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Covenant Health, which operates St. Joseph’s hospital in Bangor and St. Mary’s hospital in Lewiston, has been negotiating a new contact with Anthem.  Covenant has recently stated that unless an agreement can be reached, they will remove their physicians, providers, and other facilities in Maine from the Anthem provider network, effective July 5, 2023.

The Health Trust is concerned about the potential lack of access to these established providers and hospitals, and we understand that members may be anxious about disruption with their current providers.  However, we also recognize that there is a balance to be maintained in order to control the costs of healthcare.  Covenant has asked for very large increases in the amounts they are paid for services provided.

The Maine Municipal Employees Health Trust was founded in 1983 with the goal of containing healthcare costs while maintaining quality benefit programs and providing superior services. For forty years it has been our pleasure to serve municipal and quasi-municipal employees, retirees and their dependents.

We are pleased to offer the Lark Diabetes Prevention Program as of January 1, 2023. This smartphone-based program is recognized by the Centers for Disease Control (CDC) and is based on their well-known Prevent T2 curriculum.

Lark is a personalized digital health coaching that provides education, resources, and support to members at risk for diabetes, accessed through the Anthem Sydney Health app. Eligible members receive a free wireless smart scale upon enrollment.

You can engage in the program at your own pace. It provides digital weight loss support, nutrition therapy with customized feedback through daily check-ins, and customized guidance on sleep and physical activity.

Lark Diabetes Prevention Program Flier

In June Anthem, Inc., the parent company of Anthem Blue Cross Blue Shield Maine, changed their name to
Elevance Health and created Carelon, a new healthcare services brand. Anthem Maine will continue to use
their current name.

Effective January 1, 2023, Anthem Maine’s pharmacy benefit manager IngenioRx will join the Carelon
company and change its name to CarelonRx. As a result of this change, IngenioRx Home Delivery Pharmacy
will become CarelonRx Mail and IngenioRx Specialty Pharmacy will become CarelonRx Specialty
Pharmacy. This name change will have no impact on members’ benefits, coverage or how they fill their
prescriptions. Members using the home delivery and specialty pharmacies have been receiving updates on
this change for the past few months, and after January 1 will receive an insert in their first prescription filled
by either of these pharmacies noting the details of the new branding.

The Health Trust’s Open Enrollment period will begin on November 15, 2022, and end on December 15, 2022, for a coverage effective date of January 1, 2023. Enrollment/Change Forms must be received by the Health Trust by December 15.  If no changes are being made to coverage, no forms are required.

Under the terms of the Affordable Care Act, employers must provide employees with a Summary of Benefits and Coverage (SBC) which follows a standard format prescribed by the federal government.  This document should be distributed to all benefits-eligible employees prior to the beginning of the plan’s open enrollment period each year.

The Health Trust’s open enrollment period will begin on November 15, 2022, and end on December 15, 2022, for a coverage effective date of January 1, 2023.  This means that SBCs must be distributed to all current benefits-eligible employees before November 15, in order to comply with the law.  SBCs must also be provided to any new benefits-eligible employees, so that they are able to review and compare benefits for any health plan(s) in which they are eligible to enroll.

MaineHealth and Anthem Blue Cross and Blue Shield in Maine announced on August 17, 2022 that they have reached an agreement to their contract dispute which will keep Maine Medical Center in Anthem’s care provider network for the next two years. This means all Anthem members can continue to receive in-network services at Maine Medical Center (MMC). All other MaineHealth facilities and providers also remain in Anthem’s network.

The Maine Municipal Employees Health Trust utilizes Anthem as the claims administrator for all of our medical plans, and we also utilize Anthem’s network. Therefore, this agreement means that MMEHT members will continue to have access to MMC in 2023.

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The Health Trust will hold its Annual Reporting Meetings early this fall. These meetings provide the Health Trust staff with an opportunity to report on program operations, finances and activities, and allow members an opportunity to raise questions or concerns.

Members may participate in the Annual Meetings on one of the following dates:

• Wednesday, September 28 from 9:00 – 10:00 a.m. via Zoom
• Thursday, September 29 from 2:00 – 3:00 p.m. via Zoom
• Thursday, October 6 from 9:30 – 10:30 at the MMA Convention in Bangor

To reserve your space at one of the Annual Reporting Meetings, please click on the registration link below. If you are registering for one of the meetings being held via Zoom, you will receive a confirmation via e-mail with a link and password to participate in the Zoom meeting. No registration is required if you plan to join us at the session being held in conjunction with the MMA Convention.

Click here to register

If you have any questions regarding the Health Trust Annual Reporting Meetings, please e-mail Kristy Gould, Director of Health Trust Services, at kgould@memun.org or Lisa Rigoulot, Assistant Director of Health Trust Services, at lrigoulot@memun.org. 

Please note that the Annual Reporting Meeting is different than the Workshops designed specifically for Health Trust Retirees, which have been held in the fall.  These meetings will not be held in 2022.  Updates will be distributed to retirees via mail later this fall. Please visit the Health Trust website for information about medical coverage for retirees at https://www.mmeht.org/medical-plans/retiree-group-companion-plan/ or you may call the Health Trust at 1800-852-8300.

As you may have heard in the news, two large Southern Maine practices have recently notified patients that they have decided to withdraw from Anthem’s network, effective in late summer.   Anthem has been negotiating with these organizations, but they have been unable to settle on a new contract.

The Health Trust is dismayed and concerned about the lack of access to these established providers, Coastal Women’s Healthcare and Fore River Urology.  However, we do also understand that there is a balance to be maintained in order to control the costs of healthcare.  Both organizations have asked for very large increases (between 50 to 70%) in the amounts they are paid for services provided.

State law requires that 60 days notice be provided to members if their doctor leaves the network.  Anthem will be sending out letters to all impacted members if an agreement cannot be reached by that timeframe.

Under the Continuity of Coverage provisions, you may be able to stay with your current doctor(s) for a limited time if you are receiving certain types of care.

Under federal law, this includes care if you are:

• In treatment for a serious and complex condition. This can be a sudden (acute) illness that requires specialized treatment in order to avoid death or permanent harm. It can also be an ongoing (chronic) illness that is life threatening or potentially disabling and requires specialized care over a long period of time.
• In a hospital or other inpatient facility.
• Scheduled for nonelective surgery by your current doctor, including your post-operative care for the surgery.
• Pregnant
• Terminally ill.

Continuity of Care Application Form

Please contact MMEHT Member Services so that we can assist you with the Continuity of Coverage process, or in finding a new in-network provider if you so choose.  Member Service representatives are available Monday through Friday form 8:00 a.m. – 4:30 p.m. at 1-800-852-8300.

Did you know that you can submit a claim to your medical insurance for reimbursement of the purchase cost of an At Home COVID-19 test kit? Your medical insurance plan with Anthem covers for COVID testing, including home or self-administered tests. Reimbursement is limited to eight tests per covered member per month.

In order to receive reimbursement, you need to submit a claim form and a legible store receipt that shows the description of the item purchased.  The Anthem claim form can be found on our website here and it includes the mailing address for claims. You can also submit a claim form through the www.Anthem.com website or the Anthem Sydney app.

Members participating in the Retiree Group Companion Plan may also submit for reimbursement of At Home COVID-19 test kits purchased on or after January 15, 2022.

The U.S. Government is also providing four At Home COVID-19 test kits per household at no charge. You can sign up to receive these at https://www.covidtests.gov/