Page 27 - Covered 6 Employee Benefits 2021-2022

Questions concerning your Plan or your COBRA continuation coverage rights should be addressed
to the contact or contacts identified below. For more information about your rights under the
Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and
Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or
District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA)
in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District
EBSA Offices are available through EBSA’s website.) For more information about the Marketplace,
visit www.HealthCare.gov.

Keep your Plan informed of address changes

To protect your family’s rights, let the Plan Administrator know about any changes in the addresses
of family members. You should also keep a copy, for your records, of any notices you send to the
Plan Administrator.

Covered 6 – Human Resources 1.805.926.2055
868 Patriot Dr., Unit C, Moorpark, CA 93021

Medicare Part D Creditable Coverage Notice

Important Notice from Covered 6, LLC

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 Covered 6, LLC and about your options
under Medicare’s prescription drug coverage. This information can help you decide whether
or not you want to join a Medicare drug plan. If you are considering joining, you should
compare your current coverage, including which drugs are covered at what cost, with the
coverage and costs of the plans offering Medicare prescription drug coverage in your area.
Information about where you can get help to make decisions about your prescription drug
coverage is at the end of this notice.

There are two important things you need to know about your current coverage and
Medicare’s prescription drug coverage:

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 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. Covered 6, LLC has determined that the prescription drug coverage offered by the Kaiser plan is,
on average for all plan participants, expected to pay out as much as standard Medicare
prescription drug coverage pays and is therefore considered Creditable Coverage. Because your

Page 26