Agent Guide AWASS0318

Transcription

1 AWASS0318 Agent Guide

2 Table of Contents Affiliated Workers Association (AWA)... 1 Eligibility & Rates... 2 State Availability Insurance Benefits...4 Plan Benefits Member Portal Mobile App Limitations & Exclusions Association Benefits Online Access...12 Frequently Asked Questions...13 Enrollment Form... 14

3 About Us Membership to Affiliated Workers Association (AWA) has its advantages. You are now part of a non-profit organization comprised of small business owners, self-employed professionals and entrepreneurs from all across America. AWA is committed to providing education, resources and benefits to help our members save money, time and grow their business. As an AWA member, you receive valuable resources for information to help you navigate through the complexity of running a business. You also have access to industry-leading benefits to help you and your family stay healthy and reduce expenses in your daily life, like telemedicine, insurance and roadside assistance. Who AWA Serves AWA membership is as diverse as their population, ranging from a shop owner in Texas to a freelance web designer in Pennsylvania. Membership is open to small business owners, independent contractors and entrepreneurs ages 18 and over, and can extend to the entire family. AWA s Approach One word that defines the AWA s commitment to their members: Empowerment. AWA works tirelessly to research resources and benefits that will help their members reduce overhead expenses and learn how to succeed in their business endeavors. AWA knows their members work hard for their money, and the AWA works hard for them. Seeking out the best benefit providers and assuring top-quality services is just part of the day-to-day business for the AWA. Our Partners The AWA is proud to be a strategic partner with a national advocacy group, Small Business Majority, to support their members in small business growth and provide information on issues that impact small businesses, including government, health care reform, clean energy, and other areas. 1

4 Eligibility/Rates Individuals may enroll in an AWA SureScript Rx membership if they meet the following eligibility requirements: Reside in an available state Adults age eighteen (18) or above Dependent children covered to age 26 Common Law Spouses and Domestic Partners are accepted AWA SureScript Rx Monthly Membership Rates* MEMBER $49 MEMBER + ONE $77 MEMBER + FAMILY $87 * One-time $25 enrollment fee applies. Fee is waived when Rx is added to an active AWA membership. 2

5 State Availability AWA SureScript Rx is Available in 46 states & D.C. CA OR WA NV ID UT MT WY CO ND SD NE KS MN IA MO WI IL MI OH IN KY WV PA VA NY VT NJ DE MD ME NH MA RI CT AZ NM OK AR TN MS AL GA SC NC HI TX LA FL AK Available Not Available AWA SureScript Rx is NOT Available in: AK, HI, NY, WA. 3

6 4 Plan Benefits

7 Plan Summary OptumRx OptumRx is a Pharmacy Care Services company delivering value by helping members get their medication safely and conveniently. They evaluate medications to make sure members have access to the medications they need at the best price. This insured drug benefit covers most of the commonly prescribed generic drugs and preferred brand name drugs at low member co-pays. In addition, this benefit allows members to purchase non-preferred brand name drugs and non co-pay generics at a discounted rate, which can typically save them anywhere from 10% to 70% off of the pharmacy s retail charge. It should be noted that savings will vary depending on the specific prescription drug purchased and where it is purchased. The pharmacy network has over 66,000 pharmacies nationwide, which includes all the major chains and most of the nation s independent pharmacies. The program will cover up to a 30-day supply of covered medication up to the $150 monthly maximum with a valid prescription. Retail Co-Pays & Monthly Maximum Generic $15 or 50% (whichever is greater) Preferred Brand Name $24 or 50% (whichever is greater) Monthly Maximum $150 per covered person Drugs not included on the AWA formulary are 100% retail cost, however, members will receive the OptumRx discounted rate. Non-formulary drugs do not count toward the monthly maximum. Generic Drug Facts 1 Generic medicines are the same high quality as their brand-name versions Generic drugs go through a rigorous review process to receive FDA approval. The FDA ensures a generic medication provides the same clinical benefit and is as safe and effective as the brand-name medicine that it duplicates. Generic and Brand-name medicine have the same active ingredients, effectiveness, quality, safety, strength and benefits. But they can look different Allowable differences in size, shape, and color do not impact how medications work. Generic medicines may look different than the brand-name drugs they duplicate, but they are as safe and effective. And they can cost a lot less money Generic medicines tend to cost less than their brand-name counterparts because they do not have to repeat animal and clinical (human) studies that were required of the brand-name medicines to demonstrate safety and effectiveness. When multiple generic companies market the same product, market competition typically results in prices about 85% less than the brand-name. Many prescriptions have a trademark or brand name, as well as a chemical or generic name. By choosing a generic medication, you can save money without compromising quality. Consult with your doctor or pharmacist about lower cost options for your prescriptions. Visit optumrx.com to locate participating pharmacies and access the online drug pricing tool. The drug pricing tool will assist you in anticipating your potential drug costs. Remember to present your ID card at the Pharmacy. Your ID card will have all the information needed to fill a prescription. If there is a problem with the pharmacist or the pharmacy network, please have the pharmacist call the Pharmacy Help Desk at (800) If you have any questions about your prescription benefit, please contact RxBenefits Member Service at (800)

8 Member Portal optumrx.com The OptumRx consumer portal empowers members to become informed advocates of their own health by allowing them to easily manage and gain deeper insight into their prescription benefits. Simple The responsive design makes it easy for consumers to access their complete profile to manage their prescription benefits on any device. Smart With accurate drug pricing, proactive messaging on cost savings and all of the user s real time benefits information is readily available. Seamless Members can enroll in text message reminders for taking their medications as well as when they need to refill or renew prescriptions. My Medicine Cabinet Upon log in, members will see their My Medicine Cabinet dashboard. This makes it easy for them to view their real time benefits and access the many tools and features to help them manage their medications and health from a single page. Once registered on the website, users can access: Household access Ability to manage prescriptions on behalf of family members Proactive savings messaging Advocates for the member by providing proactive ways to save Member tools Provides easy access to the most commonly used member tools throughout the site Medicine cards Provides visibility to the most relevant information for medications a member takes 6

9 Mobile App The OptumRx app The most convenient way to manage your prescriptions. Simple You can easily refill a medication or locate a participating pharmacy. Current Prescription Drug Lists change frequently; the OptumRx App updates automatically, giving you quick access to the most current drug coverage information. Personalized Access a complete profile of your prescriptions when you view your online Medicine Cabinet. You can see all your recent and past prescriptions. Save time and money Compare prescription drug options as well as identify potential cost savings. You can easily: Find drug prices and lower-cost options View your prescription claim history Locate a pharmacy Set up refill reminders 7

10 Limitations & Exclusions Benefits are not payable for: Medications which do not require a prescription order, even if one is written, and medications which are not considered essential for the necessary care and treatment of an injury or sickness. Medications which are not prescribed in accordance with FDA-approved uses and any medication prescribed or dispensed in a manner contrary to normal medical practices. Medications administered by a physician or prescriber, and those not dispensed at a pharmacy such as those you receive at your doctor s office, in a hospital, clinic or other care facility. Medications for which the cost is recoverable under a government program, Workers Compensation, occupational disease law, or medications for which no charge is made to you. Immunization agents, allergy sera, biological sera, and charges for the administration or injection of medications. Any medication labeled Caution - limited by Federal Law to Investigational Use or experimental medications Drug classes that are excluded include injectable and intravenous drug forms, fertility, genetically engineered, growth hormones, cosmetic, smoking cessation, male sexual dysfunction, vaccines and certain diabetic supplies. Excluded generic and brand drugs are available to you under the non-covered drug portion of the program. Higher dosage strength forms of certain medications, extended release forms, kits patches and combinations products (such as compounded medications) are often excluded under the co-pay program. Same strength forms of certain medications, extended release forms, kits, patches and combination products (such as compounded medications) are often excluded from coverage under the co-pay program. Patient assistance programs may not apply to deductible and out of pocket accumulations. New to market drugs, including line extensions and new strengths until clinically reviewed. AWA SureScript Rx Plan Group #: RXBENEFIT RxBenefits Member Service (800)

11 Association Benefits 9

12 HealthFitLabs Association Benefits HealthFitLabs is an online merchant that sells only the highest-quality natural vitamins, nutritional supplements, and bath and personal care products. Visit to browse several different product search options including categories such as Healthy Lifestyle, Vitamins & Minerals, Bath & Personal Care, and Healthy Pets. Members can also search by health condition. For instance, they have supplements for Eye Health Support, as well as others like Blood Sugar Support, Mood Support and more. Or shop by brand name; there are 1,900 products available on their website. Most vitamins are available to ship within 24 hours. Members save an additional 20% off already reduced prices on their first order at checkout. HealthFitLabs is dedicated to helping members meet their health goals at the best possible prices. Health & Wellness Spa Treatments Receive a discount on Spa Week gift cards that can be used toward health and wellness spa treatments available in more than 9,000 locations, now available 365 days a year. The Spa Week concept was created with a simple goal in mind: to bring the spa & wellness experience to the masses by offering full service treatments at lower prices for a week. The concept was so popular that it is now offered all year round! Take control of your overall health and wellbeing by using resources designed to address your wellness. Through resources like massage therapy, chiropractic services, aromatherapy, foot reflexology and more, you can proactively manage your wellness for less! Treatments include: Beauty Body Treatment Chiropractic Services Facial Fitness Hair Massage Men s Grooming Nails Prenatal Wellness Be sure to check the Spa Week site regularly for exclusive deals with up to 75% off luxury services and wellness packages nationwide. 10

13 Online Membership Access Member Portal All memberships include exclusive access to our online Member Portal, a secure, convenient website that helps members to manage their membership. Visit: members.affiliatedworkersassociation.org Through quick and easy access, members can: Review their benefit information, association benefits and account information Access benefit partner websites for valuable health care savings Download and print Member materials Update contact information Add a new form of payment Important Agent Note: Initial access to Member Portal requires a valid address. Be sure to capture at time of enrollment. 11

14 Frequently Asked Questions Q. When can members begin using their Rx and other benefits? A. Members can begin using their benefits on their plan s effective date, subject to the terms and conditions of the plan. Q. Can members access their AWA SureScript Rx plan membership information online? A. Yes, membership includes access to our secure online Member Portal - members.affiliatedworkersassociation.org. Once logged in, members can view, download and print their member materials, including a temporary ID card and benefits guide, as well as access phone numbers, web links and information regarding their AWA SureScript Rx plan membership. Q. What is a Formulary? A. A formulary is a list of commonly prescribed medications specifically chosen for this plan for their safety, cost and effectiveness. Drugs are listed by common categories or class. They are placed into cost levels known as tiers. It includes both brand and generic prescription medications approved by the U.S. Food and Drug Administration (FDA). Q. How do members use the Formulary? A. The AWA SureScript Rx plan includes Tiers 5 & 6. When choosing a medication, members should use the online Drug pricing tool. It will help members choose the most cost-effective prescription drugs. If the member has a question regarding drug coverage, please visit optumrx.com or call RxBenefits Member Service at (800) Q. Why are some medications excluded from the plan? A. The AWA SureScript Rx plan has a set formulary and not all medications are covered. Drugs not included on the AWA formulary will display Plan Pays $0.00 and are 100% retail cost, however, members will receive the OptumRx discounted rate. Non-formulary drugs do not count toward the monthly maximum. Q. Should members talk to their doctor about OTC medications? A. An OTC medication may be the right treatment option for some conditions. Members should talk to their doctor about available OTC options. Even though these medications may not be covered under the plan benefits, they may cost less than the out-of-pocket expense for prescription medications. Q. What is the difference between brand-name and generic medications? A. Generic medications contain the same active ingredients (what makes the medication work) as brand-name medications, but they often cost less. Once the patent of a brand-name medication ends, the FDA can approve a generic version with the same active ingredients. These types of medications are known as generic medications. Sometimes the same company that makes a brand-name medication also makes the generic version. Q. Is Home Delivery an option? A. At this time, Home delivery is not included on the AWA SureScript Rx plan. The OptumRx consumer portal serves customers from a variety of non-awa plans, some that include Home Delivery. However, Home Delivery will display as Not Available for AWA members. Q. What if the member s doctor writes a brand-name prescription? A. If a member s doctor gives them a prescription for a brand-name medication, they should ask if a generic equivalent or lower-cost option is available and if it might be right for them. Generic medications are usually the lowest-cost option, but not always. Members should visit optumrx.com to make sure. Q. Are specialty medications included in the AWA SureScript Rx plan? A. Specialty medications treat rare or complex conditions and are typically higher cost medications. Specialty medications are 100% retail cost, however, members will receive the OptumRx discounted rate. Q. Who can members call if they have questions? A. Please contact AWA s Customer Service at (855) and one of our friendly representatives will be glad to help them! 12

15 Enrollment Form 13

16 * Fields are required. SureScript Rx Enrollment Form GROUP OR ASSOCIATION Affiliated Workers Association Requested Effective Date Are you an Entrepreneur, Self-Employed Professional or Independent Contractor? * Yes No Enrollee Name * Enrollee Address * City * State * Zip * Social Security Number Daytime Phone Number * Date of Birth * Address * Gender: Male Female AWA SURESCRIPT RX MEMBERSHIP PLAN OPTIONS (One time $25 enrollment fee applies on the Stand-Alone membership) Plan Type: Stand-Alone Add-On Plan Tier: Member Member + Spouse Member + Child(ren) Member + Family SPOUSE & DEPENDENT INFORMATION (Write spouse s name below if you are applying for Enrollee and Spouse or Enrollee and Family Plan; if no spouse or if spouse is not to be enrolled, put N/A or None in space below.) Spouse s Name Date of Birth * Social Security Number Gender (M/F) Dependent Name Date of Birth * Social Security Number Gender (M/F) Dependent Name Date of Birth * Social Security Number Gender (M/F) Beneficiary * (Please print full name) Relationship (The enrollee will be the beneficiary for his or her spouse and/or dependent children if dependents are enrolled unless designated otherwise.) I hereby enroll as a member of the Affiliated Workers Association (the Association ). I appoint the Secretary of the Association in office at any particular time as my proxy to receive notice of and attend all meetings of the members and vote on my behalf and to otherwise act for me in the same manner and with the same effect as if I were personally present. This proxy shall be valid until revoked at any time prior to voting at any meeting by executing and delivering a written notice of revocation to the Secretary of the Association, by executing and delivering a subsequently dated proxy to the Secretary of the Association or by voting in person. By signing below, I and the individuals named herein are eligible for membership. I understand that the vision Insurance benefits included in my membership are not intended as a replacement for major medical coverage. The benefits will not satisfy the individual mandate as defined by the Patient Protection and Affordable Care Act. The membership will not begin until the effective date shown on the Policy. I authorize the Affiliated Workers Association to collect any and all premiums for this membership. By signing below, I acknowledge that I have read, understand, and agree to the terms and conditions of membership as they have been presented to me. CREDIT CARD OR AUTOMATIC BANK DRAFT Credit Card Type Card Number Expiration Date Security Code Bank Name Routing Number Account Number Applicant Signature Date Agent Signature Agent Name (Print) Agent Number

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