It's Your Choice 2016
Pharmacy Benefits for Retirees with Medicare
Provided by Navitus MedicareRx (PDP)
Each January 1st, all Medicare-eligible participants covered under an annuitant contract will be automatically enrolled in the Medicare Part D prescription drug program called Navitus MedicareRx (PDP), underwritten by Dean Health Insurance, Inc., a Federally-Qualified Medicare Contracting Prescription Drug Plan. Eligible individuals enrolled as members in the Group Health Insurance Program were covered by creditable coverage through Navitus Health Solutions prior to being enrolled in Navitus MedicareRx (PDP).
What does this mean to you?
When you become eligible for coverage under Medicare Part D, you will be enrolled in the Navitus MedicareRx (PDP) through your employer group coverage. As required by Uniform Benefits, a supplemental wrap benefit is also included to provide full coverage to program members when the Medicare Part D plan does not pay, such as when you are in the deductible phase of Medicare Part D or when you reach the Medicare coverage gap, also known as the “donut hole.” You will be automatically enrolled in this supplemental wrap coverage.
Prescription Drug Benefit
1 “Zero Dollar” preventive drugs identified by the Affordable Care Act (ACA) are paid for by the plan even if the deductible has not been met.
“First Dollar” preventive drugs identified by the ACA are subject to copayment/coinsurance cost sharing, even if the deductible has not been
met. After the deductible is met, the member is still responsible for the copayment/coinsurance until the OOPL is met.
Information regarding your Medicare Part D benefit will be mailed to you by Navitus MedicareRx (PDP) upon confirmed enrollment from Medicare.
Medicare Prescription Drug Coverage
Prior Authorization Requirements
Diabetic Supply Coverage
Mail Order Program
RxCENTS Tablet-Splitting Program
Specialty Medication Program
Coordination of Benefits
PLEASE READ THIS IMPORTANT NOTICE CAREFULLY
See also your 2016 Notice of Creditable Coverage for Medicare Part D.
By completing your enrollment application or maintaining your enrollment with the Group Health Insurance Program, you agree to the following:
Navitus MedicareRx (PDP) serves a specific service area. If I move out of the area that Navitus MedicareRx (PDP) serves, I need to notify the plan so I can disenroll and find a new plan in my new area. I understand that I must use network pharmacies except in an emergency when I cannot reasonably use Navitus MedicareRx (PDP) network pharmacies. Once I am a member of Navitus MedicareRx (PDP), I have the right to appeal plan decisions about payment or services if I disagree. I will read the Evidence of Coverage document from Navitus MedicareRx (PDP) when I get it to know which rules I must follow to get coverage.
I understand that if I leave this plan and don’t have or get other Medicare prescription drug coverage or creditable prescription drug coverage (as good as Medicare’s), I may have to pay a late enrollment penalty in addition to my premium for Medicare prescription drug coverage in the future. I understand that if I am getting assistance from a sales agent, broker or other individual employed by or contracted with Navitus MedicareRx (PDP), he/she may be paid based on my enrollment in Navitus MedicareRx (PDP). Counseling services may be available in my state to provide advice concerning Medicare supplement insurance or other Medicare Advantage or prescription drug plan options, medical assistance through the state Medicaid program, and the Medicare Savings Program.
Release of Information:
This notice is provided each year, prior to the next Medicare prescription drug coverage enrollment period or whenever program coverage changes. For more information, please contact ETF or Navitus MedicareRx (PDP).
Navitus MedicareRx (PDP) Customer Care
Write: Navitus MedicareRx (PDP) Customer Care, P.O. Box 1039, Appleton, WI 54912-1039
This page was last modified on: 8/17/2016 1:06:55 PM