Schaller Anderson:
The Schaller Anderson Healthcare provider contract will not be renewed for the next health
plan year beginning October 1, 2008. All members will be given other provider options during
open enrollment and any on-going medical needs will be handled under a transition of care plan
worked out between the Department of Administration, Schaller Anderson Healthcare and
Strategic Health Development Corporation.
Provider Nominations |
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AFMC Nomination |
Dental Services:
The number of dental providers has been reduced from four to two, however ADOA Benefit
Options is still offering a pre-paid plan (Total Dental Administrators Health Plan, Inc.) and a
PPO plan (Delta Dental of Arizona). Additionally, ADOA Benefit Options expanded the tiers to
include an employee plus one tier as was implemented with the medical plans last year.
Employee contributions:
Employee contributions toward their health insurance increased slightly for the Plan Year 2008-
2009. Single coverage increases from $25 to $30 per month, employee plus one coverage
increases from $50 to $60; and family coverage increases from $125 to $150 per month.
Medical Management:
For those using the RAN+AMN, Beech Street or Arizona Foundation networks, ADOA Benefit
Options has changed Medical Management companies to Strategic Health Development
Corporation (Strategic). ADOA Benefit Options contracted with Strategic in February of 2008
to take over utilization management and review tasks previously performed by the Schaller
Anderson Healthcare group. Strategic handles prior-authorizations, review of hospital
admissions and stays, and provides case management and disease management services for
members covered under the RAN+AMN, Beech Street and Arizona Foundation networks.
Hearing Aids:
It is now $1,500 per ear. Also, now ADOA Benefit Options will cover repair and cleaning for all
hearing aids. For cochlear implants, batteries will now be covered.
CAT/CT imagery:
Prior-authorization will be required for these procedures. Authorizations requests are submitted
by your physician. ADOA Benefit Options already requires prior-authorization for MRI’s and
PET scans.
Injection prior-authorizations:
Any injections costing more than $350 each and administered at a physician’s office will require
a prior-authorization. If you are impacted by this change, you may consult with your physician
as to whether or not your condition allows you to self-administer injections after proper training.
Specific drug controls:
Due to the need to manage excessive costs of certain high dollar medications, ADOA Benefit
Options will continue reviewing clinical appropriateness criteria for identified medications.
Your physician may be asked to demonstrate the need for these particular drugs when cost
effective alternatives are available. Examples include Oxycontin and Actiq.
Independent Medical Assessments:
ADOA Benefit Options reserves the right to require independent medical assessments in cases of
high cost treatment plans. This process has been designed to assure the resources ordered are
both required and appropriate for the conditions present. Because medical technology advances
so quickly, ADOA Benefit Options wants to make sure that you are receiving both necessary
care and the best available care within the limits of our coverage.
Inappropriate Care:
The Federal Centers for Medicare and Medicaid Services (CMS) has launched an initiative to
make providers responsible for additional medical services needed as a result of avoidable
complications. ADOA Benefit Options intends to follow the CMS guidelines and refuse
payment for avoidable complications.
Autism Coverage:
Note this is a future event that begins July 1, 2009. Starting July, 2009, autism related services
will increase pursuant to a newly passed state law. Therapeutic services for those diagnosed with
autism will be the primary area of expansion.
Wellness and Mayo Clinic team up to offer the annual Health Assessment:
Benefit Options Wellness' newest addition is the Mayo Clinic Health Assessment, a professionally
developed questionnaire, designed to help members become knowledgeable about their health.
August 11, 2008 through January 30, 2009 members will have access to the Health Assessment online
through the Mayo Clinic EmbodyHealth Web Portal at www.bewellstaywell.az.gov. The Health
Assessment takes only 15 minutes to complete and offers members an opportunity to improve their
health through progressive lifestyle changes. All participants will receive a FREE T-shirt and be
entered into a drawing for 500, $25 awards. Upon completion of the Health Assessment,
members may also be eligible for FREE one-on-one telephonic EmbodyHealth Coaching.
Participants can choose from five EmbodyHealth modules including: Healthy Weight, Exercise, Stress,
Tobacco Cessation, and Nutrition. Once enrolled in EmbodyHealth Coaching the Mayo Clinic
professionals will provide support to help employees set goals, implement lifestyle changes, and
improve and maintain health.
Benefit Options Wellness is proud to offer the Mayo Clinic EmbodyHealth package of services
through the EmbodyHealth web portal www.bewellstaywell.az.gov , and encourages employees to
take an active role in their health by logging on and utilizing these valuable resources. |
