Allergan Retiree Medical Access Plan Plan Summary

Transcription

1 Allergan Retiree Medical Access Plan Plan Summary Plan Summary Amended as of October 1, 2018 The information below summarizes the eligibility requirements, enrollment information and coverage for the Allergan Retiree Medical Access Plan (the RMAP) for employees of Allergan who end employment on or after July 1, Special provisions apply to former Allergan employees with employment end dates between January 1, 2017 and December 31, Please see Appendix I for those specific provisions. The RMAP provides medical and prescription drug coverage for the RMAP participants. Eligibility for participation in the RMAP depends upon a variety of factors including: Your age at end of employment, Your Allergan service at end of employment, Your Medicare entitlement, and Your continuation of medical coverage through COBRA for the entire 18 months, if eligible for COBRA continuation benefits. Generally, you are only permitted to enroll (yourself and/or your dependents) in the RMAP when you first become eligible following your end of employment (see Section I for details). You cannot enroll at a later date once your enrollment period has expired. Additionally, you cannot add dependents to the RMAP unless you are currently enrolled in coverage and your dependents experience a HIPAA Special Enrollment Event that permits them to enroll and they elect to enroll within 30 days of the event. The RMAP is effective July 1, Please review the information provided in this summary carefully. For your convenience, the summary has been organized into five sections and an Appendix. Section I covers the eligibility requirements for participation in the RMAP. Section II provides enrollment information. Section III provides information about the continued medical and prescription drug coverage available for eligible retirees and/or covered dependents (spouse/domestic partner and children), prior to Medicare eligibility 1 (generally, under age 65). Section IV provides contact information in the event you have questions. Section V is Allergan s legal disclaimer. 1 Entitlement to Medicare due to end stage renal disease will not impact eligibility for coverage under the RMAP. For more information see the plan document for the RMAP. Page 1 of I22082 (10/18)

2 Appendix I includes the special enrollment provisions for employees with employment end dates between January 1, 2017 and December 31, Section I - Plan Eligibility To be eligible for continued medical and prescription coverage under the RMAP, you, the former employee, must satisfy each of the following criteria: 1) You must have a minimum of 5 years of service with Allergan (based on your most recent hire date or the date your legacy company was acquired by Allergan, if later). 2) You must be at least age 50 and not yet Medicare-eligible due to age or disability at your employment end date, and 3) You must elect to continue COBRA for the full 18 months, provided you are eligible. If you are not eligible for COBRA, you must elect to participate in the Plan when first eligible (1 st of the month following your employment end date). In addition, any subsidized benefits continuation you receive will run concurrent with benefits continuation under COBRA and coverage under this RMAP, if applicable. Your dependents may also be eligible for coverage under the RMAP. For information regarding coverage for your dependents, see Section III Information about the RMAP. Section II Enrollment Information Initial Enrollment. If you are eligible to participate in the RMAP but do not have medical coverage as an active employee at the time your employment ends: You will have one opportunity to elect coverage under the RMAP to be effective the first of the month following your employment end date. To elect to enroll, you must complete, sign and return the Allergan Retiree Medical Access Enrollment Form within 30 days following the date on the letter in your eligibility/enrollment package (which is sent generally within two-three weeks following your end of employment). Any coverage elected will be retroactive to the 1 st of the month following your employment end date. If you do not return the form or affirmatively elect to waive coverage, you will not be eligible to enroll at a later date. Page 2 of 8

3 If you are eligible to participate in the RMAP and were receiving Allergan medical coverage under the Allergan, Inc. Welfare Plan (the Active Plan ) as an active employee at the time your employment ends: You must elect COBRA continuation coverage and you will be eligible to elect coverage under the RMAP at the end of your 18-month period of continuation of coverage through COBRA, provided you are not Medicare-eligible. To elect to enroll, you must complete, sign and return the Allergan Retiree Medical Access Plan Enrollment Form within 45 days following the date on the letter in your eligibility/enrollment package (which is sent generally 60 days prior to the expiration of your COBRA continuation coverage). Any coverage elected will be effective the 1 st of the month following your COBRA continuation end date (irrespective of any benefits continuation period that may be available through the Allergan Inc. Severance Pay Plan). If you do not return the form or affirmatively elect to waive coverage, you will not be eligible to enroll at a later date. The Retiree Medical Access Plan Enrollment Form must be returned to the Mercer Retiree Medical Service Center, P.O. Box 14464, Des Moines, IA, Once your Allergan Retiree Medical Access Plan Enrollment Form is processed, you will receive your new medical and prescription drug I.D. cards from the insurance carriers in approximately three weeks. Additional information can be found in the Retiree Medical Access Plan Overview of Plans and Rates. After you enroll or make a change, you will receive a Confirmation Statement confirming your new election. Please retain a copy for your records. Open Enrollment. If you remain eligible for continued coverage through the RMAP, you will receive annual benefit open enrollment materials in the Fall of each year for coverage effective the following January 1. At this time, you may elect to switch plan options or insurance carriers; you may not add dependents unless they experience a HIPAA Special Enrollment Event. Section III Information about the Plan Medical Plan Options The RMAP offers the same national medical (including prescription drugs) plan options available to active employees through Aetna, Horizon BlueCross BlueShield and UnitedHealthcare. The RMAP does not offer plans through regional carriers (Kaiser, Baylor Scott & White, HMSA, Triple S). In order to elect coverage under the RMAP, you must first meet the eligibility criteria described above at the time your employment ends. Page 3 of 8

4 The Overview of Plans and Rates describes the coverages available to retirees. Additional details are found in the Summary of Benefits and Coverages (SBCs) and Benefits Booklets, available on allerganretireemedical.com or by request by calling the Mercer Retiree Medical Service Center. All coverage, benefits and rates provided by Allergan are subject to change year to year. In most cases, coverage under the RMAP ends for you, your spouse or domestic partner or your dependent child when you, your spouse or domestic partner or your dependent child becomes eligible for Medicare. All individuals covered under the Plan should be sure to apply for Medicare during a Medicare enrollment period. Dependents. You may elect coverage under the RMAP for your eligible dependents if they are eligible for coverage at the time you are first eligible for the RMAP. Otherwise, you may add your eligible dependents if they experience a HIPAA Special Enrollment Event, enrollment is consistent with that event, and enrollment is made within 30 days of the HIPAA Special Enrollment Event, as defined by the RMAP. The following family members are considered dependents who may be eligible for coverage under the RMAP: 1) Your legal spouse or domestic partner 2) Children up to age 26 3) Physically or mentally disabled children not capable of self-support. To be eligible for coverage, a disabled child over the age of 26 must also have been continuously enrolled as your dependent since the day before he or she reached age 26 and must depend chiefly on you for financial support, and not Medicare-eligible. Generally, people with disabilities (regardless of age) are eligible for Medicare 29 months after their first date of disability. 4) Not Medicare eligible (unless such eligibility is due to end stage renal disease). Once enrolled in the RMAP, if you become Medicare-eligible and cease to participate, your spouse/domestic partner may continue coverage under the RMAP to the date he/she becomes Medicare-eligible. Except as otherwise required by applicable law (e.g., COBRA or any similar state law), your dependent children will no longer be eligible to receive continued medical coverage under the RMAP when you and/or your covered spouse/domestic partner cease to receive continued coverage under the RMAP. In the event of your death, your spouse/domestic partner and dependent children, if any, are eligible to continue coverage as long as they remain an eligible dependent under the RMAP. In the event of a death, coverage for dependent children is contingent on a parent, either the retiree or spouse/domestic partner continuing coverage under the RMAP. Page 4 of 8

5 Premiums. The cost of your continued medical and prescription drug coverage options are set forth on the premium schedule included on the Allergan Retiree Medical Access Plan Enrollment Form and the Overview of Plans and Costs brochure. Premium payment must be postmarked by the 1st of each month to keep your coverage active. A billing statement will be sent to you monthly from the Mercer Retiree Medical Service Center, our retiree third party administrator which will include premium payment options. If you remain eligible for retiree coverage for the following year, new premiums and payment information will be sent to you prior to the end of the current plan year (generally, during Open Enrollment). Premiums are subject to change at any time. Allergan, in its sole and absolute discretion, will determine the expected cost to operate the RMAP and may elect to change or discontinue the RMAP at any time in the future. Termination or Cancellation of Coverage. You may continue coverage as long as you remain eligible. Once you become Medicare eligible (other than Medicare eligibility due to end stage renal disease), you will no longer be eligible to receive coverage under the RMAP. Once you and your covered spouse/domestic partner, if any, no longer receive coverage under the RMAP, your other covered dependents will also no longer be eligible to receive coverage under the RMAP nor will they be eligible for coverage under the RMAP independently, except as otherwise required by applicable law (e.g., COBRA or a state law equivalent). You can cancel your coverage or your dependents (including spouse/domestic partner) coverage at any time. If you cancel your coverage, your dependents coverage will be automatically canceled. To cancel coverage, mail or fax your written notice to the Mercer Retiree Medical Service Center. Premiums received prior to the date your written election is received will not be refunded. Once a dependent s coverage has been canceled, it cannot be added back at a later date, unless the dependent experiences a HIPAA Special Enrollment Event and you add them to coverage within 30 days of the event. Retiree medical and prescription drug coverage automatically ends on the earliest of the following dates: The last day of the calendar month preceding the calendar month in which you or your spouse/domestic partner become eligible to enroll in Medicare due to age or disability (irrespective of whether or not you actually enroll in Medicare); The date you first enrolled in the RMAP, if you provided erroneous information and would have been denied enrollment if accurate information had been provided; Page 5 of 8

6 The date on which you submit a fraudulent claim for benefits; The date you fail to make a timely premium payment; The date Allergan terminates the RMAP; The date Allergan amends the RMAP to eliminate coverage for a class of former employees of which you are a member; The date on which your dependent ceases to be a dependent under the terms of the RMAP; The date of your death; The date on which you cancel or terminate your coverage; With respect to participation in the RMAP by a covered dependent (other than a spouse/domestic partner) and to the extent permitted by applicable law, the first date on which neither you nor your spouse/domestic partner is enrolled in continued medical and prescription drug coverage under the RMAP. Section IV - Questions If you have questions about the RMAP or your premium payments, please contact: Mercer Retiree Medical Benefits Service Center by phone at by at retiree.service@mercer.com, or by mail at Mercer Retiree Medical Service Center, P.O. Box 14464, Des Moines, IA, Section V Legal Disclaimer This document is a summary of the Allergan Retiree Medical Access Plan. The summary is not intended to cover every detail. For example, it does not list all of the circumstances under which benefits will not be paid. Complete details are in the legal plan documents, summary plan description, benefit booklets, contracts, and other legal documents that govern plan operation and administration. If there should ever be any conflict between this summary and the provisions of the legal plan documents, contracts, or policies, the legal plan documents, summary plan description, benefit booklets contracts, and policies will govern. Allergan reserves the right to amend, modify or terminate the RMAP at any time and in any way in the future, for any or no reason, in its sole and absolute discretion. Additional information regarding your plan can be found in the Overview of Plans and Rates, as well as the Summary of Benefits and Coverages (SBCs) and Benefit Booklets available on allerganretireemedical.com. Page 6 of 8

7 APPENDIX 1: Special Eligibility for former Employees with Employment End Dates between January 1, 2017 and December 31, 2018 and Special Enrollment Provisions for former Employees with Employment End Dates between January 1, 2017 and September 30, 2018 Eligibility If your employment end date with Allergan is between January 1, 2017 and December 31, 2018, you are eligible for the RMAP if you are: 1. age 50 with at least 5 years of service at termination or 2. age 49 with 4 years of service as of December 31, 2017, if terminated due to Workforce Restructuring in 2018 and eligible for benefits under the Allergan, Inc. Severance Pay Plan, and 3. not yet Medicare eligible due to age or disability Years of service is based on your most recent date of hire (or date your legacy company was acquired by Allergan, if later). Enrollment If your employment end date with Allergan is between January 1, 2017 and September 30, 2018, the following special enrollment provisions apply to you. Depending on your current medical plan participation status, your opportunities to enroll in the RMAP will vary: 1. If you are currently not receiving medical coverage through the Active Plan, you will have two opportunities to enroll for coverage: a. If your employment end date is on or before April 30, 2018, enroll May 1, 2018 through June 15, 2018 for coverage effective July 1, or b. If your employment end date is after April 30, 2018, enroll within 30 days following the date your enrollment kit is mailed to you (generally within two weeks following your employment end date) for coverage effective the 1 st of the month following your employment end date, and c. Annual Open Enrollment in the Fall 2018 for coverage effective January 1, If you are currently participating in the Active Plan through COBRA or are eligible and plan to enroll in COBRA, you will be have two opportunities to enroll for coverage: a. Beginning the first of the month following the date your COBRA benefits will end, or Page 7 of 8

8 b. Annual Open Enrollment in the Fall 2018 for coverage effective January 1, 2019 If you do not enroll during the enrollment periods available to you as indicated above, you will not be eligible to enroll in the RMAP in the future. In addition, you must remain continuously enrolled in the RMAP in order to receive coverage. If your employment end date is on or after October 1, 2018, no special enrollment provisions apply. Page 8 of 8