ID Cards and Benefit Booklets » All enrollees will receive an ID card from Anthem in December. You do not need to show your Medicare card with your Anthem ID card, but you should keep it in a safe place. Only new enrollees will receive a card from SilverScript.

» If you are new to Anthem in 2020, Anthem will mail you a Welcome Kit in December that will include a “Quick Start Guide” and instructions on how to request a provider directory or Explanation of Coverage.

» If you are new to SilverScript in 2020, SilverScript will mail you an ID card in December. SilverScript will also mail you important information including a pharmacy directory, abridged formulary, Evidence of Coverage, and instructions for creating an account on www.caremark.com to use for mail‑order service.

Premium Deductions for January 2020Your January 2020 PERACare premium is deducted from your December 2019 PERA benefit on December 31, 2019, or from your bank account on December 16, 2019, if you pay by ACH deduction.

Paying Medicare Premiums If you don’t pay your Medicare Part B premium, Medicare will terminate your coverage and you will lose your Anthem MA and SilverScript Part D drug coverage.

If you are receiving a Social Security benefit, your Medicare Part B premium will be deducted from your Social Security benefit. If you are not receiving a Social Security benefit, you must pay the Medicare Part B premium directly to Medicare, unless PERA is already deducting it from your monthly benefit check. Medicare will bill you quarterly for your Part B premium. You also have the option to contact Medicare to sign up for Medicare Easy Pay to have your Part B premium withdrawn from your bank account on a monthly basis. The standard Part B premium is $144.60 in 2020 (or higher, depending on your income).

Medicare Income Related Monthly Adjustment Amount (IRMAA)If your modified adjusted gross income was over $85,000 ($170,000 for a couple) in 2018, you will be subject to Medicare’s IRMAA for Part B and Part D in 2020. Social Security will send a letter notifying you if you are subject to the IRMAA. You must pay any Part B and Part D IRMAA due or your PERACare coverage will be canceled.

Paying your IRMAA: Social Security will notify you of your IRMAA and either deduct it from your Social Security benefit or bill you for that amount along with your standard Part B premium.

Visit www.medicare.gov for more information.

Who Do I Call With Health Care Questions?When you have questions about your health care coverage with PERACare, it can be difficult to know where to turn. Use the information below to determine where to direct your questions:

Ask PERA about:

» Available plan options

» Your premium or subsidy

» When you can enroll

» Who you can enroll

» Canceling coverage

Ask your insurance carrier about:

» Whether a procedure or medication is covered

» The cost of a procedure or medication

» Claim processing

» Finding an in‑network provider

» How to appeal a denied claim or procedure

Important Information About Your 2020 PERACare Medicare Coverage

2020PLAN YEAR

2

Anthem Medicare Preferred (PPO) Medicare Advantage Plan HighlightsA key benefit of your MA plan is that your cost is the same whether the doctor is in‑ or out‑of‑network. In addition, the plans are available nationwide and are designed with easy‑to‑understand out‑of‑pocket costs.

If Your Provider Says They Don’t Accept Medicare, Medicare Advantage, or Anthem PlansSome providers may not be familiar with this type of plan and don’t know they can work with Anthem. Please encourage your provider to call Anthem’s Customer Service Team at 1‑833‑244‑3888 for more information about how they can bill and receive payment for their services.

ADDITIONAL BENEFITSVision and Hearing BenefitsYour Anthem plan provides limited vision and hearing benefits. Please refer to your Anthem materials for more information.

Preventive Care and ScreeningsYour Anthem MA plan covers your annual physical, a yearly wellness visit, and many types of screenings for things like bone mass measurements, cardiovascular disease, breast and colorectal cancer, depression, diabetes, and more.

SilverSneakers® Fitness Program SilverSneakers lets you work out when, where, and how you want—no matter your ability level or goals. You can visit any of the over 14,000 participating gyms, rec centers, or other facilities at any time.

Visit www.silversneakers.com or call Tivity Health at 1-888-423-4632 to find a fitness center near you.

NO COST

NO COST

LiveHealth OnlineYou can see a board‑certified doctor or licensed therapist/psychologist through live video chat on your smartphone, tablet, or computer from the convenience of your home. It’s a great option for some common conditions like the flu, colds, pink eye, and more. Even better, this service is offered with a $0 copay. You can sign up at www.livehealthonline.com or download the free mobile app. You will need your Anthem ID card to register.

House Call ProgramAnthem’s House Call program offers a personalized visit by a licensed clinician in the comfort of your home. You’ll have personalized time to discuss any questions or concerns about your health and receive basic health screenings, and your information will be shared with your doctor.

The House Call program is administered by independent vendors and is available at no additional cost for members who qualify. The current vendors are: Signify Health, MedXM, Matrix, and ComplexCare Solutions. Vendors will mail an introductory letter and brochure prior to making phone outreach.

CareMore HealthIn partnership with Anthem Case Management, CareMore Health brings quality and personalized care to you. No more hassle of driving to doctor appointments or having to leave your place of residence for labs, X‑rays, or other care. CareMore Health wants to get to know you and your goals, and will create a unique plan for you to stay healthy and achieve your goals. Access to CareMore Health is targeted toward certain members with certain medical conditions, and is included at no additional cost with your Anthem MA plan. CareMore Health will notify you if you qualify for the program.

NO COST

NO COST

NO COST

3

Understanding Prescription Coverage Under Anthem MA Plans Prescription benefits are administered by SilverScript (affiliated with CVS Caremark). There is no deductible for retail or mail‑order prescriptions. You can fill your prescriptions at the retail pharmacy using your SilverScript ID card or via mail order. Prescription copay amounts can be found in the materials you received from SilverScript.

SilverScript has a large national network of retail pharmacies. You can register at www.caremark.com/startnow or contact SilverScript at 1‑844‑345‑4162 to review network pharmacies.

Note: Prescriptions for High Cost tier medications are limited to a 31‑day supply whether filled at a retail pharmacy or via mail order. This provision is in place to prevent the loss or waste of these high‑cost medications.

The majority of prescription drugs you take will be covered by the SilverScript Part D prescription benefit on your plan. However, there are a small number of medications used for certain conditions that Medicare covers under the medical benefit rather than the prescription benefit. Medicare refers to these as “Part B drugs” and these medications will be covered by Anthem instead of SilverScript.

You do not need to know which type of drug you are taking. It is the responsibility of Anthem and SilverScript to follow Medicare rules to determine whether a drug is considered Part D or Part B.

Part B drugs are covered at $0 cost under both MA plans. Insulin pumps, which are considered Durable Medical Equipment, are covered at $0 cost in MA #1 and at a 20% coinsurance for MA #2.

Your Anthem ID card will include Part B prescription drug coverage information for the pharmacist at a retail pharmacy. Part B‑covered items will be processed by Anthem’s pharmacy benefit manager, IngenioRx.

Examples of Part B drugs include:

» Diabetic supplies such as a blood glucose monitor, blood glucose test strips, and lancets.

» Oral End‑Stage Renal Disease (ESRD), transplant (also called immunosuppressives), and oral cancer drugs.

If you have any questions about how your medication will be covered, call either SilverScript or Anthem Customer Service for assistance.

Low Income Subsidy (Extra Help)Because the SilverScript plan is a Medicare Part D plan, certain individuals with limited income and assets may qualify for a low income subsidy, which is sometimes called Extra Help. This program can help reduce your monthly health plan premium and may also help reduce the amount you pay for covered prescriptions. To apply for Extra Help, contact the Social Security Administration at 1‑800‑772‑1213 or visit www.ssa.gov/extrahelp to apply online.

Late Enrollment Penalty (LEP)Medicare Part D plans may assess a penalty on anyone who has gone without creditable prescription coverage for more than 63 days after turning age 65 and becoming eligible for Medicare. The cost of the LEP depends on how long you went without creditable prescription drug coverage. SilverScript will notify you by mail if they have been informed by Medicare that you owe an LEP and you will have an opportunity to correct this information if you feel it is incorrect. If you did have a period of more than 63 days when you did not have creditable prescription drug coverage, SilverScript will confirm the LEP amount to you, and PERA will deduct it from your benefit along with your PERACare premium.

Urgent Care vs. Emergency RoomThe difference between urgent care and emergency room care is the severity of the health problem. If the condition is life‑threatening, go to an emergency room. If the condition is less severe, such as a minor illness or injury, go to your nearest urgent care provider. You are more likely to be seen quicker at an urgent care facility for your minor illness or injury since emergency rooms prioritize based on your health condition. Also, your share of the cost will be less at an urgent care facility. For a list of urgent care providers, visit www.anthem.com/peracare or call Anthem at 1‑833‑244‑3888.

4

Colorado PERA Notice of Nondiscrimination Colorado PERA (the “Plan”) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

The Plan:

» Provides free aids and services to people with disabilities to communicate effectively with us, such as:

• Qualified sign language interpreters.

• Written information in other formats (large print, audio, accessible electronic formats, other formats).

» Provides free language services to people whose primary language is not English, such as:

• Qualified interpreters.

• Information written in other languages.

If you need these services, contact the PERA Civil Rights Coordinator.

If you believe that the Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

Colorado PERA, Civil Rights Coordinator 1301 Pennsylvania Street, Denver, Colorado 80203, 1‑800‑759‑7372 ext. 6271 (phone), 303‑863‑3815 (fax), or civilrightscoordinator@copera.org (email).

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Colorado PERA Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with:

U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Room 509F, HHH Building Washington, D.C. 20201 1‑800‑368‑1019, 1‑800‑537‑7697 (TDD)

Complaint forms are available at www.hhs.gov/ocr/office/file/index.html.

You can file a grievance in person or by mail, fax, or email.

5

Colorado PERA Notice of Nondiscrimination

LANGUAGE ASSISTANCE SERVICES FOR INDIVIDUALS WITH LIMITED ENGLISH PROFICIENCY

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-759-7372 ext. 6271.

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-759-7372 ext. 6271.

ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-800-759-7372 ext. 6271.

ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-800-759-7372 ext. 6271.

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-759-7372 ext. 6271.

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-759-7372 ext. 6271.

توجھ :اگر بھ زبان فارسیگفتگو م د،یکنی التیتسھ زبان بصورتی گانیرا برا شمای فراھم م باشدی .با1-800-759-7372 ext. 6271سامت دیریگب

Appendix B to Part 92—Sample Tagline Informing Individuals With Limited English Proficiency

of Language Assistance Services

ध्यान द�: य�द आप �हदी बोलते ह � तो आपके िलए मुफ्त म� भाषा सहायता सेवाएं उपलब्ध ह।� 1-xxx-xxx-xxxx (TTY:

1-xxx-xxx-xxxx) पर कॉल कर�।

1-800-759-7372 ext. 6271

Appendix B to Part 92—Sample Tagline Informing Individuals With Limited English Proficiency

of Language Assistance Services

ध्यान द�: य�द आप �हदी बोलते ह � तो आपके िलए मुफ्त म� भाषा सहायता सेवाएं उपलब्ध ह।� 1-xxx-xxx-xxxx (TTY:

1-xxx-xxx-xxxx) पर कॉल कर�।

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-800-759-7372 ext. 6271.

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-800-759-7372 ext. 6271. 번으로 전화해 주십시오.

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-759-7372 ext. 6271.

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-800-759-7372 ext. 6271.

注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-800-759-7372 ext. 6271 まで、お電話にてご連絡ください。

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-759-7372 ext. 6271.

ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-800-759-7372 ext. 6271.

6

Colorado PERA Notice of Nondiscrimination

LANGUAGE ASSISTANCE SERVICES FOR INDIVIDUALS WITH LIMITED ENGLISH PROFICIENCY

2/265 (REV 12‑19) 25M

PO Box 5800, Denver, Colorado 80217‑58001‑800‑759‑7372 www.copera.org

PRESORTEDSTANDARD

U.S. POSTAGEPAID

DENVER, COPERMIT NO. 45

Anthem’s Customer Service Team » 1‑833‑244‑3888

» Available Monday through Friday 6:00 a.m. to 7:00 p.m. (Mountain time)

» TTY users should call 711

Visit www.anthem.com/peracare to:

» Find a doctor or other medical professional

» Use your membership cards for drugs

» Order or view your Evidence of Coverage

» View a reference guide for diabetic supplies

» Learn about health and wellness programs

SilverScript’s Customer Service Team » 1‑844‑345‑4162

» Available 24 hours a day, 7 days a week

» TTY users should call 711

Visit www.caremark.com to create an account and to:

» Request prescription refills and check an order status

» Locate your nearest pharmacy

» Check drug prices

» Look for lower cost prescription alternatives

Contact the PERACare carriers for more detailed information.