Plan Changes for 2020

The Health Trust Board of Trustees has approved the following changes to the Health Trust health plans, effective January 1, 2020.

Urgent Care Services. The Health Trust will reduce the copay for services received at an urgent care facility to match the copay for services received at a walk-in center.  Instead of a $150 or $200 Emergency Room copay, members who receive care at an in-network walk-in or urgent care center will pay a specialist copay – between $20 and $40 per visit, depending on your medical plan.

The Health Trust encourages its members to seek care with a provider that delivers the most appropriate, quality care for the best value.  However, we recognize that it can be confusing to determine which facilities are walk-in centers and which are urgent care facilities.  Many of the facilities on Anthem’s approved walk-in center list have the words “urgent care” in their name, or featured on their signs.  This change is being made to encourage utilization of the most appropriate sites of care and to decrease that confusion.

New walk-in and urgent care facilities have recently opened in many areas of the state or have increased the services they offer on-site.  They also often operate at convenient hours.  This can make walk-in centers or urgent care facilities a wise option if you need non-emergency care, versus a much more expensive emergency room visit.

Pleas refer to the list of approved walk-in centers.  Once this change becomes effective on January 1, 2020, the list will be updated to include urgent care facilities.

Hearing Aids.  In accordance with Maine state mandates, the Health Trust Board recently voted to expand coverage for hearing aids under the POS and PPO plans to include coverage for adults age 19 and older.  Hearing aids will be covered when medically necessary, limited to one hearing aid per hearing impaired ear, every 36 months.

Hearing aids for members through age 18 will be covered without being subject to a dollar limit; hearing aids for members age 19 and over will be subject to a benefit maximum of $3,000 per covered hearing aid.

Copay Maximums. There will be an increase in the in-network copay maximum for all of the active medical plans.  It is important to note that this change will not affect your deductible or coinsurance amounts, nor will it change the copay that you pay for individual services or prescription drugs (with the exception of the copay for urgent care services, which will decrease, as described above).   It simply allows for a greater overall maximum out-of-pocket amount for in-network copays.

This change is consistent with the principles adopted by the Board in 2017, of making plan design changes which impact average participants to a minor degree and heavier users to a more moderate degree, as one way to help keep overall costs down.  The copay maximum will still be lower than is permitted under the Affordable Care Act.  Please refer to the plan summaries for details specific to your medical plan.

If you have questions about these changes or your benefits, please contact Health Trust Member Services at 1-800-852-8300.  The Member Services Representatives are available to take your calls Monday through Friday, from 8:00 a.m. – 4:30 p.m.

Plan Change Updates letter – November 2019

Annual Benefits Open Enrollment

The Health Trust’s Open Enrollment period began on November 15, 2019, and will end on December 15, 2019, for a coverage effective date of January 1, 2020. 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.

Information regarding rate increases was distributed to employer group representatives and participants via US Mail in early to mid-November.

If you have any questions, please contact the Health Trust Billing and Enrollment Department at 1-800-452-8786, ext. 2585 or email htbilling@memun.org. Thank you.

SBCs and Summary Documents for 2020 Now Available

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, 2019, and end on December 15, 2019, for a coverage effective date of January 1, 2020.  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.

The 2020 SBCs for each of the Health Trust’s health plans are now available at https://www.mmeht.org/employer-resources/summaries-of-benefits-and-coverage/.  The updated one-page summary documents for 2020 are also available at this link.

It is important to note that employees must be provided with a copy of the SBC for each plan in which they are eligible to enroll.  So, for example, if employees can choose between the POS C and PPO 500 plans, the employer must provide each benefits-eligible employee with the SBC for both plans (POS C and PPO 500).

SBCs may be provided to employees electronically (e.g., via e-mail), as long as certain requirements are met.  If an employee is able to access documents electronically at work, at a location where the employee is reasonably expected to perform his/her work duties, and as long as access to the employer’s electronic information system (e-mail, internet, etc.), is an integral part of the employee’s work duties, the notice may be provided electronically.

However, if there are employees who do not have access to computers at work, and for whom electronic access is not a regular integral part of their work responsibilities, notice must be provided in hard copy (paper) form, unless the employee requests otherwise.  In addition, even if an employee may be provided with an electronic version of the SBCs, if he or she requests a paper copy, the employer must provide it.

If you have any questions, please feel free to call the Health Trust at 1-800-852-8300.  Thank you.

Prescription Home Delivery Changes

If you currently fill a maintenance medication via mail order, your prescription was transferred to IngenioRx Home Delivery Pharmacy effective July 1, 2019.  IngenioRx is the new pharmacy benefits manager (PBM) which Anthem will use to fill prescriptions.

You will now need to order your refills by logging in at www.anthem.com.  If you currently utilize the auto refill program, you will still need to log in the first time to order your refills and update your credit card information.

Prescriptions for controlled substances did not transfer.  You will need a new prescription for any controlled substance medications.

Prescriptions that expired with no additional refills also did not transfer.  Please have your provider send in a new prescription to IngenioRx.

You may reach IngenioRx Home Delivery at 1-833-236-6196.  If you have any questions about your prescription benefits, please call the Health Trust Member Service Representatives at 1-800-852-8300, Monday through Friday, 8 a.m. to 4:30 p.m.

Home Delivery Information (pdf)

Wellness Works Congratulates 2019 Award Winners

On Tuesday, April 23, 2019, Wellness Works, hosted the 31st annual wellness conference. There were 84 attendees, representing over 46 of our employer groups. The morning speaker was Elizabeth Ross Holmstrom, Founder and President of BreakTogether. Elizabeth introduced the science and simple practice of mindful pauses to improve work and wellbeing.

In the afternoon Wellness Works facilitated a session, Triumphs and Trials. This session gave time for participants to share their successes and work together to find solutions to the struggles they are facing.

In the afternoon we also recognized two groups and one individual for implementing successful wellness programs at their worksite.


Town of Bar Harbor

Town of Bar Harbor

The Town of Bar Harbor received the Keeping it Local Award for highlighting local resources to enhance employee health.

 


Town of Norway

The Town of Norway

The Town of Norway was presented with the Solid and Steady Award for having a steadfast and consistent wellness program for many years.

 


Christine Hyland

Christine Hyland

Christine Hyland, formerly from the Town of Gorham, currently with Cumberland County Christine received the Planting the Seeds of Wellness Award for leading by example and cultivating healthier choices for employees.

Give your Pharmacist the Correct ID Card

Effective July 1st, Anthem changed the provider they use to manage prescriptions from Express Scripts to IngenioRx.  To help prevent any issues with processing your prescriptions, your pharmacist must have your current benefit information.

The next time you visit the pharmacy, you should show your most recent ID card and ask them to update their records. Your ID card should have an issue date on the back of September 2018 or later and the Rx BIN Number of the front of the card should read 020099.  This is an internal number that is needed when you fill prescriptions.

Letters were sent out about this transition earlier in the spring, and new medical ID cards were distributed in January.  If you don’t have your ID card, or if the issue date of your card is prior to September 2018, you may request a new ID card by calling MMEHT Member Services Monday through Friday from 8:00 a.m. to 4:30 p.m. or by email at HTMemberServices@memun.org.

What is an EOB – and why do I need it?

The Explanation of Benefits (EOB) you receive from Anthem is an important document. It provides you with details about how a service was covered, what the plan paid, and what may be your cost share responsibility. 

Co-pays are usually expected at the time a service is delivered. No EOB is sent if there is only a co-pay, or if no additional patient cost share is required.  However, other costs such as your deductible and coinsurance are most often billed after the service. We strongly suggest that you match up a corresponding EOB before making payment on medical bills you receive, and not pay up front until you have a full explanation of your costs. It can be difficult to recoup overpayments later.

The EOB document can be challenging to interpret. The Health Trust Member Service Representatives can assist with your questions. You can reach Member Services Monday through Friday from 8:00 a.m. to 4:30 p.m. at 1-800-852-8300 or at HTMemberServices@memun.org.

TDES program offers support and savings

TDES program offers support and savings

Diabetes can be a difficult disease to manage, and there are very serious consequences for those who do not effectively manage it.  Support is available to our members who have diabetes or pre-diabetes, and it comes with a significant financial incentive.

The Telephonic Diabetes Education and Support program (TDES©) features local, individualized education and support from experienced, certified diabetes educators.  It is run by our partners at Medical Care Development Public Health. Participants typically have one in-person visit and monthly follow up phone calls with a diabetes educator to help them stay on track.

While participating in the 12-month program, copays will be waived (paid by the plan) for covered prescribed diabetes medications and diabetes supplies, including testing supplies.  For graduates of the program, a TDES2! plan is available for an additional 12 months.

All adult members with MMEHT medical coverage, including retirees on the Medicare Group Companion Plan, are eligible to participate, and the program is open to members with diabetes or pre-diabetes.

For more information or to enroll, please visit our website at www.mmeht.org and click on “What’s New” for a direct link to the TDES© program, or call our Member Service Representatives at 1-800-852-830

We would like to introduce you to Reginald Winslow from the Ellsworth Water Department, an MMEHT member and a TDES© graduate!  In his words, this is how TDES© worked for him….

“Hello, my name is Reggie and I work for the Ellsworth Water Department and I love my hometown of Surry! I spend most of my workdays either in the office or doing field work. For fun I like to play with my three grandchildren.

I first signed up for TDES because of the waived copays for my diabetes medication and supplies, but soon realized I had a lot to learn about my diabetes. My diabetes education program at the Maine Coast Diabetes and Nutrition taught me a lot about how the foods you expect to affect your blood sugar actually do.

Thanks to enrolling in TDES I have better eating habits (which was difficult) and am more conscious of what is in my food. I also understand carbohydrates and though I love to eat, I am mindful of my carb intake.

When I was first diagnosed (with diabetes) my A1C was 11; it now ranges 7.3 – 8.0. This is a great program, the education is there, and the people I have worked with are great and extremely helpful. The participant book I received from TDES is wonderful, pretty informative with links to websites. A great resource to use to ask your doctor questions about your diabetes.

I recommend this program to everyone to learn what has to be dealt with and about the struggle of food choices. It is easy to say, ‘oh, I can do that,’ then reality hits!”

Preventive vs. Diagnostic Care

Preventive vs Diagnostic Care Brochure

One of the most common questions asked to our Member Service Representatives is about the difference between Preventive and Diagnostic services.

Preventive care is given to you when you’re symptom free and have no reason to believe you might be sick. Preventive care includes services such as a routine physical, tests such as a screening mammogram, a screening to see if you have diabetes or immunizations such as a flu shot.

Diagnostic care is what you receive when you have symptoms or risk factors and your doctor wants to diagnose them, or you have a condition that your physician wants to monitor. Diagnostic care includes services such as radiology, ultrasound, or laboratory tests. If you have high cholesterol, diabetes or another medical condition for which you have periodic blood work done, these tests would be considered diagnostic.

Preventive and diagnostic care may occur during the same visit. For example, during a routine check-up your doctor may also discuss a chronic condition you may have and order some tests. The tests your doctor orders may be preventive (such as a screening mammogram) and other tests may be diagnostic (such as a cholesterol check for someone with high cholesterol).

For many preventive services you won’t need to pay anything, while diagnostic services may have a copayment or coinsurance amount that you will need to pay.

Understanding the difference between preventive and diagnostic care will help you understand how your benefits are paid. If you have questions on your benefits or how a service was paid, please contact Member Services at 1-800-852-8300 Monday to Friday 8:00 a.m. to 4:30 p.m.

Download the Brochure

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