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We take care of the Customerand then some! What to Expect Moving - - PowerPoint PPT Presentation
We take care of the Customerand then some! What to Expect Moving - - PowerPoint PPT Presentation
We take care of the Customerand then some! What to Expect Moving Forward Changes New Deductible Year 9/1/2019 effective 8/31-2020 September 1st: Spousal Carve-Out Unified Group Services True Rx AdvantUs Network Benefit Plan
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Benefit Plan Design
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Open Enrollment
Your open enrollment period ends on August 23rd, with an effective date of September 1st. Remember,
- pen enrollment is your one opportunity each year to
make changes to your coverage unless you have a qualifying event such as marriage, birth or adoption. Effective 9/1, spouses who have coverage available through their employer will no longer be eligible as a dependent on your benefit plan. This spousal carve-out provision counts as a qualifying event for your spouse to enroll on their employer’s benefit plan.
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Welcome to Unified!
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- Effective September 1st, Unified will begin processing Medical and
Rx claims for New Castle Community Schools’ Members and their dependents!
- Customer Service Excellence – (800) 291-5837
- Dedicated Claims Account Manager – Jayna
- Group Health Plan Number - 6175
- Member Website – UnifiedGrp.com
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Utilization Review
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Utilization Review ensures that a patient receives the best possible and most appropriate care, while also ensuring that health care costs are managed in the most efficient and effective manner. If you have one required procedures scheduled, you will need to call Narus Health at 877.499.1774. It is ultimately the patient’s responsibility to ensure that precertification has occurred
- r a penalty may apply.
Procedures that require precertification will be listed on your new Unified Medical ID Card.
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“We take care of the Customer…and then some!”
Member Website
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UnifiedGrp.com
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UnifiedGrp.com is a secure way to view your benefits information online and at your convenience. To access UnifiedGrp.com please refer to the instructions enclosed in your packet.
Check Claim Status View your Deductible Print Forms Request ID Cards Access online wellness tools Email claims account manager
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UnifiedGrp.com
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View Claims
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Email Claim Questions
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The claim number will auto-populate. When you type in your question and hit submit it goes directly to your Claims Account Manager. This helps to expedite the response back to you.
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MyActiveHealth Engagement Platform
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Includes:
– Personal health summary – Alerts/Member Messaging – Customized action items and reminders – Health Risk Assessment (HRA) – Family history information – Health information research and medical dictionary
Functions:
– Pre-populated with medical, lab, and Rx claim data – Ability to add personal health information – Ability to print a list of medications – Provide your physicians the ability to review relevant clinical data – Can easily change your entire Engagement Platform from English to Spanish and vice versa – Includes a calendar to ender appointments and then receive reminders for those appointments – Includes pre-populated intake and immunization forms for visits to new doctors and schools/camps
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ID Cards
New ID card(s) will be mailed to your home. Due to the closing date of open enrollment, ID cards will not be delivered until after 9/1. You may access an ID card via UnifiedGrp.com after September
- 1st. Please remember to discard
all old ID cards and begin to use your new ID card(s) September 1st and beyond. Show your new ID card to all of your family’s health care providers at the next visit to ensure that your claims are submitted correctly. Also, please contact us if you need any additional ID cards.
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YOUR NEW PRESCRIPTION BENEFIT PLAN EFFECTIVE SEPTEMBER 1, 2019
www.truerx.com
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Prescription Services
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Current Medications – To ensure a smooth transition please fill any medications prior to 9/1. If you have been receiving a mail order prescription you will need to enroll in the new Mail Order Program to continue receiving a 90 day supply mailed to your home. You may also request a 90 day prescription from your doctor and obtain a three month supply at your retail pharmacy. Pharmacy Exclusions – CVS & Walgreens will no longer be a part of the pharmacy network. Be sure to locate an in-network pharmacy and ask the pharmacist to assist with transferring your prescription. Rx Help Centers – The Rx Help Centers program will continue, and the process will be more streamlined with the addition of True Rx as your Pharmacy Benefit Manager. All specialty medications will be excluded from the benefit plan. Log onto UnifiedGrp.com to access an application to enroll in the Rx Help Centers program.
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Rx Copays & OOP
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HDHP Plan
Rx & Medical Deductible
Single
$2,700
Family
$5,300 Rx & Medical Maximum OOP
Single
$5,400
Family
$10,600 30 Day Supply 90 Day Supply
Generic
$10.00 $25.00
Preferred Brand
$30.00 $75.00
Non-Preferred Brand
$60.00 $180.00
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Rx Copays & OOP
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30 Day Supply 90 Day Supply
Generic
$7.00 $14.00
Preferred Brand
$21.00, or 20% up to $250 $42.00
Non-Preferred Brand
$21.00, or 20% up to $250 $42.00 Rx Only Maximum OOP
Single
$5,900
Family
$11,800
PPO Plan
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90 Day Supply
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90 day supply prescriptions can be conveniently filled at a retail pharmacy or through mail order services. If you are currently filling through mail order and wish to continue, a new prescription will be required from your healthcare provider. Your provider will submit a new prescription to Postal Prescription Services for mail order service. True Rx’s pharmacy network consists of over 65,000 pharmacies nationwide, including many retail chains and independent pharmacies. Please call True Rx Customer Service for more information about the mail
- rder services.
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True Rx Member Access
19 True Rx offers patients secure online Member Access with you in mind. This secure internet site and mobile app allows access to prescription profiles and other important prescription information by visiting truerx.com or searching True Rx in the app store. This service will be available to you starting September 1st.
- Claim History – allows you to view prescription claims paid by your plan.
- Coverage Limits and Payment Details – enables you to view your pharmacy
claim deductible information or coverage phase.
- Drug Information - enables you to access a drug dictionary and search drugs
and conditions. It also contains a drug interaction component enabling you to compare drugs and possible interactions or side effects.
- Drug Pricing - prices drugs by applying your specific co-pay or co-insurance
that would most accurately reflect what you would pay for the prescription at the pharmacy. You can also compare price across multiple pharmacies.
- Pharmacy Locator – you can identify nearby network pharmacies with
addresses and location hours
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CUSTOMER SERVICE
Monday through Friday, 8am-6pm EST Toll Free (866) 921-4047 CustomerService@truerx.com
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- St. Vincent Health
- Henry Community Health, Daviess Community Hospital,
Hancock Regional
- Midwest Behavioral Health, Magellan, Little Clinic
- Any emergency care, urgent/emergency care while traveling
- Lowest cost to the member and to New Castle Schools
Tier I
In-Network
- Services can be rendered outside of the St.
Vincent Direct Network
- CIGNA’s discounts applied
- Higher deductibles and out of pocket costs
apply
Tier II
Out-of-Network
Using Your Direct Network
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- Henry Community Health
- St. Vincent Hospitals and Providers
- St. Vincent Neighborhood Hospitals
- Hancock Regional Health Hospitals
and Providers
- Little Clinics (Inside Kroger Stores)
- Daviess Community Hospital
- Behavioral care through Midwest
Behavioral Health
- Chiropractic care through Magellan
Chiropractic
- 5000+ primary and specialty care
physicians
EMPLOYEE HEALTH GOALS
BENEFITS? NETWORKS? CO-PAYS? CARE MANAGEMENT & WELLNESS? CLINIC, HOSPITAL, URGENT CARE, SPECIALIST? WHO IS FOLLOWING UP WITH ME? HOW DO I ACCESS INFORMATION?
Tier One Network Access
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- Unified Group Services serves as the third
party administrator and works with St. Vincent Direct to provide all member services
- Those using out-of-network services will be
encouraged to move to an in network provider and to utilize services at the Employee Wellness Center
- Unified and St. Vincent Direct will work with
members on complex care continuity or transition requirements to meet needs and minimize costs for New Castle and the member
True Rx Member Access
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