University of Chicago

Medical Coverage for Retirees Age 65 or Older
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Medicare becomes your primary medical insurer when you reach 65 and you are no longer covered for medical benefits under an employer's plan. Although Medicare will provide your primary medical coverage, Medicare does not pay your claims in full. You may incur certain expenses that Medicare does not cover altogether (for example, prescription drug coverage).

For Medicare-eligible retirees, the Retiree Medical Plan operates as a supplement to Medicare Part A and Part B coverage.

To find out how to enroll in Medicare and the Retiree Medical Plan, you may review:

• Retiree Medical Plan
• Enrolling in Medicare and the Retiree Medical Program

 Retiree Medical Plan

How It Works
Claims under the Retiree Medical Plan are administered by "BlueCross BlueShield of Illinois" (BCBSIL). Each time you need care, you can visit any eligible licensed provider of your choice. You must meet an annual deductible for the Retiree Medical Plan (in addition to the annual deductible for Medicare), then the plan covers a percentage of the cost of your care.

The amount that you have to pay out-of-pocket depends on whether:

• The service is covered by Medicare or not.
  • If services are covered by Medicare, then your out-of-pocket costs depend on whether the physician accepts Medicare assignment or not.
    • If the physician accepts Medicare assignment then you generally pay 50% of the remaining balance up to the Medicare-approved amount.
    • If the physician does not accept Medicare assignment then you generally pay 50% of the remaining balance up to the Medicare-approved amount, plus 50% of the additional 15% in excess of the Medicare-approved amount that the physician may charge.
  • If services are not covered by Medicare, but are covered under the Retiree Medical Plan, then you generally pay 20% of covered expenses based on the BCBSIL prevailing fee schedule, plus 100% of the expenses exceeding the fee schedule.

Coordination with Medicare
Your care is coordinated with your coverage under Medicare Part A and Part B. Medicare is your primary plan, which means that Medicare determines what it will pay before the Retiree Medical Plan does. Your physician will file your claims with Medicare. BCBSIL cannot process your claim until it knows the amount that Medicare has covered and paid.

Medicare will send you Medicare summary notices, explaining what Medicare has or has not covered. In addition, Medicare may simultaneously send the Medicare information to BCBSIL for secondary claims processing. Or, your doctor or hospital may send BCBSIL the Medicare information. If you're concerned whether BCBSIL is receiving your Medicare information, you should send a copy of your Medicare summary notices to BCBSIL along with a claim form to ensure that BCBSIL will process your claim.

Key Features

• For 2006, the annual deductible is $200 for each covered individual.
• For 2006, the annual out-of-pocket limit is $1,100 per family.
• In 2006, if you have Medicare, BCBSIL will apply your $200 Retiree Medical Plan deductible against the amount of the claim unpaid after Medicare pays; not the full amount of the claim approved by Medicare.
• The maximum cumulative amount the plan will cover per individual per lifetime is $2 million.
• The plan pays for a range of health care services that Medicare does not cover, such as outpatient prescription drugs, routine physical exams (only covered under $100 wellness benefit) and health care services provided outside the United States.
• Prescription drugs are administered by Caremark. You pay a copayment at the time of purchase.
  • Copayments for a 30-day supply of prescription drugs purchased at a Caremark pharmacy are $8 for generic, $20 for preferred brand-name and $35 for non-preferred brand-name.
  • Copayments for a 90-day supply of prescription drugs purchased through Caremark's mail service are $16 for generic, $40 for preferred brand-name and $70 for non-preferred brand-name.
  • Preferred brand-name refers to prescription drugs that are on a list approved for use and coverage by the medical plan. Non-preferred brand-name are not on the approved list and therefore, have higher copayments.
• Prescription drugs are not subject to the $200 deductible and do not count towards the $1,100 out-of-pocket limit.

Your Annual Costs

When you retire, your annual health care costs depend on the type of care your family needs and how often you seek treatment. However, you may want to anticipate the following expenses if you participate in the Retiree Medical Plan:

*May be subject to change

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 Enrolling in Medicare and the Retiree Medical Program

When you near your declared retirement date, contact the Social Security Administration at 800-772-1213 to enroll in Medicare Part A and Part B. If you want to participate in the Retiree Medical Plan, you must be enrolled in Medicare Part B.

If you want to enroll in the Retiree Medical Plan, you should contact the Benefits Office a couple of months before you retire.

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