet Jane, LLC has determined that the prescription drug Prescription Drug Coverage: More detailed information about
coverage offered by Queen Sweet Jane, LLC medical plan is, on Medicare plans that offer prescription drug coverage is in the
average for all plan participants, expected to pay out as much as "Medicare & You" handbook. You'll get a copy of the handbook
standard Medicare prescription drug coverage pays and is therefore in the mail every year from Medicare. You may also be
UNITED HEALTHCARE is considered Creditable Coverage. Because contacted directly by Medicare drug plans.
your existing coverage is Creditable Coverage, you can keep this
For more information about Medicare prescription drug
coverage and not pay a higher premium (a penalty) if you later
coverage:
decide to join a Medicare drug plan.
• Visit www.medicare.gov.
When can you join a Medicare Drug Plan? You can join a Medicare
drug plan when you first become eligible for Medicare and each • Call your State Health Insurance Assistance Program (see the
year from October 15 through December 7. However, if you lose inside back cover of your copy of the "Medicare & You"
your current creditable prescription drug coverage, through no fault handbook for their telephone number) for personalized help.
of your own, you will also be eligible for a two (2) month Special
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call
Enrollment Period (SEP) to join a Medicare drug plan.
1-877-486-2048.
What happens to your current coverage if you decide to join a
If you have limited income and resources, extra help paying for

Medicare Drug Plan? If you decide to join a Medicare drug plan,
Medicare prescription drug coverage is available. For
your current Queen Sweet Jane, LLC medical coverage will not be information about this extra help, visit Social Security on the
affected. Participants may keep this coverage if they elect Part D web at www.socialsecurity.gov, or call them at 1-800-772-1213
and this plan will coordinate with Part D coverage. If you decide to (TTY 1-800-325-0778).
join a Medicare drug plan and drop your current Queen Sweet Jane,
LLC medical plan coverage, be aware that you and your dependents
will NOT be able to get this coverage back.
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