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Important Notice from �̾�����Ƶ Regarding Your Prescription Drug Coverage and Medicare

Please read this notice carefully and keep where you can find it. This notice contains information about your current prescription drug coverage with �̾�����Ƶ 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. If you are considering joining, you should compare your current coverage, including which drugs are covered and at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can receive assistance regarding prescription drug coverage is included at the end of this notice.

There are two important facts that 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 obtain 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. �̾�����Ƶ has determined that the prescription drug coverage offered by the �̾�����Ƶ Health Benefits 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 existing coverage is Creditable Coverage, you can retain this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

When Can You Join A Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 to December 7.

However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?

If you decide to join a Medicare drug plan and continue your current �̾�����Ƶ coverage, you have the option to do so.

• Your current medical and prescription drug coverage through Aetna remains unchanged for you and any enrolled dependents.
• Your employee contributions remain unchanged, even if you elect Medicare Part D prescription drug coverage – there is no reduction in your contribution.
• You are responsible for the entire cost of the Medicare Part D premium.
• Your current �̾�����Ƶ medical and prescription drug program will coordinate with your Medicare coverage in accordance with federal law.

If you do decide to join a Medicare drug plan and terminate your current �̾�����Ƶ coverage, you have the option to do so.

• When your coverage ends, coverage for your enrolled dependents will also end.
• You can re-enroll in the �̾�����Ƶ program in accordance with the Plan’s procedures during an annual enrollment period, a special enrollment period, or if a qualified status change occurs that is consistent with the request for enrollment in accordance with Section 125.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

You should also know that if you terminate or lose your current coverage with �̾�����Ƶ and do not join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may increase by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) for as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

For More Information About This Notice Or Your Current Prescription Drug Coverage.

Contact the office listed below for further information.

NOTE: You will receive this notice each year. You will also receive it prior to the next Medicare drug plan enrollment period and if this coverage through �̾�����Ƶ changes. You may also request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage.

More detailed information about Medicare plans that offer prescription drug coverage can be found in the “Medicare & You” Handbook. You’ll receive a copy of the Handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage:

• .
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” Handbook for the telephone number) for personalized help
• Call 1 (800) MEDICARE or 1 (800) 633-4227. TTY users should call 1 (877) 486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, or call them at 1 (800) 772-1213. TTY users should call 1 (800) 325-0778.

Note: Retain this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

Date: October 8, 2024

Name of Entity/Sender:
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University Benefits, Office of Human Resources
Goldstein Academic Center
861 Bedford Road
Pleasantville, NY 10570
Phone: (914) 923-2828