UK Human Resources

Retirees Over 65: Medicare Carveout

Eligibility

Read about the eligibility for Medicare Carveout »

Enrollment

Once you are retired from the university and are eligible for Medicare (which is typically at age 65), you must enroll in Medicare Parts A and B through Social Security and enroll in the Medicare Carveout Classic plan through the university. Read more useful information on Medicare in general »

Once enrolled in Part B, Medicare will issue you an ID card with your Part A and Part B effective date.  An ID card will be issued by Anthem for the Medicare Carveout Classic plan as well, when you submit an enrollment form.  It is important to provide all your providers with the updated insurance information to ensure claims are processed appropriately.

Retirees SHOULD NOT enroll in Medicare Part D unless they qualify for the “Extra Help” Program through Social Security. The Extra Help program is for low income retirees and provides prescription coverage to eligible seniors for low monthly premiums and low copays. If you have been qualified through the Social Security Administration for Extra Help, please submit documentation to the UK Employee Benefits Office. In this case, you will be able to drop the UK prescription coverage and participate in the UK medical benefit only. To learn more, contact the Extra Help program at (800) 772-1213.

Summary of Benefits

Click to view full plan details of Medicare Carveout (PDF) »

Jan - Dec 2014

Major Plan Benefits

Plan Benefits for Covered Services

Plan Benefits Supplemental to Medicare Parts A & B Applicable after Medicare Parts A & B benefits have been applied, less Medicare deductibles
Deductible   $147 (must be met before copayments or coinsurance apply). Plan deductible runs concurrent with Medicare deductibles

Medical Out-of-Pocket Maximum

 

If you reach this maximum, no further out-of-pocket will be required of you for covered expenses during the year. 
Plan premiums, deductible, expenses above usual, customary and reasonable, as well as expenses for outpatient prescription drugs, except those covered by Medicare Part B, do not apply toward this maximum.

 

$2,750/member; $5,500/family

Prescription Out-of-Pocket Maximum   $3,850/member; $7,700/family
Lifetime Maximum Benefit   Unlimited
Preventative Care
*Coverage under preventative care category depends on age, symptoms and diagnosis
Routine mammogram and Pap smears, PSA screening, colonoscopy and sigmoidoscopy.*
Routine child care and immunizationsos (through age 18)
Routine adult physical exam (19 years and above, one per plan year)
80% after Deductible
Physician Services Routine outpatient laboratory tests and X-rays
Office visits (exdludes certain doagnostice lab tests and X-rays)
Lab tests and X-rays
Allergy injections
Inpatient services
Outpatient surgery and diagnostic tests
80% after Deductible
Hospital Services Inpatient hospital care(semi-private room and board, nursing care, ICU)
Physcian visits to emergency room
Outpatient surgery, outpatient nonsurgical care
Outpatient tests, lab and X-ray
Ancillary services
Organ transpland
80% after Deductilbe
Hospital Services • Emergency Care (emergency room, emergency services) 80% after $75 copayment waived if admitted)

Other Medical Services

 

• Physical therapy, respiratory, occupational, or speech therapy 80% after Deductible
• Home health services 80% after Deductible
• Durable medical equipment 80% after Deductible
• Oxygen 80% after Deductible

• Skilled nursing facility
(limited to 100 days per benefit period)

80% after Deductible

• Ambulance 80% after Deductible
• Immediate care facility 80% after Deductible

Mental Health

• Inpatient hospital care

80% after Deductible

• Outpatient care 80% after Deductible

Substance Abuse

• Inpatient hospital care

80% after Deductible

• Outpatient care 80% after Deductible
*Inpatient hospital admissions do not require prior authorization.  However, notification of hospital admissions is requested.

Rates

Click to view current Medicare Carveout rates »