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1 Independent School District #492 Austin Public Schools March 1, 2012 Health Insurance Plan 2/21/2012.

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Presentation on theme: "1 Independent School District #492 Austin Public Schools March 1, 2012 Health Insurance Plan 2/21/2012."— Presentation transcript:

1 1 Independent School District #492 Austin Public Schools March 1, 2012 Health Insurance Plan 2/21/2012

2 2 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 Benefits effective March 1, 2012

3 Austin Independent School District # Benefit Plan Comparison (In-Network) Benefit250/500 Plan1200/2400 Plan Lifetime MaximumUnlimited Deductible$250 Single / $500 Family$1,200 Single / $2,400 Family Coinsurance Percentage80/20% Out of Pocket Maximum (OOPM)$2,500 Single / $5,000 Family Hospital Inpatient80% after deductible to OOPM, then 100%. Hospital Outpatient80% after deductible to OOPM, then 100%. Emergency Room Services80% after deductible to OOPM, then 100%. Inpatient Physician Visits80% after deductible to OOPM, then 100%. Inpatient Maternity Services80% Prenatal Care80% Well Baby Care Visit Maximum:100% Birth to 12 Months100%, no visit limitation 12 Months to 24 Months100%, no visit limitation 24 Months to age 6100%, no visit limitation Immunizations (up to age 18)100% Outpatient Diagnostic Testing, X-ray & Lab Services 80% after deductible to OOPM, then 100%. Physician Office Visit80% after deductible to OOPM, then 100%. Preventive Care100% Full Preventive Care

4 Benefit 250/500 Plan1200/2400 Plan Mental Health – Inpatient80% after deductible to OOPM, then 100%. Mental Health – Outpatient80% after deductible to OOPM, then 100%. Chemical Dependency – Inpatient80% after deductible to OOPM, then 100%. Chemical Dependency – Outpatient80% after deductible to OOPM, then 100%. Organ Transplants (performed at an Organ Transplant Network Facility) 80% after deductible to OOPM, then 100%. Organ Transplants - Performed at any other Facility 80% after deductible to OOPM, then 100%. Durable Medical Equipment80% after deductible to OOPM, then 100%. All other Eligible Expenses80% after deductible to OOPM, then 100%. Prescription Drugs – You pay: $0 Generic Copay 80% after deductible to OOPM, then 100%. $35 Formulary Copay $50 Non-Formulary Copay Prescription Drug Out-of-Pocket Maximum Limit $1,000 Single Included in medical deductible and out-of- pocket maximum limit $2,000 Family 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. Austin Independent School District # Benefit Plan Comparison (In-Network)

5 5 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

6 Large provider network means access to your choice of care

7 7 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

8 Services and support that help you manage your health

9 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 Coordinated, personalized support for you

10 10 Were here to help Customer Service (651) or (866) –Monday – Thursday 8a.m.– 5p.m. Friday 9a.m. -5p.m. Find a doctor online: −Go to −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: −Go to −Click on member tab −Click on “prescription drugs” −Click on “myprime.com”

11 More support for your health 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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16 16 Prescription drugs

17 17 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: Prime Therapeutics telephone number is located on the back of your ID card

18 2012 Prescription drug benefit 250/500 Plan *For eligible drugs available at participating 90dayRx pharmacies. Retail Pharmacy 90dayRx* Retail Pick-up or Home Delivery Days Supply31 days90 days Generic$0 copay Preferred Brand (Formulary) $35 copay$70 copay Non-Preferred Brand (Non-formulary) $50 copay$100 copay Separate Drug - out-of-pocket maximum $1,000 Individual $2,000 Family

19 2012 Prescription drug benefit 1200/2400 plan Member cost-share after deductible is met Retail Pharmacy 90dayRx* Retail Pick-up or Home Delivery Days Supply31 days90 days Generic80% After Deductible Preferred Brand (Formulary) 80% After Deductible Non-Preferred Brand (Non-formulary) 80% After Deductible *For eligible drugs available at participating 90dayRx pharmacies.

20 20 Ask for generics and save Generics work the same as brand name drugs, but cost less Brand name $120 Generic equivalent Co-pay $xx Brand name co-pay Generic equivalent $20 Member cost Actual Cost

21 21 Order 90-day supplies* * For eligible drugs available at participating 90dayRx pharmacies. 90dayRx program: Home delivery or pharmacy pick-up Less expensive More convenient

22 22 Specialty Rx Available for specific chronic conditions Often the prescriptions require special handling Order from a specialty network pharmacy –Fairview Specialty Pharmacy, LLC* (612) fax −Triessent fax Contact customer service with questions regarding Specialty Rx

23 23 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

24 24 Questions?


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