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The Dartmouth College Medicare Supplement (DCMS) Plan

Click here FlexOnline Logo  to access the Dartmouth benefits enrollment system.

Retiree Medical Benefits for Medicare Eligible Members  

The DCMS Plan is available to qualifying Dartmouth College Medicare eligible retirees age 65+, and members who are Medicare eligible due to disability.  There will be no changes to the DCMS plan format or out of pocket design for 2017.   

2017 DCMS plan premium

Beginning January 1, 2017 the monthly DCMS premium rate will be $496.73 per covered member per month. This change will be reflected in the monthly statement you receive mid-January for your January 2017 benefits. Those whose plans are fully subsidized and do not owe a household balance will not receive a monthly statement.  

SilverScript® Prescription Drug Cost Share

The amount you pay out of your pocket for your prescription drugs will be determined by the table below, according to the tier your specific drug falls into.  To find out if your drug is on the formulary (list of Medicare Part D covered prescription drugs), or about any restrictions, please call SilverScript Customer Care at 1‑866‑693‑4621. Please read the annual enrollment materials sent to you from SilverScript for details about your plan. You can find additional information at dartmouth.silverscript.com..

Retail Pharnacy Generic Preferred Brand Non-Preferred Brand
1-30 day supply $5 $25 $40
31-60 day supply $10 $50 $80
61-90 day supply $15 $75 $120
Mail OrderGenericPreferred BrandNon-Preferred Brand
1-90 day supply $10 $50 $80

* A Copayment is a flat dollar amount that you pay out of pocket for each covered drug you purchase.

No Change to Out of Pocket Maximum for 2017

There will be no change to the annual DCMS out of pocket maximum 7for 201. The annual out of pocket maximum per member for covered services is $900.  This includes up to $450 toward medical costs and up to $450 toward prescription drug costs each year.

 

More Information

Eligibility & Medicare
Medicare
SilverScript (Dartmouth's Medicare Part D Plan)
Plan Details and Summaries
Costs
Changing Your Election
Who to Contact
Helpful Medicare Summaries

 

Eligibility & Medicare

In order to be eligible for the Dartmouth College Medicare Supplement (DCMS) Plan, you must  meet the minimum qualifications for the DCMS plan, and be enrolled in Medicare Part A and Part B, according to the rules outlined by the Social Security Administration.  You should not enroll in a separate Medicare Part D if you want to be covered on the on the DCMS plan.  The DCMS plan will supplement Medicare Parts A & B and provides Medicare Part D prescription drug coverage as well.

For additional information on Medicare, you should visit  Medicare.gov or the Social Security Administration website or contact your local Social Security Office.  You can find your local office by visiting the Social Security Administration office locator website

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Plan Details

As stated above, the Medicare Supplement Plan will supplement Medicare Parts A & B.  These expenses are subject to a $250 deductible, followed by a 20% coinsurance to a maximum of $200, a total out-of-pocket expense of $450 for your medical services for the year.

The Medicare Part D plan offered through Dartmouth College includes a *tiered copayment for each prescription drug purchase, until you've met the annual $450 out of pocket maximum. 

Retail Pharnacy Generic Preferred Brand Non-Preferred Brand
1-30 day supply $5 $25 $40
31-60 day supply $10 $50 $80
61-90 day supply $15 $75 $120
Mail OrderGenericPreferred BrandNon-Preferred Brand
1-90 day supply $10 $50 $80

* A Copayments is a flat dollar amount that you pay out of pocket for each covered drug you purchase.

Further detail is available in the following resources:

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 Active Employees becoming Medicare eligible

If you are not a retiree and are eligible for Medicare (ex. because you are turning 65 or due to a disability), you should contact the Benefits Office for more information about coverage.

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Changing Your Election 

If you would like to change your election in the Dartmouth College Medicare Supplement (DCMS) Plan, you may do so during Open Enrollment or any time during the year if you have a qualify event.  You can do so by notifying the Benefits Office in writing within 30 days of your qualifying event.   

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Helpful Medicare Summaries & Links

2017 Medicare & You booklet (English)
2017 Medicare & You booklet (Spanish)
Who Pays First (Medicare Coordination of Benefits Summary)
Higher Income Beneficiary Rules (IRMAA premiums)
IRMAA Premium Reimbursement Form 
Medicare Extra Help program
TriCare for Life

 
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Who to Contact

For questions on Medicare, please visit either Medicare.gov or the Social Security Administration website or contact your local Social Security Office. You can find your local office by visiting the Social Security Administration office locator website.

For questions about the DCMS Plan, you may contact Cigna Health Insurance:

  • Toll-free phone number: 1-855-469-4619 
  • Send claims to:  P.O. Box 182223, Chattanooga, TN 37422-7223
  • Website: http://www.MyCigna.com/

If you would like to make changes to your coverage or have questions on your eligibility for the DCMS plan, you should contact the Benefits Office:

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Last Updated: 11/30/16