2019-20 Benefits Open Enrollment Boulder Valley School District
Why are we making changes? • BVSD’s healthcare goals are to improve our members’ quality & satisfaction, control costs and improve the overall health of our members • Colorado’s Rising Cost of Healthcare • http://www.bellpolicy.org/2018/12/17/health-care-brief/ • https://coloradosun.com/2019/01/03/colorado-health-care-costs-explained/ • https://www.civhc.org/2018/11/08/colorados-health-care-costs-continue-to-rise-above-other-states/ • Cost of benefits to BVSD taxpayers $34 million/year • BVSD is balancing providing comprehensive benefits with escalating costs • Options considered Implement employee only premium • Increase deductibles, copays, out of pocket maximums • • Reduce plan benefits (e.g., eliminate coverage of services or procedures) • Bundled pricing (e.g., The Zero Card)
What’s changing? • The district contribution is increasing from $613 to $644 per month. • BVSD’s Self -funded • Medical plan is changing to UMR from Cigna. • Prescription plan is moving to Rx Benefits from Cigna. • Employees on Cigna will be moved to equivalent plans unless you make changes during open enrollment. • Dependent premiums on all medical and dental plans are increasing. • A few changes will affect UMR & Kaiser Permanente plans. • Deductibles & out-of-pocket maximums are unchanged on all plans.
What’s changing? (cont.) • VSP will maintain the same rates; there are a couple of plan enhancements. • The Zero Card is offered at no charge to UMR members. • Voluntary benefits will be offered for the first time through Aflac: • Accident Insurance • Critical Illness Insurance • Refer to the BVSD 2019-2020 Benefits Guide for specific information.
What do I need to do? • Review 2019-2020 BVSD benefits guide. • If you want to change elections, complete the Google OE form by April 30 (sent via email or at https://www.bvsd.org/benefits/Pages/OPEN%20ENROLLMENT.aspx) • Open enrollment is only available online (no paper forms) • Review the new offering from Aflac and fill out the application if you’d like to enroll. • Familiarize yourself with the new websites, mobile applications, and phone numbers if you’re enrolled with UMR/RxBenefits. Also, be sure to check out the benefits of using a Zero Card provider.
UMR Medical
How to read your ID card Your group health Your member ID number plan number Family members covered under your plan Your pharmacy benefits information Your medical provider network
Signing up for umr.com Visit umr.com on your desktop 1 computer or tablet device Click Login/Register to sign up 2 Helpful hints Have your UMR member ID card handy • Spouses and adult children must create • their own online account You must provide a valid email address • Select a username and password you can remember • 8
See your benefits information anytime, anywhere With umr.com you can: • View My taskbar , your personalized to-do list • Check your benefits and see what’s covered • Look up what you owe and how much you’ve paid • Find a doctor in your network • Learn about medical conditions and your treatment options • Use UMR’s Cost Estimator to compare prices of quality providers (replaces Health Care Blue Book).
The Zero Card Medical Bundling
Meet the Zero Card Say goodbye to deductibles, copays and coinsurance
Healthcare for FREE Boulder Valley School District has made this program available to employees and dependents covered by the self-funded plan (UMR) to keep you in the BEST health possible. You Pay $0 for covered services and never have to worry about copays or deductibles.
How easy is it? Call, email or chat live Your doctor recommends a We will take care of all the with your own Zero Card specific service or surgery. details and you pay $0. Personal Health Assistant. 2 1 You can search for a provider at www.thezerocard.com , call, email or chat live with one of The Zero Card’s Personal Health Assistants.
How to find care
Cards The Zero Card Contact The Zero Card at The Zero Card contracts with 855-816-0001 prior to scheduling Lab Card for lab services. appointments & procedures. Save card, show it at Quest facilities and utilize it only for Lab Services. You do not need a card for Zero Card services outside of labs.
RxBenefits Pharmacy
Who is RxBenefits? RxBenefits is your Pharmacy Benefit Administrator (PBA). We partner with the country’s largest Pharmacy Benefit Managers (PBMs) to bring greater discounts, • enhanced access, and improved Member Services to our clients and their employees. • Your pharmacy benefits coverage will be with Express Scripts. Your benefits are provided by Express Scripts. RxBenefits administers the services for a more personal and • manageable approach. Contact RxBenefits at 800.334.8134 with any pharmacy-related questions. What’s New? You have access to our Member Services Team, available Monday through Friday, 7 a.m.-8 p.m. Central Time. Our knowledgeable representatives can assist you with questions such as: Can you help Can you assist me with my Advocacy. Expertise. Service. Is my drug covered? transition my mail benefits questions? What will it cost? order scripts? Are there lower cost Is my pharmacy alternatives? in the network? 17 17
What to Expect • Effective July 1, your pharmacy coverage There are more than 68,000 pharmacies with Express Scripts will be administered by in the Express Scripts network, including most RxBenefits. national chains and many independent stores • As part of your new pharmacy benefits plan, you will receive: New combo ID card (Medical & Rx) • For questions or concerns, members can contact • Summary of Benefits RxBenefits Member Services at Access to concierge-level service • 800.334.8134 Access to Express-Scripts.com to review • Monday through Friday Advocacy. Expertise. Service. medication tiers, drug pricing, local 7 a.m.-8 p.m. Central or emailing pharmacies, plan details and ways to RxHelp@RxBenefits.com maximize benefits. New members will need to create an account. 18 18
Member services Before You used your old insurance card. If you had any questions, or issues, you Your pharmacy provider was would call the PBM 800#. direct with the PBM. Now RxBenefits Member Services Service as it is meant to be Friendly and knowledgeable live representatives who are: Advocacy. Expertise. Service. You will receive a new ID card Present your new ID card • Committed to following the issue to that lists contact details for at the pharmacy on or after July 1. resolution RxBenefits Member Services Questions? Call the RxBenefits • Focused on serving members, not You will have access to Member Services number listed on rushing them high-touch, superior service. your new ID card. It’s that simple! 19 19
The Express Scripts app For Members on the Go Register your account from your mobile device • • Transfer eligible maintenance medications to Express Scripts Pharmacy Select and schedule prescription refills and enroll • eligible prescriptions in auto refills • Check Express Scripts Pharmacy order shipping information Locate a nearby pharmacy using GPS • Advocacy. Expertise. Service. Access DrugDigest database for information, • uses, possible side effects, etc. • Set a reminder for medication doses 20 20
Frequently asked questions Q: Are my drugs covered? A: You can access a copy of the most current Performance Drug List at www.Express-Scripts.com or by contacting RxBenefits Member Services at 800.334.8134. Your medications may not be in the same tier level under Express Scripts as they were under Cigna, so please review the performance drug list since it may provide lower cost alternatives for your medications. Also, discussing generics with your physician could save you money. Q: Can I still use my same ID card?! A: No. Please use your new UMR medical/pharmacy ID when you fill your prescriptions on or after July 1, 2019. Q: If my coverage is with Express Scripts, why do I need to call RxBenefits? A: Your benefits are being provided by Express Scripts, but RxBenefits administers the services for a more personal, manageable approach. Contact RxBenefits for any pharmacy-related questions. Advocacy. Expertise. Service. Q: What happens if my questions require contact with Express Scripts? A: RxBenefits Member Services reps have access to Express Scripts systems. If RxBenefits needs to contact Express Scripts to resolve an issue, they will stay on the line, explain the issue, and monitor your problem until it is resolved. 21 21
Kaiser Permanente Medical/Pharmacy
Plan changes effective 07/01/2019 Service New Benefit Emergency Room Copay Increasing from $200 to $250 Urgent Care Copay Increasing from $75 to $100 Brand Name Drug Copay Increasing from $60 to $75 Out of Area Dependent Outpatient generic, brand, specialty, and non-preferred Benefit drugs will be 50% coinsurance. Mail order is not available
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