Medicare Supplement Benefits - Frequently Asked Questions

• Who is eligible to enroll in PEHP’s Medicare Supplement Program?
• When can an individual enroll in PEHP’s Medicare Supplement Program?
• What options are available under PEHP’s Medicare Supplement Program?
• How often can I change from High Option to Low Option Medicare Supplement?
• What benefits do the High and Low Option provide?
• How do you file a Medicare Supplement Claim?
• What is the Prescription Drug Benefit under PEHP’s Medicare Supplement High Option?
• How can an individual save additional money on their prescription drugs?
• How can an individual participate in the mail order pharmacy program?
• How can I obtain more information on PEHP’s Medicare Supplement Program?

The PEHP Medicare Supplement Program is also available for individuals that are under the age of 65 that have Medicare coverage and are eligible to receive benefits through the Utah Retirement Systems. If you are under the age of 65 and have Medicare coverage, you need to submit a current copy of your Medicare card when you apply for the Medicare Supplement Program.

1. An individual can enroll in the PEHP Medicare Supplement Program when they are retired and turn 65. Individuals have 90 days after turning age 65 to enroll in the Program and the policy will be effective on their 65th birthday. The individual will be responsible for the premium from the effective date of the policy. Individuals may also wait until the following January for the policy to be effective.
   
2. There is an open enrollment period during the month of December each year for individuals who wish to enroll in the PEHP Medicare Supplement Program.
   
3. You had PEHP medical coverage through your employer and enroll within 60 days of termination from PEHP active group coverage.

The PEHP Medicare Supplement Program has two options available, High Option and Low Option. High Option includes coverage for prescription drugs and Low Option does not. The member and their spouse must be enrolled in the same option.

Individuals can change from High Option to Low Option or Low Option to High Option Medicare Supplement every year.

High and Low Option Medicare Supplement provides supplemental coverage for eligible services under Medicare. Most Medicare eligible benefits are payable at 80% of Medicare's approved amounts. PEHP’s Medicare Supplement Program covers 20% of Medicare’s approved amounts. Additionally, PEHP’s Medicare Supplement Program covers 100% of the Inpatient Hospital Deductible and 20% (or $20) of the $100 annual deductible for eligible medical expenses covered under Medicare Part B. Please see the Medicare Supplement Benefits Summary for more information.

All claims must be submitted to Medicare first. After Medicare processes the claim they will send an Explanation of Benefits form to the member. The member should then send a copy of the Explanation of Benefits with an itemized bill to PEHP, 560 East 200 South, Salt Lake City, Utah 84102. Please be aware that it is the member’s responsibility, not the Provider’s, to make sure that PEHP receives all of the Medicare Explanation of Benefits for all services.

PEHP’s High Option Medicare Supplement program prescription drug benefit is provided through a drug card system. Individuals must present their prescription drug card at the pharmacy, after an individual meets a $200 deductible they will pay 20% of PEHP’s discounted fee for a generic drug with a $5 minimum or 40% of PEHP’s discounted fee for a brand name drug with a $5 minimum or 50% of PEHP’s discounted fee for Non-preferred drugs (drugs that are not on PEHP’s preferred drug list) with a $5 minimum. Individuals can purchase up to a 90-day supply of prescription drugs at the retail pharmacy.

Individuals on PEHP’s Medicare Supplement High Option can realize savings on their prescription drugs by using the mail order pharmacy program.
An individual will pay 20% of PEHP’s discounted fee for generic and a name brand drugs with a $5 minimum up to a $50 maximum for a 90-day supply. An individual will pay 50% of PEHP’s discounted fee for Non-preferred drugs (drugs that are not on PEHP’s preferred drug list) with a $5 minimum and no maximum for a 90-day supply.

Participating in the mail order program is easy. Members should complete an order from, attach the original copy of the prescription from the doctor and mail it to Paid Prescriptions at the address on the envelope. Refills can be ordered by calling 1-800-903-4725 or can be ordered on line at www.medcohealth.com. Also additional information can be obtained by accessing Medco Health’s web site.

Detailed information on PEHP Medicare Supplement Program can be obtained by contacting PEHP, at 801-366-7555 or 1-800-765-7347.