PEIA Special Medicare Plan benefits are available for PEIA insureds who have Medicare as their primary insurance coverage, but are not enrolled in the Humana/PEIA Medicare Advantage and Prescription Drug (MAPD) Plan. Enrollment in the Special Medicare Plan is generally for no more than one calendar year.
For more information, please view the Medicare Benefits Guide and the Special Medicare Plan Booklet.
PEIA offers the Special Medicare Plan to two groups of Medicare-eligible retirees:
1. Members who are unable to access medical care through the PEIA Medicare Advantage (Humana) Plan due to provider network limitations are permitted, on a case-by-case basis, to move into PEIA’s Special Medicare Plan. These members may remain in the Special Medicare Plan until adequate provider access becomes available.
2. Medicare-eligible employees who retire after the beginning of a plan year, and retired employees who become eligible for Medicare during the Plan year will be moved to the Special Medicare Plan. Retired members who are enrolled in an HMO when they become Medicare-eligible will be transferred to PEIA’s Special Medicare Plan. These members in the Special Medicare Plan will be moved to PEIA’s Medicare Advantage Plan at the beginning of the next plan year (the following January).
Under the Special Medicare plan, the member purchases traditional Medicare Parts A and B, and their secondary medical and prescription claims are paid by UMR and Express Scripts, respectively. Medical benefits under the Special Medicare Plan are generally the same as those provided under PEIA’s Medicare Advantage plan.
Contact UMR
Phone: 888-440-7342 (Toll-Free) 7:00 a.m. - 7:00 p.m.
UMR's Website
Contact Express Scripts
Phone: 1-855-224-6247
Express Scripts Website