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UniCare's group health and life insurance plan that began covering CP ministers and other employees on March 1, 1999, is generating positive feedback. Until becoming insured by UniCare, the program had always been a fully-insured, indemnity plan. Now, whever possible UniCare's preferred provider organizations (PPOs) are used and a prescription drug program is now available to all participants. As would be expected, the small co-pays and not having to meet the calendar year deductible that are both basic features of the new group plan are especially popular. Plus, it is not overstating to say that everyone appreciates not having to file claim forms when PPO providers are used. Too often, that can really be a hassle. As far as benefits are concerned: mental health coverage has been improved immensely as a direct result of federal legislation; well baby care and immunizations are now covered to age two; and allergy shots, immunizations, annual pap smears, routine mammograms, and prostate screenings are included and paid at 100% after the $25 co-payment is made for in-network doctor's office visits.
Approximately 93% of all participants have access to UniCare's PPO (in-network), but 7% do not. For these enrollees, the regional networks of hospitals and doctors with which UniCare has contracted do not have sufficient local providers to make usage of the PPO practical. These employees and their families continue to be covered by an indemnity plan just like the plan all of us have had for the last ten years, but with the addition of the new prescription drug plan and the improved benefits. On the plan renewal date of each year (March 1), participants that are considered out-of-network by the insurer may choose to go in-network and that decision will determine how claims are paid for the next year. Participants are required to be enrolled in a PPO, when possible, in order for the plan to receive discounted services.
UniCare provides individuals ID cards (to participants, their spouses, and dependent children who attend college away from home or who live in another location) for each regional network that is included in UniCare's PPO. Participants in the indemnity plan receive still different ID cards. Each employee must sign and put his or her Social Security Number (SSN) on the back of every card issued to his or her family. In California, the PPO plan ID cards are individualized with the employee's name and SSN printed on them and are provided by the area network. On the front of the PPO plan ID cards and on the back of the indemnity plan cards is a very important toll-free telephone number (1-800-288-8630) for providers and employees to use to verify eligibility and benefits and to obtain information on claims and network providers. Amazing things can be done with this number!
All enrolled employees, their spouses, and other specified dependents are also provided a prescription program ID card that includes the employee's name and SSN. A toll-free telephone number (888-218-4844) is also included on the back of these cards. Additional duplicate cards may be obtained by using this telephone number as well as other pertinent information.
The board's consultant, Brian Sinclair-Whitely, and board staff, have been in the process of reviewing the drafts of the plan booklets, marking errors and changes for the UniCare's underwriters. Since it is crucial for the final copy of the plan description to be accurate, this is a painstaking process. However when the booklet is in its final form, participants will be mailed a booklet as soon as possible.
UniCare has honored any deductibles that were met in January and February of 1999 while CIGNA was the insurer. Some of you may have had claims applied to the calendar year and/or the in-patient deductibles since the original list was received by UniCare. The board's consultant arranged for CIGNA to update the figures in order for claims to process accurately.
Under the prescription drug program, participating pharmacies provide a 34 day supply of generic drugs for $25 co-payment or brand-name medicines for a $20 co-payment. If a prescription costs less than the co-pay, the lesser amount is paid. This feature is very popular because it can produce significant savings on health care expenses.
Also available is the mail order prescription program (Precision Rx) that allows enrollees on maintenance type medication to save even more money by getting a ninety day supply of a prescribed drug for only $40. To use this program, a three month prescription that is renewable three times, if possible, should be obtained from your physician. This way, a year's supply of the needed medication has been approved. A packet that provides the necessary forms and information may be obtained from the Board of Stewardship office. The first time, a form must be sent to Express Pharmacy Services and the drugs are delivered postage-paid to your home. Thereafter, refills may be ordered by mail, FAX, on-line or simply by telephone.
HOME BENEFITS INSURANCE For more information, contact Mark Duck
Page updated on April 6, 2004 Information updated on March 25, 2003 Pages maintained by Elinor Swindle Brown