REMIF Health Plan

REMIF Health Plan
Welcome to the new REMIF Health Plan. As you know, the REMIF Health Plan has transitioned
to a Self-Funded plan beginning July 1, 2015. As a result, you are receiving new ID cards, and you
will soon receive a new Summary Plan Description and Evidence of Coverage booklet. Enclosed
with this mailing are your new ID cards and information about your new Plan.
WHAT’S NEW?
The REMIF Health Plan will be administered by HealthComp, a licensed Third Party Administrator. HealthComp will
handle all member services, including enrollment, terminations, billing, claims, ID cards, and COBRA administration.
The new program allows us to offer the same benefits we offered prior to July 1, 2015, and includes access to the same
medical providers. No matter which benefit option you chose at Open Enrollment, you will continue to have access to
the Anthem Prudent Buyer Preferred Provider Organization (PPO) network. Access to the same medical providers is
very important to our members. This is because your medical provider plays an important role in helping you stay
healthy.
For members on an HSA benefit option, your deductible increased from $1,250 to $1,300 as required by the federal
guidelines.
For some, your prescription drug copay could change due to changes in the formulary. For those using mail order, you
will need to set up a new account and obtain a new 90 day prescription from your physician.
New Prescription Drug Company – EnvisionRx
Starting July 1st your new pharmacy vendor is EnvisionRx for all REMIF plans. Envision has an extensive network of
contracted pharmacies which includes all major chains, plus many independent pharmacies. We encourage you to
check your pharmacy by visiting the EnvisionRx website at www.EnvisionRx.com. For more information on pharmacy
benefits, please review our important Prescription Drug Plan Information enclosed in this packet.
Important Information about Transition Care
We want to help make your transition experience seamless and easy. There are several issues that can come up when
transitioning to a new plan and new administrator. Below are some guidelines to help ensure that you and your family
do not experience service interruptions:
Authorizations for medical care and testing: Anthem has advised us that all active authorizations on file will transfer to
the new Plan effective July 1st. We strongly advise that all members verify that any authorizations for you or your
covered dependents are on file by calling Anthem at (800)-274-7767. You could also ask your physician to contact
Anthem at (800) 274-7767 as soon as possible to verify that your authorizations have transferred to the new Plan; or
obtain authorization for new service if:
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You have been authorized for a surgery or procedure to take place after July 1st
You have been authorized for specialized treatment that will begin or continue after July 1st
You have been authorized for a specific test or diagnostic procedure (including MRI, CT Scan, PET Scan, or other
nuclear medicine test) after July 1st
You need authorization for services to take place after July 1st
For all other authorization questions, please call HealthComp at (800) 442-7247.
Mail Order Prescriptions: If you are currently using the Express Scripts mail order program, you will need to establish a
new account with Orchard Pharmaceutical Services, and get a new 90 day prescription from your physician. To establish
your new account, call Orchard at (866) 909-5170, go online at www.orchardrx.com, or complete and submit the mail
order form (available from your Human Resources Department). Once your new account is established, your physician
will need to contact Orchard at the number above to provide a new 90 day prescription.
NEED HELP?
We’re here for you! If you have questions regarding your benefits or if you need assistance with transition care, please
contact your Human Resources representative, or call our broker, RealCare at (800) 939-8088, Option 2.
REMIF Health Plan
Quick Reference Guide
Help is available when you need it! Here’s a guide to help you determine who to call
when you need assistance with your health Plan.
MEDICAL PLAN
Call HealthComp Member Services for:
• Information on medical or prescription claims
• Information on deductibles or out of pocket maximums
• New medical Plan ID Cards
• Eligibility information
• General medical benefit questions
• Prior authorization questions
(800) 442-7247
Call Anthem for:
• Assistance with Utilization Review, Prior Authorizations
(800) 274-7767
Call EnvisionRx for:
• Questions about prescription coverage
• Assistance with prior authorizations
• Help in finding a pharmacy
Call Orchard Pharmacy for:
• Mail order pharmacy questions: (866) 909-5170
• Specialty Pharmacy questions: (877) 437-9013
Call RealCare Insurance Brokers for:
• Assistance with claims issues
• Help understanding benefits or eligibility
(800) 361-4542
See Below
(800) 939-8088, Option 2
DENTAL PLAN
Call Delta Dental for:
• Information on dental claims and benefits
• Help in finding a Delta Dental provider
(800) 765-6003
VISION PLAN
Call VSP for:
• Information on vision claims and benefits
• Help in finding a VSP provider
(800) 877-7195
Dear REMIF Plan Participant: Welcome to HealthComp! REMIF has contracted with HealthComp as part of a continuing effort to offer its employees a high level of health insurance benefits and benefit administration. This announcement will provide you with an overview of how to best utilize services provided by HealthComp. CUSTOMER / MEMBER SERVICES HealthComp Available to assist you and your Providers with Questions (800) 442‐7247 regarding Eligibility, Benefits & Claims www.healthcomp.com MEDICAL EPO/PPO NETWORK Anthem Blue Cross of CA/Anthem Blue Card
Available for locating a network provider in your area. www.anthem.com/ca Anthem Blue Cross UTILIZATION REVIEW (800) 274‐7767 – Provider Services Claims Inside California: ADDRESS FOR ANTHEM PROVIDER MEDICAL CLAIM SUBMISSIONS P.O. Box 60007, Los Angeles, CA 90060‐0007 Claims Outside California: Submit to your local BCBS office HealthComp ADDRESS FOR DIRECT MEMBER REIMBURSEMENT CLAIM SUBMISSIONS (Non‐Anthem provider claims paid by Member) P.O. Box 45018, Fresno, CA 93718 PRESCRIPTION BENEFITS MANAGER EnvisionRx (800) 361‐4542 www.envisionrx.com Medical Claims Administration: As your new benefit plan administrator, HealthComp is available to assist you with your medical and prescription claims, eligibility and benefit inquiries. Our Customer Service Representatives are available to support you Monday through Friday from 6:00 a.m. to 4:30 p.m. PST at (800) 442‐7247. You may also access your claims history and eligibility information at any time via HCOnline (www.healthcomp.com), our secure, dedicated website for REMIF. HCOnline allows plan participants the opportunity to email our Customer Service Representatives with questions regarding claims benefits as well as order new ID Health Cards outside of HealthComp’s normal business hours. Please refer to our “HCOnline” handout for additional information regarding HCOnline access. EPO/PPO Network: Anthem Blue Cross of California is your exclusive provider organization (EPO) and preferred provider organization (PPO). For EPO members, you must use an Anthem provider for benefits to be eligible for coverage. For PPO members, to ensure you receive the highest level of benefits, we encourage you to use a participating Anthem provider. To confirm or locate participating providers you may visit the website listed above. All benefit, claims and eligibility questions should be directed to HealthComp. Utilization Review: Anthem Blue Cross will provide Utilization Review and Case Management for you and your enrolled dependents. Your provider should contact Anthem to initiate any preauthorization review. Please contact Anthem or refer to your plan document for the list of procedures requiring precertification. Due to the clinical information required by Anthem to initiate preauthorization review, we encourage your provider to contact Anthem directly. Prescription Benefits Manager: EnvisionRx is your Prescription Benefits Manager. You may utilize any pharmacy that accepts EnvisionRx to fill your prescriptions. If you have any questions regarding your prescriptions, including locating a participating pharmacy, requesting a preferred brand prescription drug listing, or for prescriptions which require a pre‐authorization or override, please contact EnvisionRx at the number listed above. Please note that EnvisionRx will be able to assist with your questions after Open Enrollment has been completed and eligibility has been uploaded in their system. Should you have any questions, please do not hesitate to contact HealthComp’s Customer Service department at the number listed in the box above. We look forward to serving you! Mailing Address: P.O. Box 45018 Fresno, CA 93718‐5018 Phone: (800) 442‐7247 • Fax: (559) 499‐2464 • www.healthcomp.com Important Prescription Drug Plan Information
Your Prescription Benefits Manager (PBM) will move from Express Scripts/Anthem Blue Cross to Envision Rx effective July 1,
2015. Due to the change in vendors, we would like to take this opportunity to make you aware of some differences that may affect
your prescriptions.
• Because EnvisionRx has a broad network of retail prescription pharmacies, most members will be able to continue using the same
retail pharmacies. To verify that your current pharmacy is contracted with Envision Rx or to locate a network pharmacy, visit the
Envision Rx website at www.envisionrx.com and select “Pharmacy Locator” under “Resource Tools” on the main menu bar.
• Most refills will be available without a new prescription; however, you may need to request a new prescription from your
physician for certain types of prescriptions, or if you switch pharmacies.
• Members using the Express Scripts mail order pharmacy service will need to establish a new account with Orchard
Pharmaceutical Services and obtain a new 90 day prescription from your physician.
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To establish your new account, call Orchard at (866) 909-5170, or go online at orchardrx.com or complete and send
the mail order form (available from your Human Resources Department). Once you’ve established a new account,
your physician will need to contact Orchard to provide a new 90 day prescription. Your physician can contact
Orchard at the number above to obtain instructions for submitting your new prescription.
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• After July 1 Specialty medications must be obtained through the Orchard Specialty Pharmacy. As a convenience to members, if
you or a family member is currently taking a specialty medication, you will be able to receive your first specialty prescription
through any contracted retail pharmacy. This will allow you time to set up your new account with Orchard Specialty Pharmacy.
To obtain your first refill at a retail store, please contact your physician to request a new prescription for your local pharmacy.
Also, please contact Orchard Specialty Pharmacy at (877) 437-9012 or register online at www.orchardspecialty.com (click
“Orchard Connect” to get started.
• Many drugs will have the same copays, however some may be lower or higher depending on differences between Envision Rx’s
preferred drug list and Express Script’s preferred drug list.
• To locate Envision Rx’s preferred drug list, visit the Envision website at www.envision rx.com and click on “Formulary” under the
Resource Tools. Then, select “Preferred Drug List.” Remember because the formulary list is so extensive, the list you see will not
include ALL covered drugs. If your drug is not listed, please call Envision at (800) 361‐4542 to find out how your drug is covered.
• Members will need to get new prescriptions from a physician for controlled substances and specialty medications.
• There may be some disruption in prescriptions that have been reviewed and authorized by Express Scripts that Envision Rx will
need to re‐authorize. If you have previously had a prescription authorized by Express Scripts we recommend that you obtain a
new authorization through Envision Rx as well.
Things you can do…
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Refill existing prescriptions before June 30
Visit www.Envisionrx.com to:
o Confirm your pharmacy is participating
o Search for preferred prescriptions
o Register as a new member
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Establish your Orchard mail order account and obtain a
new prescription
Call Envision to verify whether you need a new
authorization for your prescription
Should you have any questions regarding how to obtain a prior authorization, prescription override, or have any difficulties refilling
your prescription, please contact Envision Rx’s Member Service Department at (800) 361‐4542. Envision will be able to assist with
your questions effective July 1, 2015.
Sincerely,
HealthComp
Mailing Address: PO Box 45018, Fresno, CA 93718-5018
Phone: 800.442.7247 Fax: 559.499.2464
www.healthcomp.com
Electronic EOB Statements
Sign up for electronic Explanations of Benefits (EOBs) today!
HealthComp now offers you the option to go paperless and receive an e-mail notification whenever a new
explanation of benefits (EOB) statement has been posted online. Online EOBs contain the same information as
the printed EOBs you receive in the mail, and can be viewed 24 hours a day, 7 days a week. You’ll also enjoy
the convenience of referencing archived EOBs at any time.
The e-Advantage:
Secure
Eco-Friendly
Convenient
View EOBs 24/7
To Access EOBs Online:
1. In Internet Explorer, browse to www.healthcomp.com
2. Click on Members
3. Click on HCOnline
• If you have not previously logged into HCOnline you will
need to complete the New User Registration.
• Click on Member registration and follow the prompts to
register.
4. Log in and Select User Account
5. Then select Electronic EOB Signup
6. If you don’t have an email address on file, enter the email address where you would like to receive the EOB
notifications.
7. If you already have an email address on file, you may change it to a different email address at your discretion by
clicking on the Change button.
8. Check the box Yes, receive Explanation of Benefits (EOB) notification via email.
Click Save. Please allow 1-2 business days for this feature to go into effect. You may revert back to receiving
paper EOB at any time by simply checking the box No, send me paper Explanation of Benefits (EOB).
9. Be sure to add [email protected] to your contacts, to ensure delivery of electronic EOB notifications.
Sign up today by visiting HCOnline
If you have any questions or require assistance, please contact HealthComp’s customer service team at
800.442.7247 or [email protected]
Mailing address: PO Box 45018, Fresno, CA 93718-5018
Phone: 800.442.7247 Fax: 559.499.2464
www.healthcomp.com
HealthComp ID card goes DIGITAL
HealthComp is pleased to provide you the convenience of a digital member ID card. Here are some advantages of a digital
card over the old-school plastic card:
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One less thing to carry in your packed wallet. By accessing your digital ID card, you don’t have to keep the plastic
version in your wallet anymore.
Large family? Instead of sharing a card, every family member can print their own ID card.
Online means up-to-date. As soon as your account with HealthComp is updated, your digital ID card is updated.
If your ID card is lost/stolen, no more waiting for a replacement card via mail.
You can email a copy of the card to your providers or your family members.
You can print copies to give to your providers.
Access HealthComp ID card on the web:
 In Internet Explorer, browse to
www.healthcomp.com
 Click on Members after entering website
 Click on HCOnline from the drop down menu
 Log in to your HCOnline account
 Under Health Plan tab select ID Cards option
 Click on Digital ID Card button
Access HealthComp ID card on smart phone/tablet:
 Visit m.healthcomp.com
 Tap Members
 Tap HCOnline and log in
 Tap Digital ID Card
If you require assistance, please contact HealthComp’s customer service team at: 800.442.7247
Mailing address: PO Box 45018, Fresno, CA 93718-5018
Phone: (800) 442-7247 Fax: (559) 499-2464
www.healthcomp.com
Need a doctor?
Finding one online is fast and easy.
With our Find a Doctor online tool, it’s simple to look for
doctors who are part of the Anthem Blue Cross network.
Whether you’re checking to see if a family favorite is in the
network or looking for someone new, it’s a snap!
To Find a California Provider:
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Go to anthem.com/ca
Under Useful Tools on the right, select Find a Doctor
Under Search by selecting a plan/network, go to Select a State and select California
Under Select a plan/network, choose Blue Cross PPO (Prudent Buyer – Large Group) from the
drop-down menu.
Using the drop-down boxes, select what type of doctor and the location you are looking for, then
select Search.
For more info about a provider (like skills and training), just select that name in the directory
To Find a Non-California Provider:
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Go to anthem.com/ca
Under Useful Tools on the right, select Find a Doctor
Under Search by selecting a plan/network, go to Select a State and select the state in which you
require a provider
Under Select a plan/network, choose Medical Employer-Sponsored National PPO (Blue Card
PPO) from the drop-down menu.
Using the drop-down boxes, select what type of doctor and the location you are looking for, then
select Search.
For more info about a provider (like skills and training), just select that name in the directory
To Search for doctors, hospitals, pharmacies and more from your mobile device, go to
anthem.com/ca. You can also download our free app from the app store on your Apple or
Android smartphone. Search Anthem Blue Cross and download.