Changes to Your Prescription Plan

Anthem is the Plan Administrator for the Maine Municipal Employees Health Trust medical plans and they currently contract with Express Scripts to manage your prescription benefits. Anthem has been working for the last 15 months to develop IngenioRx, a new pharmacy benefits manager, and will be transitioning the Health Trust prescription coverage from Express Scripts to IngenioRx. Starting July 1, 2019 all prescriptions will be filled through IngenioRx. There will be no change to your prescription benefits as a result of this change, but you do need to be sure you are using the correct ID card when you fill your prescriptions.

You should have received a letter from Anthem recently, explaining more details of the transition. Members who currently use home delivery services with Express Scripts to obtain their prescriptions will now fill their prescriptions through IngenioRx, and in most cases the existing prescriptions will transfer to the new system. Members who fill prescriptions through home delivery will get an additional letter explaining more details about the transition.

Members who currently fill specialty medications through Accredo specialty pharmacy will now fill their prescriptions through IngenioRx, and in most cases the existing prescriptions will transfer. Members who fill prescriptions through a specialty pharmacy will get an additional letter explaining more details about the transition. These members will also receive a phone call from the specialty care team to further assist with the transition to IngenioRx.

You should have already received a new ID card at the beginning of the year and this card contains all the information to process prescription claims with IngenioRx. If your card is dated before December 2018, you may have an outdated card. 

Rest assured that the Health Trust will be working with Anthem to transition our members’ prescription benefits with as little disruption as possible. Our Member Services team will be available to assist members with the transition, answer questions and order new ID cards if needed. Member Services can be reached Monday through Friday from 8:00 a.m. to 4:30 p.m. at 1-800-852-8300.

2019 Health Trust Administrative Workshops – Register Now!

2019 Health Trust Administrative Workshops – Register Now!

In May, the Maine Municipal Employees Health Trust will be conducting four Administrative Workshops at locations throughout the state. These workshops are designed to support employees who are responsible for the day-to-day billing and enrollment functions for their participating employer with the Maine Municipal Employees Health Trust. There is no charge to attend these workshops, and we encourage you to attend. New administrators may find this workshop especially helpful.

The workshops will provide you with information about these and other important topics:

  • Determining who is eligible for coverage
  • Enrolling new employees and when coverage begins
  • Reporting changes in employee salaries
  • How and when to terminate benefits
  • Reconciling the monthly Health Trust bill
  • Annual Open Enrollment options

We will also address recurring issues related to billing and eligibility and how to best handle them. Focus will be on learning what resources are available to assist in administering the Health Trust benefits.

You may wish to review the MMEHT Guide to Billing and Enrollment prior to attending the workshop. The Guide is updated regularly.

This year’s Administrative Workshops will be held on the following dates:

Day/Date

Location

Time

Tuesday, May 7 Maine Municipal Association

60 Community Dr, Augusta

9:00 – 11:00 a.m.

Thursday, May 9 Presque Isle City Hall

Council Chambers

12 Second St, Presque Isle

9:00 – 11:00 a.m.

Tuesday, May 21 Scarborough Municipal Building

Council Chambers A

259 US Route 1, Scarborough

9:00 – 11:00 a.m.

Thursday, May 30 Auburn City Hall

Council Chambers

60 Court St, Auburn

9:00 – 11:00 a.m.

Register Now

If you have any questions, please e-mail Linda Mack, Health Trust Enrollment & Data Services Manager at lmack@memun.org or call 1-800-452-8786, ext. 2223.

Did you receive your new medical identification card?

All members who have health insurance with the Maine Municipal Employees Health Trust should have received a new identification (ID) card early in 2019. It is important that you present the correct ID card when you have medical services or fill a prescription. 

You can easily tell if you have the new ID card by checking some information. On the back of your card, on the bottom left hand side of the card, is a print date. This date should be a December 2018 date. On the front of the card the RxBIN number should be 020099.  This is an internal number that is needed when you fill prescriptions.

In mid-2019 Anthem will be changing the provider they use to fill prescriptions.  If you present an older card after that, it will not work.  Please be certain you are carrying the correct ID card. 

If you are on the Health Trust vision plan, you do not receive an identification card. Your vision provider should be able to access your VSP benefits information on the VSP system. If you would like to have an ID card for reference, you can easily print one from the VSP website www.vsp.com.

If you are on the Health Trust dental plan, when you enroll you will receive two ID cards per family from Northeast Delta Dental issued in the subscriber’s name only. Additional ID cards can be requested from the Health Trust if needed.

If you have a family of five or more people on your health insurance, you would have received the ID cards in more than one envelope.  If you or any of your covered dependents do not have your new medical ID card, or need a dental ID card, please call the Member Service Representatives Monday through Friday from 8:00 a.m. to 4:30 p.m. or email us 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

ACA News: Preventive coverage will now include statins

Anthem is updating its ACA preventive care coverage to include generic low-to-moderate dose statins due to the US Preventive Services Task Force recommendation regarding Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. This coverage is effective for December 1, 2017.

Anthem will cover generic low-to-moderate dose statins at 100%, no member cost share for members between the ages of 40-75 years old who have one of the following cardiovascular disease (CVD) risk factors: diabetes, hypertension, dyslipidemia and/or smoking. Risk factors will be identified proactively by pharmacy and medical data.

If a member is not proactively identified, the provider can call or fax Anthem’s Prior Authorization Center if they feel that the member meets the age and risk factor criteria and should receive their generic low-to-moderate dose statin at 100% coverage, no member cost share.

Below is a list of generic low-to-moderate dose statins:

  • Atorvastatin 10 – 20mg
  • Fluvastatin IR and XL 20 – 80mg
  • Lovastatin 10 – 40mg
  • Pravastatin 10 – 80mg
  • Simvastatin 5 – 40mg
  • Rosuvastatin 5 – 10mg

Anthem Data Breach Legal Notice

You may have received in the mail, or via e-mail, a notice regarding a legal settlement reached with Anthem. We have had phone calls inquiring if this notice was authentic or if it was spam mail. The notice is a legitimate one. Anthem reached a settlement in June to resolve a class action lawsuit relating to the 2015 cyber-attack against the company.

For individuals whose information was impacted by the cyber-attack, which was announced by Anthem in February 2015, the settlement provides for an additional two years of credit monitoring and identity protection services. Alternatively, members who already have credit monitoring services may submit a claim to receive alternative compensation for up to $36 instead of credit services.

For more information, visit www.DataBreach-Settlement.com, or call 1-855-636-6136.

Congratulations to the 2017 Wellness Awards winners!

On Tuesday, April 25, 2017 the Maine Municipal Employees Health Trust’s Wellness Department hosted the 29th annual wellness conference. There were 74 attendees, representing 40 of our member groups. Two groups and one individual were recognized for implementing comprehensive wellness programs at their worksites.

Knox County
Knox County received the Biggest Leap award for offering a wellness program that made the most leaps and bounds. The Knox County wellness committee pushed themselves this past year to consider the health needs of employees and offered programs that have a positive and lasting impact on their health.

 

City of South Portland
The City of South Portland received the Highest Peak award for taking their wellness program to the next level. The City of South Portland’s wellness committee challenged themselves to involve more employees in the wellness program. They did so by offering incentives and a wide variety of programs to meet the heath interests of individual employees.

 

Denise Mungen
Denise Mungen, EcoMaine, was honored with the Wellness Champion award for inspiring others to be their healthiest self. She was successful by using her passion, empathy and ability to recognize and overcome barriers to meeting the health needs of employees who work shift work.

 

A grant from Wellness Works, the health education and promotion program of Maine Municipal Employees Health Trust, provides the necessary funding to help offset the cost of worksite wellness initiatives.  If you would like more information on how to get a wellness program started at your worksite, please contact Anne Charles.

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