Schedule of Benefits

• Medicare Part D Information
• Medical Benefits
• Lifetime Maximum
• Prescription Drugs

Members are advised not to enroll in Medicare Part D as Anthem will provide prescription drug coverage under the Anthem SmartValue Medicare Advantage plan.

• Exception: low-income members may benefit from Part D. Contact the BPO if you have received communications regarding low-income options available through Part D.

The benefits under the Anthem SmartValue plan will be nearly the same as they were under the WELS VEBA Medicare Supplement Plan. There will be a $500 per member per calendar year deductible with 100% coverage for eligible charges after satisfaction of this deductible. The $500 Anthem deductible does include the Medicare Part B deductible.

If the Member is not covered by Medicare, the member will not be eligible to be enrolled in the Anthem SmartValue Medicare Advantage plan.

The Anthem SmartValue Medicare Advantage plan continues to be a good value in comparison to individual plans available through commercial insurers. The plan is available to all members in any region of the United States and allows them to continue to use trusted medical care providers.

There is no lifetime maximum benefit for Medical and Prescription Drug benefits under the Anthem SmartValue Medicare Advantage plan.

Members enrolled in the Anthem SmartValue plan have prescription drug coverage through Anthem's pharmacy benefit manager, NextRx. Members can obtain prescription drugs using one of the following methods.

Retail Pharmacy

A Member may use their card to purchase up to a 34-day supply of prescribed drugs at any participating pharmacy. Important! New with the Anthem plan, members may receive up to a 90-day supply of prescription drugs at certain network pharmacies listed with an asterisk in the Anthem enrollment kit at the mail Co-Pay amount.

The pharmacist will collect the Member's Co-Pay portion of the cost for a prescription. The Member does not submit a claim to Anthem.

Mail Service Pharmacy

A Member may use the NextRx Mail Service Pharmacy when the Member's Physician writes a prescription which exceeds a 34-day supply. The prescription may include up to a 90-day supply.

The Member submits the order to the Mail Service Pharmacy and pays the Member's Co-Pay portion of the cost to the pharmacy. The Member does not submit a claim to Anthem.