IMPORTANT NOTICES ABOUT MEDICAL COVERAGE

• Health Insurance Portability and Accountability Act of 1996 Notification for Medical Program Eligibility (HIPAA)
• Certificate of Creditable Coverage
• Your Prescription Drug Coverage and Medicare

HIPAA (HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996) NOTIFICATION FOR MEDICAL PROGRAM ELIGIBILITY

If you are declining enrollment for yourself or your eligible family members because of other medical insurance or group medical plan coverage, you may be able to enroll yourself and your eligible family members* in a UC-sponsored medical plan if you or your family members lose eligibility for that other coverage (or if the employer stops contributing toward the other coverage for you or your family members.) You must request enrollment within 31 days after you or your family member's other medical coverage ends (or after the employer stops contributing toward the other coverage).

In addition, if you have a newly eligible family member as a result of marriage or domestic partnership, birth, adoption, or placement for adoption, you may be eligible to enroll your newly eligible family member. If you are an employee, you may be eligible to enroll yourself and your eligible family member(s).  You must request enrollment within 31 days after the marriage or partnership, birth, adoption, or placement for adoption.

If you decline enrollment for yourself or for an eligible family member because of coverage under Medicaid (in California, Medi-Cal) or under a state children’s health insurance program (CHIP), you may be able to enroll yourself and your eligible family members in a UC-sponsored plan if you or your family members lose eligibility for that coverage.  You must request enrollment within 60 days after your coverage or your family members’ coverage ends under Medicaid or CHIP.

Also, if you are eligible for health coverage from UC but cannot afford the premiums, some states have premium assistance programs that can help pay for coverage.  For details, see the Notice provided in UC’s Open Enrollment booklet or call your Benefits Office.  You may also contact the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services at www.cms.gov or 1-877-267-2323, ext. 61565. 

IF YOU DO NOT ENROLL YOURSELF AND/OR YOUR FAMILY MEMBER(S) IN MEDICAL COVERAGE WITHIN THE 31 DAYS WHEN FIRST ELIGIBLE OR WITHIN A SPECIAL ENROLLMENT PERIOD DESCRIBED ABOVE, YOU MAY ENROLL AT A LATER DATE. However, each member will need to complete a waiting period of 90 consecutive calendar days before medical coverage becomes effective and your premiums may need to be paid on an after-tax basis, or you/they can enroll during the next Open Enrollment Period.

To request special enrollment or obtain more information, employees should contact your local Benefits Office and retirees should call UC Customer Service (1-800-888-8267).

Note: If you are enrolled in a UC medical plan, you may be able to change medical plans if:

 - you acquire a newly eligible family member; or

 - your eligible family member loses other coverage.

In either case, you must request enrollment within 31 days of the occurrence.

* TO BE ELIGIBLE FOR PLAN MEMBERSHIP, YOU AND YOUR FAMILY MEMBERS MUST MEET ALL UC EMPLOYEE OR RETIREE ENROLLMENT AND ELIGIBILITY REQUIREMENTS.   AS A CONDITION OF COVERAGE, ALL PLAN MEMBERS ARE SUBJECT TO ELIGIBILITY VERIFICATION AUDIT BY THE UNIVERSITY AND/OR INSURANCE CARRIERS.

 

Your Prescription Drug Coverage and Medicare

Important Notice from the University of California about Your Prescription Drug Coverage and Medicare

Prescription Drug Coverage

Starting January 1, 2006, new prescription drug plan coverage became available to everyone with Medicare.  All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare.

Creditable Coverage

The University of California has determined that the prescription drug coverage in the following retiree medical plans – Anthem Blue Cross PLUS Medicare, Anthem Blue Cross PPO Medicare, Core Medicare, High Option Supplement to Medicare, Health Net Seniority Plus, Health Net Medicare COB, Kaiser Permanente California/Seniority Plus, and the Kaiser Umbrella Plan are considered Creditable Coverage. This means the prescription drug coverage provided in these plans meets or exceeds the Medicare Part D standards for the year.

Non-Creditable Coverage

The University of California has determined that the prescription drug coverage in the following plan is non-  Creditable Coverage - Anthem Blue Cross PPO Medicare without prescription drugs. This medical plan does not include prescription drug coverage so it does not meet the minimum Medicare Part D standard to be considered Creditable Coverage.

This is important to know because if you go 63 continuous days or longer without prescription drug coverage that’s creditable you may have to pay a higher premium (penalty) for late enrollment in a Medicare Part D prescription drug plan.

Additionally, if you decide to join a Medicare Part D drug plan, your University of California coverage in this plan will not be affected. You and your eligible dependents will still be eligible to receive all of your current medical plan benefits.

Prescription Drug Formulary

The prescription drugs (formulary) included in your medical plan may change at any time during the year as a result of Medicare Part D mandates. Contact your health plan directly or check your health plan’s website for  prescription drug formulary information. 

For additional details, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227)