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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 SIPS Consults, Corp. 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 SIPS Consults, Corp.’s 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 prescription
coverage in your area. Information about where you can get help to drug coverage, your monthly premium may go up by at least 1%
make decisions about your prescription drug coverage is at the end of the Medicare base beneficiary premium per month for every
of this notice. month that you did not have that coverage. For example, if
you go nineteen months without creditable coverage, your

Please note: If you are not Medicare eligible, and none of your
premium may consistently be at least 19% higher than the
covered family members are Medicare eligible, no action is required
Medicare base beneficiary premium. You may have to pay this
on your part.
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 For more information about this notice or your current
to 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, 972-572-1988 x304. NOTE: You may

(like an HMO or PPO) that offers prescription drug coverage. All receive this notice at other times in the future such as before
Medicare drug plans provide at least a standard level of coverage the next period you can enroll in Medicare prescription drug
set by Medicare. Some plans may also offer more coverage for a coverage, and if this coverage changes. You also may request a
higher monthly premium. copy.

• SIPS Consults, Corp. has determined that the prescription drug For more information about your options under Medicare
coverage offered by SIPS Consults, Corp.’s medical plan is, on Prescription Drug Coverage: More detailed information about
average for all plan participants, expected to pay out as much as Medicare plans that offer prescription drug coverage is in the
standard Medicare prescription drug coverage pays and is therefore "Medicare & You" handbook. You'll get a copy of the handbook
considered Creditable Coverage. Because your existing coverage is in the mail every year from Medicare. You may also be
Creditable Coverage, you can keep this coverage and not pay a contacted directly by Medicare drug plans.
higher premium (a penalty) if you later decide to join a Medicare
For more information about Medicare prescription drug
drug plan.
coverage:
When can you join a Medicare Drug Plan? You can join a Medicare
• Visit www.medicare.gov.
drug plan when you first become eligible for Medicare and each
year from October 15 through December 7. However, if you lose • Call your State Health Insurance Assistance Program (see the
your current creditable prescription drug coverage, through no fault inside back cover of your copy of the "Medicare & You"
of your own, you will also be eligible for a two (2) month Special handbook for their telephone number) for personalized help.
Enrollment Period (SEP) to join a Medicare drug plan.
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call
What happens to your current coverage if you decide to join a 1-877-486-2048.
Medicare Drug Plan? If you decide to join a Medicare drug plan,

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