Randi Seaberg
Director

From: Seaberg, Randi

Sent: Thu Feb 05 13:57:02 2015

To: Adam Goldstein (agoldstein@washingtonea.org); Elder, Gregg; Lindsey, Susan; Moore, Jeffrey; Ringo, Molly; Shepherd, Kelly

Cc: jkink@washingtonea.org; Newcomb, Kellee

Subject: United Healthcare update

Importance: Normal

Attachments: image001.png

February 5, 2015

Dear Trustees:

One full month into the new plan year with UnitedHealth Care (UHC), the transition is fully underway. Many covered members are receiving care, prescriptions and accessing necessary services without difficulty. Although websites, procedures and forms have changed; the majority of employees are navigating this transition well. Bumps in implementation were expected and have occurred. HR/Benefits staff are committed to continuing to work towards accessible and easily understandable medical benefits for all our employees.

Following are the most common glitches HR/Benefits staff have been working to remediate.

Dual coverage:

Presently there are 15 couples (30 employees) who choose to dual cover each other.

For some of these families, prescription issues have been challenging.

Previously, Premera coordinated dual coverages and our dual-covered employees rarely experienced pharmacy issues. They went to the pharmacy, picked up their prescriptions and weren ’t expected to pay a deductible and/or co-pay. With UHC, reports are that pharmacies are having difficulties coordinating the coverage and thus our employees are expected to pay co-pays and or deductibles for their prescriptions.

The fix for this:

Benefits has structured the information sent to UHC in a manner they are more accustomed to, reflecting these families in a specific way to alert UHC to the presence of dual coverage.

This updated format was sent to UHC on January 27, 2015. UHC is now in communications with Optum Rx (the UHC pharmacy vendor) to determine a way to also reflect the dual coverage for prescription coverage.

There is a reimbursement form to send for any out of pocket expense incurred. This form can be found XXX and has been put on the district website.

Alternative Care- Chiropractic, Acupuncture, Naturopathic Care:

The UHC customer service team is not accustomed to our plan provisions as they are new and unique. The information UHC customer care representatives had access to was misleading and confusing for members and providers alike.

The Fix:

New information for the customer service representatives that is more concise, easy to interpret and specific to our plan is being developed. (To be reviewed by HR/Benefits staff, hopefully soon!)

Once the new information is available to UHC customer care representatives the employee and/or their physician ’s office should receive correct information when they call. This will result in less confusion and reduced attempts to get the correct information.

Prescription Coverage in General:

UHC follows strict FDA guidelines regarding medication dispensation that Premera was more lenient about.

UHC will only allow prescriptions to be filled to the FDA designated amount – thus creating a supply limit. (i.e. if a member previously received a month ’s worth of migraine medication, UHC/Optum will only provide enough medication for one week at a time. The next week will need to be filled separately and with another copay.)

Additionally, the tiered structure with UHC is designed differently from Premera. Generic prescriptions may not always fall in the least expensive Tier one. Generics may be subject to higher co-pays and/or deductible.

Contraception may be subject to co-pays and or deductibles. UHC/Optum has designated a list of free contraception options. Some contraception that former Premera members received at zero cost may now be subject to higher co-pays and/or their deductible.

The Fix:

UHC has provided HR with supplemental information to assist benefits staff with pharmacy benefits questions. HR/Benefits staff have maintained close contact with UHC representatives and Mercer.

			Randi Seaberg Director Human Resources Department rseaberg@everettsd.org 425-385-4104 \| 425-385-4102 Fax