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Telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care.  It has been recognized that telehelath can provide an effective option to obtain care initially, while still helping to control the spread of infectious disease.  It also offers convenience!

Anthem’s LiveHealth Online program is available to MMEHT members.  Using LiveHealth Online, you can have a private video visit with a doctor via your smartphone, tablet or computer to get quick care for a common health issue, or access a provider through the Employee Assistance Program (EAP).   LiveHealth Online lets you have a video visit with a board certified doctor or licensed therapist from home, work, while travelling – anywhere you have an internet connection.

In most cases, you will pay a specialist co-pay for the LiveHealth Online visit.  If you use your EAP benefit for counseling visits, there’s no charge.

Through December 31, 2021, cost shares for telehealth and telephone-only visits, including visits for mental health, will be waived for providers in the Anthem network, including for LiveHealth Online.

Please see the link below for more information about LiveHealth Online.

LiveHealth Online Information

If you or a family member are ill, it is understandable that you may be anxious and concerned if it could potentially be the coronavirus that causes COVID-19.  In order to control the spread of COVID-19, providers encourage you to first call or use technology when possible, to check your symptoms prior to seeking medical care in person. 

Anthem’s Sydney Care App now includes a Coronavirus Assessment tool.  This will give you a quick and easy way to assess your symptoms and then, if you choose to, the app can connect you with a doctor through a LiveHealth Online video session or a Virtual Care text session right from your phone.

Through June 14, 2020, Anthem will waive member cost shares for telehealth visits, such as through LiveHealth Online.  Members can also utilize one Virtual Care text session at no cost between now and June 14, 2020. Additional Virtual Care text sessions cost $19 each.

Sydney Care App Information

For learn more about COVID-19 and its potential symptoms, please visit the special section of the MMEHT website, which contains links to sources for support and information. 

MMEHT COVID-19 (coronavirus) Webpage

As we all know, the public health situation in Maine and the U.S. regarding the coronavirus outbreak is a major concern, and it is evolving rapidly. Like every organization and business in Maine, MMA is affected and must make prudent decisions about continuing to provide important services, while protecting the health of our members and employees.

In an abundance of caution, we will be cancelling the in-person 2020 Administrative Workshops, which were scheduled for early May in locations around the state.  Staff is currently exploring an on-line option to share this important information with those who administer Maine Municipal Employees Health Trust benefits.

As always, we encourage you to contact Eligibility & Data Services Manager Linda Mack if you have any questions about the workshops, or any Trust administrative processes.  Linda may be reached at 1-800-452-8786, ext. 2223 or at lmack@memun.org.

Thank you for your understanding.

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.

List of In-Network Walk-In Clinics and Urgent Care facilities

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.

Home Delivery Information (pdf)

On Tuesday, April 23, 2019, Wellness Works, hosted the 31^st 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 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 was presented with the Solid and Steady Award for having a steadfast and consistent wellness program for many years.

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.

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!”