Frequently Asked Questions - Medicare Supplement Benefits

• Who is eligible to participate in PEHP's Medicare Supplement Program?
• When can an individual enroll in PEHP's Medicare Supplement Program that includes a Medicare approved prescription drug plan?
• Common Questions regarding the prescription drug benefits.

1) Retired individuals age 65 and over that have earned service credit with Utah Retirement Systems, are a participant with a URS Defined Contribution Plan, or previously had PEHP medical coverage.

2) Individuals under the age of 65 who have Medicare coverage and are a member or a Dependent of a member who has earned service credit with URS or is a participant with a URS Defined Contribution Plan.

3) Spouses and approved disabled Dependents of those eligible under numbers 1 and 2. Each eligible Member and Dependent can enroll in the PEHP Medicare Supplement Plan that best meets his or her individual needs.

1) When you first become eligible for Medicare, during the period that starts three months before the month you turn age 65 and ends three months after the month you turn age 65. If you receive Medicare benefits due to a disability, you can join three month before and after your 24th month of cash disability benefits.

2) When your active group coverage terminates you have 63 days to enroll in PEHP's Medicare Supplement Plan to avoid paying an enrollment penalty on PEHP's Medicare Prescription Drug plan.

Your effective date for PEHP's Medicare Supplement Plan will be the first day of the month following the date of PEHP's receipt of the enrollment form.

TO AVOID A LAPSE IN COVERAGE, PEHP MUST RECEIVE YOUR ENROLLMENT FORM 30 DAYS PRIOR TO THE MONTH THAT YOU TURN AGE 65 OR 30 DAYS PRIOR TO THE MONTH THAT YOUR ACTIVE GROUP COVERAGE ENDS. IF YOUR ENROLLMENT FORM IS RECEIVED TIMELY BY PEHP, YOUR COVERAGE WILL BE EFFECTIVE THE FIRST OF THE MONTH THAT YOU TURN AGE 65 OR THE FIRST OF THE MONTH YOUR ACTIVE GROUP COVERAGE TERMINATES.

3) PEHP's Medicare Supplement plans open enrollment is November 15th through December 31st of each calendar year. At that time you can elect to stay on the same PEHP Medicare Supplement option, select another PEHP Medicare Supplement option or cancel your PEHP Medicare Supplement coverage.

PEHP's three prescription drug plans are administered by Medco and are approved by Medicare. The service are for both plans includes all 50 states and the District of Columbia. If you choose either the Basic Plan, the Basic Plus, or the Enhanced Plan, you will be enrolled in the Medco Medicare Prescription Drug Plan for PEHP, offered though Medco's Containment Life Insurance Company.

1) Where can you get your prescriptions?

The Medco Medicare Prescription Drug Plan for PEHP includes a network of pharmacies contracted with Medco to provide prescriptions to plan Members. You must use a participation pharmacy to receive plan benefits. The Medco Medicare Prescription Drug Plan for PEHP may not pay for you prescriptions if you use and out-of-network pharmacy, except in certain cases. The pharmacies in this network may change at any time. Call Medco at 1-800-590-2239 for network pharmacy information or for help finding a pharmacy. Prescriptions are also available through the Medco-by-Mail prescription service.

2) Does PEHP cover Medicare Part B or Medicare Part D medications?

If your drug would be covered by Medicare Part A or Part B, it can't be covered by Medicare Part D even if your choose not to participate in Part A or Part B. Some drugs may be covered under Medicare Part B in some cases and thought this Plan (Medicare Part D) in other cases, but never both at the same time. In general, your pharmacist or provider will determine whether to bill Medicare Part B or Medco for the drug in question.

3) Does my plan have a prescription drug formulary?

Yes. A formulary is a preferred list of drugs selected to meet patient needs.