Download Legally Required Notice of Non-Creditable Coverage About

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ADT Health and Group Benefits
P.O. Box 199575
Dallas, Texas 75219-9575
Notice of Creditable Coverage
MyADTHR.com
EmployeeAccess: 1-888-833-1839
ADT Prescription Drug Coverage
Medicare Part D
This notice has information about your current prescription drug coverage with ADT and your options under Medicare’s
prescription drug coverage. This notice applies to you and/or your covered family members who are eligible for
Medicare prescription drug benefits and can help you decide whether you want to join a Medicare drug plan.
ADT Prescription Drug Coverage
ADT compared its current prescription drug
coverage to the standard Medicare drug plan,
and has determined that the ADT prescription
drug coverage is, on average for all participants,
expected to pay out as much as standard
Medicare prescription drug coverage in 2017 and
is considered Creditable Coverage. Since your
existing coverage is, on average, at least as
good as standard Medicare prescription drug
coverage, you can keep this coverage and not
pay a higher premium (a penalty) if you later
decide to join a Medicare drug plan without a
significant break in coverage (see below).
Medicare Part D—What is it?
Medicare Part D, introduced in 2006, is the
prescription drug coverage available to everyone with
Medicare and offered by private insurers. You can get
this coverage if you join a Medicare Prescription Drug
Plan or a Medicare Advantage Plan (like an HMO or
PPO) that offers prescription drug coverage. All
Medicare drug plans provide at least a standard level
of coverage set by Medicare. Some plans may also
offer more coverage for a higher monthly premium.
More Information
Each year Medicare participants will receive a
Medicare & You handbook and may be contacted by
Medicare. You may also visit your State Health
Insurance Assistance Program for assistance (contact
information can be found in the handbook).
You can also find information at www.medicare.gov or
call 1-800-633-4227 (TTY 1-877-486-2048).
If you have limited income and resources, visit
www.socialsecurity.gov, or call 1-800-772-1213 (TTY
1-800-325-0778) for information about assistance in
paying for Medicare prescription drug coverage.
Keep this Creditable Coverage Notice
If you decide to join a Medicare drug plan, you
may be required to provide a copy of this notice
when you join to show whether you have
maintained creditable coverage and to determine
whether you are required to pay a higher
premium (a penalty).
When can I enroll?
You can join a Medicare drug plan when you first
become eligible for Medicare and each year from
October 15 through December 7. If you choose not to
enroll in Medicare Prescription Drug coverage when
first eligible, you may have to wait to join and may pay
a higher premium (a penalty) if you enroll at a later
time. This higher premium may apply as long as you
have Medicare prescription drug coverage.
What if I lose creditable coverage?
If you lose creditable prescription drug coverage,
through no fault of your own, you will be eligible for a
sixty day Special Enrollment Period to join a Medicare
Part D plan. In addition, if you lose or decide to
discontinue ADT coverage, you will be eligible for an
Employer Group Special Enrollment Period to join a
Medicare Part D plan at that time. Before
discontinuing ADT coverage, compare your current
coverage, including which drugs are covered at what
cost, with the coverage and costs of the plans offering
Medicare prescription drug coverage in your area.
Can I enroll in both Medicare Part D and the ADT
plan?
Yes. However, coverage may be redundant and you
should review duplication of coverage rules and total
plan premiums. If you decide to enroll in both plans,
you will likely be paying both your regular ADT plan
premium as well as your Medicare Part D premium.
However, under the ADT retiree health plan you
cannot receive duplicate payments on your
prescription drug costs. As a result, coverage may be
redundant and you will not receive additional benefits
by enrolling in two plans.
What if I discontinue ADT prescription drug
coverage and don’t sign up for a Medicare drug
plan?
If you decide to enroll in a Medicare prescription drug
plan and you are an active employee or family
member of an active employee, you may also
continue your ADT coverage. In this case, the ADT
plan will continue to pay primary or secondary costs
as it had before you enrolled in a Medicare
prescription drug plan. If you waive or drop ADT
coverage, Medicare will be your only payer. You can
re-enroll in the ADT plan at annual enrollment or if you
have a special enrollment event (such as a marriage).
How often will I receive this Notice of Creditable
Coverage?
You will get this notice each year, when you are
eligible to join a Medicare drug plan, and also if ADT
coverage changes.
Where can I get an additional copy of this Notice
of Creditable Coverage?
If you need another copy, please call ADT
EmployeeAccess at 1-888-833-1839 or send a written
request to:
ADT Health and Group Benefits
P.O. Box 199575
Dallas, Texas 75219-9575