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What is the UPREHS Health Care Prepayment Plan?
UPREHS is contracted as a Health Care Prepayment Plan (HCPP) with the Centers for Medicare and Medicaid Services (CMS), the Federal agency that administers Medicare. This contract authorizes UPREHS to pay your Original Medicare Part B claims to participating providers for office visits and office services, consultations, hospital visits, and surgical procedures. When UPREHS HCPP receives a participating physician’s claim for your services, payments for Original Medicare Part B benefits and your UPREHS Medicare Secondary Plan benefits are made in one check directly to the physician, which eliminates billing Railroad Medicare and you.
What is the UPREHS Secondary Plan?
The UPREHS Medicare Secondary Plan (MSP) makes payment for covered benefits after Original Medicare Part A or B or the UPREHS HCPP has paid the primary Medicare payment for allowed services. UPREHS MSP pays the Medicare Part A and B annual deductible amounts and coinsurance for allowed charges for covered benefits. You may be partly or totally financially responsible for charges that Medicare did not pay from nonparticipating providers. The UPREHS MSP reduces payment to 40% of the Medicare coinsurance and annual deductible amounts for covered benefits from UPREHS nonparticipating providers. A UPREHS nonparticipating provider is a physician, hospital, or other health care provider who has not signed a UPREHS participation agreement. UPREHS does not know if these providers participate with Medicare or not. All Medicare members who elect coverage under the UPREHS MSP are also automatically enrolled in the UPREHS Medicare HCPP. Members must be entitled to Original Medicare Part A and enrolled in Part B to elect coverage under the UPREHS MSP and HCPP.
What is the UPREHS Prime Medicare Plan / Medicare Part D Plan?
UPREHS is contracted with the Centers for Medicare & Medicaid Services (CMS) as an Employer Group Waiver Plan (EGWP) direct contract Medicare Part D Prescription Drug Plan. As an EGWP, our membership is available only to union members, Union Pacific Railroad or affiliated Railroad Medicare retires and their spouse/widow/widower. CMS does not require an EGWP to perform some of the contractual requirements that apply to for-profit Part D plans because of our membership restriction. UPREHS was founded solely to serve you - our members. Current UPREHS Medicare members have been automatically enrolled in our Plan so that UPREHS can continue to provide your prescription drug benefits while you receive Medicare benefits. Now that you are enrolled in the UPREHS Prime Medicare Plan you are getting your Medicare Prescription Drug coverage through UPREHS. This Benefit Guide explains your benefits and services, what you have to pay, and the rules you must follow to get your prescription drugs covered.
Last Updated: 04/17/2008 |
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UPREHS. Plan for Life.™ 
