Due to the weather the ACA Reporting workshop originally scheduled for January 16 will now be held on Thursday, January 23, starting at 9:00 am, here at MMA in Augusta.
The list of Walk-In Centers has been updated recently, and new facilities are being added around the state. These facilities can be a good option if you need treatment for an injury or illness and can’t see your primary care doctor, but it’s not an emergency. Walk-In Centers take patients without an appointment and are usually open longer hours, including evenings and weekends.
The doctors and nurses at these facilities can help you with all kinds of things such as minor sprains and strains, sports injuries, sore throats, earaches and the flu. Some centers do x-rays or run other tests on-site and can let you know quickly if you need more specialized care.
The co-pay for a Walk-In Center is equal to that of a specialist co-pay, versus the much higher cost of an emergency room. Effective January 1, 2020 the copay for services received at an urgent care facility was reduced 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.
Not sure if it’s an emergency? Let a Nurse help you decide. Here’s an emergency rule of thumb: Call 911 or go to the nearest ER if you think delaying care could put your health a serious risk. If you’re still not sure where to go for care, call the 24/7 Nurseline at 1-800-607-3262. Registered Nurses are available anytime day or night to help you decide.
Please join us at this year’s annual ACA Reporting Workshops! The Health Trust, in conjunction with the Maine Municipal
Association, will once again offer a series of workshops designed to provide employers with a “refresher course” on the
Affordable Care Act’s reporting requirements. These workshops will be held in January 2020, well in advance of the ACA’s
new reporting deadline.
In this workshop, we’ll walk you through the Form 1095-C and 1094-C reporting requirements. The Form 1095-C and 1094-
C reporting requirements, and the employer shared responsibility provisions, only apply to Applicable Large Employers.
As a result, these workshops are probably best suited to large employers – those with 50 or more full-time plus full-time
Each workshop will include time for questions and answers. Space is limited, so sign up soon!
- Wednesday, January 8, 2020 9 am – noon, Scarborough
- Thursday, January 16, 2020 9 am – noon, Augusta (Workshop POSTPONED until Thursday, January 23, 9 am to noon)
- Tuesday, January 21, 2020 9 am – noon, Presque Isle
- Wednesday, January 22, 2020 1 pm – 4 pm, Orono
To register for one of the ACA Reporting workshops, please e-mail Anne Wright, Director, Health Trust Services, at
email@example.com. Please note which workshop you would like to attend. You will receive a confirmation via e-mail.
For additional details, click here.
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 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.
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.
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.
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 Norway
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.
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.
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!”