WHAT’S NEW FOR PLAN YEAR 2007-2008
August 01, 2007
There are numerous changes to our Benefit program this year. This is a summary of the changes for our Plan effective October 1, 2007.
Eligibility Change:
One of the most important changes this year is the addition of a new category for “Employee + 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: employee and spouse or employee 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, the plan will now reimburse members for smoking/tobacco cessation aids (nicotine patch, nicotine gum, etc.) up to a cost of $500 per lifetime.
- Voluntary and court ordered substance abuse residential treatment:
- Studies demonstrate that residential treatment allows for better treatment and a better success rate. Our goal is to increase the likelihood of success for our members while reducing costs.
- Encouraged use of generic medications:
- 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 examination limit from $250 to $1500:
- 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 from $75 to $125 per visit:
- 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.
- Raise specialist co-pays from $10 to $20
|
