2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Complete (PPO) Chapter 1: Getting started as a member 8 how you usually pay your plan premium, unless your monthly benefit isn’t enough to cover the extra amount owed. If your benefit check isn’t enough to cover the extra amount, you will get a bill from Medicare. You must pay the extra amount to the government. It cannot be paid with your monthly plan premium. If you do not pay the extra amount you will be disenrolled from the plan and lose prescription drug coverage. If you disagree about paying an extra amount, you can ask Social Security to review the decision. To find out more about how to do this, contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778). Section 5 More information about your monthly premium Section 5.1 Can we change your monthly plan premium during the year? Monthly plan premium changes and employer-sponsored benefit changes are subject to contractual arrangements between your plan sponsor (PEBB) and us, and as a result, monthly plan premiums generally do not change during the plan year. Your plan sponsor is responsible for notifying you of any monthly plan premium changes or retiree contribution changes (the portion of your monthly plan premium your plan sponsor requires you to pay) prior to the date when the change becomes effective. However, in some cases, your plan sponsor may need to start paying or may be able to stop paying a Late Enrollment Penalty. (The Late Enrollment Penalty may apply if you had a continuous period of 63 days or more when you didn’t have “creditable” prescription drug coverage.) This could happen if you become eligible for the “Extra Help” program or if you lose your eligibility for the “Extra Help” program during the year: · If your plan sponsor currently pays the Part D late enrollment penalty and you become eligible for “Extra Help” during the year, your plan sponsor would no longer pay your penalty. · If you lose Extra Help, you may be subject to the late enrollment penalty if you go 63 days or more in a row without Part D or other creditable prescription drug coverage. You can find out more about the “Extra Help” program in Chapter 2, Section 7. Section 6 Keeping your plan membership record up to date Your membership record has information from your enrollment form, including your address and telephone number. It shows your specific plan coverage. Let us know about these changes: · Changes to your name, your address, or your phone number. · Changes in any other medical or drug insurance coverage you have (such as from your employer, your spouse or domestic partner’s employer, Workers’ Compensation, or Medicaid).