Your Medicare prescription drug coverage as a member of Medco Medicare Prescription Plan® for Tennessee Val ey Authority (TVA) This mailing gives you the details about your Medicare prescription drug coverage from January 1 – December 31, 2009, and explains how to get the prescription drugs you need. This is an important legal document. Please keep it in a safe place. Medco Medicare Prescription Plan Customer Service: For help or information, please call Customer Service or go to our plan website at www.medco.com.
Calls to this number are free: 1-800-592-4520 TTY/TDD users call: 1-800-716-3231 Hours of Operation: Our business hours are 24 hours a day, 7 days a week (except Thanksgiving and Christmas). Customer Service is available in English and other languages. This Plan is offered by Medco Containment Life Insurance Company and Medco Containment Insurance Company of New York, referred to throughout the EOC as “we,” “us,” or “our.” Medco Medicare Prescription Plan is referred to as “Plan” or “our Plan.” Our organization contracts with the Federal government. This information may be available in a different format, including Spanish and braille. Please call Customer Service at the numbers listed above if you need plan information in another format or language. Esta información puede estar disponible en otros idiomas u otros formatos, incluyendo una versión en español y una versión en braille. Póngase en contacto con el departamento de Atención al cliente marcando los números que se indican arriba, si necesita recibir la información del plan en otro formato u otro idioma. Important Information How your plan wil change for 2009 This is the time of year when we like to thank you for your membership and let you know of new plan changes for the upcoming year. Beginning January 1, 2009, there will be some changes to our Plan.
You are enrolled in Medco Medicare Prescription Plan for Tennessee Valley Authority (TVA) in 2008 and your plan coverage and costs are changing. All changes will be effective January 1, 2009.
This is just a brief summary of the changes in your Plan for 2009. Make sure to read the next few pages for answers to important questions you may be asking. If you have any questions, call Customer Service. Note: If you are receiving help from your state Medicaid agency or State Pharmaceutical Assistance Program (SPAP), such as a reduced co-payment, these reductions are not reflected in this packet. Please call your state SPAP at the numbers listed in Section 8 if you have questions. Changes to your monthly plan premium Your monthly premium for your Medicare Supplement plan includes the Medicare Part D prescription benefit as well as medical coverage. TVA will send you a letter in late October with your 2009 Medicare Supplement premium.
This monthly premium amount does not include any late enrollment penalty you may be responsible for paying (see Section 1 in the Evidence of Coverage (EOC) for more information). Changes to Your Part D Prescription Drug Benefits Deductible No change for 2009 Initial Coverage Limit (total medication costs paid by Tier 1 co-payments for $10.00 co-payment for a No change for 2009 generic drugs one-month (30-day) supply at a retail network pharmacy $30.00 co-payment for a three-month (90-day) supply at a retail network pharmacy $20.00 co-payment for a three-month (90-day) supply from our mail-order pharmacy Tier 2 co-payments for $30.00 co-payment for a No change for 2009 preferred brand-name one-month (30-day) supply at a retail network pharmacy $90.00 co-payment for a three-month (90-day) supply at a retail network pharmacy $60.00 co-payment for a three-month (90-day) supply from our mail-order pharmacy Tier 3 co-payments $50.00 co-payment for a No change for 2009 for non-preferred one-month (30-day) supply at brand-name drugs a retail network pharmacy $150.00 co-payment for a three-month (90-day) supply at a retail network pharmacy $100.00 co-payment for a three-month (90-day) supply from our mail-order pharmacy Tier 4 co-payments for $50.00 co-payment for a No change for 2009 specialty drugs one-month (30-day) supply at a retail network pharmacy $150.00 co-payment for a three-month (90-day) supply at a retail network pharmacy $100.00 co-payment for a three-month (90-day) supply from our mail-order pharmacy Catastrophic Coverage After your true out-of-pocket After your true out-of-pocket costs reach $4,050, you are costs reach $4,350, you are eligible for coverage as eligible for coverage as detailed by the chart below. detailed by the chart below. Generic drugs Greater of $2.25 for generics Greater of $2.40 for generics or drugs treated as generics or or drugs treated as generics or 5% coinsurance 5% coinsurance Brand-name drugs Greater of $5.60 or Greater of $6.00 or 5% coinsurance 5% coinsurance Prior Authorization Prior authorization is now required for the following drugs for the 2009 plan year: LIDODERM Drug Tier Changes From 2008 to 2009 2008 Tier 2009 Tier 2008 Tier 2009 Tier BARACLUDE CEFOXITIN COMBIVIR DIBENZYLINE EFFEXOR XR EPIRUBICIN HCL SOLUTION MATULANE CARBONATE METOPROLOL TARTRATE NIMODIPINE NORDITROPIN CARTRIDGE NORDITROPIN OXSORALEN NORDIFLEX PEN PEG-INTRON 2008 Tier 2009 Tier 2008 Tier 2009 Tier PEG-INTRON PEG-INTRON REDIPEN PAK 4 RIBASPHERE RIBAVIRIN TRIZIVIR VIRACEPT Drugs That Have Been Removed From Our Formulary for the 2009 Plan Year ALPHATREX AMITRIPTYLINE/ CHLORDIAZEPOXIDE BD ECLIPSE SYRINGE/ 1ML/30GX1/2" BD NEEDLE/30G X 1/2" CAMPTOSAR CARNITOR CLARINEX CLARINEX REDITABS CLARINEX-D 12 HOUR CLARINEX-D 24 HOUR DEPO-TESTOSTERONE DEXASPORIN DEXTROSE 2.5% DIFLUCAN IN NACL DIPROLENE DYNABAC D5-PAK ESTRADIOL/ ETH-OXYDOSE NORETHINDRONE FLOXIN OTIC FLOXURIDINE FLUOR-OP FOSAMAX PLUS D GENERLAC KETOTIFEN FUMARATE LAMICTAL LIPOSYN III LOPROX SHAMPOO METHERGINE NITRO-BID NYSTATIN VAGINAL OCUSULF-10 OPIUM TINCTURE ORAMORPH SR PAREGORIC PHOSPHOLINE IODIDE PLENAXIS PROCTO-KIT PULMICORT RESERPINE RISPERDAL ROCALTROL STROMECTOL SULFACETAMIDE SURMONTIL TRILEPTAL VOLTAREN With this notice, you also received a 2009 Evidence of Coverage and a new formulary that will be effective January 1, 2009. Medicare has reviewed and approved the covered drugs listed in the formulary. Please see Section 10 for more information about the drug coverage described in the table above. This is your Annual Notice of Change Why am I receiving this information? We are sending this Annual Notice of Change (ANOC) so you can review the 2009 coverage offered through this Plan. Each year from November 15 through December 31, you may make a change to your Medicare plan and Medicare prescription drug coverage, with your new plan beginning on January 1. Certain individuals, such as those with Medicaid, those who get extra help, or who move, can make changes at other times. If you want to stay in our Plan, you don’t need to do anything. You will still be a member of our Plan for the coming year. Note: If you are a member of a State Pharmaceutical Assistance Program (SPAP) or an employer group, you may be required to belong to a specific plan in order to continue to get the additional benefits you may be receiving. Please check with your SPAP or employer before switching to another prescription drug program. The phone numbers for your SPAP can be found in Section 8 of the Evidence of Coverage. _________________________________________________________________________________________ What if my drugs are not on the formulary or are in a more expensive cost-sharing tier? We have changed our formulary. The new formulary may be different from the one you are using. We have added, removed, or placed more limitations on some of the drugs we cover. Please review the formulary to see if we still cover the drugs that you currently take. To get a complete listing of all the drugs we cover, you may visit our website or call Customer Service. If a drug we currently cover for you is not on our new formulary, you will need to talk to your doctor about taking an alternative drug that is available on our new formulary. If you wish to continue coverage of your current drug, you or your doctor can request a formulary exception on or after January 1. Beginning January 1, you will get a temporary supply of the drug we currently cover for you that is not on our new formulary. You will need to talk to your doctor about switching to a covered drug, or request a formulary exception before your temporary supply runs out. If a drug we currently cover for you is on our new formulary but has been moved to a higher non-preferred cost-sharing tier, you can talk with your doctor about taking an alternative drug that is available in a lower cost-sharing tier. If you wish to pay the lower preferred cost-sharing amount for your current drug, you or your doctor can request a tiering exception on or after January 1. Please refer to Section 5 in the Evidence of Coverage for instructions on how to file an exception. _________________________________________________________________________________________ What do I need to know if I qualify for extra help (the low-income subsidy, or LIS) from Medicare to pay for my prescription drugs? If you do qualify for extra help, a copy of your “Evidence of Coverage Rider for Those Who Receive Extra Help Paying for Their Prescription Drugs” is enclosed in this package. The “Evidence of Coverage Rider for Those Who Receive Extra Help Paying for Their Prescription Drugs” has more specific information on your premiums and cost-sharing in 2009. Read this important information carefully. If you don’t know what level of extra help you qualify for, you can call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Where can I get more information? The Evidence of Coverage on the following pages has more information on our plan’s coverage, including information on how to make changes to your membership in Section 6. Please call Customer Service if you have any questions. You can also get information about the Medicare program and other Medicare plans available by visiting www.medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY/TDD users should call 1-877-486-2048. Medco Health Solutions, Inc., 100 Parsons Pond Drive, Franklin Lakes, NJ 07417 Medco is a registered trademark of Medco Health Solutions, Inc. Medco Medicare Prescription Plan is a registered trademark of Medco Health Solutions, Inc. 2008 Medco Health Solutions, Inc. All rights reserved. LT917320
CAMPBELL UNIVERSITY SPORTS CAMP MEDICAL INFORMATION This form must be completed and returned in order to participate in the sports camp Name of Camp__________________________________ Male______ Female_____ Dates of Camp________________________________ Participant’s Name________________________________ Soc. Sec. #_________________________ Date of Birth_____________________ Address______
Biology 3400 Midterm March 4, 2010 Time: 75 minutes Instructions 1. Do not open the exam booklet until you are instructed to do so. 2. Put your name, signature and student number on the exam booklet cover page, the last page, the start of the written answer section and the multiple choice answer sheet. Print your name on the last page of the exam booklet. 3. This examination is out of a t