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UCBCares® 1-844-599-CARE (2273)

This site is intended for US residents.
UCBCares® 1-844-599-CARE

Help coordinating health insurance

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Health insurance approval can be complicated. CIMZIA is considered a specialty drug, and insurance companies often have special requirements that must be met before they agree to cover your medication. For instance, you may have to have failed on another drug for the treatment of AS before taking CIMZIA. That’s where CIMplicity®b can help. We can verify whether CIMZIA is covered under your insurance plan. This is called a benefits investigation. We can help your doctor’s office with paperwork the insurance company may require before starting CIMZIA, sometimes referred to as prior authorization.

Your coverage How we can help

Commercial or private insurance

Insurance typically provided by your employer or a private insurance carrier

For general insurance help:
Call 1-866-4-CIMZIA (1-866-424-6942, option 2)


Government insurance

Medicare, Medicaid, or other government insurance plan

Call 1-866-4-CIMZIA (1-866-424-6942, option 2) and an advocate will help you

No insurance

If you are uninsured, other financial assistance may be available through the Patient Assistance Program (PAP)

Call 1-866-395-8366 (option 4) and we may be able to put you in touch with an independent organization that can help

Your coverage

Commercial or private insurance

Insurance typically provided by your employer or a private insurance carrier

Government insurance

Medicare, Medicaid, or other government insurance plan

No insurance

If you are uninsured, other financial assistance may be available through the Patient Assistance Program (PAP)

How we can help

For general insurance help:
Call 1-866-4-CIMZIA (1-866-424-6942, option 2)


Call 1-866-4-CIMZIA (1-866-424-6942, option 2) and an advocate will help you

Call 1-866-395-8366 (option 4) and we may be able to put you in touch with an independent organization that can help

Private (commercial) insurance

This type of insurance is often offered by an employer, or you can buy insurance through a private (not government) insurance provider.

Under the Affordable Care Act (ACA), everyone must have a major medical insurance policy. The Health Insurance Marketplace (also known as the Exchange) can help you learn more about health insurance plans available in your state. You’ll be able to compare them based on cost, benefits, and other features. Visit HealthCare.gov for more information about coverage available in your state.

Many people are offered health insurance by their employers. Programs vary, especially in terms of coverage, co-pays, and deductibles. The cost to the employee can also vary from employer to employer or plan to plan. You can also purchase private insurance in instances where you are not employed, your employer doesn’t offer insurance, or you simply choose to buy it on your own.

Things to consider:

  • Different insurance plans cover different amounts of your co-pay and deductible

  • Medicine may be covered under either medical benefits or pharmacy benefits, depending on the type of medication and/or where it’s taken

  • If you take prescription drugs, the company that makes your medicine may have a co-pay savings program. Contact the drug company for more information

  • If you receive your insurance through your employer, you may only be able to change plans during their open enrollment period. Contact your HR representative to find out when open enrollment begins and ends

About the Health Insurance Marketplace (the Exchange)

The Health Insurance Marketplace (also known as the Exchange) was created through the Affordable Care Act (ACA), also known as “Obamacare.” The Exchange is your state’s price comparison website for government-supported (subsidized) health insurance.

Each year, there is an open enrollment period. This is the only* time you can enroll in a plan, switch plans, or apply for cost assistance.

*Certain life events may qualify you for a special enrollment period.

The Health Insurance Marketplace provides:

  • A side-by-side comparison of insurance prices and benefits

  • Health coverage options for people without insurance who are looking for private individual and family plans

  • Premium tax credits for individuals earning less than $47,080* and families earning less than $63,720 (family of 2, amount varies depending on family size)

  • Health coverage for individuals who do not have access to affordable, quality health insurance (even if the individual has access to employer-based insurance)

  • An application for Medicaid (for individuals who earn less than $16,243*†)

  • Small Business Health Options Program (SHOP), which helps small businesses with fewer than 50 full-time employees find health insurance

*Annual salaries are based on the 2015 Federal Poverty Limit (FPL) guidelines. For more information and to see the full FPL table, please visit http://obamacarefacts.com/federal-poverty-level/.

Maximum eligibility for Medicaid in states that expanded Medicaid through the ACA. For states that did not expand Medicaid, the FPL is 133%.

Many states have their own Exchange, but www.healthcare.gov is the official Health Insurance Marketplace website.

Things to consider:

  • Different insurance plans will cover different amounts of your co-pay and deductible

  • If you take prescription drugs, the company that makes your medicine may have a co-pay savings program. Contact the drug company for more information

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Short-term and supplemental insurance

This is a type of insurance that is temporary or in addition to major medical coverage. It is often purchased when you're in between jobs, a student, a seasonal worker, or if you missed an open enrollment period at work.

Short-term insurance

Short-term health insurance is temporary health insurance when you’re in between coverage. It is not considered minimum essential coverage.

Some individuals and families choose short-term insurance because they need:

  • A temporary solution because they are in between jobs, a temporary or seasonal employee, a recent college graduate, or missed the open enrollment periods

  • Something to cover them while traveling out of network

  • Protection against unforeseen illnesses or accidents (also known as catastrophic coverage)

  • A low cost and quick approval

  • Coverage until their Exchange plan starts

Supplemental insurance

Supplemental insurance is meant to be in addition to your major medical health insurance plan. It is sold by private companies (not provided by the government regardless of your income level). These plans can help pay some of the healthcare costs that your health insurance plan does not cover, like co-pays, coinsurance, and deductibles.

Some individuals and families choose a supplemental plan because:

  • They have specific medical needs that go beyond their regular health insurance plan

  • They need a temporary plan to enhance their current health insurance plan until they can switch during open enrollment

  • They are transitioning between jobs

  • They need coverage for dental and vision only plans (which aren’t usually covered by most major medical plans)

  • They are traveling and their current medical plan does not cover healthcare costs outside their region

  • They qualify for Medicare but need additional support to cover out-of-pocket expenses (Medicare supplemental plans include Medicare Part D, Medigap, and Medicare Advantage)

Supplemental plans, including those in the individual, family, and Medicare markets, are purchased through private companies and are not available through government-sponsored websites.

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Medicare

Medicare is a health insurance program that is funded by the federal government. It is designed for people 65 and older, as well as people under 65 who have certain disabilities, regardless of your income level. Also, anyone with end-stage kidney failure may qualify. There are a number of coverage options depending on your individual needs.

Medicare Part A covers inpatient hospital treatment, including extended care facilities.

Medicare Part B is optional outpatient insurance to cover services and supplies that are considered medically necessary. This also covers most injectable medications given at your doctor’s office or in a hospital outpatient setting.

Medicare Part D, also known as the Medicare Prescription Drug Plan, offers optional coverage for outpatient pharmacies, adding prescription drug coverage to original Medicare.

Visit Medicare.gov for more information, to sign up, and to see what kind of coverage you may be able to receive.

Medicare is a federally funded health insurance program for:

  • People ages 65 or older

  • People under 65 with certain disabilities

  • People of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant)

Medicare coverage is based on 3 main factors:

  1. Federal and state laws.

  2. National coverage decisions made by Medicare about whether something is covered.

  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

If you qualify for Medicare but need additional support to cover out-of-pocket expenses, there are supplemental insurance options that may help. For Medicare enrollees, there are certain rules that you must follow in order to get supplemental insurance. Please see the table below for a summary or visit www.medicare.gov for more detailed information on any of the Medicare policies listed.

Medicare options

Original Medicare Coverage Costs

1.Medicare Part A

Inpatient hospital coverage; includes extended care facility (pays up to 80% of the cost)

Most people do not pay a monthly premium. In 2015, each person has a $1260 deductible for each benefit period. Once the deductible is fulfilled, most people are responsible for paying 20% of the Medicare-approved cost

2.Medicare Part B

Optional outpatient insurance to cover services and supplies that are considered medically necessary (pays up to 80% of the cost)

Most injectable medications given at your doctor's office or a hospital outpatient setting

In 2015, most people paid $104.90 each month, which is automatically deducted from their Social Security check. There is also a deductible of $147 for each benefit period

Enrollees are responsible for paying 20% of the Medicare-approved cost after they have fulfilled their deductible

Supplemental insurance*    

3.Medicare Prescription Drug Plan
(Medicare Part D)

Optional prescription drug plan for outpatient pharmacies (adds drug coverage to original Medicare)

Cannot be used with Medigap

Monthly premium, co-pays, and drugs covered can vary by plan (higher-income enrollees may pay more)

To join Medicare Part D, you will need to give your Medicare number and the date your Part A and/or Part B coverage started

4.Medigap

Medigap can help pay for costs that original Medicare doesn't cover, like co-pays, coinsurance, and deductibles

Medigap no longer offers prescription drug coverage, but you may be able to join the Medicare Prescription Play (Medicare Part D)

There are 10 different Medigap policies. Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which one they offer

Each private insurance company decides how it will set the price, or premium, for its Medigap policies

It is important to ask how an insurance company prices its policies. The way they set the price affects how much you pay now and in the future

The cost of Medigap policies can vary greatly. There can be big differences in the premiums that different insurance companies charge for exactly the same coverage. Make sure that when you are comparing insurance companies, you are also comparing the same Medigap plan

5.Medicare Part C
(Medicare Advantage)

A type of Medicare plan that is provided by a private company. These policies must provide the minimum benefits of Medicare Part A and Part B and generally provide drug coverage

Medigap policies cannot be used to pay your Medicare Advantage Plan co-pays, deductibles, and premiums

Most people pay the Part B premium ($104.90) each month in addition to their Medicare Advantage premium; you may also pay a co-pay or coinsurance for covered services. Costs, extra coverage, and rules vary by plan

Original Medicare

1.Medicare Part A

Coverage

Inpatient hospital coverage; includes extended care facility (pays up to 80% of the cost)

Cost

Most people do not pay a monthly premium. In 2015, each person has a $1260 deductible for each benefit period. Once the deductible is fulfilled, paying 20% of the Medicare-approved most people are responsible for cost

2.Medicare Part B

Coverage

Optional outpatient insurance to cover services and supplies that are considered medically necessary (pays up to 80% of the cost)

Most injectable medications given at your doctor's office or a hospital outpatient setting

Cost

In 2015, most people paid $104.90 each month, which is automatically deducted from their Social Security check. There is also a deductible of $147 for each benefit period

Enrollees are responsible for paying 20% of the Medicare-approved cost after they have fulfilled their deductible

2.Medicare Part B

Supplemental insurance*

3.Medicare Prescription Drug Plan
(Medicare Part D)

Coverage

Optional prescription drug plan for outpatient pharmacies (adds drug coverage to original Medicare)

Cannot be used with Medigap

Cost

Monthly premium, co-pays, and drugs covered can vary by plan (higher-income enrollees may pay more)

To join Medicare Part D, you will need to give your Medicare number and the date your Part A and/or Part B coverage started

4.Medigap

Coverage

Medigap can help pay for costs that original Medicare doesn't cover, like co-pays, coinsurance, and deductibles

Medigap no longer offers prescription drug coverage, but you may be able to join the Medicare Prescription Play (Medicare Part D)

There are 10 different Medigap policies. Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which one they offer

Cost

Each private insurance company decides how it will set the price, or premium, for its Medigap policies

It is important to ask how an insurance company prices its policies. The way they set the price affects how much you pay now and in the future

The cost of Medigap policies can vary greatly. There can be big differences in the premiums that different insurance companies charge for exactly the same coverage. Make sure that when you are comparing insurance companies, you are also comparing the same Medigap plan

5.Medicare Part C
(Medicare Advantage)

Coverage

A type of Medicare plan that is provided by a private company. These policies must provide the minimum benefits of Medicare Part A and Part B and generally provide drug coverage

Medigap policies cannot be used to pay your Medicare Advantage Plan co-pays, deductibles, and premiums

Cost

Most people pay the Part B premium ($104.90) each month in addition to their Medicare Advantage premium; you may also pay a co-pay or coinsurance for covered services. Costs, extra coverage, and rules vary by plan

*Supplemental plans are purchased through private companies and are not available through government-sponsored websites.

Medigap policies can be priced (or rated) in 3 different ways: community-rated (pay the same premium, regardless of age), issue-age-rated (the younger you are when you buy, the cheaper it will be; price will not change as you age), and attained-age-rate (premium is based on your current age, so your premium goes up as you get older).

Things to consider:

  • If you are 65 years or older, you are eligible for Medicare

  • Other types of financial assistance may be available to use along with Medicare

  • Co-pay cards for prescription assistance cannot be used with Medicare

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Medicaid

Medicaid is a type of insurance that is provided by the state you live in. It is specifically designed to provide health coverage for:

  • Low-income adults

  • Children and pregnant women

  • People who qualify under an eligible category

  • People ages 65 and older

  • Individuals with disabilities

Visit Medicaid.gov for more information, to sign up, and to see what kind of coverage you may be able to receive.

Medicaid is provided by states based on federal requirements. It is jointly funded by states and the federal government and is available to individuals who earn less than $16,243.*

*Annual salaries are based on the 2015 Federal Poverty Limit (FPL) guidelines. For more information and to see the full FPL table, please visit http://obamacarefacts.com/federal-poverty-level/.

States create and provide their own Medicaid programs. Each state determines the type, amount, time, and scope of services available to eligible individuals. States are required to cover certain “mandatory benefits” and can choose to provide other “optional benefits” through the Medicaid program. If you have questions or need more detailed information, please visit www.medicaid.gov.

Things to consider:

  • There are eligibility requirements, and, in most cases, you will need to provide income verification

  • Deductibles and co-pays may be covered by Medicaid depending on your state’s plans

  • Co-pay cards for prescription assistance cannot be used with Medicaid

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aEligibility: Not valid for prescriptions that are reimbursed, in whole or in part, under Medicare (including Medicare Part D), Medicaid, similar federal- or state-funded programs (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico), or where otherwise prohibited by law. Product dispensed pursuant to program rules and federal and state laws. Claims should not be submitted to any public payor (ie, Medicare, Medicaid, Medigap, Tricare, VA, and DoD) for reimbursement. Patients and pharmacists are responsible for notifying insurance carriers or any other third party who pays for or reimburses any part of the prescription filled using this card as may be required by the insurance carrier's terms and conditions and applicable law. The maximum annual benefit amount is $11,000 per calendar year. The parties reserve the right to amend or end this program at any time without notice.

bThe CIMplicity program is provided as a service of UCB and is intended to support the appropriate use of CIMZIA. The CIMplicity program may be amended or cancelled at any time without notice. Some program and eligibility restrictions may apply.

Glossary: understanding insurance terms

Here is a list of insurance-related words you may need to understand.
For a downloadable PDF of the glossary, click here.

Benefit period: The amount of time you are covered under the terms of your insurance plan.

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Benefits investigation: Checking to see if a service or prescription is covered under your insurance plan.

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Coinsurance: Your share of the cost of a covered healthcare service, usually a percentage of the allowed amount for the service (for example, 10%). You pay coinsurance after you’ve met your deductible.

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Co-pay: A flat fee you pay for certain covered services such as a doctor's visit or prescriptions. The amount can vary depending on the type of insurance you have or the service being performed.

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Co-pay savings program: Usually sponsored by a drug company, these programs offer assistance paying the co-pay portion of a particular treatment or service.

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Deductible: A flat dollar amount you must pay out of your own pocket before your plan begins to pay for covered services.

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Exchange plan: The insurance you set up through the Healthcare Marketplace.

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Income verification: Proof of how much money you earn from your job or receive through government assistance.

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Inpatient: Healthcare treatment you receive when you're admitted to a healthcare facility like a hospital or nursing facility.

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Medically necessary: Healthcare services or supplies that are needed in order to diagnose or treat an illness, injury, disease, condition, or symptoms and that meet accepted standards of medicine.

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Medicare Advantage: Also known as Medicare Part C. This Medicare plan is offered by a private company that contracts with Medicare to provide you with Medicare Part A and Part B benefits.

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Medicare-approved cost: The amount Medicare will pay for a specific healthcare service or treatment.

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Medicare Part D: A program that helps pay for prescription drugs for people with Medicare.

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Medigap: Extra health insurance you can buy from a private company to pay healthcare costs not covered by original Medicare (for example, co-pays, deductibles, and healthcare if you travel outside the United States).

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Minimum essential coverage: The amount of insurance coverage a person needs to meet the individual responsibility requirement under the Affordable Care Act.

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Open enrollment period: The time period when a person can sign up for a health insurance plan.

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Out of network: When you receive healthcare services from providers who are not covered by your health insurance.

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Outpatient: When you receive healthcare services without being admitted to a hospital or healthcare facility.

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Premium: The amount of money that you must pay for health insurance. You (or your employer) may pay your premium every month, every quarter, or once a year.

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Prior authorization: Getting your health plan’s approval for a service or prescription ahead of time to be sure that service or prescription will be covered.

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Co-pay card

$0 co-paya when you use our Co-Pay Savings Card (eligibility restrictions and maximum limits apply).

CIMplicity
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aEligibility: Not valid for prescriptions that are reimbursed, in whole or in part, under Medicare (including Medicare Part D), Medicaid, similar federal- or state-funded programs (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico), or where otherwise prohibited by law. Product dispensed pursuant to program rules and federal and state laws. Claims should not be submitted to any public payor (ie, Medicare, Medicaid, Medigap, Tricare, VA, and DoD) for reimbursement. Patients and pharmacists are responsible for notifying insurance carriers or any other third party who pays for or reimburses any part of the prescription filled using this card as may be required by the insurance carrier's terms and conditions and applicable law. The maximum annual benefit amount is $11,000 per calendar year. The parties reserve the right to amend or end this program at any time without notice.

bThe CIMplicity program is provided as a service of UCB and is intended to support the appropriate use of CIMZIA. The CIMplicity program may be amended or cancelled at any time without notice. Some program and eligibility restrictions may apply.

UCBCares® 1-844-599-CARE (2273)

Monday - Friday 8:00 AM - 5:00 PM ET

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CIMZIA®, CIMplicity®, cimplicity®, and UCBCares® are registered trademarks of the UCB Group of Companies. All other trademarks and registered trademarks are the property of their respective holders.

©2016 UCB, Inc. All rights reserved.

©2016 UCB, Inc. All rights reserved.

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