Hawaii Employer-Union Health Benefits Trust Fund

Medicare allows enrollment in only one Medicare Part D or Medicare Advantage Plan. EUTF Medicare Part D and Medicare Advantage plan options include:

• EUTF and HSTA VB Medicare Part D prescription drug plan administered by SilverScript
• EUTF and HSTA VB Kaiser Permanente Senior Advantage Medical and Prescription Drug Plan (includes Medicare Part D)

If you or your covered dependent(s) are enrolled in Medicare Part B and enrolled in the EUTF or HSTA VB retiree CVS prescription drug plan, you will automatically be enrolled in the Medicare Part D prescription drug plan administered by SilverScript (SSI), a CVS subsidiary company. You have the right to opt out of this plan, by CMS regulations, and will receive an Opt-out letter directly from SSI. However, do not opt-out of the SSI drug plan if you wish to maintain your EUTF drug plan. Opting-out of the SSI drug plan will terminate your enrollment in the EUTF drug plan altogether.

If you or your covered dependent(s) are enrolled in Medicare Part B and enrolled in the EUTF or HSTA VB retiree Kaiser medical and prescription drug plan, you will be automatically enrolled in the EUTF or HSTA VB Kaiser Permanente Senior Advantage Plan (KPSA plan), unless you live in Kauai, Molokai, Lanai and parts of Hawaii Island which include Pahala, Naalehu and Hawaii Volcanoes National Park. If you choose to opt-out of the EUTF or HSTA VB KPSA plan, you will be disenrolled from medical and drug coverage effective the date you became Medicare eligible or prospectively effective 45 days from opting-out of the EUTF or HSTA VB KPSA plan at the end of the pay period. If you have any dependents on your Kaiser Permanente plan, they will also lose their medical and drug coverage.

If in the future you enroll in a non-EUTF Medicare Part D or Medicare Advantage plan, you will be disenrolled from any EUTF Medicare Part D plan, including KPSA. CMS may assess a Medicare Part D premium:

• If your modified adjusted gross income is above a certain amount, also referred to as the Part D income-related monthly adjustment amount (Part D-IRMAA)
• If you do not enroll in Medicare Part D when you first become eligible, a late enrollment penalty may be assessed.

The EUTF does not reimburse Medicare Part D premiums or penalties.

The EUTF or HSTA VB retiree medical and/or prescription drug plans cover many of the same benefits as a Medigap policy. Therefore, careful consideration should be taken before you enroll in a Medigap plan as enrollment in a non-EUTF Medigap or any other Medicare Advantage and Medicare Part D prescription drug plan may jeopardize your enrollment in an EUTF or HSTA VB retiree medical and/or prescription drug plan.