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Under the terms of the Affordable Care Act, employers must provide employees with a Summary of Benefits and Coverage (SBC) which follows a standard format prescribed by the federal government.  This document should be distributed to all benefits-eligible employees prior to the beginning of the plan’s open enrollment period each year.

The Health Trust’s open enrollment period will begin on November 15, 2019, and end on December 15, 2019, for a coverage effective date of January 1, 2020.  This means that SBCs must be distributed to all current benefits-eligible employees before November 15, in order to comply with the law.  SBCs must also be provided to any new benefits-eligible employees, so that they are able to review and compare benefits for any health plan(s) in which they are eligible to enroll.

The 2020 SBCs for each of the Health Trust’s health plans are now available at https://www.mmeht.org/employer-resources/summaries-of-benefits-and-coverage/.  The updated one-page summary documents for 2020 are also available at this link.

It is important to note that employees must be provided with a copy of the SBC for each plan in which they are eligible to enroll.  So, for example, if employees can choose between the POS C and PPO 500 plans, the employer must provide each benefits-eligible employee with the SBC for both plans (POS C and PPO 500).

SBCs may be provided to employees electronically (e.g., via e-mail), as long as certain requirements are met.  If an employee is able to access documents electronically at work, at a location where the employee is reasonably expected to perform his/her work duties, and as long as access to the employer’s electronic information system (e-mail, internet, etc.), is an integral part of the employee’s work duties, the notice may be provided electronically.

However, if there are employees who do not have access to computers at work, and for whom electronic access is not a regular integral part of their work responsibilities, notice must be provided in hard copy (paper) form, unless the employee requests otherwise.  In addition, even if an employee may be provided with an electronic version of the SBCs, if he or she requests a paper copy, the employer must provide it.

If you have any questions, please feel free to call the Health Trust at 1-800-852-8300.  Thank you.

If you currently fill a maintenance medication via mail order, your prescription was transferred to IngenioRx Home Delivery Pharmacy effective July 1, 2019.  IngenioRx is the new pharmacy benefits manager (PBM) which Anthem will use to fill prescriptions.

You will now need to order your refills by logging in at www.anthem.com.  If you currently utilize the auto refill program, you will still need to log in the first time to order your refills and update your credit card information.

Prescriptions for controlled substances did not transfer.  You will need a new prescription for any controlled substance medications.

Prescriptions that expired with no additional refills also did not transfer.  Please have your provider send in a new prescription to IngenioRx.

You may reach IngenioRx Home Delivery at 1-833-236-6196.  If you have any questions about your prescription benefits, please call the Health Trust Member Service Representatives at 1-800-852-8300, Monday through Friday, 8 a.m. to 4:30 p.m.

Home Delivery Information (pdf)

On Tuesday, April 23, 2019, Wellness Works, hosted the 31^st annual wellness conference. There were 84 attendees, representing over 46 of our employer groups. The morning speaker was Elizabeth Ross Holmstrom, Founder and President of BreakTogether. Elizabeth introduced the science and simple practice of mindful pauses to improve work and wellbeing.

In the afternoon Wellness Works facilitated a session, Triumphs and Trials. This session gave time for participants to share their successes and work together to find solutions to the struggles they are facing.

In the afternoon we also recognized two groups and one individual for implementing successful wellness programs at their worksite.

Town of Bar Harbor The Town of Bar Harbor received the Keeping it Local Award for highlighting local resources to enhance employee health.

Town of Norway The Town of Norway was presented with the Solid and Steady Award for having a steadfast and consistent wellness program for many years.

Christine Hyland Christine Hyland, formerly from the Town of Gorham, currently with Cumberland County Christine received the Planting the Seeds of Wellness Award for leading by example and cultivating healthier choices for employees.

Effective July 1st, Anthem changed the provider they use to manage prescriptions from Express Scripts to IngenioRx.  To help prevent any issues with processing your prescriptions, your pharmacist must have your current benefit information.

The next time you visit the pharmacy, you should show your most recent ID card and ask them to update their records. Your ID card should have an issue date on the back of September 2018 or later and the Rx BIN Number of the front of the card should read 020099.  This is an internal number that is needed when you fill prescriptions.

Letters were sent out about this transition earlier in the spring, and new medical ID cards were distributed in January.  If you don’t have your ID card, or if the issue date of your card is prior to September 2018, you may request a new ID card by calling MMEHT Member Services Monday through Friday from 8:00 a.m. to 4:30 p.m. or by email at HTMemberServices@memun.org.

The Explanation of Benefits (EOB) you receive from Anthem is an important document. It provides you with details about how a service was covered, what the plan paid, and what may be your cost share responsibility. 

Co-pays are usually expected at the time a service is delivered. No EOB is sent if there is only a co-pay, or if no additional patient cost share is required.  However, other costs such as your deductible and coinsurance are most often billed after the service. We strongly suggest that you match up a corresponding EOB before making payment on medical bills you receive, and not pay up front until you have a full explanation of your costs. It can be difficult to recoup overpayments later.

The EOB document can be challenging to interpret. The Health Trust Member Service Representatives can assist with your questions. You can reach Member Services Monday through Friday from 8:00 a.m. to 4:30 p.m. at 1-800-852-8300 or at HTMemberServices@memun.org.

Diabetes can be a difficult disease to manage, and there are very serious consequences for those who do not effectively manage it.  Support is available to our members who have diabetes or pre-diabetes, and it comes with a significant financial incentive.

The Telephonic Diabetes Education and Support program (TDES^©) features local, individualized education and support from experienced, certified diabetes educators.  It is run by our partners at Medical Care Development Public Health. Participants typically have one in-person visit and monthly follow up phone calls with a diabetes educator to help them stay on track.

While participating in the 12-month program, copays will be waived (paid by the plan) for covered prescribed diabetes medications and diabetes supplies, including testing supplies.  For graduates of the program, a TDES²! plan is available for an additional 12 months.

All adult members with MMEHT medical coverage, including retirees on the Medicare Group Companion Plan, are eligible to participate, and the program is open to members with diabetes or pre-diabetes.

For more information or to enroll, please visit our website at www.mmeht.org and click on “What’s New” for a direct link to the TDES^© program, or call our Member Service Representatives at 1-800-852-830

We would like to introduce you to Reginald Winslow from the Ellsworth Water Department, an MMEHT member and a TDES^© graduate!  In his words, this is how TDES^© worked for him….

“Hello, my name is Reggie and I work for the Ellsworth Water Department and I love my hometown of Surry! I spend most of my workdays either in the office or doing field work. For fun I like to play with my three grandchildren.

I first signed up for TDES because of the waived copays for my diabetes medication and supplies, but soon realized I had a lot to learn about my diabetes. My diabetes education program at the Maine Coast Diabetes and Nutrition taught me a lot about how the foods you expect to affect your blood sugar actually do.

Thanks to enrolling in TDES I have better eating habits (which was difficult) and am more conscious of what is in my food. I also understand carbohydrates and though I love to eat, I am mindful of my carb intake.

When I was first diagnosed (with diabetes) my A1C was 11; it now ranges 7.3 – 8.0. This is a great program, the education is there, and the people I have worked with are great and extremely helpful. The participant book I received from TDES is wonderful, pretty informative with links to websites. A great resource to use to ask your doctor questions about your diabetes.

I recommend this program to everyone to learn what has to be dealt with and about the struggle of food choices. It is easy to say, ‘oh, I can do that,’ then reality hits!”

One of the most common questions asked to our Member Service Representatives is about the difference between Preventive and Diagnostic services.

Preventive care is given to you when you’re symptom free and have no reason to believe you might be sick. Preventive care includes services such as a routine physical, tests such as a screening mammogram, a screening to see if you have diabetes or immunizations such as a flu shot.

Diagnostic care is what you receive when you have symptoms or risk factors and your doctor wants to diagnose them, or you have a condition that your physician wants to monitor. Diagnostic care includes services such as radiology, ultrasound, or laboratory tests. If you have high cholesterol, diabetes or another medical condition for which you have periodic blood work done, these tests would be considered diagnostic.

Preventive and diagnostic care may occur during the same visit. For example, during a routine check-up your doctor may also discuss a chronic condition you may have and order some tests. The tests your doctor orders may be preventive (such as a screening mammogram) and other tests may be diagnostic (such as a cholesterol check for someone with high cholesterol).

For many preventive services you won’t need to pay anything, while diagnostic services may have a copayment or coinsurance amount that you will need to pay.

Understanding the difference between preventive and diagnostic care will help you understand how your benefits are paid. If you have questions on your benefits or how a service was paid, please contact Member Services at 1-800-852-8300 Monday to Friday 8:00 a.m. to 4:30 p.m.

Download the Brochure

Anthem is updating its ACA preventive care coverage to include generic low-to-moderate dose statins due to the US Preventive Services Task Force recommendation regarding Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. This coverage is effective for December 1, 2017.

Anthem will cover generic low-to-moderate dose statins at 100%, no member cost share for members between the ages of 40-75 years old who have one of the following cardiovascular disease (CVD) risk factors: diabetes, hypertension, dyslipidemia and/or smoking. Risk factors will be identified proactively by pharmacy and medical data.

If a member is not proactively identified, the provider can call or fax Anthem’s Prior Authorization Center if they feel that the member meets the age and risk factor criteria and should receive their generic low-to-moderate dose statin at 100% coverage, no member cost share.

Below is a list of generic low-to-moderate dose statins:

• Atorvastatin 10 – 20mg
• Fluvastatin IR and XL 20 – 80mg
• Lovastatin 10 – 40mg
• Pravastatin 10 – 80mg
• Simvastatin 5 – 40mg
• Rosuvastatin 5 – 10mg

You may have received in the mail, or via e-mail, a notice regarding a legal settlement reached with Anthem. We have had phone calls inquiring if this notice was authentic or if it was spam mail. The notice is a legitimate one. Anthem reached a settlement in June to resolve a class action lawsuit relating to the 2015 cyber-attack against the company.

For individuals whose information was impacted by the cyber-attack, which was announced by Anthem in February 2015, the settlement provides for an additional two years of credit monitoring and identity protection services. Alternatively, members who already have credit monitoring services may submit a claim to receive alternative compensation for up to $36 instead of credit services.

For more information, visit www.DataBreach-Settlement.com, or call 1-855-636-6136.

On Tuesday, April 25, 2017 the Maine Municipal Employees Health Trust’s Wellness Department hosted the 29th annual wellness conference. There were 74 attendees, representing 40 of our member groups. Two groups and one individual were recognized for implementing comprehensive wellness programs at their worksites.

Knox County
Knox County received the Biggest Leap award for offering a wellness program that made the most leaps and bounds. The Knox County wellness committee pushed themselves this past year to consider the health needs of employees and offered programs that have a positive and lasting impact on their health.

City of South Portland
The City of South Portland received the Highest Peak award for taking their wellness program to the next level. The City of South Portland’s wellness committee challenged themselves to involve more employees in the wellness program. They did so by offering incentives and a wide variety of programs to meet the heath interests of individual employees.

Denise Mungen
Denise Mungen, EcoMaine, was honored with the Wellness Champion award for inspiring others to be their healthiest self. She was successful by using her passion, empathy and ability to recognize and overcome barriers to meeting the health needs of employees who work shift work.

A grant from Wellness Works, the health education and promotion program of Maine Municipal Employees Health Trust, provides the necessary funding to help offset the cost of worksite wellness initiatives.  If you would like more information on how to get a wellness program started at your worksite, please contact Anne Charles.