Coverage for Retirees Age 65 or Older
The Retiree Medical Plan supplements Medicare. 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).
Medical Coverage with the Retiree Medical Plan and Medicare
For Medicare-eligible retirees, the Retiree Medical Plan operates as a supplement to Medicare Part A and Part B coverage. 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.
Select Key Features
The following represents a partial list of the features the Retiree Medical Plan. Please refer to the Retiree Medical Plan Information brochure for detailed information.
- For 2012, the annual deductible is $200 for each covered individual.
- For 2012, the annual out-of-pocket limit is $1,100 per family.
- In 2012, 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.
- Prescription drugs are not subject to the $200 deductible and do not count towards the $1,100 out-of-pocket limit.