· 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have...
22
1
Transcript of · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have...
![Page 1: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/1.jpg)
1
![Page 2: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/2.jpg)
2
![Page 3: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/3.jpg)
3
![Page 4: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/4.jpg)
4
![Page 5: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/5.jpg)
5
![Page 6: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/6.jpg)
6
![Page 7: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/7.jpg)
7
![Page 8: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/8.jpg)
8
![Page 9: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/9.jpg)
9
![Page 10: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/10.jpg)
10
![Page 11: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/11.jpg)
11
![Page 12: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/12.jpg)
12
![Page 13: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/13.jpg)
13
![Page 14: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/14.jpg)
14
![Page 15: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/15.jpg)
15
![Page 16: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/16.jpg)
16
![Page 17: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/17.jpg)
[<Group> has selected the <plan name> for its Medicare-eligible retirees] [and their dependents.]
You will be automatically enrolled into this plan unless you tell <company name> that you want to opt-out of
the plan. If you choose to opt-out of this plan, please contact <company name> [at <1-XXX-XXX-XXXX>,
TTY 711, <days/hours of operations>][or][at <mailing address>][or][at <URL.com>] [no later than <date>].
[If you wish to continue to receive Medical [and Prescription drug] coverage through <group name>, you do
not need to take any action.]
17
![Page 18: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/18.jpg)
18
![Page 19: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/19.jpg)
19
![Page 20: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/20.jpg)
20
![Page 21: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/21.jpg)
21
![Page 22: · 2019-10-24 · You can decline by contacting ERS toll-free at (877) 273-4377 You cannot have two Part D prescription plans at once. If you enroll in another plan you will be automatically](https://reader034.fdocuments.net/reader034/viewer/2022050409/5f85ec6707bf8204a805ce44/html5/thumbnails/22.jpg)
22