Middlesex Borough Board of Education

Transcription

1 Middlesex Borough Board of Education 8/1/18 Medical and Prescription Transition Employee Benefits Consulting & Brokerage I Labor Relations & Human Resources Support Client Services & Claims Adjudication I Compliance & Regulatory Guidance I Enrollment & Decision Support Technology Wisdom. To your benefit. TM

2 Agenda Introductions & Housekeeping Transition from Horizon to AmeriHealth Transition from Horizon to Benecard Open Enrollment What You Need to Know Contact Information Q & A Wisdom. To your benefit. TM

3 Introductions & Housekeeping Brown & Brown Benefit Advisors, the district s broker, is leading the transition from Horizon to AmeriHealth. No change to the Horizon Dental plan. Benefits are guaranteed equal to or better than the Horizon plan you are currently enrolled in. Effective date is August 1, Enrollment: No enrollment forms are needed, unless you are making changes to your current elections. If so the forms are due to the Business Office by FRI June 29th. If not, you will automatically be enrolled into the plan that is equal to your current plan. Contact the Business Office for enrollment forms if you wish to make changes to your current election. Horizon Dental is NOT changing. Please hold on to your current ID cards. Wisdom. To your benefit. TM

4 Transition from Horizon to AmeriHealth New medical ID cards will be mailed to your homes. Make sure to present your new ID cards to your doctors as of 8/1/18. As of 8/1/18 please register/login to your member portal at There you can obtain a temporary ID card, view benefits and EOBs, access provider search, and more! Deductible and Coinsurance carryover credit for any accumulations during 1/1/18-7/31/18 will be submitted electronically in late August, with the data we receive from Horizon. Forms are also available. Transition of Care is available in certain cases. Disabled Dependents- special forms need to be completed for continuation of coverage beyond age 26. Lab Work- AmeriHealth s in-network lab is Labcorp. Prior-authorizations will not automatically transfer to the new carrier, and may be requested in certain circumstances. Wisdom. To your benefit. TM

5 Transition from Horizon to Benecard New Prescription ID cards will be mailed to your homes. Make sure to present your new ID cards to your pharmacies as of 8/1/18. As of 8/1/18 please register/login to your member portal at Prior-authorizations will not automatically transfer to the new carrier, and may be requested in certain circumstances. Wisdom. To your benefit. TM

6 Open Enrollment At Open Enrollment You Can: Enroll or remove a dependent Enroll yourself and any eligible dependents if currently waiving Waive coverage for a possible cash incentive If waiving you must complete a waiver form. You may re-enroll within 30 days as the result of a qualified life event or at open enrollment July 1 st for any reason. Change to a less expensive medical plan to INCREASE YOUR NET PAY Chapter 78 Contributions Calculator available: Enroll your child who is under 31 but over 26 if they qualify under Chapter 375 (special forms required) Wisdom. To your benefit. TM

7 WHY AMERIHEALTH NEW JERSEY? NCQA accredited health plan Access to one of the largest and strongest regional networks Dedicated account management team Strong commitment to health and wellness Ranked one of the Best Places to Work in NJ by NJBIZ six years in a row! Actively involved in New Jersey and your local community

8 PUBLIC EMPLOYER TRUST 63 CLIENTS 12,000+ MEMBERS Absecon BOE Avalon BOE Barrington BOE Bay Head BOE* Berlin Township BOE Borough of Highlands Borough of New Providence Clementon BOE Deerfield BOE Delanco BOE* Dunellen Boro BOE Edgewater Park BOE* Elsinboro BOE* Essex Fells BOE* Folsom BOE* Franklin Twp BOE* Frenchtown BOE* Garwood BOE* Haddon Heights BOE Haddonfield BOE Haddon Township BOE Hainesport BOE Lafayette BOE* Lawnside BOE Lopatcong BOE Magnolia BOE Mansfield Township BOE Mannington Township BOE Margate City BOE* Middlesex BOE* Milltown BOE Moorestown Township Mount Ephraim BOE Mullica BOE* National Park BOE New Hanover Township BOE Oaklyn Borough BOE* Palmyra HS District* Pennsville BOE Pine Hill BOE Pine Hill Fire Department Pine Hill MUA Pitman BOE Readington BOE Runnemede BOE* Salem City BOE Salem County Special Service School Distric Salem County Vo-Tech School District* Somerdale BOE Somers Point BOE South Hunterdon Schools Stone Harbor BOE Stow Creek Township School District Stratford BOE Surf City Borough Sussex County ESC Union County Vo-Tech School District Union Township BOE Verona BOE Wallkill BOE Washington Township BOE (Warren County Westville BOE Woodlynne BOE* * New Trust Client Effective 2018

9 NETWORK OPTIONS REGIONAL PREFERRED One of the largest networks of doctors, hospitals, and labs in New Jersey*. Seamless access into Southeastern PA and Delaware** Southeastern PA NJ Over 39,000 primary care physicians and specialists. DE *Data derived from analysis of information provided by a third party vendor and is subject to change. ** The AmeriHealth New Jersey service area includes all New Jersey and Delaware counties and nine Pennsylvania counties in the Philadelphia area including: Northampton, Lehigh, Bucks, Berks, Montgomery, Philadelphia, Delaware, Chester and Lancaster.

10 NETWORK OPTIONS NATIONAL ACCESS Access to one of the largest network in the region, Regional Preferred, plus access to PHCS when going outside of the Regional Preferred Service Area. Key stats: 4,750 hospitals 87,500 ancillary care facilities 229,000 primary care facilities 598,000 specialists

11 VISION PROGRAM OVERVIEW Plan Benefit Horizon AmeriHealth POS Eye Exam $5 Copayment $5 Copayment Hardware $50 Every Two Years $100 Every Two Years EPO Eye Exam $40 Copayment $10 Copayment Hardware $50 Every Two Years $100 Every Two Years PPO Eye Exam Not Covered Not Covered Hardware Not Covered Not Covered Non Routine Eye Care Specialist Copay when visiting a participating AmeriHealth provider

12 TECHNOLOGY & RESOURCES Online account management systems, personalized tools, and a variety of programs to help maximize benefits. Health insurance that s mobile. Online account management at amerihealthexpress.com or download the free AHNJ On the Go app Commit2Wellness Earn Wellness Dollars for completing an approved fitness program, smoking cessation program, or weight loss program. Provider Finder Find a provider quickly and easily with our provider finder search tool amerihealthnj.com/providerfinder. MDLIVE virtual care, anywhere! Access to non-emergency health care to all of fully-insured members and dependents.

13 MOBILE APP AHNJ ON THE GO Medicine Cabinet List of medications manually entered with images, drug and food interactions, warning labels, additional info, and the ability to set daily or weekly reminders Primary Care Provider Info Members can easily keep track of their PCP s name, phone number and designated sites My Health Assistant A tool to get and stay healthy set goals, build an activity plan. Trackers help track progress and manage the plan on the go. Benefit Plan Info Subscribers and dependents can quickly access basic benefits information Finders Locate Hospitals, Doctors, Urgent Care, and Pharmacies Doctor s Visit Assistant Members can achieve a more productive office visit by preparing for the visit beforehand: Display, , or fax an ID card to the provider View open referrals Record notes and capture documents or pictures

14 COMMIT2WELLNESS PUBLIC SECTOR Earn wellness points for completing a variety of healthy activities. To redeem points members must: Complete a Personal Health Profile on amerihealthexpress.com (Earn 25 points) Record activity by submitting proof of completion Points are redeemed for gift cards by accessing the member portal Each Wellness Point is worth $1 dollar Members and dependents over the age of 18 are eligible for this benefit Earn up to 600 Wellness Points per calendar year AmeriHealth New Jersey 14

15 Benecard Services Over 28+ years in administering prescription drug benefit programs to New Jersey school boards Currently administer prescription drug benefit programs for nearly 200 New Jersey public sector clients We control everything in-house (no sub-contracting) Full service benefit administration including our own claim adjudication system, call center, mail order warehouse and specialty drug pharmacy 15

16 Benecard s Commitment to Service 99% of pharmacies within New Jersey and approximately 95% nationwide, including all major retail chains 24/7/365 toll-free access to live member service representatives Fully automated web resources to member specific information including mail order refill/status, claims history, and pharmacy locator at 16

17 Prescription Benefits in the Palm of Your Hand Mobile App Features Mail order made easy with Benecard Central Fill. View prescriptions due to be refilled, request refills, and track the status of your orders. Network pharmacies at the tip of your finger. Use the Pharmacy Finder feature to locate network pharmacies nearby or in areas where you may be traveling. Drug pricing tool to help you make the most of your benefits. Compare drug pricing at up to five different pharmacies at once to ensure you re getting the best value on your prescriptions. 17

18 Co-payments and Benefit Designs Your co-payments and benefits will match your current prescription program. RETAIL CO-PAY MAIL ORDER CO-PAY GENERIC MEDICATION $13.00 $26.00 $39.00 $8.00 BRAND MEDICATION $18.00 $36.00 $54.00 $ days or 100 units, whichever is greater Over 100 units and falls between days Over 100 units and falls between days Up to 90 days 18

19 Mail Order Effective August 1, 2018, you must obtain a new prescription from your physician for any maintenance medications (including specialty medications) you wish to fill through the mail order pharmacy regardless of the number of refills you have remaining on your current mail order prescriptions You will receive the mail order packet along with your ID card in mid-july You will not need new prescriptions for existing fills through your retail pharmacy 19

20 Using the Mail Order Pharmacy Here are three ways to get started with Benecard Central Fill mail order pharmacy: 1. Complete Benecard s mail order form and mail your new prescriptions to Benecard Central Fill. 2. Your physician can fax your prescription(s) to Benecard at once you receive your ID card. Be sure that your physician includes the cardholder name, card ID number, shipping address, and date of birth. If the Brand medication is necessary, then you will need to inform the physician to check off Do Not Substitute on the prescription. 3. You can call Benecard Member Services line at the number on the back of your ID card. Provide our Member Service Representative with your physician s name, physician s phone and fax number, and medication name(s) and we will reach out to your physician to obtain your prescription(s). If the Brand medication is necessary, then you will need to inform the Member Service Representative to ensure the physician will check off Do Not Substitute on the prescription. * For controlled substance medications, Benecard, by law, will require the original prescription(s) from your physician. You must mail the original prescription(s) with the completed mail order form to Benecard Central Fill. 20

21 Contact Information AmeriHealth & Benecard Premier Member Services: Davis Vision: General Website: Member Portal: Benecard: Benecard: Brown & Brown Benefit Advisors Please make an initial outreach call to the carrier s customer service number, and note the date & time of your call, name of the representative, and reference number. If you need further assistance after your call please contact: Crystal Bromiley, Account Specialist, cbromiley@advisorsbb.com Wisdom. To your benefit. TM

22 Q & A Thank you! Wisdom. To your benefit. TM