Williamson County Diabetes Care Plan. Member Guide

Transcription

1 Williamson County Diabetes Care Plan Member Guide Administered by Allegiance Benefit Plan Management, Inc. providing the Cigna Open Access Network and CVS CareMark Pharmacy Services

2 Welcome Williamson County Diabetes Care Plan (DCP) Williamson County understands that diabetes is a major health problem and if not managed properly, can lead to serious health complications. Williamson County offers additional resources, support, and enhanced medical and prescription drug benefits through a Diabetes Care Plan. Enrolling in the DCP is the first step to better health. Please use this guide to learn more about the many services and benefits available to enrollees of the DCP. Diabetes Care Plan benefits include: Three free diabetes-related doctor visits Select free diabetes-related prescription drugs and supplies Wellness education to help you understand your condition Free dilated retinal eye exam Reminders for essential screenings and exams Case Management Value you can appreciate The DCP offers superior value with enhanced medical and prescription drug benefits to provide support to participants. When you enroll, you ll receive up to three diabetes-related doctor visits, as well as select prescription drugs and supplies at no cost a potential savings of hundreds of dollars each plan year.

3 Important Program Information How the DCP works Eligible participants (age 18 or older) must be enrolled in one of the Williamson County Medical Plans and diagnosed with diabetes or pre-diabetes. Enroll in the DCP by completing and submitting the DCP enrollment form. Enrollment in the DCP can occur anytime during the plan year and you will be able to use your existing ID card to start receiving the enhanced benefits. Complete all required Health Actions by October 31st of each plan year in order to remain enrolled in the DCP. Claims history may be reviewed to ensure you have met the requirements. In some circumstances you may be asked to submit documentation to report completion of required health actions. Fill your diabetes-related prescription drugs and supplies at any retail or mail order pharmacy contracted with the CVS CareMark Network. Included in this packet is a list of the prescription drugs that are available to you at no cost. Your pharmacy plan will be updated so you can use your existing ID card. Visit your Cigna Open Access Network doctor for three free diabetes-related visits. Your medical plan will be updated so you can use your existing ID card to receive enhanced coverage. Remember to always use a Cigna Open Access Network doctor. Take advantage of the opportunity to talk with your StarPoint Case Manager. Your personal case manager will be providing educational material by mail and reaching out to you by phone to review outstanding required Health Actions and discuss any questions or concerns you may have about the program. Always take great care to manage your health and improve your education!

4 Health Action Requirements Listed below are the minimum care requirements to stay enrolled in the DCP. If your required Health Actions have not been completed by October 31st, you will automatically be removed from the DCP. For Example, if you do not complete the required Health Actions during November 1, 2012 October 31, 2013, you will be ineligible for the DCP effective November 1, If you complete a Health Action requirement that the claims administrator does not have record of, you will need to complete a Health Actions notification form and submit documentation of the completed Health Action(s). Doctor visits, screenings and frequencies required for enrollment in the DCP may be different from the care plan designed by you and your doctor. The DCP Health Plan actions should not replace the care plan designed by you and your doctor. Health Actions must be completed between 11/1 through 10/31 of each Plan Year

5 Medical and Pharmacy Benefits Being diligent about taking your diabetes prescriptions and monitoring your blood sugar can be critical to maintaining your health. That s why Williamson County is making many diabetes-related prescription drugs and supplies, as well as doctor visits, available at no cost to you when you enroll in the DCP and follow the required Health Actions. To see the current list of the prescription drugs and supplies visit wilco and review the DCP prescription drug list contained under the Pharmacy Icon. For your convenience, a list is included at the end of this brochure, but please note this may be subject to change throughout the year and you should review the website for current information. The list includes insulin (oral and injectable) blood glucose testing supplies and certain prescription drugs that treat cholesterol, high blood pressure and depression. If your medication is not listed, you may want to discuss other options with your doctor so you can benefit from this program. Primary Care or Specialist Doctor Visits Pharmacy Retail (31-day Supply) Pharmacy Mail Order (90-day Supply) Diabetes Care Plan No cost to you for three diabetes-related visits per year No cost to you for select prescriptions and supplies No cost to you for select prescriptions and supplies Note: The above table reflects your in-network costs for diabetes-related care. Be sure to fill your prescriptions at any CVS CareMark Network pharmacy. Standard benefits apply for all other non diabetes-related care except those listed on the DCP prescription drug list. The Cigna Open Access Network will be your source for contracted medical providers. Click the Find a Doctor link on your dedicated website at You can fill your prescriptions at any retail or mail order pharmacy contracted with the CVS CareMark Network. For more information on the Pharmacy network, visit

6 CVS CareMark Diabetic Meter Program Regular blood glucose testing is essential for people with diabetes. The CVS CareMark Diabetic Meter Program can provide you with a free Meter and test strips to monitor your blood glucose levels. Call Toll-Free for assistance with ordering your free meter DCP members can call the CVS CareMark Diabetic Meter Team toll-free on weekdays between 8 am to 6 pm for assistance with their free meter kit. A Customer Care representative can help you choose one of five available meters. For added convenience, a representative can contact your physician to request and process prescriptions. Meter kits will be shipped directly from the manufacturer to members within 7 to 10 days of the order. Test strips and lancets can be shipped from CVS CareMark within 10 to 14 days. Members may receive no more than one meter kit as part of their pharmacy benefits every plan year. Meters are provided by Roche (ACCU-CHEK) and LifeScan (OneTouch). ACCU-CHEK or OneTouch blood glucose meter kit, which includes a starter supply of test strips and lancets, at no cost, is part of CVS CareMark Mail Service Pharmacy benefits. Vision Care Managing diabetes and pre-diabetes also involves protecting your eyes. Diabetes can damage the blood vessels in the retina. This damage is called diabetic retinopathy, which can lead to blindness and other eye problems. Finding and treating retinopathy early may prevent vision loss. Retinopathy often does not cause symptoms that you can notice in the early stage so, regular eye exams are important. The DCP addresses this concern by providing you with a benefit to see an ophthalmologist or optometrist (eye doctor) who cares for people with diabetes. Protect your Eyes Have a dilated eye exam at least once a year with the provider of your choice. Call your eye doctor right away if you have any vision changes.

7 How to Enroll If you, or any of your dependents who are over 18 years old, have received a diagnosis of diabetes or pre-diabetes, complete the DCP enrollment form and submit to the Human Resources Department. You can be enrolled in the DCP anytime throughout the benefit year. The DCP benefits will be effective upon completing and submitting an enrollment form. You will retain your current medical plan election in addition to receiving the DCP enhancements. A new ID card will not be required. Williamson County Human Resources Department 301 S/E Inner Loop, Suite 108 Georgetown, Texas Phone hr@wilco.org Support you can count on Case Management Perhaps the most valuable resource available to you under the DCP is access to, and outreach from, a Case Manager who will be assigned to you through StarPoint Medical Group. Your Case Manager will reach out to you upon your enrollment and will be available to discuss the benefits and requirements of the DCP, as well as assist with questions you may have regarding your condition. Your Case Manager will initiate follow up calls to remind you of outstanding required Health Actions and keep you up-to-date with diabetesrelated news and information through quarterly mailings. Your Case Manager will provide you with their contact information so you can get in touch anytime you have questions or concerns. StarPoint :

8 Frequently Asked Questions How will I receive my free diabetes-related prescription drugs and supplies? You can fill your free prescriptions at any retail pharmacy that contracts with CVS CareMark or use CVS CareMark mail order pharmacy. Your pharmacy plan will be updated automatically so you can use your existing ID card to receive the enhanced pharmacy coverage. For more information on the CVS CareMark network pharmacies visit How will I receive three no cost diabetes-related visits to my doctor? As part of the DCP, you will automatically have three free diabetes-related visits if your claim is coded as related to diabetes or pre-diabetes. Simply present your ID card at your doctor visit and feel free to let them know you have three no cost diabetes-related visits as part of your DCP. Which medications are free under the DCP? You will have the benefit of free select prescription drugs used to treat diabetes, pre-diabetes, and other related conditions. This includes insulin's (oral and injectable), blood glucose testing supplies and certain medications that treat cholesterol, high blood pressure and depression. All other medications will be covered at the standard benefit level for retail and mail order. A list has been included in this brochure which may be subject to change. Please review the current information on the website by selecting the pharmacy icon. How are the DCP required Health Actions determined? Health actions are based on recommendations by the American Diabetes Association for treating diabetes and pre-diabetes. They are also based on guidelines from the American Cancer Society. How are my required Health Actions tracked? The Claims Administrator will review claims history to track your required Health Actions. The Case Manager assigned to you will review this information and reach out to discuss your progress. In some instances, such as with screenings that may not be required yearly, you will need to complete a Health Actions notification form and submit documentation of the completed Health Action(s). How do I reach a Case Manager? After your initial diagnosis of diabetes or pre-diabetes, or enrollment in the DCP, a Case Manager will call you twice by telephone and if they can not reach you, they will send you a letter at your home address with their contact information. The Case Manager serves as a valuable resource for information and will help you benchmark your progress with the Health Action requirements. What happens if I don t complete my Health Actions in the compliance period? Not completing your required Health Actions during the benefit period which starts on November 1st and ends the following October 31st will make you ineligible for continued participation in the DCP for future years.

9 Contact Information For more information on the Diabetes Care Plan, please contact the following resources: Enrollment Benefit questions Williamson County Human Resources 301 S/E Inner Loop, Suite 108 Georgetown, Texas Phone: am to 5pm, Monday through Friday Allegiance Benefit Plan Management, Inc am to 7pm, Monday through Friday Website:

10 DCP Prescription Drug List Free diabetes related prescription drugs and supplies list is subject to change

11 Diabetes Care Plan (DCP) Enrollment Form SECTION I : Employee ID Number: Employee First Name: Employee Last Name: Employee Address: City: State: Zip Code: Employee Phone Number: Employee SECTION II : I am the Employee (Skip to Section III & IV) I am a dependent, age 18 or older (Complete Section II, III, & IV) DCP Enrollee Social Security Number: DCP Enrollee Date of Birth: DCP Enrollee Gender: Female Male DCP Enrollee First Name: DCP Enrollee Last Name: DCP Enrollee Address: City: State: Zip Code: DCP Enrollee Phone Number: DCP Enrollee SECTION III : Eligible participants (age 18 or older) must be enrolled in one of the Williamson County Medical Plans and diagnosed with diabetes or pre-diabetes. I am enrolled in one of the Williamson County Medical Plans OR I understand my DCP enrollment is contingent upon enrolling one of the Williamson County Medical Plans I certify I meet the eligibility requirements for DCP Enrollment and understand I must complete all required Health Actions by October 31st of each plan year in order to remain enrolled in the DCP. SECTION IV: Employee Signature: DCP Enrollee Signature: Date: Date: Submit your DCP enrollment form to the Human Resources Department: hr@wilco.org Fax: (512) S/E Inner Loop, Suite 108 Georgetown, TX 78626