new in 2013

New in 2013 v Out of Pocket Maximums v Pharmacy Co-Pays v Drug - PowerPoint PPT Presentation

2013 Plan Year 1 New in 2013 v Out of Pocket Maximums v Pharmacy Co-Pays v Drug Management Programs v Balanced Premiums 2 New in 2013 Out of Pocket Maximums v Out of Pocket Maximums will be increasing by: v $500 for

  1. 2013 Plan Year 1

  2. New in 2013 v Out of Pocket Maximums v Pharmacy Co-Pays v Drug Management Programs v Balanced Premiums 2

  3. New in 2013 – Out of Pocket Maximums v Out of Pocket Maximums will be increasing by: v $500 for Employee Only to $1500 v $750 for Employee + Spouse to $2250 v $750 for Employee + Children to $2250 v $1,000 for Employee + Family to $3000 v Note: These numbers represent the In-Network OOP Max. Out-of-Network OOP is also increasing. No immediate impact! Will only affect your Co-Insurance AFTER you reach your Deductible. 3

  4. New in 2013 – Pharmacy Co-Pays Member Pays Plan Pays Remaining HRA Deductible Deductible Medical Me ical Pha harma macy y Co-Ins -Insuranc nce Co-P -Pays ys $40 Brand 10% $120 In Network Specialty 4

  5. New in 2013 – Pharmacy Co-Pays v After a Member’s Deductible is met, the Member will begin paying only a Co-Pay for Brand name and Specialty medications, instead of Co- Insurance v $40 Brand Name / $120 Specialty v Limits a Member’s Out-of-Pocket expenses for typically expensive prescription medications v If cost of prescription is less than Co-Pay amount, Member pays the lesser of the two amounts v Remember that Generics are still $0 Out-of-Pocket to Members Co-Pay System limits your financial exposure and helps you to budget for monthly expenses! 5

  6. New in 2013 – Drug Management Programs v New Drug Management programs will limit over- spending and medication drug waste – saves YOU and LSU First money! v New Programs: v Select Home Delivery v Step Therapy with Grandfathering v Supplemental Prior Authorizations v Drug Quantity Management 6

  7. New in 2013 – Drug Management Programs v Select Home Delivery • Encourages Members to fill their maintenance medications using Express Scripts Mail Order Pharmacy • ESI will reach out to members who take maintenance medications to offer the choice • Members will need to choose to “opt-out” of mail order • Fast, at-home service – No extra trips to the pharmacy! • Receive 3 months supply at a time (Co-Pays will apply) Express Scripts Customer Service will work with you to set up your Home Delivery for you! 7

  8. New in 2013 – Drug Management Programs v Step Therapy with Grandfathering • Requires Members to try Generic medications at $0 cost before pricey brand name drugs on NEW prescriptions • Grandfathering allows Members currently receiving brand name medications to continue without first trying generics • Any existing prescription not refilled within 130 days will be considered NEW and will be required to be filled as generic at the time it is filled Generic medications are JUST AS effective as name brand medications at $0 cost to you! 8

  9. New in 2013 – Drug Management Programs v Supplemental Prior Authorizations • Already in place with some drugs – just added a few more to the list • Very few Members affected • If a Member’s prescribed medication is on a Supplemental Prior Authorization List, the Member’s physician will be contacted to discuss alternate treatment options or provide authorization to dispense medication as written Express Scripts and your Physician will be involved to find the most effective care for you. 9

  10. New in 2013 – Drug Management Programs v Drug Quantity Management • Aligns dispensed quantity of prescription with FDA-approved dosage guidelines • Will eliminate wasteful spending – ensures the most cost effective product strength is dispensed • If a Member receives two monthly prescriptions for a low dose of one medication, they could receive one monthly prescription at a higher dose for just as effective treatment Drug Quantity Management can help you eliminate multiple co-pays for Brand name medications. 10

  11. New in 2013 – Balanced Premiums v LSU First Plan’s value far outweighs the Employee Share cost, and balancing is needed to provide a fair value to all Members v Employee Cost will STILL be lowest of all OGB offered plans v Few tiers experienced premium balancing: • Employee + Spouse • Some Employee + Family rates 11

  12. LSU First Review of Current Benefits 12

  13. Meet Your LSU First Team LSU System - Sponsors LSU First and is financially responsible for paying your claims. CIGNA - Your medical claims administrator, including an extensive medical management program, and your provider for a wide-ranging national network. ESI - Your pharmacy benefits administrator for retail and mail order service. Verity HealthNet - Provides your robust Verity local network coverage and your First Choice Provider Network Coverage. 13

  14. Important Plan Features v Remember , once your Health Reimbursement Account (HRA) dollars are exhausted : Ø LSU First pays 100% for First Choice Providers Ø LSU First pays 100% for generic drugs v Remember , LSU First pays $5,000 for Critical Illness Benefits Ø Stroke Ø Major Organ Transplants Ø Heart Attack Ø Renal Failure Ø Invasive Cancer Ø Coronary Artery Bypass Surgery v Remember , LSU First reimburses your Transplant related travel expenses for you and one dependent up to $10,000 14

  15. Important Plan Features v Remember, Free Preventive Care with First Choice and In-Network Providers without using HRA dollars Ø Routine Preventive Care ° Well-Baby Care and Well-Child Care ° Adult Care ° One routine vision exam per Plan Year Ø Immunizations ° Based on age, gender and family history Ø Routine Mammogram, PSA, Pap Smear ° Based on age, gender and family history Visit LSU First at for more Wellness information 15

  16. CIGNA’s Clinical Programs Ø Lifestyle Management Programs Ø Comprehensive Oncology • Need help making healthy changes? • One on one support every step of the way • Get Telephonic or Online Support • Specially trained cancer support nurse • Self Paced Format • 24 Hour Health Information Line • Support available 24/7 • End of life care Tobacco Cessation Ø Chronic Condition Support Weight Management • Manage a chronic health condition • Create a personal care plan Stress Management • Understand medications or doctor’s orders • Identify triggers that affect your condition Ø Healthy Pregnancies, • Make educated decisions on your treatment Healthy Babies • Prenatal Support Program Ø Health Advisor • Cash bonus for program completion • Specialized trained nurses • $250 if enrolled by end of • Coaches First Trimester • Nutritionist • $125 if enrolled by end of • Clinicians Second Trimester 16

  17. Additional Programs Health Risk Assessment Employee Assistance Program (EAP) v Predicts future health issues fairly accurately v Provides a Wide Range of Support for YOU v Gives you control to start making simple v Legal Issues changes to improve your health v Childcare, Eldercare, even Pet Boarding v Managing Stress v Creates a deeper understanding of your v Relocation Assistance health risk and offers effective solutions v And more! v Online coaching is available to you v These valuable services are free and can be utilized by calling 1.866.929.5781 v Totally confidential v Up to three (3) visits with an In-Network v Logon to to complete counselor are available for all Members 17

  18. Websites for CIGNA and Express Scripts v v Manage Your Accounts with CIGNA and Express Scripts v Search for First Choice, CIGNA Open Access Plus, and Verity Providers v Download claim and reimbursement forms v View Communication Newsletters v View contact information your LSU First team 18

  19. Key Contact information v Please ensure you update your contact information with your HR team v CIGNA Clinical Outreach is successful when we have current phone numbers on file v CIGNA’s Health Assessment completions trigger outreach calls based on risk factors and current information 19

  20. Assistance and More Information v LSU First toll-free phone line (for any questions and concerns) Ø 1.866.929.LSU1 (1.866.929.5781) v LSU First Website: Ø v Follow LSU First on Facebook or Twitter v E-mail Ø v Call an experienced Member Advocate Ø 1-866-607-5325 or 225-906-1249 20

  21. Questions 21

Download Presentation
Download Policy: The content available on the website is offered to you 'AS IS' for your personal information and use only. It cannot be commercialized, licensed, or distributed on other websites without prior consent from the author. To download a presentation, simply click this link. If you encounter any difficulties during the download process, it's possible that the publisher has removed the file from their server.


More recommend