1901 Las Vegas Blvd. So. Suite 107 Las Vegas, Nevada (702)
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1 TM 1901 Las Vegas Blvd. So. Suite 107 Las Vegas, Nevada (702) Important Notice from the Culinary Health Fund About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the Culinary Health Fund and about your options under Medicare s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare 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. The Culinary Health Fund has determined that the prescription drug coverage offered by the Culinary Health Fund is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current Culinary Health Fund coverage will not be affected. You will continue to receive benefits under the Culinary Health Fund as long as you are eligible. Remember that the Fund provides medical and other benefits in addition to prescription drug benefits. There are no Culinary Health Fund coverage penalties or exclusions for joining a Medicare drug plan. If you are a retiree, you are no longer eligible for Culinary Health Fund benefits once you become eligible for Medicare. If you are a dependent of a retiree, you will lose eligibility when the retiree becomes eligible for Medicare, (unless you elect COBRA coverage). Once you become eligible for Medicare, you should enroll. If you decide to join a Medicare drug plan and drop your current Culinary Health Fund coverage, please be aware that you and your dependents will not be able to get this coverage back unless you
2 re-establish eligibility requirements under the Culinary Health Fund or elect COBRA coverage within the election period. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with the Culinary Health Fund and don t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information About This Notice Or Your Current Prescription Drug Coverage Contact the Culinary Health Fund s Customer Service Office for further information about this notice. NOTE: You ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through the Culinary Health Fund changes. You also may request a copy of this notice at any time. 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 drug plans. For more information about Medicare prescription drug coverage: Visit Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help Call MEDICARE ( ). TTY users should call If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at or call them at (TTY ). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Date: October 2014 Name of Sender: Culinary Health Fund Contact: Culinary Health Fund Address: 1901 Las Vegas Blvd. South, Suite 107 Phone Number:
3 TM 1901 Las Vegas Blvd. So. Suite 107 Las Vegas, Nevada (702) Aviso Importante de Culinary Health Fund Sobre su Cobertura para Recetas Médicas y Medicare Por favor lea este aviso cuidadosamente y guárdelo donde pueda encontrarlo. Este aviso contiene información sobre su cobertura actual para recetas médicas con el Culinary Health Fund y sus opciones bajo la cobertura de Medicare para medicamentos recetados. Esta información le puede ayudar a decidir si desea participar o no en el plan de recetas médicas de Medicare. Si usted está considerando inscribirse, debe comparar su cobertura actual, incluyendo los medicamentos que están cubiertos a qué costo, con la cobertura y los costos de los planes en su área que ofrecen cobertura de Medicare para medicinas recetadas. Al final de esta notificación hay información acerca de donde usted puede obtener ayuda para tomar decisiones sobre su cobertura de recetas médicas. Hay dos cosas importantes que usted necesita saber sobre su cobertura actual de Medicare y la cobertura de Medicare de medicamentos recetados: 1. La cobertura de Medicare para recetas médicas está disponible desde el 2006 para todas las personas con Medicare. Usted puede obtener esta cobertura si se inscribe en un Plan de Medicare para Recetas Médicas, o un Plan Medicare Advantage (como un PPO o HMO) que ofrece cobertura para medicamentos recetados. Todos los planes de Medicare para recetas médicas proporcionan por lo menos un nivel estándar de cobertura establecido por Medicare. Algunos planes podrían ofrecer más cobertura por una prima mensual más alta. 2. El Culinary Health Fund ha determinado que la cobertura para recetas médicas ofrecida por el Culinary Health Fund, en promedio para todos los participantes del Plan, pagará tanto como lo hará la cobertura estándar de Medicare para recetas médicas para todos los participantes del plan y por lo tanto es considerada Cobertura Acreditable. Debido a que su cobertura actual es Acreditable, usted puede mantener esta cobertura y no pagar una prima más alta (una penalidad), si más tarde decide inscribirse en un plan de Medicare. Cuándo puede inscribirse en un plan de Medicare de medicamentos? Usted puede inscribirse en un plan de Medicare de medicamentos en cuanto sea elegible para Medicare y cada año del 15 de octubre al 7 de diciembre. Sin embargo, si pierde su Cobertura Acreditable Actual, y no es su culpa, usted será elegible durante dos (2) meses en el Período de Inscripción Especial (SEP) para inscribirse en un Plan de Medicare de medicinas. Qué sucede con su cobertura actual si decide inscribirse en un plan de Medicare de medicamentos? Si decide inscribirse en un plan de Medicare de medicamentos recetados, su cobertura actual con Culinary Health Fund no se verá afectada. Usted seguirá recibiendo beneficios del Culinary Health Fund mientras sea elegible. Recuerde que el Culinary Health Fund proporciona beneficios médicos y otros beneficios además del beneficio de recetas médicas. No hay penalidades ni exclusiones en la cobertura del Culinary Health Fund por inscribirse en el plan de recetas médicas de Medicare. Si usted está jubilado/a, usted ya no será elegible para los beneficios del Culinary Health Fund una vez que sea elegible para Medicare. Si usted es dependiente de una persona jubilada, usted perderá la elegibilidad una vez que la persona jubilada sea elegible para Medicare, (salvo que usted opte por la cobertura de COBRA). Una vez que usted sea elegible para Medicare, debería inscribirse. Si decide inscribirse en un plan de medicamentos de Medicare y dejar su cobertura actual con el Culinary
4 Health Fund, por favor tenga presente que usted y sus dependientes no podrán obtener esta cobertura nuevamente al menos que usted cumpla de nuevo con los requisitos de elegibilidad bajo el Culinary Health Fund o al menos que elija la cobertura de COBRA dentro del periodo de elección. Cuándo pagará usted una prima más alta (penalidad) por inscribirse en un plan de Medicare de medicamentos? Usted también debería saber que si cancela o pierde su cobertura actual con el Culinary Health Fund y no se inscribe en una cobertura de Medicare para recetas médicas dentro de los primeros 63 días después de que su cobertura actual termine, usted podría pagar una prima más alta (una penalidad) por inscribirse en una cobertura de Medicare para recetas médicas después. Si usted lleva 63 días o más sin Cobertura Acreditable para recetas médicas, su prima mensual podría aumentar por lo menos un 1% al mes por cada mes que usted no tuvo esa cobertura. Por ejemplo, si usted lleva diecinueve (19) meses sin Cobertura Acreditable, su prima siempre podría ser por lo menos 19% más alta de lo que la mayoría de la gente paga. Usted podría tener que pagar esta prima más alta (penalidad) mientras tenga la cobertura de recetas médicas de Medicare. Además, usted tendría que esperar hasta el próximo mes de octubre para inscribirse. Para más información sobre este aviso o sobre su cobertura actual para recetas médicas Llame a las Oficinas de Servicios al Cliente del Fund para obtener más información sobre esta notificación. NOTA: Usted recibirá este aviso cada año. Usted también recibirá el aviso antes del próximo período en el cual usted puede inscribirse en la cobertura de Medicare para recetas médicas, y en caso de que esta cobertura con Culinary Health Fund cambie. Además, usted puede solicitar una copia.de este aviso en cualquier momento. Para más información sobre sus opciones bajo la cobertura de Medicare para recetas médicas Hay más información detallada sobre los planes de Medicare que ofrecen cobertura para recetas médicas en el manual de Medicare y Usted. Medicare le enviará por correo un ejemplar del manual todos los años. También es posible que los planes de Medicare para recetas médicas le llamen directamente. Para más información sobre la cobertura para recetas médicas de Medicare: Visite Llame a su Programa Estatal de Asistencia sobre Seguros de Salud (consulte la portada interior de su manual Medicare y Usted para obtener los números telefónicos) para obtener ayuda personalizada Llame al MEDICARE ( ). Los usuarios con teléfono de texto (TTY) deben llamar al Si usted cuenta con ingresos y recursos limitados, hay ayuda adicional que paga por un plan de Medicare para recetas médicas. Para más información sobre esta ayuda adicional, visite la SSA en línea en o llámeles al (Los usuarios con teléfono de texto (TTY) deberán llamar al ). Recuerde: Guarde este aviso de cobertura acreditable. Si decide inscribirse en uno de los planes de medicamentos recetados de Medicare, es posible que necesite dar una copia de este aviso cuando se inscriba, a fin de demostrar si mantiene o no una cobertura acreditable y si debe pagar (o no) una prima más alta (una penalidad). Fecha: Octubre del 2014 Nombre del Remitente: Culinary Health Fund Contacto: Culinary Health Fund Dirección: 1901 Las Vegas Blvd. South, Suite 107 Número de Teléfono:
5 TM 1901 Las Vegas Blvd. So. Suite 107 Las Vegas, Nevada (702) Mahalagang Paunawa mula sa Culinary Health Fund Tungkol sa Iyong mga Sakop na Reseta ng Gamot at Medicare Basahin lamang nang mabuti at itago ang paunawa ng ito kung saan ay maaari mo ito ng matagpua ng muli. Ang paunawa ng ito ay may impormasyon tungkol sa kasalukuya ng sakop ng iyong resetang gamot sa Culinary Health Fund at tungkol sa iyong mga pagpipilian tungkol sa mga resetang gamot sa ilalim ng sakop ng Medicare. Ang impormasyo ng ito ay maaari ng makatulong sa iyo upang magdesisyon kung gusto o ayaw mo ng sumali sa isang plano ng mga gamot ng Medicare. Kung ikaw ay nag-iisip na sumali, dapat mong ihambing ang iyong kasalukuyang saklaw, kung ano ng gamot ang sakop at magkano, sa mga saklaw at gastos ng mga plano ng reseta ng gamot na iniaalok sa ilalim ng Medicare sa iyong lugar. Ang impormasyon kung saan ka maaari ng makakuha ng tulong upang gumawa ng mga pagpapasya tungkol sa saklaw ng iyong mga resetang gamot ay nasa banda ng huli ng paunawa ng ito. May dalawang mahalaga ng bagay na kailangan mong malaman tungkol sa iyong kasalukuyang saklaw at mga resetang gamot ng Medicare: 1. Ang mga reseta ng gamot ng Medicare ay nag-umpisa ng makuha noong 2006 ng bawat tao ng may Medicare. Maaari mong makuha ang saklaw na ito kung sumali ka sa isang Plano sa Reseta ng Gamot ng Medicare o sumali sa Medicare Advantage Plan (tulad ng isang HMO o PPO) na nag-aalok ng sakop sa mga resetang gamot. Lahat ng plano ng gamot ng Medicare ay nagbibigay ng hindi bababa sa isang pamantaya ng antas na itinakda ng Medicare. Ang ilang mga plano ay maaari ding mag-aalok ng mas marami ng saklaw na may mas mataas na buwanang bayad sa seguro. 2. Natukoy ng Culinary Health Fund na ang mga sakop na resetang gamot na iniaalok ng Culinary Health Fund ay, karaniwan para sa lahat ng kalahok sa plano, ay inaasaha ng mababayaran ang kung ano man ang pangkaraniwa ng saklaw ng reseta ng gamot ng Medicare at samakatuwid ay itinuturing na Creditable Coverage. Sapagkat ang iyong kasalukuya ng saklaw ay Creditable Coverage, maaari mo ng ipag-patuloy ang saklaw na ito ng hindi magbabayad ng mas mataas na buwana ng bayad sa seguro (isang multa) kung ikaw ay magpasya sa banda ng huli na sumali sa isang plano ng gamot ng Medicare. Kailan ka Maaari ng Sumali sa Plano ng Gamot ng Medicare? Maaari kang sumali sa isang plano ng gamot ng Medicare noong una ka ng maging karapat-dapat para sa Medicare at bawat taon mula sa Oktubre 15 - Disyembre 7. Gayunpaman, kung mawala ka sa iyong kasalukuyang creditable coverage ng mga resetang gamot, ng hindi mo naman kasalanan, maaari ka din maging karapat-dapat sa dalawang (2) buwa ng Espesyal na Panahon ng Pag-papatala (SEP sa Ingles) upang makasali sa isang plano ng gamot ng Medicare. Ano ang Mangyayari sa Iyong Kasalukuyang Saklaw Kung Magpasya ka ng Sumali sa Isang Plano ng Gamot ng Medicare? Kung magpasya ka ng sumali sa isang plano ng gamot ng Medicare, ang iyong kasalukuyang saklaw sa Culinary Health Fund ay hindi maaapektuhan. Patuloy kang makakatanggap ng mga benepisyo sa ilalim ng Culinary Health Fund hangga t ikaw ay karapat-dapat. Tandaan lamang na ang Fund ay nagbibigay ng mga medikal at iba pang mga benepisyo bukod pa sa benepisyo ng
6 reseta ng gamot. Walang multa ang saklaw ng Culinary Health Fund o pagpapaalis dahil sa pagsali sa isang plano ng gamot ng Medicare. Kung ikaw ay isang pensiyonado, ikaw ay hindi na karapat-dapat para sa mga benepisyo sa Culinary Health Fund sa sandaling ikaw ay maging karapat-dapat sa Medicare. Kung ikaw ay isang sustentado ng isang pensiyonado, mawawala sa iyo ang pagiging karapat-dapat kapag ang pensiyonado ay naging karapat-dapat sa Medicare, (maliban kung pinili mo ang saklaw ng COBRA). Sa sandali ng ikaw ay maging karapat-dapat para sa Medicare, kailangan mong magpatala. Kung magpasya ka ng sumali sa isang plano ng gamot ng Medicare at bitiwan ang iyong kasalukuya ng saklaw sa Culinary Health Fund, mangyari ng alamin na ikaw at ang iyong mga sustentado ay hindi na maaari ng makuha ng muli ang saklaw na ito maliban kung muli mo ng maibabalik ang mga kinakailangan upang maging karapat-dapat sa ilalim ng Culinary Health Fund o piliin ang saklaw ng COBRA sa loob ng panahon ng pagpili. Kailan ka Magbabayad ng mas Mataas na Buwana ng Bayad sa Seguro (Multa) Upang Makasali sa Isang Plano ng Gamot ng Medicare? Dapat mo ring malaman na kung binitiwan mo o nawala ang iyong kasalukuyang saklaw sa Culinary Health Fund at hindi ka sumali sa isang plano ng gamot ng Medicare sa loob ng sunod-sunod na 63 araw matapos ang iyong kasalukuyang saklaw, maaari kang magbayad ng isang mas mataas na buwana ng bayad sa seguro (isang multa) upa ng makasali sa isang plano ng gamot ng Medicare. Kung umabot ka ng 63 tuloy-tuloy na mga araw o mas matagal pa na walang creditable coverage ng resetang gamot, ang iyong buwana ng bayad sa seguro ay maaaring tumaas ng hindi bababa sa 1% ng pinakamababa ng bayad sa seguro ng tumatanggap ng Medicare buwan-buwan para sa bawat buwan na wala ka ng saklaw. Halimbawa, kung umabot ka ng labinsiyam na buwan na wala ng creditable coverage, ang iyong buwana ng bayad sa seguro ay tutugon sa 19% na mas mataas kaysa sa pinakamababa ng buwanan ng bayad ng tumatanggap ng Medicare. Ikaw ay maaaring magbayad nito ng mas mataas na buwana ng bayad sa seguro (isang multa) hangga t mayroon ka ng saklaw ng reseta ng gamot ng Medicare. Bilang karagdagan, maaari ng kailangan mong maghintay hanggang sa susunod na Oktubre upang makasali. Para sa Karagdagang Impormasyon Tungkol sa Paunawa ng Ito O sa Iyong Kasalukuyang Saklaw ng Reseta ng Gamot... Makipag-ugnayan sa Opisina ng Tagapagbigay Serbisyo ng Culinary Health Fund para sa karagdagang impormasyon tungkol sa paunawa ng ito. TANDAAN: Makukuha mo ang paunawa ng ito bawat taon. Makukuha mo din ito bago dumating ang susunod na panahon na maaari ka ng sumali sa isang plano ng Medicare tungkol sa mga gamot, at kung ang saklaw na ito mula sa Culinary Health Fund ay mababago. Maaari ka din humiling ng kopya ng paunawa ng ito sa anumang oras. Para sa Karagdagang Impormasyon Tungkol sa Iyong Mga Pagpipilian sa Ilalim ng Resetang Gamot ng Medicare Mga higit pang detalyadong impormasyon tungkol sa plano ng Medicare na nag-aalok ng saklaw ng mga resetang gamot ay nasa libreta ng Medicare & You. Makakakuha ka ng kopya ng libreta sa koreo taon-taon mula sa Medicare. Maaari ka ding tawagan nang direkta ng mga plano ng gamot ng Medicare. Para sa iba pang impormasyon tungkol sa saklaw ng gamot ng Medicare: Bisitahin ang: Tawagan ang iyong State Health Insurance Assistance Program (tingnan ang loob ng takip sa likod ng iyong kopya ng libreta ng Medicare & You para sa kanilang mga numero ng telepono)
7 para sa personal na tulong Tawagan ang MEDICARE ( ). Ang mga gumagamit ng TTY ay dapat tawagan ang Kung limitado ang iyong kita at mga mapagkukunan, mayroo ng dagdag tulong sa pagbabayad ng saklaw ng resetang gamot ng Medicare. Para sa impormasyon tungkol sa karagdagang tulong na ito, bisitahin ang Social Security sa web sa o tumawag sa kanila sa (TTY ). Tandaan: Itago ang paunawa ng Creditable Coverage na ito. Kung nagpasya ka ng sumali sa isa sa mga plano ng gamot ng Medicare, maaari ng kailanganin mo ng magpakita ng kopya ng paunawa ng ito kung sumali ka upang ipakita kung o hindi mo napanatili ang creditable coverage at, samakatuwid, kung o hindi mo kinakailangang magbayad ng isang mas mataas na buwana ng bayad sa seguro (isang multa). Petsa: Oktubre 2014 Pangalan ng Nagpadala: Culinary Health Fund Makipag-alam: Culinary Health Fund Address: 1901 Las Vegas Blvd. South, Suite 107 Numero ng Telepono:
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