Dear Retiree:
This letter serves as notice to all Medicare-eligible and Medicare participating retirees about your option NOT to participate in Medicare Part D coverage because the IDB health plan already provides pharmacy benefits for you and your eligible dependents.
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the Inter-American Development Bank through Cigna and prescription drug coverage available for people with Medicare. It also explains the options you have under Medicare prescription drug coverage and can help you decide whether or not you want to enroll. At the end of this notice is information about where you can get help to make decisions about your prescription drug coverage.
- Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans (like an HMO or PPO) that offer prescription drug coverage. All Medicare prescription 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.
- The Bank’s Benefit Consultants have determined that the prescription drug coverage offered by the Inter-American Development Bank is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage.
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Because your existing coverage is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay extra if you later decide to enroll in Medicare prescription drug coverage.
The IDB Plan includes a prescription drug benefit for all participants. Benefits are provided for brand name and generic prescription drugs. The Plan pays 100% of the charges less the corresponding co-pays per the table below.
PRESCRIPTION DRUG BENEFITS
In the USA
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Tier
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Co-pay Retail
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Co-pay Mail-order*
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30-day supply
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90-day supply
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Generic
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$5
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$10
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Formulary (preferred) Brand
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$15
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$30
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Non-Formulary Brand
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$30
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$60
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Specialty
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$40
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$80
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Outside the USA
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Co-pay
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$5
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N/A
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Lifestyle drugs (e.g. erectile dysfunction, impotence) • Limit of 4 pills per month
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* $0 mail order co-pay for generic and preferred brands, for preventive conditions only such as high blood pressure, high cholesterol, diabetes, asthma, osteoporosis, heart attack and stroke, and prenatal nutrient deficiency
Prescription drugs and medicines covered under the IDB Plan are those that are medically necessary and can be obtained only when prescribed by a Provider who is a physician or a dentist. (More information about the prescription drug benefit is available in the Insurable Benefits Handbook.)
Since the IDB Plan is, on average for all participants, expected to pay out at least as much as the standard Medicare prescription drug coverage will pay, current participants in the IDB Plan would not gain any additional prescription coverage by participating in a Medicare plan.
You may enroll for Medicare prescription drug coverage when you are first eligible for Medicare and each year from October 15th through December 7th. However, if you lose your current creditable prescription drug coverage through no fault of your own, or if you decide to terminate your IDB coverage, you will be eligible for a two (2) month special enrollment period to enroll in a Part D plan.
Because your IDB plan is considered Creditable Coverage, if you decide to continue to participate in the IDB plan without enrolling in Medicare Part D at this time, you will not be subject to a late enrollment penalty if you enroll in Part D at a later date.
If you decide to join a Medicare drug plan, your current IDB coverage will not be affected, but will pay secondary to Medicare. If you drop your IDB coverage, you will not be able to get it back.
Keep in mind that if you drop your IDB coverage and go 63 days or longer without prescription drug coverage that’s at least as good as Medicare’s prescription drug coverage, your monthly premium will go up 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 will always be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to enroll.
You will receive this notice annually and at other times in the future such as before the next period you can enroll in Medicare prescription drug coverage, and if this coverage through Cigna changes. You also may request a copy.
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug plans:
- Visit www.medicare.gov
- Call your State Health Insurance Assistance Program (see the inside back cover of the Medicare & You handbook for their telephone number) for personalized help,
- Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you can call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice handy. If you enroll in one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show that whether or not you are required to pay a higher premium (a penalty).
HRD/INS
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