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SUMMARY OF THE MILA NATIONAL HEALTH PLAN: WRAP-AROUND PLAN

SUMMARY OF THE MILA WRAP-AROUND PLAN
Who is Eligible For Coverage Regular Pensioners and their dependents who are eligible to enroll in Medicare and who are not enrolled in a Medicare Advantage Plan.
If eligible, must a person enroll in Medicare? The covered person must enroll in Medicare, Part A and Part B. Generally, the person should not enroll in Medicare, Part D.
Which Plan pays first and controls - Medicare or MILA? Medicare pays before MILA. If the expense is eligible for Medicare benefits, Medicare’s rules apply. Otherwise, MILA’s rules apply.
What expenses are eligible for MILA reimbursement? Generally, the Plan pays benefits based upon the person’s Medicare deductibles and coinsurance expenses that remain after Medicare’s payments.
What Benefits Will MILA Pay
For Medicare, PART A MILA will pay 100% of the Part A deductible and the portion of any expense which is covered by Medicare but is the Member’s responsibility.
For Medicare, PART B The first $150 of the Part B eligible expenses are the person’s deductible ($300 per family) in a calendar year. Thereafter, the person pays 20% until the person’s maximum out-of-pocket expense is reached. Thereafter, the Plan pays 100% for the balance of the calendar year.
Skilled Nursing(up to 100 days per calendar year) Person pays 20% of Eligible Charge after deductible
Home Health Care- (Includes up to 120 visits per calendar year.) Visits include part-time or intermittent nursing care or for care supervised by an RN, part-time or intermittent services of a home health aide and visits for physical, occupational or speech therapy Person pays 20% of Eligible Charge after deductible
What Is The Person’s Maximum Out-of-Pocket Expenses? The person will pay no more than $2,500 in MILA deductible and coinsurance expenses during the calendar year.
What Is The Plan’s Maximum Benefit? The MILA Plan will pay no more than $500,000 during a person’s retirement.
Plan Limitations and Exclusions The Premier Plan’s provisions which apply to Out-of-Network benefits also apply to this Plan unless Medicare applies a benefit limit, in which case, the Medicare limit will apply.
PRESCRIPTION DRUG IN-NETWORK OUT-OF-NETWORK
Prescription Brand Deductible per Family $500 Deductible applies to all Brand Name Drugs when a generic equivalent is available
Retail
Retail Copay- up to 30-day supply (Generic) $5 $5
Retail Copay- up to 30-day supply (Preferred Brand) $10 $10
Retail Copay- up to 30-day supply (Non-Preferred Brand) $25 $25
For Retail: Up to 30-day supply- First fill plus one refill per prescription
Maintenance Choice or Mail Order
Mail Order Copay- up to 90-day supply (Generic) $5 Not Covered
Mail Order Copay- up to 90-day supply (Preferred Brand) $15 Not Covered
Mail Order Copay- up to 90-day supply (Non-Preferred Brand) $50 Not Covered
For Mail Order & Maintenance Choice: Up to 90-day supply- First fill plus one refill per prescription