Medicare Part D Reimbursement Forms Now Available
November 1, 2018
Medicare Part D-IRMAA reimbursement forms for 2018 are now available. Reimbursement claims can be filed beginning January 1, 2019, and the deadline to submit is June 30, 2019.
Retiree members of the plan get their healthcare benefits through the Aetna Medicare Advantage Plan. All of the major interactions that members need regarding the plan will take place with Aetna. There are numerous areas of this website that drive our active members to contact Aetna when they have specific questions about their healthcare, like claims management, finding a healthcare provider, etc. A separate Aetna account must be established by members. For a summary of your benefit coverages and other pertinent information, please go to the Forms and Documents tab.
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The Affordable Care Act allows employer group plans like State-Wide Schools Cooperative (SWSCHP) to work with Medicare Part D (prescription drug plan) to provide drug coverage for retirees and dependents enrolled in Medicare A and B. This partnership allows the plan’s retiree program to save money on the cost of prescription benefits because Medicare Part D will now cover some of the expense for retiree’s prescription drug plan.
What do I need to do to enroll in coverage? State-Wide Schools Cooperative (SWSCHP) automatically enrolls eligible retirees and dependents into the SilverScript Employer Group plan. You do not need to take any action to enroll, other than look for your new prescription ID card to replace your current prescription ID card.
How are SilverScript and CVS Caremark affiliated? SilverScript is a subsidiary of CVS Caremark.
How does the Employer Group Waiver Plan with SilverScript work? SilverScript is a Medicare-approved prescription drug plan that partners with your employer plan to provide prescription benefits. Both SilverScript and your employer will provide coverage on your prescriptions to ensure that your coverage remains consistent with your current non-Medicare coverage.
What prescription drug coverage will be available for non-Medicare-eligible dependents with a Medicare eligible family member? Non-Medicare-eligible participants will continue to be enrolled in their current CVS Caremark coverage. There no changes to the provisions for non-Medicare eligible beneficiaries.
I’ve heard about a Coverage Gap or Doughnut Hole with Medicare Part D plans. Now that we’re on SilverScript, will that apply to me? No, because you have enhanced benefits through your employer plan, you will not experience a Coverage Gap or Doughnut Hole.
How are Medicare Part-B ONLY medications covered? Drugs typically covered by Part B (such as diabetic testing supplies) should be submitted to SWSCHP Aetna Medicare Advantage Plan. Exception: Needles, Syringes and Insulin injection devices will remain covered under the SilverScript plan.
How are Part D vs. Part B medications covered? Part D drugs are covered by the SilverSript Med D primary and wrap plan. Part B drugs should be processed through SWSCHP Aetna Medicare Advantage Plan.
If I decide to opt out of the SilverScript plan, can I retain medical coverage? Yes, you can opt out of SilverScript and still retain your SWSCHP Aetna Medicare Advantage Plan.
I have a PO Box, but not a street address; can I use my PO Box address? Yes, a PO Box is acceptable as a Permanent Address as long as beneficiary attests to residing within the coverage area/United States.
Will my current mail order prescriptions transfer to my new plan? Yes, most mail order prescriptions (with available refills) will be transferred to your new SilverScript account. Controlled substance medications cannot be transferred. CII prescriptions must be received via HARD COPY. CIII and lower can be faxed in to Caremark mail order. These will require new prescriptions.
Can I continue to obtain my current prescriptions at the retail pharmacy? Retirees can continue to obtain their current prescriptions at a retail pharmacy, provided that refills available and haven’t expired at the time of fill. They must present their new SilverScript ID card to their pharmacy on and after January 1st.