2007 NYU Retiree Medical Plan Summary of Benefits

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					2011 NYU Retiree Medical Plan Summary of Benefits
Medicare-Eligible Participants Over Age 65
(Coordination with Medicare Part A & B applicable)

Retirement Date on or after January 1, 1989 and hired before 9/1/11 and age 50 or over.

                              MEDICARE                                                NYU RETIREE MEDICAL PLAN
                                                                              You pay 20% of Medicare-approved (limiting)
Office visit: Medicare pays 80% of Medicare-approved (limiting)
                                                                              charges, less any Medicare payment, after you have
charges after you have met the $162 calendar year deductible
                                                                              met the $200 calendar year deductible
Preventive Services (Bone mass measurements, Cardiovascular
Screening, Colorectal Cancer screening, Diabetes testing and self-
management services, Mammograms, Nutritional Therapy)                         Routine physical exams are not covered.
Note: Routine physical exams, except for the one-time initial preventive
physical exam within 6 months of enrollment in Part B, are not covered.
Annual Deductibles for 2011:                                                  Individual: $200
Part A: $1,132                                                                Family: $500 (after one individual meets individual
Part B: $162                                                                  deductible).
Out-of-pocket maximum                                                         Individual: $1,000
N/A for Medicare                                                              Family: $2,000
Lifetime maximum
                                                                              $ 1,000,000.
N/A for Medicare
Inpatient hospitalization (benefit period ends 60 days after discharge)
Day 1-Day 60: Medicare pays all charges over $1,132 Deductible                You pay 20% of Medicare-approved (limiting)
Day 61-90: Medicare pays all charges over $283 per day coinsurance            charges, less any Medicare payment, after you have
Day 91-365: $566 per day coinsurance (or less) up to 60 non-                  met the $200 calendar year deductible
renewable lifetime reserve days
Pre-Certification of Surgeries and Procedures                                 Not required
                                                                              You pay 20% of Medicare-limiting charge, less any
Anesthesia, Lab Tests, X-Rays, Surgery, In-Hospital Doctors Visits
                                                                              Medicare payment, after you have met the deductible
Blood for transfusions: Medicare pays after the first three pints per         You pay 20% of Medicare-limiting charge, less any
year                                                                          Medicare payment, after you have met the deductible
Emergency Room: Medicare pays 80%. If you are admitted to the
                                                                              You pay 20% of Medicare-limiting charge, less any
hospital, Medicare pays according to the inpatient hospitalization fee
                                                                              Medicare payment, after you have met the deductible
schedule.
                                                                              You pay 20% of Medicare-limiting charge, less any
Ambulance: Medicare pays for necessary services
                                                                              Medicare payment, after you have met the deductible
Skilled Nursing Facility (only after hospitalization of at least 3 days
and beginning within 30 days of discharge)
First 20 days: Medicare pays all charges over $1,132 Deductible               You pay 20% of Medicare-limiting charge, less any
Day 21-100: Medicare pays all charges over $141.50 per day                    Medicare payment, after you have met the deductible
coinsurance
No benefits are payable after 100 days of care in a “benefit period”
Home Health Care: Limited coverage if homebound with a skilled
                                                                              You pay 20% of Medicare-limiting charge, less any
need for an intermittent or part time basis for a short period of time from
                                                                              Medicare payment, after you have met the deductible
a Medicare-certified home health agency (HHA).
Hospice Care: Medicare pays for palliative care when life expectancy          You pay 20% of Medicare-limiting charge, less any
is six months or less.                                                        Medicare payment, after you have met the deductible
Outpatient Mental Health: Medicare pays 55% for charges over                  You pay 20% of Medicare-limiting charge, less any
deductible and coinsurance for approved mental health services.               Medicare payment, after deductible
Psychiatric Hospital: Medicare pays for charges over deductible and
                                                                              You pay 20% of Medicare-limiting charge, less any
coinsurance for up to 190 lifetime days in a Medicare-certified specialty
                                                                              Medicare payment, after you have met the deductible
psychiatric hospital.
Vision Care – Routine Exam                                                    Not covered
Vision Care – Eye Glasses (Medicare covers after cataract surgery)            Not covered
Durable Medical Equipment: When medically necessary, Medicare
                                                                              Not covered
will generally pay 20 percent coinsurance, after deductible.

* Medicare covers only services that are medically necessary and charges that are considered reasonable.

Medicare Part A pays for hospital, skilled nursing, hospice care and some home health care.
Medicare Part B helps pay for physician services, hospital outpatient care, durable medical equipment and other services,
including some home health care.

Prescription Drug Coverage for NYU Retiree Medical Plans
Under the NYU Retiree Health Plans, you are automatically enrolled in the Caremark Prescription Drug Plan, at no additional cost.

                           NYU Prescription Drug Plan* (Administered by Caremark, Inc.)
Annual Deductible                                                   None
Annual Maximum                                                      None
Lifetime Maximum                                                    None
                                                                    $10 Generic
Prescription Drugs – Retail (30-day supply)
                                                                    $35 Brand-name on Caremark’s Primary Drug List
                                                                    $55 Brand-name not on Caremark Primary Drug List
Prescription Drugs – Mail Order (90 day supply)
                                                                    $5 Generic
                                                                    $75 Brand - Preferred
                                                                    $90 Brand Non-Preferred
Prescription Drugs – Mail Order (180 day supply)
                                                                    $10 Generic
                                                                    $150 Brand - Preferred
                                                                    $180 Brand Non-Preferred
Notes:
    Two fills of maintenance drugs are covered at retail pharmacy per calendar year; third and subsequent fills of maintenance
    drugs at retail pharmacy will be subject to a $75 copayment. Contact Caremark to determine if your medication is
    considered “maintenance.”
    If you purchase a brand-name drug that is not on Caremark’s Primary Dug List because there is no other brand on the
    market, you will pay the Primary Drug List copay.
    You now have more flexibility when filling your prescriptions for maintenance prescription drugs. The new cost-saving
    option, called “Maintenance Choice,” lets you choose which is more convenient for you and your covered dependents --
    getting your long-term maintenance prescriptions mailed to your home, or picking up the maintenance at your local CVS
    pharmacy. The copay will be the same either way. After the first time you fill a maintenance medication through mail order
    you will receive a notice from CVS/Caremark offering you the choice of how you want your maintenance medications
    filled.

* NYU Prescription Drug coverage is creditable coverage which meets or exceeds the coverage available from Medicare Part D.
If you are Medicare-eligible, you do not need to enroll in Medicare Part D prescription drug coverage.

				
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