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2020 UPREHSMEDICARE PLANANNUAL NOTICE OFCHANGE (ANOC)This booklet contains important information and changes about your 2020 Medicarebenefits. Please make sure you review this carefully.H4652 ANOC 2020
GENERATIONS STRONGIn 1870, Union Pacific and other railroad companies recognized a need to treat sick andinjured employees. From that need, railroad hospital associations were born. Theseassociations flourished as the “iron road” crisscrossed the United States. At their peak, 35different hospital associations served nearly 550,000 railroad employees with more than 3,700hospital beds. These hospital associations were the forerunner of today’s health insuranceplans. In 1947, the hospital associations separated from the railroads and became independententities dedicated to providing coverage and care for railroad employees.The last 149 years have brought significant advancements in medicine and health care andhave set the stage for today’s modern health plan. Union Pacific Railroad Employees HealthSystems (UPREHS) or UP Health has been there every step of the way.The face of UP Health has evolved, but our commitment to you remains constant. Today, weare one of only five remaining hospital associations. We recognize the need to grow andchange with the times and the industry so we can continue to provide you with healthinsurance coverage for the next 149 years.With an eye on the future, we are excited to announce the face of UP Health will evolve onceagain in 2020 with a new company name and logo. We hope our new brand will honor thelong history and contribution railroaders have made—and continue to make—since 1870.Our nation has long depended on the railroads, and those who work them. It’s how weconnected this great country from one end to the other — moving goods, materials, and oureconomy forward. Those who came before you paved the way, and you keep the traditionalive. They had a steadfast health partner, and you do too.Introducing a new name for an old tradition — Iron Road Healthcare.
UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS WILLBECOME IRON ROAD HEALTHCARE ON JANUARY 1, 2020Iron Road Healthcare (formerly UPREHS) HCPP Part B & MedicarePart A & B Secondary Plan (MSP)Annual Notice of Changes for 2020You are currently enrolled as a member of Iron Road Healthcare’s (sponsored by UPREHS)HCPP Part B & Medicare Part A & B Secondary Plan (MSP). This plan includes a Part DPrescription Drug Plan (PDP), administered by OptumRx. Next year (2020), there will besome changes to the plan’s benefits. This booklet tells you about the changes. If you want to continue your coverage with Iron Road Healthcare, do nothing andyou will automatically be re-enrolled. Otherwise, you have from October 15 untilDecember 7 to make changes to your Medicare coverage for next year. PLEASE NOTE: If you decide to enroll in a different Medicare plan, you willautomatically be dis-enrolled from the Iron Road Healthcare Medicare plan.Additional Resources Please contact our Member Services department at 800-547-0421 for additionalinformation. (TTY/TDD users should call 711; this is a free service). Member Servicesis available Monday through Friday from 7:30 a.m. to 3:30 p.m., MST. You can alsoemail us at help@uphealth.com or visit our website at www.uphealth.com. If you speak a language other than English, language assistance services are available toyou free of charge. Please refer to the back of this booklet for a list of languages.About Iron Road Healthcare (sponsored by UPREHS) Iron Road Healthcare (sponsored by UPREHS) is contracted as a Health CarePrepayment Plan (HCPP) with the Centers for Medicare and Medicaid Services (CMS),the federal agency that administers Medicare. When this booklet says “we,” “us,” or “our,” it means Iron Road Healthcare. When itsays “plan” or “our plan,” it means the Iron Road Healthcare HCPP Part B & MedicarePart A & B Secondary Plan (MSP).Plan sponsored by UPREHS H4652 ANOC 2020
Iron Road Healthcare Medicare Plan Annual Notice of Changes for 2020Summary of Important Costs & Benefit Changes for 2020The table below compares the 2019 costs and 2020 costs for Iron Road Healthcare Medicareplan in several important areas. Please note this is only a summary of changes. A copy ofthe Evidence of Coverage is located on our website at www.uphealth.com to see if otherbenefit changes affect you. You may also call Member Services to ask us to mail you a copyof the Evidence of Coverage.CostMonthly plan premium*2019 (this year)2020 (next year) 255 255(no change)Your premium may be higher orlower than this amount. See Section3.1 for details.UPREHS covers yourdeductibleIron Road Healthcarecovers your deductiblePart A is 1,364Part B is 185Part D is 4152020 deductibles notavailable at time ofprinting.Maximum out-of-pocket amountUPREHS does not have amaximum out-of-pocketIron Road Healthcaredoes not have amaximum out-of-pocketPart D prescription drug coveragePlease refer to the 2019ANOC from OptumRxfor information onchanges to Part D. Yourpremium of 255 permonth includes Part Dcoverage.Please refer to the 2020ANOC from OptumRxfor information onchanges to Part D. Yourpremium of 255 permonth includes Part Dcoverage.For Medicare approvedservices, we pay 80% ofthe Part B annualdeductible, plus 80% ofthe costs not paid byMedicare, up to an annuallimit of 600. You pay theremaining deductible, plusthe cost of services thatexceed our annual limit.For Medicare approvedservices, we pay 100% ofthe Part B annualdeductible, plus 100% ofthe covered costs not paidby Medicare. No annuallimit.Deductible(See Section 3.5 for details.)Chiropractic ServicesNew benefitPlan sponsored by UPREHS 2020 Annual Notice of Change H4652
Iron Road Healthcare Medicare Plan Annual Notice of Changes for 2020CostMental Health(for inpatient, outpatient & partialhospitalization services)New benefitEye Care / Refractive ServiceBenefit changeCompression / Job stockingsBenefit changeSECTION 12019 (this year)2020 (next year)If the diagnosis is forDementia or Alzheimer’s,and treatment is approvedby Medicare, we cover thePart B annual deductible,plus the costs not paid byMedicare.For Medicare approvedservices, we cover thePart B annual deductible,plus 100% of the coveredcosts not paid byMedicare.This is not a Medicarebenefit, however UPREHScovers one refractiveservice annually. Paymentamount must be withinthe plan allowableamount. You pay for theamount not allowed by theplan, and/or for additionalexams.Not a covered benefitThis is not a Medicarebenefit, but UPREHScovers this. Member mustsubmit a request forreimbursement with acopy of the receipt.Not a covered benefit.We Are Changing the Plan’s NameOn January 1, 2020, our plan name will change to Iron Road Healthcare Medicare plan. Thisplan is sponsored by UPREHS.You will receive a new Iron Road Healthcare Member ID card in December. You will need touse your new card beginning on January 1, 2020. Our website will also change towww.ironroadhealthcare.com on January 1, 2020.You will also receive a new Part D member ID card from OptumRx.Plan sponsored by UPREHS 2020 Annual Notice of Change H4652
Iron Road Healthcare Medicare Plan Annual Notice of Changes for 2020SECTION 2Unless You Choose Another Plan, You Will Be AutomaticallyRe-Enrolled in Iron Road Healthcare Medicare plan in2020If you do nothing to change your Medicare coverage by December 7, 2019, we willautomatically re-enroll you in our HCPP Part B & Medicare Part A & B Secondary, andPart D Prescription Drug Plan, administered by OptumRx.You have choices about how to get your Medicare coverage. If you want to change to adifferent plan you may do so from October 15 until December 7. Your membership in the newplan will being on January 1, 2020. If you are eligible for long term care, low income subsidiesor Medicaid, you can change plans at any time. For more information, see your Medicare &You handbook.The information in this document tells you about the differences between your currentbenefits and the benefits you will have on January 1, 2020.SECTION 3Changes to Benefits and Costs for Next YearSection 3.1 – Changes to the Monthly PremiumCostMonthly premium2019 (this year)2020 (next year) 255 255(no change)(You must also continue to pay yourMedicare Part B premium.) Your monthly plan premium will be more if you are required to pay a lifetime Part Dlate enrollment penalty for going without other drug coverage that is at least as good asMedicare drug coverage (also referred to as “creditable coverage”) for 63 days or more.If you have a higher income, you may have to pay an additional amount each monthdirectly to the government for your Medicare prescription drug coverage.Your monthly premium will be less if you are receiving “Extra Help” with yourprescription drug costs.Section 3.2 – Changes to the Provider NetworkPlease review the 2020 Provider Directory to see if your providers are in our network.Plan sponsored by UPREHS 2020 Annual Notice of Change H4652
Iron Road Healthcare Medicare Plan Annual Notice of Changes for 2020There are always changes to our network of providers. If your provider is out-of-network, youmay be partly or totally financially responsible for charges that Medicare did not pay from anout-of-network provider.To see the most current provider directory, please visit FirstHealth tomPage. We strongly recommend youcheck the provider directory and call your provider in advance of receiving treatment to ensurethe provider is in our network.Section 3.3 – Changes to Part D and the Pharmacy NetworkA list of covered drugs is called a Formulary or “Drug List.”Review the Drug List from OptumRx to make sure your drugs will be covered next year andto see if there will be any restrictions.Amounts you pay for your prescription drugs may depend on which pharmacy youuse. Medicare drug plans have a network of pharmacies. In most cases, your prescriptions arecovered only if they are filled at an in-network pharmacy. Our Part D Prescription Drug Plan(PDP) is administered by OptumRx. Please refer to the 2020 information you should havereceived from OptumRx. If you did not receive a package, please contact OptumRx, Westrongly suggest that you review the current Pharmacy Directory to see if your pharmacy isstill in the OptumRx network.To reach OptumRx, call (866) 443-1095 (TTY/TDD users call 711). OptumRx is available 7days a week, 24 hours a day. Their website is www.optumrx.com.SECTION 4Deciding Which Plan to ChooseWe hope to keep you as a member next year but if you want to change for 2020 follow thesesteps:Step 1: Learn about and compare your choices You can join a different Medicare health plan from October 15 to December 7.To learn more about Original Medicare and the different types of Medicare plans, readMedicare & You 2020, call your State Health Insurance Assistance Program, or call Medicare(see Section 8 for contact information).You can also find information about plans in your area by using the Medicare Plan Finder onthe Medicare website. Go to https://www.medicare.gov and click “Find health & drug plans.”Here, you can find information about costs, coverage, and quality ratings for Medicareplans.Plan sponsored by UPREHS 2020 Annual Notice of Change H4652
Iron Road Healthcare Medicare Plan Annual Notice of Changes for 2020Step 2: Change your coverage To change to a different Medicare health plan, you will need to enroll in the new plan.You will automatically be disenrolled from the Iron Road Healthcare Medicare planSECTION 5Deadline for Changing PlansIf you want to change to a different type of plan, like a Medicare Advantage plan, or make achange to your prescription drug coverage for next year, you can do it from October 15 untilDecember 7. The change will take effect on January 1, 2020.If you want to change to a different cost plan, you can do so anytime the plan is acceptingmembers. The new plan will let you know when the change will take effect.If you want to disenroll from our plan and have Original Medicare for next year, you can makethe change up to December 7. The change will take effect on January 1, 2020.Are there other times of the year to make a change?In certain situations, changes are also allowed at other times of the year. For example, peoplewith Medicaid, those who get “Extra Help” paying for their drugs, and those who move out ofthe service area may be allowed to make a change at other times of the year.PLEASE NOTE: If you join another plan by December 7, 2019, your new coverage will starton January 1, 2020. You will be dis-enrolled from the Iron Road Healthcare (sponsored byUPREHS) HCPP Part B & Medicare Part A & B Secondary Plan (MSP) and Part DPrescription Drug Coverage (PDP), administered by OptumRx.Iron Road Healthcare does not hold regular open enrollment periods.SECTION 6 Programs That Offer Free Counseling about MedicareThe State Health Insurance Assistance Program (SHIP) is a government program with trainedcounselors in every state.SHIP is independent (not connected with any insurance company or health plan). It is a stateprogram that gets money from the Federal government to give free local health insurancecounseling to people with Medicare. SHIP counselors can help you with your Medicarequestions or problems. They can help you understand your Medicare plan choices and answerquestions about switching plans. Visit https://www.shiptacenter.org/ for more information.SECTION 7Programs That Help Pay for Prescription DrugsYou may qualify for help paying for prescription drugs. Below we list different kinds of help:Plan sponsored by UPREHS 2020 Annual Notice of Change H4652
Iron Road Healthcare Medicare Plan Annual Notice of Changes for 2020 “Extra Help” from Medicare. People with limited incomes may qualify for “ExtraHelp” to pay for their prescription drug costs. If you qualify, Medicare could pay up to75% or more of your drug costs including monthly prescription drug premiums,annual deductibles, and coinsurance. Additionally, those who qualify will not have acoverage gap or late enrollment penalty. Many people are eligible and don’t even knowit. To see if you qualify, call:o 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-4862048, 24 hours a day, 7 days a week;o The Social Security Office at 1-800-772-1213 between 7 am and 7 pm, Mondaythrough Friday. TTY/TDD users should call, 1-800-325-0778 (applications); oro Contact your local State Medicaid Office to complete an application. Help from your state’s pharmaceutical assistance program. Most states have aprogram called SHIP that helps people pay for prescription drugs based on theirfinancial need, age, or medical condition. To learn more about the program, check withyour State Health Insurance Assistance Program or visit their website awww.shiptacenter.org. Prescription cost-sharing assistance for people with HIV/AIDS. The AIDS DrugAssistance Program (ADAP) helps ensure that ADAP-eligible individuals living withHIV/AIDS have access to life-saving HIV medications. Individuals must meet certaincriteria, including proof of state residence and HIV status, low income as defined by thestate, and uninsured/underinsured status. Medicare Part D prescription drugs that arealso covered by ADAP qualify for prescription cost-sharing assistance. For moreinformation on eligibility criteria, covered drugs, or how to enroll in the program,contact the program in your state of residence.SECTION 8 Questions?Section 8.1 – Getting Help from Iron Road HealthcareQuestions? We’re here to help. Please call Member Services at 800-547-0421 (TTY/TDD call711). We are open Monday through Friday from 7:30 a.m. to 3:30 p.m., MST. You can alsoemail us at help@uphealth.com or visit our website at www.uphealth.com.Read your 2020 Evidence of Coverage (it has details about next year's benefits and costs)This Annual Notice of Changes gives you a summary of changes in your benefits and costs for2020. For details, look in the 2020 Evidence of Coverage for Iron Road Healthcare. TheEvidence of Coverage is the legal, detailed description of your plan benefits. It explains yourrights and the rules you need to follow to get covered services and prescription drugs. A copyof the Evidence of Coverage is located on our website at www.uphealth.com. You may also callMember Services to ask us to mail you an Evidence of Coverage.Plan sponsored by UPREHS 2020 Annual Notice of Change H4652
Iron Road Healthcare Medicare Plan Annual Notice of Changes for 2020Visit our WebsiteYou can also visit our website at www.uphealth.com. As a reminder, our website has the mostup-to-date information about our provider network (Provider Directory) and our list ofcovered drugs (Formulary/Drug List).Section 8.2 – Getting Help from MedicareTo get information directly from Medicare:Call 1-800-MEDICARE (1-800-633-4227)You can call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY/TDDusers should call 1-877-486-2048.Visit the Medicare WebsiteYou can visit the Medicare website (https://www.medicare.gov). It has information about cost,coverage, and quality ratings to help you compare Medicare health plans. You can findinformation about plans available in your area by using the Medicare Plan Finder on theMedicare website. (To view the information about plans, go to https://www.medicare.gov andclick on “Find health & drug plans.”)Read Medicare & You 2020You can read Medicare & You 2020 Handbook. Every year in the fall, this booklet is mailed topeople with Medicare. It has a summary of Medicare benefits, rights and protections, andanswers to the most frequently asked questions about Medicare. If you don’t have a copy ofthis booklet, you can get it at the Medicare website (https://www.medicare.gov) or by calling1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY/TDD users shouldcall 1-877-486-2048.Plan sponsored by UPREHS 2020 Annual Notice of Change H4652
About Iron Road Healthcare (sponsored by UPREHS) Iron Road Healthcare (sponsored by UPREHS) is contracted as a Health Care Prepayment Plan (HCPP) with the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicare. When this booklet says "we," "us," or "our," it means Iron Road Healthcare.
