1. Alcon Retiree Medical Coverage & Medicare

2. Topics to Cover Which Plan Is Primary – Alcon or Medicare?
Which Parts Of Medicare Do I Enroll In?
When & How To Enroll In Medicare
Coordination of Alcon Medical Plan Benefits with Medicare
Medicare Coordination Examples
How to Find UHC Network Providers
Filing Claims when Medicare is Primary
Funding for Retiree Medical
Retiree Medical Premiums

3. Which Plan is Primary – Alcon or Medicare?
Retirees and spouses less than age 65: the Alcon Retiree Medical Plan
Retirees and spouses age 65 or older: Medicare (Parts A and B) is primary, the Alcon Medical Plan is secondary. Medicare coverage, both Parts A & B, are required in order to receive benefits under the Alcon Retiree Medical Plan.
Disabled Individuals: if entitled to Social Security disability benefits, Medicare is primary in most cases, even if younger than age 65

4. What If I Am 65 but my Spouse is not? Or, Vice Versa
If your spouse is less than 65: the Alcon Retiree Medical Plan will provide primary coverage (even if you are age 65 or older), until he/she reaches age 65, then the Alcon Plan becomes secondary to Medicare
If your spouse is age 65 or older: Medicare will be his/her primary coverage, and the Alcon Plan will be secondary, even if you have not yet reached age 65

5. Which Parts Of Medicare Do I Enroll In?
When you reach age 65 and are retired, Medicare becomes your primary health insurance:
You should enroll in Medicare Parts A and B
Medicare Part A is hospital insurance; Medicare Part B is supplementary medical insurance (doctor’s fees, outpatient hospital services)
The Alcon Plan will not pay benefits until Medicare has first paid its portion of the charges under Part A or Part B (except for prescription drug benefits)
If you retire after age 65:
You will already be enrolled in Medicare Part A
You will have a “Special Enrollment Period” following retirement to enroll in Part B without penalty

6. Which Parts Of Medicare Do I Enroll In?
Do NOT enroll in Medicare Part D (Prescription Drug coverage). The Alcon Plan provides full prescription drug coverage and cannot coordinate with Medicare Part D.
Alcon Retiree Medical coverage will be cancelled and cannot be reinstated if:
You enroll in Medicare Part D, or
You enroll in a Medicare Advantage Plan/ Medicare HMO that has prescription drug benefits

7. When & How To Enroll In Medicare
Medicare is available at the beginning of the month in which you reach age 65 - contact Medicare to apply 1-3 months before your 65th birthday
Medicare coverage begins 1st day of month that you reach age 65
You will be automatically enrolled in Medicare Part A (hospital coverage) when you become eligible & will get a Medicare ID card
You must make an election to enroll in Medicare Part B and pay the applicable premiums:
If you don’t enroll when initially eligible - must wait until next Medicare enrollment period and pay surcharge on Part B premiums
The Alcon Medical Plan will not pay benefits on Part B eligible expenses until Part B has paid first

8. Coordination of Alcon Medical Plan Benefits with Medicare
New Coordination Method 1/1/2010 – “Medicare Carve Out”
Approach used by over 80% of our industry and the majority of other U.S. employers who offer retiree medical
How it Works-
The Alcon Plan will first determine what it would normally pay before any Medicare payment. Then, any Medicare payment is subtracted from that amount to determine the amount the Alcon Plan pays.
If Medicare’s payment is greater than or equal to the Alcon plan’s normal benefit, the Alcon plan will pay $0.
You will have to pay most Alcon Plan deductibles, copays and coinsurance, just like active employees and pre-65 retirees.

9. Medicare Coordination Example 1 – UHC Network hospital stay
2009 Alcon Retiree Medical Plan
Medicare Supplement
2010 Alcon Retiree Medical Plan
Medicare Carve-Out *
Total Charge: $8,000
Medicare ineligible charge: $1,000 (provider must write-off)
Net Claim: $7,000
Medicare Pays 80% = $5,600
Alcon Plan pays $7,000 – $5,600 = $1,400
Without Medicare, Alcon Plan would have paid = $6255 ($7,000 - $50 deductible x 90%)
Alcon plan pays $6255 – $5600 = $655
Total Paid = $7,000
Total Paid = $6,255
Retiree pays $0
Retiree pays $745
*if Medicare’s payment is equal to or greater than the Alcon plan’s normal benefit, the Alcon plan pays $0

10. Medicare Coordination Example 2 – UHC Network Doctor’s visit
2009 Alcon Retiree Medical Plan
Medicare Supplement
2010 Alcon Retiree Medical Plan
Medicare Carve-Out Plan*
Total Charge: $300
Medicare ineligible charge: $75 (provider must write-off)
Net Claim: $225
Medicare Pays 80% after $155 deductible = $56
Alcon Plan pays $225 - $56 = $169
Without Medicare, Alcon Plan would have paid $225 - $20 copay = $205
Alcon plan pays $205 – $56 = $149
Total Paid = $225
Total Paid = $205
Retiree pays $0
Retiree pays $20
*if Medicare’s payment is equal to or greater than the Alcon plan’s normal benefit, the Alcon plan pays $0

11. Medicare Coordination Example 3 – Out of Network provider
2009 Alcon Retiree Medical Plan
Medicare Supplement
2010 Alcon Retiree Medical Plan
Medicare Carve-Out *
Total Charge: $8,000
Medicare ineligible charge: $1,000 (provider must write-off)
Net Claim: $7,000
Medicare Pays 80% = $5,600
Alcon Plan pays $7,000 – $200 deductible - $5,600 = $1,200
Without Medicare, Alcon Plan would have paid $7,000 - $300 deductible x 60% = $4,020
Alcon plan pays $0*
Total Paid = $6,800
Total Paid = $5,600
Retiree pays $200
Retiree pays $1,400
*if Medicare’s payment is equal to or greater than the Alcon plan’s normal benefit, the Alcon plan pays $0

12. How to Find UHC Network Providers
Using UHC network providers after age 65 can save $$ for you & Alcon:
Higher benefits paid under the Alcon Plan
Discounts on services given by UHC network providers
From the internet:
Open Internet Explorer and go to
Click on Find Physician or Facility
Search by provider type or geographic area to get a list of UHC participating providers
By phone: call UHC member service at

13. Filing Claims when Medicare is Primary
Medical claims should be submitted to Medicare FIRST by the provider or you:
If the provider accepts Medicare Assignment, Medicare will make payment directly to the provider; if the provider does not accept Medicare Assignment, Medicare will make payment to the patient
Medicare will pay its Part-A and Part-B benefits based on the “Medicare approved charge”
After Medicare has paid, the remaining expense will be sent to UHC under the “Medicare Direct Rollover” program for consideration under the Alcon Plan
If you need to file a claim yourself, submit an Alcon medical claim form with the Medicare “Explanation of Benefits” statement to United HealthCare
Prescription drugs are covered ONLY under the Alcon plan - use your Alcon Medical Plan ID card to fill prescriptions under the Alcon plan (don’t file with Medicare)

14. Funding for Retiree Medical
Alcon has contributed $113.5 million to a VEBA Trust which can only be used for health benefits of employees, retirees and their dependents
An additional $65 million has been contributed to a special 401(h) account and can be used only for Retiree Medical costs

15. Retiree Medical Premiums
Retiree medical premiums based on retiree’s Medicare status, years of service with Alcon, and dependents covered
When retiree reaches age 65, retiree medical premiums are reduced (1st day of month following 65th birthday)
Premium payments administered by ADP Direct Bill –
Premiums may be paid by bank account draft or check
Premium Payments made 1 month in advance
Contact ADP at , option 2, for questions or changes

16. Have Questions?
Medical Claims & coverage: contact United Healthcare,
Retiree Premium Payments: ADP Benefits Solution Center, , option 2
Medicare: or visit your local Social Security office
Other questions: Alcon Benefits Department, or