2010 Medicare Benefits at a Glance

Refer to the 2010 NALC Health Benefit Plan brochure (RI 71-009) for complete details. 2009 Medicare Benefits at a Glance and Previous brochures are also available.

When Medicare is primary payor (Medicare Part B for prescriptions), all deductibles, coinsurances and copayments are waived, except for prescription drugs. See the chart below for a brief overview. Rely on your brochure for benefits when Medicare does not pay.

Benefit	You Pay
Hospitalization (no precertification required)
Inpatient Medical/Surgical and Mental Health	Nothing
Outpatient	Nothing
Physician Care
Annual Routine Physical Exam	Nothing
Adult Routine Immunizations and Tests	Nothing
Inpatient and Outpatient Medical and Surgical Care	Nothing
Mental Health and Substance Abuse	Nothing
Prescription Drugs *This is a mandatory generic program with a 30-day limit at local retail.
Retail: Note: You may purchase up to a 90-day supply (84-day minimum) of covered drugs and supplies at a CVS/Caremark Pharmacy through our Maintenance Choice Program. You will pay the applicable mail order copayment (see below) for each prescription purchased.	Preferred Network Retail — Network Retail — Non-network Retail —	10% of cost for generics/20% of cost for brand name 10% of cost for generics/20% of cost for brand name 45% of allowance
Mail Order:	60-day supply —	$7 generic $37 brand name
	90-day supply —	$4 NALCSelect generic $10 generic $55 brand name
	Specialty Drugs —	$150 for 30-day supply $350 for greater than 30-day supply
Catastrophic Limits	You pay nothing after coinsurance total $4,000 per person or family for prescription drugs purchased at a network retail pharmacy.
When you have Medicare Part D We waive the following at retail when Medicare Part D is the primary payor: Refill limitations Day supply

This is a summary of some of the features of the NALC Health Benefit Plan. Detailed information on the benefits for the 2010 NALC Health Benefit Plan can be found in the official brochure. All benefits are subject to the definitions, limitations, and exclusions set forth in the official brochure.