(This section is a Summary of Material Modifications [SMM] to the Summary Plan Description [SPD].)
The following changes to current
January 1, 2013.
Other Changes May Apply to HMO Coverage
Unless noted, the changes in this guide do not apply to Health Maintenance Organization (HMO) options. You will need to check the YBR website during the annual open enrollment period or contact the carriers of those options directly for their 2013 plan changes. Carrier contact information is located on the back of your HMO ID card and in the Benefits At-a-Glance and Resource Contact Information booklet.
New This Year:
Special Online-Only Enrollment Period
Already know what you want to elect for 2013? You will have an opportunity to make your elections — only on the YBR website — beginning Monday, October 8, 2012 through Sunday, October 21, 2012. The chart at right shows the timing for enrolling in and/or changing your coverage during the annual open enrollment period:
| From: | Monday, October 8, 2012 at 9:00 a.m., ET, through Sunday, October 21, 2012 |
Monday, October 22, 2012 at 9:00 a.m., ET, through Friday, November 2, 2012 at 5:00 p.m., ET |
|---|---|---|
| You may: | View your coverage and costs and make your elections on the YBR website. You will not be able to call the |
View your coverage and costs and make your elections on the YBR website. You may also call the |
| Be sure to take action before Friday, November 2, 2012 at 5:00 p.m., ET. Late enrollments will not be accepted. | ||
Medical Cost Increase for 2013
Your costs for medical coverage will likely increase on average more than usual in 2013 due to
Change to Out-of-Network Ambulance Coverage for Standard Point of Service (POS) Option
In 2013, out-of-network ambulance coverage will increase from 60 percent to 80 percent. This means that when you use an out-of-network ambulance under the Standard POS medical option, the Plan will pay for 80 percent of reasonable and customary (R&C) charges.
Medco and Express Scripts Are Now One Company
The combined company is in the process of changing the name on all communications to Express Scripts. Beginning on October 1, 2012, the new member website will be www.express-scripts.com. Until the renaming process is complete, you will sometimes see the Medco name in your prescription drug communications and online.
Please continue to refill your prescriptions as you normally would by using your current prescription drug ID card, refill order forms, the member website or the toll-free member services telephone number on your ID card.
Changes to the Express Scripts Medicare™ (PDP) for Alcatel-Lucent (formerly the Medco Prescription Drug Plan for Medicare-Eligible Participants)
Due to adjustments made by the Centers for Medicare & Medicaid Services (CMS), there will be some changes to your drug coverage for 2013:
- The annual deductible is increasing.
- The prescription drug cost limit is increasing.
- Cost sharing is changing in the "donut hole."
- Cost sharing is changing outside of the "donut hole."
The chart below highlights the differences for 2013.
| 2012 | 2013 | |
|---|---|---|
| Deductible Amount | $320 |
$325 |
| "Donut Hole" | After total payments (including copayments and deductible, plus the Plan's cost for the drugs) reach $2,930, you pay 86% of the cost of generic drugs and about 50% of the cost of most brand-name drugs, up to $4,700. | After total payments (including copayments and deductible, plus the Plan's cost for the drugs) reach $2,970, you pay 79% of the cost of generic drugs and about 47.5% of the cost of most brand-name drugs, up to $4,750. |
Cost sharing outside of the “donut hole” |
You pay the greater of 5% of the cost or a copayment of $2.60 for generics/$6.50 for brand-name drugs, per prescription, for the remainder of the year. |
You pay the greater of 5% of the cost or a copayment of $2.65 for generics/$6.60 for brand-name drugs, per prescription, for the remainder of the year. |
| (While you are in the "donut hole," either the Plan pays the rest of the costs for covered drugs, or they are paid for by drug manufacturers' discounts.) For more information about how the Plan works, see page 10 of the Benefits At-a-Glance and Resource Contact Information booklet. | ||
Changes to Medco/Express Scripts Prescription Drug Coverage for Participants Not Eligible for Medicare
As part of
"Member Pays the Difference" Program
Effective January 1, 2013, if you purchase a brand-name drug when a generic equivalent is available, you will pay the generic copayment, plus the difference in cost between the brand-name and generic drug.
Expanded Coverage Management Programs
Medco/Express Scripts uses a set of coverage management programs to determine how the Plan will cover certain prescription drugs. These programs now cover additional categories of prescription drugs. You will be notified by Medco/Express Scripts if you are impacted by any of these programs.
New-Look YBR Website
The YBR website was updated in May 2012. If you have not been to YBR since the update, you will notice some enhancements.
You will be prompted to indicate whether you would prefer to receive communications from the
Please note: Your election for receipt of communications on the YBR website will not impact the method of delivery for your annual open enrollment communication materials.
New for Participants Who Receive a Form W-2
The Affordable Care Act (healthcare reform law) requires that employers disclose the value of the employer-provided benefit for health insurance coverage on each participant's Form W-2. This means that plan participants who receive a 2012 Form W-2 from
Premium Costs
Review the YBR website during the annual open enrollment period for your 2013 premium costs.
Annual Open Enrollment Is Going Green
As part of our corporate environmental commitment, more of your benefit information is available to you online instead of in print.
1 Includes COBRA participants and survivors in the Family Security Program (FSP).