Medicare and BSSP

How will my Butte School Self-Funded Programs (BSSP) coverage coordinate with Medicare?

• Your BSSP medical plan will pay all prescription benefits (subject to BSSP plan deductibles, co-pays, limitations, etc.) regardless of whether or not you have Medicare. 

• The amount of hospital, physician and other health care provider benefits your BSSP plan will pay depends on whether BSSP or Medicare is your primary coverage. 

 BSSP is primary when you are covered under a BSSP active plan. 

• BSSP active coverage can be as an employee or spouse. 

• When BSSP is your primary coverage, BSSP will pay all claims under the BSSP plan except for those related to end-stage renal disease.  If you have end-stage renal disease, please see the Summary Plan Description for an explanation of your benefits. 

 Medicare is primary when you are covered under a BSSP retiree plan. 

• If you are eligible for Medicare Part A, BSSP payments will be based on amounts under Medicare Part A and B, regardless of whether you have Medicare Parts A and B or actual Medicare payments. For this reason, you are encouraged to purchase Medicare Part B when you are eligible for Medicare Part A.

• BSSP will not pay any more than the Medicare-approved amount for hospital charges.

• When services are provided by a network provider who accepts Medicare, BSSP will pay the difference between (a) what the BSSP plan would have paid without Medicare and (b) what Medicare paid (or would have paid if you elected not to purchase Medicare B coverage).  Example:  You are billed $100 of covered expense, and in the absence of Medicare BSSP would have paid $80.  If Medicare pays $50, BSSP will pay the remaining $30. 

• When services are by a network provider who does not accept the Medicare assignment, BSSP will pay the difference between what the BSSP plan would have paid without Medicare and the limiting charge as determined by Medicare. 

• The combined about of benefits from your BSSP plan and Medicare will equal, but not exceed, what your benefit would have been from your BSSP plan alone if you were not eligible for Medicare.  Your BSSP plan will not pay any benefit when Medicare’s payment is as much or more than the benefit under your BSSP plan.  

Information regarding your Medicare benefits may be found at http://my.medicare.gov. 

 

Important Notice from Butte Schools Self-funded Programs About
Your Prescription Drug Coverage and Medicare

CREDIBLE COVERAGE NOTIFICATION

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Butte Schools Self-Funded Programs and prescription drug coverage available for people with Medicare. It also explains the options you have under Medicare prescription drug coverage and can help you decide whether or not you want to enroll. At the end of this notice is information about where you can get help to make decisions about your prescription drug coverage.

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
    
2. Butte Schools Self-Funded Programs has determined that the prescription drug coverage offered by the our medical plans are, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage.

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Because your existing coverage is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay extra if you later decide to enroll in Medicare prescription drug coverage.

Individual’s can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from November 15th through December 31st. Beneficiary’s leaving employer/union coverage may be eligible for a Special Enrollment Period to sign up for a Medicare prescription drug plan.

You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area.

If you do decide to enroll in a Medicare prescription drug plan and drop your Butte Schools Self-Funded Programs prescription drug coverage, be aware that you and your dependents may not be able to cannot get this coverage back.

Please contact us for more information about what happens to your coverage if you enroll in a Medicare prescription drug plan.

You should also know that if you drop or lose your coverage with Butte Schools Self-funded Programs and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later.

If you go 63 days or longer without prescription drug coverage that’s at least as good as Medicare’s prescription drug coverage, your monthly premium will go up at least 1% per month for every month that you did not have that coverage. For example, if you go nineteen months without coverage, your premium will always be at least 19% higher than what many other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following November to enroll.

For more information about this notice or your current prescription drug coverage…

Contact our office for further information at 530-532-5837. NOTE: You will receive this notice annually and at other times in the future such as before the next period you can enroll in Medicare prescription drug coverage, and if this coverage through Butte Schools Self-funded Programs changes. You also may request a copy.

For more information about your options under Medicare prescription drug coverage…

More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug plans:

• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help,
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you call them at 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show that you are not required to pay a higher premium amount.

                             Date:       September 30, 2007
Contact--Position/Office:      Christy Patterson, Executive Director
                        Address:      1859 Bird Street Oroville, CA 95965
             Phone Number:      530-532-5837

For more information

Contact:
Christy Patterson, Executive Director
Phone: (530) 532-5837
Email: cpatters@bcoe.org

Cathy Ramirez, Administrative Assistant
Phone: (530) 532-5838
Email: cramirez@bcoe.org

Fax: (530) 532-5836