WHAT’S NEW IN PLAN YEAR 2008 FOR Retireee and LTD << UPDATED >>
October 05 , 2007
There are numerous changes to our Benefit program this year. This is a summary of the changes for our Plan effective January 1, 2008:
Eligibility Change:
One of the most important changes this year is the addition of a new category for non-Medicare retirees: “Member + one dependent”. This category or tier of coverage is intended to aid those who formerly had to enroll in the “Family” tier. Examples of persons eligible are: member and spouse or member and one child. This tier is not available to unmarried couples or domestic partners. We will request proof of the relationship between those applying for this tier unless we already have the evidence in our files. “Dependent” is defined in the Benefits Enrollment Guide, which is available at www.benefitoptions.az.gov.
Plan Design Changes:
- Smoking/Tobacco Cessation Aids:
- To assist members with their efforts to quit smoking, all of the plans will now reimburse members for smoking/tobacco cessation aids (nicotine patch, nicotine gum, etc.) up to a cost of $500 per lifetime. There are numerous resources available to assist those who wish to quit tobacco use. These resources include the Arizona Department of Health Services Tobacco Education and Prevention Program (602- 364-0824), ASH program (1-800-556-6222) and the member’s County Health Department.
- The procedure for obtaining reimbursement for smoking/tobacco cessation aids will be published on the web page, www.benefitoptions.az.gov.
- Voluntary and court ordered substance abuse residential treatment:
- Previously, only hospitalizations for those with chemical and alcohol dependency were covered. Studies demonstrate that residential treatment allows for better treatment and a better success rate. Current costs for acute hospital treatment run over $14,000 per stay, while residential treatment is less than half that cost.
Our goal is to increase the likelihood of success for our members while reducing costs.
- Encouraged use of generic medications:
- Physicians have the option of approving the “generic substitution” on prescriptions. When there is a generic available and the member insists the prescription be dispensed as written (rejecting the generic), the pharmacy will ask the member to pay the difference between the generic version and the brand version of the named drug.
- This policy change will require more members to choose generic drugs. If there is a medical reason for the brand name drug, the physician should not approve the “generic substitution” option. Accordingly, the member will not be charged the difference if the physician designates “no substitution.”
- Increase the annual physical limit from $250 to $1500:
- The prior limit was not adequate to cover all lab and diagnostic testing. If these preventative services (yearly physical) totaled more than $250, members were asked to pay the overage.
- This change does not change the fee schedule for physicians and laboratories. It is intended to encourage thorough examinations to detect illness or serious conditions earlier.
- Approve mammograms annually for women 40-49 years of age:
- This change models the recommendations from the American Cancer Society. Women 40 years and older are encouraged to receive regular annual screenings.
- Increase Emergency Room Co-pays to $125 per visit for all plans except SecureHorizons:
- In 2006, Plan members visited emergency rooms over 25,000 times. Many of these services could have been safely provided at an urgent care facility or a physician’s office. Waits for non-emergent care at emergency rooms are often three and four times the wait at urgent care centers.
- All plans have arrangements with urgent care centers and co-pays for those visits remain at $20. Members can call their plan Nurseline or help number for assistance in deciding whether to seek emergency or urgent care.
- Seek emergency care if a life is in jeopardy or permanent loss is imminent.
- Raise specialist co-pays from $10 to $20 per visit for all plans except SecureHorizons:
- Many patients seek specialty care when primary care would suffice. When routine conditions are the cause of the visit, specialists generally cost the plan much more than primary care physicians.
- Primary care physicians include: general medicine, internal medicine, family medicine, and OB. We encourage members to carefully consider which type of physician is needed before making appointments. Plan Nurseline or triage staff may assist members who are unsure about which level of care to seek.
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