If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (apenalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. ForMoreInformationAbout ThisNoticeOrYourCurrentPrescription Drug Coverage… Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through RSM Electron Power, Inc. changes. You also may request a copy of this notice at any time. ForMoreInformationAbout YourOptionsUnderMedicarePrescription Drug Coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year you are eligible from Medicare. You may also be contacted directly by Medicare drug plans.
For more information about Medicare prescription drug coverage:
•
Visit www.medicare.gov .
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov , or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember:Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Date: Name of Entity/Sender: Contact -Position/Office: Address:
January 23, 2024 RSM Electron Power, Inc. Susan Panagopoulos, Director, Human Resources 100 Engineers Road Hauppauge, NY 11788 (631) 586-7600
Phone Number:
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