Fresno Unified School District

Transcription

1 Envision Insurance Company Fresno Unified School District Saturday, September 27, 2014 Presented by: Jim McDonough Director Employer Group Waiver Plans

2 Envision Insurance Company (EIC) Question: Who is Envision Insurance Company (EIC)? EIC is 6 th largest Medicare Part D Company Currently have over 400K members enrolled in our Part D programs Current Part D Rx Administrator for the Fresno Unified School District Medicare Retirees Name of your program: EnvisionRx Plus Employer Group Toll Free Customer Service: Available 24/7, year round 2

3 Question: What is the EnvisionRxPlus Retiree Plan? The plan consists of two separate but integrated plans: 1. The first is the Prescription Drug Plan (PDP) that is a Centers for Medicare and Medicaid (CMS) approved Part D plan called an Employer Group Waiver Plan (EGWP). These benefits mirror the Medicare Part D Standard Plan. 2. The second is what is referred to as Wrap plan that supplements the EGWP. The Wrap fills in gaps and covers most of the costs and prescription drugs that the Medicare Part D standard plan does not. Together, the plans are meant to provide coverage consistent with the Active Employee prescription plan. 3

4 Question: Who Is Eligible For The EnvisionRx Plus Retiree Plan? Medicare eligible retirees and their Medicare eligible spouses/dependents The District requires its retirees to be enrolled in Medicare Part A and Part B, once eligible. Dependents not eligible for the EnvisionRx Plus Plan are still eligible for coverage under District s commercial plan with Citizens Rx. 4

5 Question: How do I become enrolled? Most Medicare retirees are already enrolled in the EnvisionRx Plus Plan. Those eligible and not enrolled target enrollment date is January 1, Members who become Medicare eligible in 2015 and after will automatically be enrolled shortly after their 65 th birthday and enrollment in Medicare. You have the right to opt-out. If you choose to opt out of the plan you will not be allowed to re-enroll in the District s Rx coverage. You can remain covered under the medical coverage. 5

6 Question: What can I expect in the mail? The government requires that all Medicare Part D Plans send a variety of communications both prior to and following enrollment to ensure you understand key procedures, rights and responsibilities. If you have any questions, Call us at (available 24/7, year round) 6

7 Pre-Enrollment Mailings Welcome Letter Explaining Your Ability To Opt-Out Of The Plan Summary of Benefits Welcome Packet Welcome Letter ID Card for the EnvisionRx Plus plan Evidence of Coverage List of Drugs on the FUSD Medicare formulary Pharmacy Directory Mail Order Brochure After Enrollment Explanation of Benefits Transition Letters Annual Notice of Change 7

8 Question: What are the benefits? Plan design remains the same: $10 copay for Generics $35 copay for Brand and Specialty Drugs Same copays for Retail purchases and Mail Order purchases days supply Retail days supply for Mail Order 8

9 Question: What Drugs Are Covered? EnvisionRxPlus has worked with the District to ensure the same drugs covered under the Citizens Rx plan are covered under this plan. The list of drugs will be mailed to you or you can see the formulary at 9

10 Question: What Pharmacies Can I Go To? Envision has over 60,000 network pharmacies in the USA. You can access the pharmacy locator function by visiting us at A Pharmacy Directory will be mailed each November. 10

11 EnvisionRx Plus Employer Group Question: Can I have my prescriptions delivered via Mail Order? Absolutely. Orchard Pharmaceutical Services is the mail order pharmacy vendor. They can be contacted via phone at or online at 11

12 Question: What If I Have Other Questions? You have several options available to you. -Call our Member Services hotline at (TTY/TDD Users should call 711). This is available to you 24 hours a day, 7 days a week. -You can send an to Customerservice@envisionrxplus.com. -You can write us at: EnvisionRxPlus E. Aurora Rd., Suite 201 Twinsburg, OH You can fax us at:

13 Thank You! Additional Questions 13