“We take care of the Customer…and then some!”
What to Expect Moving Forward Changes New Deductible Year 9/1/2019 – effective 8/31-2020 September 1st: Spousal Carve-Out Unified Group Services True Rx AdvantUs Network
Benefit Plan Design
Open Enrollment Your open enrollment period ends on August 23 rd , with an effective date of September 1 st . Remember, open enrollment is your one opportunity each year to make changes to your coverage unless you have a qualifying event such as marriage, birth or adoption. Effective 9/1, spouses who have coverage available through their employer will no longer be eligible as a dependent on your benefit plan. This spousal carve-out provision counts as a qualifying event for your spouse to enroll on their employer’s benefit plan.
Welcome to Unified! 5 •Effective September 1st, Unified will begin processing Medical and Rx claims for New Castle Community Schools’ Members and their dependents! • Customer Service Excellence – (800) 291-5837 • Dedicated Claims Account Manager – Jayna • Group Health Plan Number - 6175 • Member Website – UnifiedGrp.com
Utilization Review 6 6 Utilization Review ensures that a patient receives the best possible and most appropriate care, while also ensuring that health care costs are managed in the most efficient and effective manner. If you have one required procedures scheduled, you will need to call Narus Health at 877.499.1774 . It is ultimately the patient’s responsibility to ensure that precertification has occurred or a penalty may apply. Procedures that require precertification will be listed on your new Unified Medical ID Card.
Member Website “We take care of the Customer…and then some!”
UnifiedGrp.com 8 8 UnifiedGrp.com is a secure way to view your benefits information online and at your convenience. To access UnifiedGrp.com please refer to the instructions enclosed in your packet. Check Claim Status View your Deductible Print Forms Access online wellness Email claims account Request ID Cards tools manager
UnifiedGrp.com 9
View Claims 10
Email Claim Questions 11 The claim number will auto-populate. When you type in your question and hit submit it goes directly to your Claims Account Manager. This helps to expedite the response back to you.
MyActiveHealth Engagement Platform 12 Includes: Functions: Personal health summary Pre-populated with medical, – – lab, and Rx claim data Alerts/Member Messaging – Ability to add personal health – Customized action items and reminders – information Health Risk Assessment (HRA) – Ability to print a list of – Family history information – medications Health information research and medical – Provide your physicians the – dictionary ability to review relevant clinical data Can easily change your entire – Engagement Platform from English to Spanish and vice versa Includes a calendar to ender – appointments and then receive reminders for those appointments Includes pre-populated intake – and immunization forms for visits to new doctors and schools/camps
ID Cards 13 New ID card(s) will be mailed to your home. Due to the closing date of open enrollment, ID cards will not be delivered until after 9/1. You may access an ID card via UnifiedGrp.com after September 1 st . Please remember to discard all old ID cards and begin to use your new ID card(s) September 1 st and beyond. Show your new ID card to all of your family’s health care providers at the next visit to ensure that your claims are submitted correctly. Also, please contact us if you need any additional ID cards.
YOUR NEW PRESCRIPTION BENEFIT PLAN EFFECTIVE SEPTEMBER 1, 2019 www.truerx.com
Prescription Services 15 Current Medications – To ensure a smooth transition please fill any medications prior to 9/1. If you have been receiving a mail order prescription you will need to enroll in the new Mail Order Program to continue receiving a 90 day supply mailed to your home. You may also request a 90 day prescription from your doctor and obtain a three month supply at your retail pharmacy. Pharmacy Exclusions – CVS & Walgreens will no longer be a part of the pharmacy network. Be sure to locate an in-network pharmacy and ask the pharmacist to assist with transferring your prescription. Rx Help Centers – The Rx Help Centers program will continue, and the process will be more streamlined with the addition of True Rx as your Pharmacy Benefit Manager. All specialty medications will be excluded from the benefit plan. Log onto UnifiedGrp.com to access an application to enroll in the Rx Help Centers program.
Rx Copays & OOP 16 HDHP Plan Rx & Medical Deductible Single $2,700 Family $5,300 Rx & Medical Maximum OOP Single $5,400 Family $10,600 30 Day Supply 90 Day Supply Generic $10.00 $25.00 Preferred Brand $30.00 $75.00 Non-Preferred Brand $60.00 $180.00
Rx Copays & OOP 17 PPO Plan Rx Only Maximum OOP Single $5,900 Family $11,800 30 Day Supply 90 Day Supply $7.00 $14.00 Generic Preferred Brand $21.00, or 20% up to $42.00 $250 Non-Preferred Brand $21.00, or 20% up to $42.00 $250
90 Day Supply 18 90 day supply prescriptions can be conveniently filled at a retail pharmacy or through mail order services. If you are currently filling through mail order and wish to continue, a new prescription will be required from your healthcare provider. Your provider will submit a new prescription to Postal Prescription Services for mail order service. True Rx ’s pharmacy network consists of over 65,000 pharmacies nationwide, including many retail chains and independent pharmacies. Please call True Rx Customer Service for more information about the mail order services.
True Rx Member Access 19 True Rx offers patients secure online Member Access with you in mind. This secure internet site and mobile app allows access to prescription profiles and other important prescription information by visiting truerx.com or searching True Rx in the app store. This service will be available to you starting September 1 st . • Claim History – allows you to view prescription claims paid by your plan. • Coverage Limits and Payment Details – enables you to view your pharmacy claim deductible information or coverage phase. • Drug Information - enables you to access a drug dictionary and search drugs and conditions. It also contains a drug interaction component enabling you to compare drugs and possible interactions or side effects. • Drug Pricing - prices drugs by applying your specific co-pay or co-insurance that would most accurately reflect what you would pay for the prescription at the pharmacy. You can also compare price across multiple pharmacies. • Pharmacy Locator – you can identify nearby network pharmacies with addresses and location hours
CUSTOMER SERVICE Monday through Friday, 8am-6pm EST Toll Free (866) 921-4047 CustomerService@truerx.com
Using Your Direct Network 21 •St. Vincent Health •Henry Community Health, Daviess Community Hospital, Tier I Hancock Regional •Midwest Behavioral Health, Magellan, Little Clinic •Any emergency care, urgent/emergency care while traveling In-Network •Lowest cost to the member and to New Castle Schools • Services can be rendered outside of the St. Vincent Direct Network Tier II • CIGNA’s discounts applied • Higher deductibles and out of pocket costs Out-of-Network apply
Tier One Network Access 22 • Henry Community Health EMPLOYEE • St. Vincent Hospitals and Providers • St. Vincent Neighborhood Hospitals • Hancock Regional Health Hospitals BENEFITS? NETWORKS? CO-PAYS? and Providers • Little Clinics (Inside Kroger Stores) CARE MANAGEMENT & WELLNESS? • Daviess Community Hospital CLINIC, HOSPITAL, URGENT CARE, SPECIALIST? • Behavioral care through Midwest Behavioral Health WHO IS FOLLOWING UP WITH ME? • Chiropractic care through Magellan Chiropractic HOW DO I ACCESS INFORMATION? • 5000+ primary and specialty care physicians HEALTH GOALS
True Rx Member Access 23 Unified Group Services serves as the third • party administrator and works with St. Vincent Direct to provide all member services Those using out-of-network services will be • encouraged to move to an in network provider and to utilize services at the Employee Wellness Center Unified and St. Vincent Direct will work with • members on complex care continuity or transition requirements to meet needs and minimize costs for New Castle and the member
Any Questions?
Recommend
More recommend
