PDP. Ask. Learn. Understand your Medicare. With a little help from HAP. hap.org/medicare. (800) or TTY/TDD (800)

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1 Alliance Medicare Rx (pdp) Prospective members: If you have questions, or for full information about our benefits, enrollment periods or plan network, call a licensed HAP Medicare Sales Representative toll-free at: PDP hap.org/medicare (800) or TTY/TDD (800) Current members: If you have any questions, please contact Client Services toll-free at: (800) or TTY/TDD (800) For your convenience, our offce hours are: October 1 through February 14 8 a.m. to 8 p.m., seven days a week February 15 through September 30 8 a.m. to 8 p.m., Monday through Friday 8 a.m. to noon, Saturday Outside of those business hours, you may access our Interactive Voice Recording system at the same number and leave your name and phone number. A HAP Medicare Customer Service Representative will return your phone call the next business day. If you prefer, you can mail your questions to: HAP Client Services, Attn: Medicare 2850 W. Grand Boulevard Detroit, MI hap.org/medicare Ask. Learn. Understand your Medicare. With a little help from HAP Health Alliance Plan of Michigan. A Nonprofit Company. Y0076_ALL PDP FF BRO CMS ACCEPTED 09/09/2013

2 We can all use a little reassurance. A focus on living a full and healthy life: Yours. To achieve and maintain good health, be sure to choose a good partner. One that looks out for your overall well-being and supports your efforts to achieve a healthy lifestyle. HAP offers a full range of Medicare plans that focus on healthy living. It doesn t stop there. Alliance Medicare Rx (pdp) delivers low, fixed copays and coinsurance on the Brand-name and Generic prescription drugs you take. A stand-alone PDP, it complements Medicare Supplement plans such as Alliance Medicare Supplement by adding prescription drug benefits. We are committed to working with you by providing information that can better help you achieve the best health possible so you can enjoy doing everything you love to do. A dependable, Michigan-based partner. Alliance Medicare Rx is a Medicare-approved plan from Alliance Health and Life Insurance Company (Alliance). Alliance is a wholly owned subsidiary of Health Alliance Plan (HAP), a nonprofit, Michigan-based company that has been serving the community for more than 50 years and Medicare beneficiaries for 25 years. You can tell how much your friends truly care by the little things they do for you. Shouldn t you expect as much from your Medicare Prescription Drug Plan (PDP)? We think so. That s why Health Alliance Plan (HAP) offers this booklet and many other resources to help you make sense out of an important decision that affects you and your family. This booklet will focus on providing you with what you need to get the most out of your Medicare Prescription Drug Plan. 3

3 Live life healthy. Live life secure. We know how important getting your prescription drugs is to you. Alliance Medicare Rx is designed to help you get your prescriptions filled easily and save money on the Brand-name and Generic prescription drugs that your doctor prescribes. The plan accomplishes this through low, fixed copays on the medicines you take and also by enabling you to take full advantage of our negotiated prices on the cost of your prescription drugs. Even if you don t take a lot of medicine now, Alliance Medicare Rx: Can help provide financial protection if your prescription needs change or you have unexpected drug expenses in the future Can complement Medicare Supplement plans, such as Alliance Medicare Supplement, by adding prescription drug benefits* Added safeguards. For members taking multiple prescription drugs or specialty drugs, we created a special Medication Therapy Management Program. Developed by a team of doctors and pharmacists, our free program is designed to: Identify potentially harmful drug interactions and determine effective alternatives to help avoid them Pay special attention to using appropriate drugs for complex medical conditions Identify ways to reduce prescription drug costs while still providing safe, effective, quality coverage If you are enrolled in our Medication Therapy Management Program, you will have your own clinical pharmacist a trained specialist who works with you and your physicians to help ensure your medication regimen is effective in treating your needs. Convenience. Alliance Medicare Rx covers both Brand-name and Generic prescription drugs at any pharmacy in our broad network of more than 2,000 pharmacies including retail, mailorder, medical center, long-term- care facility, and Indian Health, Tribal and Urban pharmacies. If you travel, you can get your prescription drugs at any network pharmacy with nationwide locations (like CVS and Kmart). And you are always covered throughout the U.S. for emergency prescriptions. To receive your prescription drug benefit, you must use network pharmacies except under non-routine circumstances when you cannot reasonably use network pharmacies. Cost-sharing for drugs purchased out-of-network in an emergency may be higher. Benefits, formulary, pharmacy network, premiums and/or copayments/coinsurance may change on January 1 of each year. *Neither Alliance Medicare Supplement nor its agents are connected with Medicare and are not connected with or endorsed by the United States government or the federal Medicare program. 5

4 Is Alliance Medicare Rx the right prescription drug coverage for you? Alliance Medicare Rx Prescription Drug Benefits Premium $67.50 Deductible Tier and Category $0 Generic $75 Brand $30-day supply*: Inspired customer service. Customer service is deeply rooted in the HAP culture. It is what each HAP employee strives for each day with every phone call, every , every member touchpoint. We make it easy so you can focus your attention on doing what s best for you and your family. One of the ways we provide this high level of service is by making sure as a new HAP member, you have your very own Personal Service Coordinator someone fully trained in our Medicare plans, who understands the decisions you face and has the answers to your questions. Your Personal Service Coordinator is here for you, ready to provide assistance and explain plan details. After the first two years as a HAP member, whenever you want extra assistance or information, you can call any of our HAP Medicare Customer Service Representatives. These are dedicated men and women who specialize in Medicare, are knowledgeable about Medicare Part D, work here in southeast Michigan and can access your plan records immediately. This brochure provides a general overview of Medicare Prescription Drug Plans and summarizes important benefits of Alliance Medicare Rx. Please review the Alliance Medicare Rx Summary of Benefits for more detailed information before making a decision about your coverage. For information about our network pharmacies, please refer to the Alliance Medicare Rx Pharmacy Directory, or visit us at hap.org/medicare. Initial Coverage Limit: $2,850** 1 Preferred Generic $5 The combined drug costs 2 Non-Preferred Generic $17 paid by you and the plan. 3 Preferred Brand $45 4 Non-Preferred Brand 31% 5 Specialty Tier 31% Coverage Gap*** (Donut Hole) Tiers 1 and 2 72% Tiers 3, 4, and % (plus applicable dispensing fee) Catastrophic Coverage: Tiers 1 and 2 $2.55 or 5% whichever is greater After you pay $4,550 in annual out-of-pocket costs** Tiers 3, 4, and 5 $6.35 or 5% whichever is greater All drug prices are based on the Alliance-negotiated price. You pay the lower of your copay or the actual cost of a covered drug. Limitations, copayments and restrictions may apply. Brand deductible only applies to Tiers 3, 4, and 5. *A 90-day supply is available on most prescriptions filled through mail-order or select pharmacies at 2½ times the applicable 30-day copay. **Excludes monthly premiums and costs of non-covered drugs, including costs of drugs purchased outside the U.S. ***See page 12 for details on the Coverage Gap. 7

5 Enrolling in Alliance Medicare Rx You can enroll in Alliance Medicare Rx if you are entitled to Medicare benefits under Part A or enrolled in Part B, and reside in the state of Michigan. To remain enrolled, you must reside in the state of Michigan. If you are enrolled in Part B, you must continue to pay your Part B premium. If you decide to have your monthly premiums paid as a withholding from your Social Security check, or move from that method to direct billing from Alliance, it can take up to three months for the request to take effect. You will remain responsible for those premiums. If you have a Medicare Supplement policy, you may join Alliance Medicare Rx for your Medicare prescription drug coverage. Questions about Alliance Medicare Rx? Our licensed HAP Medicare Sales Representatives can answer questions about your coverage, our formulary and our pharmacy network. Call us toll-free at (800) or TTY/TDD (800) For your convenience, from October 1 through February 14, our offce hours are 8 a.m. to 8 p.m., seven days a week. During the rest of the year, our regular offce hours are Monday through Friday, 8 a.m. to 8 p.m. and Saturday, 8 a.m. to noon. Outside of those business hours, you may access our Interactive Voice Recording system at the same number and leave your name and phone number. A HAP Medicare Customer Service Representative will return your phone call the next business day. You can also write to us at: HAP Client Services, Attn: Medicare, 2850 W. Grand Boulevard, Detroit, MI Visit us on our website at hap.org/medicare. If you already have drug coverage through your Medicare Supplement plan, you must decide whether you want to keep that drug coverage or join a stand-alone Medicare Prescription Drug Plan. If you join a stand-alone plan like Alliance Medicare Rx, your Medicare Supplement policy will automatically be changed to exclude drugs. If you have Original Medicare only, you are eligible to join a stand-alone Prescription Drug Plan like Alliance Medicare Rx. If you are enrolled in: a Medicare Advantage private-fee-for-service (PFFS) plan that does not provide Medicare prescription drug coverage; a Medicare Savings Account (MSA) plan; or a 1876 Cost plan, you can enroll in a stand-alone drug plan like Alliance Medicare Rx. You will not be disenrolled from your PFFS, MSA or 1876 cost plan. If you are enrolled in a Medicare Advantage HMO or PPO plan, or in a Medicare Advantage PFFS plan that includes Medicare prescription drugs, you will be disenrolled from the HMO, PPO or PFFS if you sign up for a drug plan like Alliance Medicare Rx. 9

6 Additional information. About stand-alone Medicare Prescription Drug Plans. What is a stand-alone Medicare Prescription Drug Plan? Medicare Prescription Drug Plans, authorized under Medicare Part D, are sold by companies that have been approved by the federal Medicare program such as Alliance. They provide only prescription drug benefits and can be paired with other forms of coverage for medical benefits. How do I qualify to enroll in a stand-alone Prescription Drug Plan? Anyone who is entitled to Medicare Part A or enrolled in Medicare Part B is eligible to join a PDP during the specified enrollment periods. To be eligible for Alliance Medicare Rx, you must reside in the state of Michigan. To get Medicare prescription drug coverage, you have several choices. You can: Join a Medicare Prescription Drug Plan like Alliance Medicare Rx or Enroll in a Medicare Advantage plan with prescription drug coverage like HAP Senior Plus (hmo), HAP Senior Plus (hmopos) or Alliance Medicare PPO You generally cannot be enrolled in both types of plans at the same time. You may have access to qualified benefits through other sources, such as employer- or union-sponsored benefits, or the Veterans Administration (VA). Check with your employer, union or the VA before you make any decisions about your prescription drug coverage. When is the best time to join? If you are new to the Medicare program, you are eligible to join a Prescription Drug Plan. Your initial enrollment period extends for seven months, including: Three months prior to your eligibility for Medicare The month you become eligible for Medicare Three months after you become eligible for Medicare If you decide not to enroll in a Medicare Part D plan when you are first eligible, you may pay a penalty if you choose to join later. That penalty will continue as long as you participate in the Medicare Part D program. If you are already in the Medicare program, you can change drug plans during the annual Open Enrollment Period, change Medicare Advantage plans or return to Original Medicare. The annual Open Enrollment Period runs from October 15 through December 7, and any change in coverage is effective January 1. In certain situations, there are additional periods during which you might be able to enroll. Visit the Medicare website at for more information, or call a licensed HAP Medicare Sales Representative at the phone number shown on the back cover. Is Extra Help available for prescription drug coverage? People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to 75% or more of your drug costs, including monthly prescription drug premiums, annual deductibles and coinsurance. Additionally, those who qualify will not be subject to the Coverage Gap or a late enrollment penalty. Many people are eligible for these savings and don t even know it. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: MEDICARE ( ). TTY users should call , 24 hours a day, 7 days a week; The Social Security Administration at (800) between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call (800) ; or your state Medicaid offce. 11

7 Additional information. About Alliance Medicare Rx. I take several prescription drugs. Can I find out if Alliance Medicare Rx covers them? Yes. You may have received a copy of our formulary. If not, feel free to call us for a copy, or visit our website to find out whether your current medications are in our formulary. Go to hap.org/medicare. All Medicare-approved Prescription Drug Plans must offer at least two alternative drugs for every class and category (if two exist). If any of your drugs are not covered, your physician may be able to prescribe an effective alternative that is covered. If not, your physician can speak with us about whether an exception should be made to cover your current prescription. To receive a copy of our formulary, call us toll-free at: (800) TTY/TDD (800) Monday through Friday, 8 a.m. to 8 p.m. and Saturday, 8 a.m. to noon. From October 1 through February 14, you may call seven days a week, 8 a.m. to 8 p.m. What is the Coverage Gap ( Donut Hole )? Alliance Medicare Rx has an Initial Coverage Limit of $2,850. This limit is the total of what you pay (excluding premiums) plus what the plan pays for your covered drugs. Once the total drug cost exceeds the Initial Coverage Limit, you enter the Coverage Gap for your drug benefit. When you have Part D coverage, you pay 72% of our negotiated price for Generic drugs purchased in the Coverage Gap. For Brand-name drugs, you pay only 47.5% (less than half) of our negotiated price in the Coverage Gap, plus any applicable pharmacy dispensing fee. While you pay only 47.5% of the cost for Brand-name drugs in the Coverage Gap, the full cost counts toward your annual total out-of-pocket cost for prescription drugs, allowing you to exit the Coverage Gap sooner. After you have paid $4,550 in out-ofpocket costs (not including premiums or costs for drugs not covered under our program), Catastrophic Coverage begins. (See the chart on page 7 for coverage information.) NOTE: if you are eligible for Extra Help from the Social Security Administration for prescription drugs, you will not have a Coverage Gap. Where can I get my prescriptions filled? With Alliance Medicare Rx, you can go to any network pharmacy that is convenient for you. Alliance Medicare Rx covers both Brand-name and Generic prescription drugs at any pharmacy in our broad network of more than 2,000 pharmacies, including retail, mail-order, medical center, long-term- care facility, and Indian Health, Tribal and Urban pharmacies. Prescriptions filled out-of-network will be covered only in limited situations, such as an emergency. Cost-sharing for drugs purchased out-of-network in an emergency may be higher. You can call us for details on how to submit a claim for out-of-network pharmacy services. Is a mail-order service available with Alliance Medicare Rx? Yes. Mail order is available for 90-day supplies and can help you save time and money on medications you take on a regular basis. You can also obtain a 90-day supply of your medications at most retail pharmacies in our network. Where can I learn more about Alliance Medicare Rx? Call a Michigan-based licensed HAP Medicare Sales Representative toll-free at: (800) or TTY/TDD (800) Monday through Friday, 8 a.m. to 8 p.m. and Saturday, 8 a.m. to noon. From October 1 through February 14, you may call seven days a week, 8 a.m.to 8 p.m. If you prefer, you can write to us at: Hap Client Services Attn: Medicare 2850 W. Grand Boulevard Detroit, MI Or visit us at hap.org/medicare. 13

8 Call today. To enroll in Alliance Medicare Rx, you can use one of the following five options: 1. Call a licensed HAP Medicare Sales Representative toll-free at: (800) or TTY/TDD (800) Monday through Friday, 8 a.m. to 5 p.m. Additional information. If I have a stand-alone Medicare Prescription Drug Plan, can I also have a Medicare Supplement plan? Yes. You can complement your stand-alone PDP with a Medicare Supplement plan. A plan like Alliance Medicare Supplement can help pay some of the out-of-pocket hospital and medical costs not covered by Original Medicare. These are the costs that you pay under Original Medicare, like deductibles, coinsurance, copays or expenses for emergency medical care outside the U.S. With an Alliance Medicare Supplement plan, you can cover those costs and know that you are protected by Alliance Health and Life Insurance Company, a wholly owned subsidiary of Health Alliance Plan (HAP). Call a licensed HAP Medicare Sales Representative toll-free to learn more about Alliance Medicare Supplement. Alliance Medicare Supplement is not connected with or endorsed by the United States government or the federal Medicare program. Neither Alliance Medicare Supplement nor its agents are connected with Medicare. An Alliance Medicare Supplement policy may not fully cover all of your medical costs. Contact your local Social Security Offce toll-free at (800) or TTY (800) , Monday through Friday, 7 a.m. to 7 p.m., or consult the booklet Medicare and You for more details about Medicare Supplement insurance plans. 2. Mail a completed enrollment form to: HAP Medicare Division, 2850 W. Grand Boulevard, Detroit, MI Enroll online at hap.org/medicare 4. Enroll online through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at 5. Come to a HAP Medicare workshop where you can talk with other Medicare beneficiaries. We hold workshops in Wayne, Oakland, Macomb, Genesee, Lapeer, Livingston, Monroe, St. Clair and Washtenaw counties. A licensed HAP Medicare Salesperson will be present with information and applications to assist you. For dates and locations, or for accommodation of persons with special needs at sales meetings, call us toll-free at (800) or TTY/TDD (800) , Monday through Friday, 8 a.m. to 6 p.m. ET Important information. Alliance Medicare Rx (pdp) is a plan with a Medicare contract. Enrollment in the plan depends on contract renewal. Please contact HAP for details. HAP Senior Plus (hmo), HAP Senior Plus (hmo-pos) and Alliance Medicare PPO are health plans with Medicare contracts. Enrollment in the plans depends on contract renewal. Alliance Medicare Rx, Alliance Medicare PPO and Alliance Medicare Supplement are products of Alliance Health and Life Insurance Company, a wholly owned subsidiary of Health Alliance Plan. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact HAP. 15

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