Healthcare Forum II Questions 1. I recently heard on the radio about Healthcare Cooperatives in other states, i.e. Montana. What are your thoughts on

Transcription

1 Healthcare Forum II Questions 1. I recently heard on the radio about Healthcare Cooperatives in other states, i.e. Montana. What are your thoughts on these and their feasibility? a. The University continuously reviews a variety of funding options and opportunities. At this point, the University believes that the current self funded approach best serves our purposes from a cost and access perspective. 2. What incentives might be offered to employees who regularly exercise and keep their weight, cholesterol, etc. within certain parameters? a. The University continues to explore options regarding the use of incentives to encourage participating employees to take charge of their health. This includes exploring potential premium differentials based on biometric measurements or other incentives that may be implemented in the future. 3. My son, who is 30 years old has been continued on my insurance since he turned 26 because he has a disability. Will he continue to be carried under UMR? a. The Plan provision regarding continued coverage for a disabled dependent over the age of 26 will not change. A dependent may continue on your insurance at this time as long as they meet the requirements outlined. 4. Is there live chat web access to the Ask A Nurse for the library resources and services? a. No, this service is only available via telephone. 5. Are calls to Ask A Nurse anonymous or are participants required to identify themselves? a. The nurses will ask for the member ID in order to identify the caller. 6. What happens to my HSA with Tango now that we are switching to WageWorks? Can I still use my Tango HSA? Will they be combined with a new account? a. We are working with Tango, Optum Bank, Wage Works and BNY to make the transition as smooth and seamless as possible. Please watch for final updates in the near future. 7. Will money contributed to an HSA this year be transferred to WageWorks next year? a. See #6 above. 8. If you call Teladoc and they can t help you, do you have to pay again for an in office visit? a. Yes, if you have a consultation with the Teladoc physician and then see another physician in their office, there will a charge for each service. Remember, Teladoc is not to replace your regular physician. Their services are for convenience or urgent purposes only. 9. Who would be able to assist me in deciding if it s beneficial for me to have two health care coverages? Two providers? a. That decision is for you and your family (if any) to make. Each person s situation is different and specific to their circumstances. We recommend you look at the coverages that are available to you, determine which one best fits you and your family s needs, and then check into the coordination of benefit provisions of each plan to see how they will work with each other if you are covered by both. 10. What does Premium Tier 1 mean to me regarding providers? a. The UnitedHealth Premium Tier 1 symbol helps people to quickly and easily find doctors who have been recognized for providing value. UnitedHealth Premium Tier 1 physicians have received the Premium designation for: Quality & Cost Efficiency OR Cost Efficiency & Not Enough Data to Assess Quality 11. Is there a maximum number of office visits? a. No. 12. What are the co pays and deductibles on the various plans?

2 a. Please refer to the Schedule of Benefits and the Summary of Benefits and Coverage (SBC) that will be delivered to you during open enrollment for a comparison of the available Plans. 13. What are you doing to get domestic partner coverage? a. As a state agency, we evaluate the components of our benefits plan coverage annually and follow the guidance given by the state. 14. Are routine vision exams covered at 100%? a. Yes, under the medical plan one routine vision exam per year is covered at 100%; under the voluntary vision plan an in network exam is covered under$15 co pay. How much for glasses? a. Glasses are not covered under the medical plan. If you elect the voluntary vision plan, there is a $ retail frame allowance to use toward the cost of the frames you select. The overall cost is dependent upon the frames and lenses you select and the service provider used. Please refer to the UHC Vision outline available during open enrollment. How often? a. Frames are covered once every 24 months and lenses once every 24 months. Are cataracts covered by medical or by vision? a. Cataracts are covered by the medical plan. 15. How long is the contract with UMR? a. The contract with UMR is dependent upon their delivery of acceptable customer service and administration of the Plan. The University will be going back into the market in at least 5 years to evaluate available options, or sooner if UMR fails to provide services expected and acceptable to the University. 16. I came last year and took to heart trying to lower costs by price shopping. I found cheaper lab work and cheaper prescriptions only to be told these would not count toward my deductible. I am on the HDHP so pretty much pay for all my costs myself. It seems ridiculous that by choosing the cheapest option, which would also cause me to meet my deductible slower and save everybody money I can t count that toward my deductible. (I think they are referencing getting a better discount for services without running it through insurance, and thereby not applying it to the deductible.) a. UMR: If EnvisionRx will credit the prescription towards the deductible, by passing that information to us, we will credit as well. b. EnvisionRx: Typically we do not see situations where the cash price is cheaper than the contracted rate, however; if there were to ever be a situation like this, the member can submit a direct member reimbursement (DMR) for the medication. Please note the member will not be reimbursed anything if the amount is less than the contacted rate as DMRs will be reimbursed at the pharmacy network rate less the copayment, however; the claim would be submitted in our system. The amount the member paid would then apply towards the deductible and/or out of pocket, unless the medication is a generic medication which do not apply towards the deductible and therefore the amount would only apply towards the out of pocket. c. 17. Will it be easier to find what preventive costs are covered? a. UVU members can call UMR Customer Service if they have any questions. 18. How can I verify if my current physician is on the choice plus plan? a. We recommend you go to: and click on Find a Provider in the upper left hand section of the screen,

3 then click on medical, and scroll down to UnitedHealthcare and click on Choice Plus or Options PPO and follow the instructions to search for a provider. We also recommend that, even if your provider is on the list, that you call your physicians office to verify that they are indeed continuing to participate in the UnitedHealthcare Choice Plus network. You can also call UMR Customer Service and they will verify it for you. 19. A growing number of employees, particularly faculty, have 0, 1, or 2 dependents. Why do these employees pay premiums that are close to or identical to employees, with a, literally, unlimited number of dependents? a. The University has elected to use a three tier premium structure (i.e., Single, Two Party, or Family). Under this arrangement, the Two Party tier accommodates employees opting to cover just their spouse, or just one eligible child; while the Family tier accommodates employees opting to cover a spouse plus one or more children, or just two or more children (no spousal coverage). The University charges participating employees the same premium based on the coverage tier elected (Single, Two Party, or Family). So, for example, any employee that elects Single coverage will pay the same premium, regardless of their age, gender, or job description. Employees make up an average of 31% of the enrollment in the Medical Plan at UVU, while spouses account for 24%, and children make up the remaining 45%. However, employees (31% of enrollment) account for over 45% of claims paid, spouses (24%) for 33%, and children (45%) account for less than 22% of claims paid. It is clearly not the large number of children that are driving the costs of the program. 20. Please explain plan design. What does that entail? a. Plan design refers to deductible levels, copayments, coinsurance, and out of pocket maximums. 21. How much is the buy up option to Options PPO? a. Please refer to the pricing information in the open enrollment materials. 22. Will existing treatment plans and patient/emi histories be migrated to UMR? For example, if ongoing treatment is needed how do we migrate the treatment? Will EMI cooperate with authorizations that were given previously? a. UMR has requested that EMI send claim history files, as well as prior authorization information so that treatment plans can continue without disruption. To be sure your information has transferred, please call the prior authorization number on the back of your UMR ID card to verify. You may be asked to supply information, if UMR does not have the information. 23. Change to WageWorks will require new HSA account? b. Yes Will transition be seamless? a. The University is working with Wage Works and Tango to make the process as seamless as possible for employees. Debit cards? a. One card will be issued at the time of enrollment. There is no limit on the number of additional cards that can be requested. 24. Maternity management available to spouse? c. Yes What other Wellness programs available to spouse? a. All care management programs are open to all spouses.

4 25. If some doctors of Central Utah Medical Clinic are on the plan, but the clinic isn t on the plan, how does that work? d. The providers who are participating on the network will receive the in network level of benefit. The providers/facilities that are not in the network will receive the out ofnetwork level of benefits. Member should always verify all providers and facilities they see or use are par with the network. There are some exceptions to this rule for some pathology, radiology and anesthesiology services. 26. What happens to our Medco prescriptions? Will we need all new prescriptions to move them over? e. For prescriptions being purchased at a retail pharmacy, assuming there are refills available, you will need to show the pharmacist your new prescription drug card and tell them that there has been a change. There should be no need for you to get a new prescription from your doctor as long as the prescription is still valid. For prescriptions being obtained via mail order you will need a new prescription. 27. Can you have both the Choice Plus and Options PPO? f. No, because there is no reason to have both. Options PPO is a larger network which includes all the doctors and facilities of the Choice Plus network. Options PPO includes additional doctors and facilities that are not in the Choice Plus network, yet have agreed to participation in the Options PPO network. 28. You mentioned IHC facilities like UVRMC and American Fork are in the Choice Plus network. Are other IHC facilities, such as clinics or urgent care, in this network too? g. Most IHC facilities will be participants on the Choice Plus Network. You can search for facilities as outlined above. 29. I m a brand new UVU employee. Do I sign up for EMI then UMR? h. If you are eligible for coverage before July 1 st, then you should sign up for coverage under EMI, and then again during open enrollment under UMR. 30. Is there an adoption benefit in place with UMR? i. Yes, the plan will continue to have the same adoption benefit. 31. Does living in SLC mean I have to choose the Options PPO network that costs 3.5% more? Is this like a tax for not living in UT County? j. No, you do not have to choose Options PPO unless you wish to have access to some of the non IHC facilities or other physicians who are not participating on the Choice Plus Network on an in network basis. 32. With chronic management, what is this assessment fill out form you mentioned? k. There is no form to complete. To qualify for the $100 gift card, the member must have one of the seven conditions, call within 90 days to enroll and have at least three coaching calls with the nurse. The nurse will ask several questions about the current management of the condition in order to determine if coach would benefit the member. 33. Supposing you don t want to do things online? Where and when will there be people giving out and collecting paper forms? l. Please see your HR team for guidance. 34. Do we have the grace period to spend our FSA after July 1? m. Yes 35. What is considered specialty medicine? n. Specialty Prescription Medications typically refers to the higher cost injectibles and oral or topical meds, most of which have been formulated to address very specific illnesses, may have a variety of side effects, and may require special handling and storage.

5 36. How does UMR work as a secondary insurance? o. This will work in the same manner that it currently does. If we are primary we pay the claim without regard to the secondary coverage. The member/provider will need to take the UMR EOB and submit that to their secondary coverage along with the claim for them to issue payment. If we are secondary we need the member/provider to submit the claim to UMR with the primary carrier s EOB. An exception to this rule would be for those who have dual coverage through UVU. If UMR has that list of dual covered individuals, will coordinate internally. 37. What can we do to have alternative care options, such as naturepathic doctors, covered by insurance or by an FSA? p. Under the FSA, only expenses allowed under section 213(d) of the Internal Revenue Code are reimbursable by the FSA. These types of providers are not covered under the medical plan. 38. Is there domestic partner coverage? q. No, the University s Plan does not recognize domestic partner s as eligible for coverage. 39. Is access to a nutritionist part of the wellness program? r. Yes. 40. What is the co insurance coverage on the Choice Plus Plan? s. The three plans currently offered will continue to offer the same co insurance levels. The only difference is the network access, with applicable premium. 41. It takes 4 business days for UVU to make the HSA deposit, then another 4 business days to get that deposit from Tango Health. Why does it take so long? t. UVU: The current processing time for deposits to an HAS account is 0 2 days post pay date. This is due to the amount of time it takes to reconcile the accounts and deposit money from UVU's account to individual accounts with Optum Bank. Users who elect direct deposit rather than debit card reimbursement will see an additional five days processing time for the money to be transferred from their HSA to their personal checking or savings account. 42. Will the HSA Tango Account move smoothly to WageWorks? u. See question #7 43. Teladoc Cost $40 total? Or is this a co pay for a PPO? v. Green plan co pay is $20; White plan co pay is $25; HDHP plan is $40, (the total cost), until the deductible is met then the co pay is $20. Teledoc will send a copy of the bill to UMR to document your payment and apply to your deductible or out of pocket maximum. 44. What do you do if your primary care doctor is not on the list? w. You can complete a nomination form obtained from the HR team and submit it to UMR for consideration. Final contracting is between UnitedHealthcare and the physician and may take several months to finalize, if both parties agree. 45. Will prescriptions be forwarded from Express Scripts to EnvisionRx? x. There will be an open refill transfer file sent from Express Scripts. Controlled substances will need a new prescription. There may be instances where members will need a new prescription. The new member letter will contain information on this topic as well as mail order. 46. Why is the cost for a couple more than 2x the cost of a single and 13% higher? y. This is an industry standard based on actuarial practices and tables. Typically, couples, either in their child bearing years or in their empty nest stage of life, are more costly to

6 the plan than a single contract holder. Spouses currently account for more claim costs per person than employees at UVU. The University has used actuarial rates and structures when setting the tier rates for the Plan. 47. If your doctor sends you to the Hunstman Cancer Center, would you be covered under the white plan? Do you have to have the extended plan? (I think they mean Care Plus v Options PPO) z. The White plan benefits are exactly the same regardless of which network you choose. The covered physicians and facilities may differ based on your network choice at the time of enrollment, If you elect the Options PPO network, then Yes, the Huntsman Cancer Center (at U of U campus) would be covered as in network. If you select the Choice Plus network then the Huntsman Cancer Center would be considered out ofnetwork. 48. When and where will a summary of benefits be made available to us? aa. Summary Benefit Coverage (SBC) documents are available now and can be found on the HR website at The Summary Plan Description may not be available until sometime after July 1 st.