IMRF Endorsed Plans

Medical Plans for Retirees/Spouses 65 and over

Seniors Choice (underwritten by Loyal American Insurance Company)

• Available to retirees residing nationwide (except Florida)
• Retirees can choose one of the three Medical Plans listed below
• Retirees can choose one of the three Prescription Drug plans listed below, or no prescription drug plan
  

Seniors Choice Plans

Core Medical Benefits	Seniors Choice Plan Option A	Seniors Choice Plan Option B	Seniors Choice Plan Option C
Plan Deductible	N/A	$0.00	$250.00
Part A
First 60 days	Covered after Medicare Payment	Covered after Seniors Choice deductible & Medicare Payment	Covered after Seniors Choice deductible & Medicare Payment
Days 61 - 90	Covered after Medicare Payment	Covered after Seniors Choice deductible & Medicare Payment	Covered after Seniors Choice deductible & Medicare Payment
Days 91 - 150	Covered after Medicare Payment	Covered after Seniors Choice deductible & Medicare Payment	Covered after Seniors Choice deductible & Medicare Payment
Additional 365 days (lifetime)	Pays 100%	Pays 100% of Medicare eligible expenses	Pays 100% of Medicare eligible expenses
Skilled Nursing Facility
First 20 days	Medicare pays all approved amounts, plan pays $0.00	Medicare pays all approved amounts, plan pays $0.00	Medicare pays all approved amounts, plan pays $0.00
Days 21 - 100	$0.00	Covered after Deductible & Medicare Payment	Covered after Deductible & Medicare Payment
100+ days	$0.00	No Benefit	No Benefit
Part B (Medical)
Part B Deductible	$0.00	N/A	N/A
Remainder of Medicare Eligible Expenses	20%	N/A	N/A
DOV (Medicare Approved amounts)	N/A	Covered after Deductible & Medicare Payment; $10.00 co-payment *	Covered after Deductible & Medicare Payment; $10.00 co-payment *
Out Patient Services (Medicare Approved amounts)	N/A	Covered after Deductible & Medicare Payment; $0.00 - $20.00 co-payment *	Covered after Deductible & Medicare Payment; $0.00 - $20.00 co-payment *
Emergency Room - Professional Services (Non Hospital Admittance)	N/A	Covered after Deductible & Medicare Payment; $100.00 co-payment *	Covered after Deductible & Medicare Payment; $100.00 co-payment *

*Co-payments apply once the deductible has been satisfied

Prescription Drug Plans

• Medicare-Eligible Seniors Choice Group Plan Participants only
• Plans administered by Community CCRx
  

	Seniors Choice	SC Preferred	SC Premier
Phase 1: Deductible	$0.00	$0.00	$0.00
Phase 2: Initial Coverate	Up to $2,510	Up to $2,510	Up to $2,510
31-day supply, you pay
Generics	$4.00	$4.00	$4.00
Preferred Brands	$40.00	$40.00	$40.00
Brands	$60.00	$60.00	$60.00
Speciality	33%	33%	33%
90-day supply, you pay
Generics	$8.00	$8.00	$8.00
Preferred Brands	$80.00	$80.00	$80.00
Brands	$120.00	$120.00	$120.00
Speciality	33%	33%	33%
Phase 3: Coverage Gap	Amount you pay between the Initial Coverage and until you reach $4,050 in out-of-pocket covered prescription drug costs
31-day supply, you pay
Generics	100%	$4.00	$4.00
Preferred Brands	100%	100%	$40.00
Brands	100%	100%	$60.00
Speciality	100%	100%	33%
90-day supply, you pay
Generics	100%	$8.00	$8.00
Preferred Brands	100%	100%	$80.00
Brands	100%	100%	$120.00
Speciality	100%	100%	33%
Phase 4: Catastrophic Coverage
30-day supply, you pay
Generics (including brands drugs treated as generic)	$2.25	$2.25	$2.25
All others	$5.60	$5.60	$5.60
Or, the greater of:	5% coinsurance	5% coinsurance	5% coinsurance
Rate	$50.65	$58.78	$102.85

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