Transcript Renewal Info CCStpa ISD492

Independent School District
#492 Austin Public Schools
March 1, 2012
Health Insurance Plan
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2/21/2012
Benefits effective March 1, 2012
• The Austin Public School health plan went out for
bid for coverage effective 3/1/2012
• Why – Renewal from UMR (TPA -Third Party
Administrator) was not affordable
• Recommendation to change TPA’s to CCStpa
based on capabilities and cost
• Management & Insurance Committee
recommended changes in carriers at renewal time
• Board of Directors approved recommended
changes
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Austin Independent School District #492
2012 Benefit Plan Comparison (In-Network)
Benefit
250/500 Plan
1200/2400 Plan
Unlimited
Unlimited
$250 Single / $500 Family
$1,200 Single / $2,400 Family
80/20%
80/20%
$2,500 Single / $5,000 Family
$2,500 Single / $5,000 Family
Hospital Inpatient
80% after deductible to OOPM, then 100%.
80% after deductible to OOPM, then 100%.
Hospital Outpatient
80% after deductible to OOPM, then 100%.
80% after deductible to OOPM, then 100%.
Emergency Room Services
80% after deductible to OOPM, then 100%.
80% after deductible to OOPM, then 100%.
Inpatient Physician Visits
80% after deductible to OOPM, then 100%.
80% after deductible to OOPM, then 100%.
Inpatient Maternity Services
80%
80%
Prenatal Care
80%
80%
Well Baby Care Visit Maximum:
100%
100%
Birth to 12 Months
100%, no visit limitation
100%, no visit limitation
12 Months to 24 Months
100%, no visit limitation
100%, no visit limitation
24 Months to age 6
100%, no visit limitation
100%, no visit limitation
100%
100%
Outpatient Diagnostic Testing, X-ray &
Lab Services
80% after deductible to OOPM, then 100%.
80% after deductible to OOPM, then 100%.
Physician Office Visit
80% after deductible to OOPM, then 100%.
80% after deductible to OOPM, then 100%.
100% Full Preventive Care
100% Full Preventive Care
Lifetime Maximum
Deductible
Coinsurance Percentage
Out of Pocket Maximum (OOPM)
Immunizations (up to age 18)
Preventive Care
Austin Independent School District #492
2012 Benefit Plan Comparison (In-Network)
Benefit
250/500 Plan
1200/2400 Plan
Mental Health – Inpatient
80% after deductible to OOPM, then 100%.
80% after deductible to OOPM, then 100%.
Mental Health – Outpatient
80% after deductible to OOPM, then 100%.
80% after deductible to OOPM, then 100%.
Chemical Dependency – Inpatient
80% after deductible to OOPM, then 100%.
80% after deductible to OOPM, then 100%.
Chemical Dependency – Outpatient
80% after deductible to OOPM, then 100%.
80% after deductible to OOPM, then 100%.
Organ Transplants (performed at an Organ
Transplant Network Facility)
80% after deductible to OOPM, then 100%.
80% after deductible to OOPM, then 100%.
Organ Transplants - Performed at any
other Facility
80% after deductible to OOPM, then 100%.
80% after deductible to OOPM, then 100%.
Durable Medical Equipment
80% after deductible to OOPM, then 100%.
80% after deductible to OOPM, then 100%.
All other Eligible Expenses
80% after deductible to OOPM, then 100%.
80% after deductible to OOPM, then 100%.
$0 Generic Copay
Prescription Drugs – You pay:
$35 Formulary Copay
80% after deductible to OOPM, then 100%.
$50 Non-Formulary Copay
Prescription Drug Out-of-Pocket
Maximum Limit
$1,000 Single
$2,000 Family
Included in medical deductible and out-ofpocket maximum limit
NOTE: This is only a summary of your group health and dental benefits. All Benefits are subject to the detailed description of
your coverage’s, exclusions, conditions and limitations listed in your benefit plan booklets. If this outline and your benefit plan
booklet conflict, the benefit plan booklet prevails.
CCStpa: The right partner for you
• Founded in 1982 — 30 years experience
• Purchased by Blue Cross Blue Shield of
Minnesota in 1985
• Headquartered in Eagan
• Outstanding service and responsiveness
of a top notch TPA
– dedicated claims, service, and account
management to Austin Public Schools
• Integrated resources and industry
expertise of a large health plan
– Compliance, Contracts, Legal departments
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Large provider network means
access to your choice of care
CCStpa, not your average tpa.
• Access to Minnesota’s broadest network
– Access to virtually all doctors, hospitals and
other health care providers in the state
– Strong negotiations produce deep discounts
• Relationships with national networks
ensure access and savings anywhere in
the country for people traveling or
dependants residing outside of MN.
– PHCS
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Services and support that
help you manage your health
Coordinated, personalized support for you
Customer service and connections
• Check claims status, order ID
cards, view membership, view
benefits, print forms, search for
providers
• Answers benefits coverage
and other questions
• Provides information about
available services and tools
• May connect you to a nurse
or other health specialists
Were here to help
• Customer Service (651)-662-5425 or (866) 356-2425
– Monday – Thursday 8a.m.– 5p.m.
Friday 9a.m. -5p.m.
• Find a doctor online:
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Go to www.ccstpa.com
Click on member tab
Click on “Find a doctor”
Choose the EPNI network to match network listed on ID card, or
the PHCS travel network when traveling
• Check drug list online:
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Go to www.ccstpa.com
Click on member tab
Click on “prescription drugs”
Click on “myprime.com”
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More support for your health
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Health Assessment and Online Coaching
Stop-Smoking Support
CCS Member Center
Online Wellness Center
– General health information
– Tips for nutrition, fitness, safety, etc.
– Stay on track with health goals
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Prescription drugs
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Prime Therapeutics and CCStpa
• Prime Therapeutics network of pharmacies includes
over 60,000 pharmacies nationwide.
• Cub, CVS, Target, Walgreens, Walmart
• Independent and local drug stores
• Access information at:
• www.myprime.com
• 1-800-509-0545
• Prime Therapeutics telephone number is located on
the back of your ID card
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2012 Prescription drug benefit
250/500 Plan
Retail
Pharmacy
90dayRx*
Retail Pick-up or
Home Delivery
Days Supply
31 days
90 days
Generic
$0 copay
$0 copay
Preferred Brand
(Formulary)
$35 copay
$70 copay
Non-Preferred Brand
(Non-formulary)
$50 copay
$100 copay
Separate Drug -
$1,000 Individual
out-of-pocket maximum
$2,000 Family
*For eligible drugs available at participating 90dayRx pharmacies.
2012 Prescription drug benefit
1200/2400 plan
Member cost-share after deductible is met
Days Supply
Retail
Pharmacy
90dayRx*
Retail Pick-up or
Home Delivery
31 days
90 days
Generic
80% After Deductible
Preferred Brand
(Formulary)
80% After Deductible
Non-Preferred Brand
(Non-formulary)
80% After Deductible
*For eligible drugs available at participating 90dayRx pharmacies.
Ask for generics and save
Generics work the same as brand name drugs, but cost less
Member
cost
Actual
Cost
$xx
$xx
Generic equivalent Co-pay
$120
$20
Brand name co-pay
Brand name
Generic equivalent
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Order
90-day supplies*
90dayRx program:
• Home delivery or
pharmacy pick-up
• Less expensive
• More convenient
* For eligible drugs available at participating 90dayRx pharmacies.
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Specialty Rx
• Available for specific chronic conditions
• Often the prescriptions require special handling
• Order from a specialty network pharmacy
–
Fairview Specialty Pharmacy, LLC*
1-800-595-7140
(612) 672-5262 fax
www.fairviewspecialtyrx.org
− Triessent
1-888-216-6710
1-866-203-6010 fax
• Contact customer service with questions regarding Specialty Rx
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Step Therapy
• Step Therapy is based on FDA guidelines, clinical
evidence and research to ensure you are taking the
most appropriate medication
• Physicians and pharmacists review medications to
determine which is appropriate and lower-cost
alternative medications
• Previously qualified Step Therapy participants will be
grandfathered and will not have to re-qualify
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Questions?
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