CBIA Health Connections
Medicare plan from Anthem Blue Cross & Blue Shield

CBIA Health Connections participants can take advantage of Anthem Blue Cross & Blue Shield's Medicare solution for medicare-eligible employees, dependents, and retirees.

CBIA Offers Plan F with an enhanced Part D prescription drug rider (called Blue MedicareRx^SM) with $10/25/40 copays for only $331.05/month.

The premium reflects Plan F and the enhanced Part D prescription drug plan. The enhanced Part D prescription drug plan is creditable according to CMS guidelines.

Note: The Medicare rate renews on January 1 regardless of a company's renewal date.

To see who qualifies for this plan, please refer to the TEFRA/DEFRA chart in the CBIA Health Connections Administration Manual. For retired employees, an employer must have elected to offer retiree benefits to qualified individuals. If you're not sure what retirement option was elected, please contact CBIA Customer Service at 860-525-2242. Employees must also have Medicare Parts A & B in effect to qualify for this benefit.

Enrollment Policy

The Federal Government has very stringent policies pertaining to enrollment and disenrollment in Medicare.

All requests for enrollment or disenrollment must be processed by the last business day of the month to be effective on the 1^st of the month following. There will be no requests for enrollment or disenrollment processed retroactively. There will be no exceptions. CBIA must receive all forms at least 4 business days prior to the requested effective date.

Enrollment Instructions:

1. Complete the Anthem Enrollment and Membership Change form.(includes Plan F Medical and Part D Prescription drug plan)

2. Complete the Health Connections Enrollment/Change Form (choose one) HC, HC2, or 51+

3. Make three copies of the Anthem forms.

4. Return the original and one copy to CBIA. Employer retains the second copy. Employee retains the third copy.

5. Remember to include a copy of the employee's Medicare card showing active coverage in Parts A&B.

Please note: Qualified enrollees must submit their paperwork to CBIA prior to the requested effective date of coverage.

All Information and Forms:

• Plan F

• Blue MedicareRx Plan Description

• Blue MedicareRx Summary of Benefits

• Anthem Blue MedicareRx 2008 Formulary (List of Covered Drugs)

• Anthem Enrollment and Membership Change Form (includes Plan F Medical and Part D prescription drug plan)

• CBIA Health Connections Enrollment/Change Form (choose one) HC, HC2, or 51+

• Medicare Mail-order Prescription Order Form

• 2008 CMS Medicare Handbook