Insurance Coverage for the Medicare-eligible Member

1 Insurance Coverage for the Medicare-eligible Member 2019. Table of contents 3. State Health Plan's grandfathered status .. 3. Notice of non-discrimination .. 4. Language 4. Signing up for medicare Parts A and B .. 7. What happens when you turn down Part B?.. 7. Automatic enrollment in the medicare Supplemental Plan .. 7. Moving to prescription drug Coverage with Express Scripts medicare .. 8. Your Insurance cards .. 8. Coverage in active employment 9. medicare at 65 for active employees .. 9. Working in an Insurance - eligible job after 9. Retirees hired in an Insurance - eligible job who continued life Insurance .. 10. Coverage in retirement situations .. 10. eligible retirees who turn 65.

2 10. Ineligible retirees who turn 65 .. 10. Retirees who leave active employment after 65 .. 11. Ineligible retirees whose spouses or children are eligible for medicare .. 11. Coverage in disability situations .. 11. Before age 65 .. 11. End-stage renal disease .. 12. Your health Insurance options with 12. How medicare pays alongside the medicare Supplemental Plan and Standard Plan .. 13. medicare Supplemental Plan Coverage .. 14. Insurance Coverage for the Medicare-eligible Member | 2019 1. How PEBA health plans pay with medicare .. 15. Standard Plan Coverage .. 18. Using Express Scripts medicare for prescription drug Coverage .. 20. Immunization benefits (available through medicare or Express Scripts medicare ).

3 22. Filing claims as a retiree with medicare .. 22. How medicare works with other forms of PEBA Coverage .. 23. Creditable Coverage letter .. 25. medicare Part D: frequently asked questions .. 27. Comparison of health plans .. 30. 2019 Monthly premiums .. 33. 2 Insurance Coverage for the Medicare-eligible Member | 2019. Disclaimer State Health Plan's Benefits administrators and others chosen by grandfathered status your employer who may assist with Insurance enrollment, changes, retirement or termination The Public Employee Benefit Authority and related activities are not agents of the believes the State Health Plan is a South Carolina Public Employee Benefit grandfathered health plan under the Patient Authority (PEBA) and are not authorized to bind Protection and Affordable Care Act (the the South Carolina Public Employee Benefit Affordable Care Act).

4 Authority. As permitted by the Affordable Care Act, a The Insurance Benefits Guide contains an grandfathered health plan can preserve certain abbreviated description of Insurance benefits basic health Coverage that was already in effect provided by or through the South Carolina when that law was enacted. Being a Public Employee Benefit Authority. The Plan of grandfathered health plan means that your plan Benefits documents and benefits contracts may not include certain consumer protections contain complete descriptions of the health and of the Affordable Care Act that apply to other dental plans and all other Insurance benefits. plans, for example, the requirement for the Their terms and conditions govern all benefits provision of preventive health services without offered by or through the South Carolina Public any cost sharing.

5 However, grandfathered Employee Benefit Authority. If you would like to health plans must comply with certain other review these documents, contact your benefits consumer protections in the Affordable Care administrator or the South Carolina Public Act, for example, the elimination of lifetime Employee Benefit Authority. limits on benefits. The language in this document does not create Questions regarding which protections apply an employment contract between the and which protections do not apply to a employee and the South Carolina Public grandfathered health plan and what might Employee Benefit Authority. This document cause a plan to change from grandfathered does not create any contractual rights or health plan status can be directed to the plan entitlements.

6 The South Carolina Public administrator at or Employee Benefit Authority reserves the right to revise the content of this document, in whole or in part. No promises or assurances, whether written or oral, which are contrary to or inconsistent with the terms of this paragraph create any contract of employment. Insurance Coverage for the Medicare-eligible Member | 2019 3. Notice of non- at , discrimination or by mail or phone at: The South Carolina Public Employee Benefit Department of Health and Human Services Authority (PEBA) complies with applicable 200 Independence Avenue, SW. Federal civil rights laws and does not Room 509F, HHH Building Washington, discriminate on the basis of race, color, national 20201.

7 Origin, age, disability, or sex. PEBA does not , (TDD). exclude people or treat them differently Complaint forms are available at because of race, color, national origin, age, disability, or sex. PEBA: Language assistance Provides free aids and services to ATENCI N: si habla espa ol, tiene a su people with disabilities to communicate disposici n servicios gratuitos de asistencia effectively with us, such as: ling stica. Llame al Qualified sign language interpreters . Written information in other formats (large print, audio, accessible electronic formats, other formats) CH : N u b n n i Ti ng Vi t, c c c d ch v h . Provides free language services to tr ng n ng mi n ph d nh cho b n. G i s.

8 People whose primary language is not English, such as: Qualified interpreters : , . Information written in other languages . If you need these services, contact PEBA's . Privacy Officer. If you believe that PEBA has failed to provide ATTENTION : Si vous parlez fran ais, des these services or discriminated in another way services d'aide linguistique vous sont propos s on the basis of race, color, national origin, age, gratuitement. Appelez le disability, or sex, you can file a grievance with: PAUNAWA: Kung nagsasalita ka ng Tagalog, PEBA Privacy Officer, 202 Arbor Lake Dr., maaari kang gumamit ng mga serbisyo ng Columbia, SC 29223, (phone), tulong sa wika nang walang bayad. Tumawag sa (fax), or at You can file a grievance in person or by mail, fax, or email.

9 If ВНИМАНИЕ: Если вы говорите на you need help filing a grievance, PEBA's Privacy русском языке, то вам доступны бесплатные Officer is available to help you. услуги перевода. Звоните You can also file a civil rights complaint with the ACHTUNG: Wenn Sie Deutsch sprechen, stehen Department of Health and Human Services, Ihnen kostenlos sprachliche Office for Civil Rights, electronically through the Hilfsdienstleistungen zur Verf gung. Office for Civil Rights Complaint Portal, available Rufnummer: 4 Insurance Coverage for the Medicare-eligible Member | 2019. : , : УВАГА! Якщо ви розмовля те . укра нською мовою, ви можете звернутися до безкоштовно служби мовно п дтримки. Телефонуйте за номером.

10 : .. ATEN O: Se fala portugu s, encontram-se dispon veis servi os lingu sticos, gr tis. Ligue , para .. Insurance Coverage for the Medicare-eligible Member | 2019 5. When you or someone you know becomes eligible for medicare 6 Insurance Coverage for the Medicare-eligible Member | 2019. Signing up for medicare you are covered as an active employee. This period is from January 1 to March 31 of each Parts A and B year, and Coverage begins on July 1. For every 12-month period you were not covered by Part To receive full benefits with any state-offered B after you were first eligible , your medicare retiree group health plan when you become premium will be 10 percent higher. Contact eligible for medicare , you will need to be medicare to learn more about enrollment and covered by both Part A and Part B.