Medicare D Delivery System Claims Adjudication Retiree Benefit Outsourcing Short Term Disability COBRA Flexible Spending Accounts Health Reimbursement Accounts (HRA) Health Savings Accounts (HSA) High Deductible Plans Consumer Directed Plans	Case Management National Vendor Access Custom Plan Designs Cost Analysis & Plan Recommendations Provider Verification Wellness Programs Online Capabilities Reinsurance

Medicare D Delivery System Includes

• ACTUARIAL STUDY: Arrange for and obtain Actuarial Study through our relationship with a National Actuary, using claim reports provided by the client. Pure cost is passed through to the client.
• SUBSIDY: PBS will perform these services.
  • Initiate RDS application for client, acting as Account Manager
  • submit retiree eligibility list and maintain the eligibility for 12 month process
  • communicate with and obtain claims data reports from PBM *
  • submit monthly, quarterly or annual claims to collect subsidy
  • track and submit revisions to subsidy requests
  • initiate and submit year-end reconciliation
  • communicate with retirees
  • setup account for collection of EFT
  • perform monthly reconciliation of account for accurate EFT
  • monitor RDS website for advice, corrections, approvals, new information
  • allocate prescription drug rebates

* Where there is a charge to receive claims data, pure costs will be passed on to the client.

• MEDICARE D: PBS will enroll retiree groups in the Medicare D plan and bill the monthly premium to the retiree. Individuals may also be enrolled and billed by the PBM.
• EMPLOYEE COMMUNICATIONS: PBS will develop all retiree communications (with the authorization of the client) and deliver as written materials, meeting handouts and will conduct retiree meetings upon the request of the client.
• APPLICATION PROCESS: PBS will provide assistance in the application process and submit all applications to the PBM for Medicare D.
• ANNUAL AND INTERMITTANT CREDITABLE COVERAGE LETTERS: PBS will generate and mail both creditable and non-creditable coverage letters.
• DETERMINATION OF CREDITABILITY: If the client is able to provide a one year claim summary, by individual, PBS will perform the analysis and recommendation on the creditability.
• MEDICARE D WRAP/ENHANCEMENT: PBS will design a wrap/enhancement to the plan to meet the client’s objectives and determine the cost of the supplemental plan.