WHEN DO I NEED TO CONTACT ANTHEM FOR INFORMATION
- Verification of Provider participation in the Anthem network. Log on to Anthem.com or call 1-800-810-2583
- Claims. Logon to www.anthem.com or call 1-877-811-3106
- Precertification call 1-800-832-7850
- Plan Benefits
- Transparency in Coverage: https://www.anthem.com/machine-readable-file/search
WHEN DO I NEED TO CONTACT CONTRACTORS HEALTH TRUST (CHT) FOR INFORMATION?
- Plan benefits
- Requests for ID cards
- CHT Customer Service 303-935-2475 or 1-833-935-2475
DOES ANTHEM OFFER ANY HEALTH-RELATED PRODUCT AND SERVICE DISCOUNTS?
Yes. Anthem offers select health-related product and service discounts through SpecialOffers@Anthem.
Here are some of the discounts included:
- Health and Beauty
- Alternative therapy, including acupuncture and massage therapy
- LASIK eye surgery, eyeglass frames and accessories and contact lenses
- Fitness centers
- Maternity must-haves, nursery essentials, baby gear and
- Programs related to managing stress, stopping smoking, living lean or successfully managing alcohol
This is just a snapshot of what we have available to ensure you and your family can make the most of your benefit coverage.
ARE THERE ANY TOOLS OR RESOURCES TO COMPARE COSTS OF VARIOUS PROCEDURES, DIAGNOSTIC TESTS OR OFFICE VISITS?
Yes. Anthem Care Comparison helps you understand the cost differences at local facilities for selected procedures, diagnostic tests and office visits.
Your health is too important to leave to chance. If different places charge different amounts for the same service, we think you deserve to know that. Especially if you share in those out-of-pocket costs. Having a clear understanding of cost and quality can help you make more informed decisions. And that could lead to better health!
Services included in Anthem Care Comparison are common elective, non-emergency procedures available in your member’s geographic area. You can select from a list of inpatient procedures, outpatient procedures, diagnostic tests and office visits. From time to time, new services and features will be added it becomes available.
This innovative tool allows your members to make comparisons based on the quality factors that matter most to them. Like the number of specific procedures performed, patient safety, facility complication rates, mortality rates and average length of stay.
ARE THERE ANY HEALTH AND WELLNESS TOOLS AND OTHER RESOURCES AVAILABLE ONLINE?
Yes. Anthem offers a suite of interactive online health-related tools and resources. Health assessments, Health news, as well as a searchable library of more than 25,000 articles, reports and news stories on a wide
range of health and wellness topics, Preventive health guidelines, Patient safety information, and a Medical reference encyclopedia of health topics from A to Z.
IS THERE A MOBILE DEVICE PROVIDER FINDER?
Yes, you can search for a health care provider from mobile device. Download the Sydney Member Mobile app from the Anthem website www.anthem.com for provider and other information.
HOW DO I FIND A DOCTOR?
Locate in-network providers through Anthem’s online provider finder by going to www.anthem.com and selecting the Find a Provider link or calling 1-800-810-2583. The directory allows you to search for both doctors and health care facilities (including urgent care facilities). A search can be made more specific by choosing a specialty, entering the name of a doctor or a facility, selecting a gender, languages spoken or if a doctor is accepting new patients and can serve as a primary care physician. Once the required information is entered, a list of doctors or facilities that matches the search criteria will display. You’ll save money if you see a participating Anthem in-network provider or Blue Card participating provider.
WHAT DO I DO IF I NEED TO SEEK CARE OUTSIDE THE STATE OF COLORADO?
You have access to the national Blue Card (BCBS) Network of providers. Just have the provider send your claim to their local host BCBS plan. You’ll save money if you see a participating Anthem in-network provider or Blue Card participating provider. If you need to find a participating Blue Card provider call 1-800-810-2583 and ask for providers in the Blue Card network.
WHY DOES MY CARD HAVE AN ANTHEM LOGO ON IT?
Contractors Health Trust contracts with Anthem in order to provide you with the strongest provider network in the state of Colorado.
WHERE CAN I FIND MORE INFORMATION ON COBRA?
More information can be found by visiting COBRA FAQ’s.
Your Rights and Protections Against Surprise Medical Bills
When you receive emergency care (other than ground ambulance services) or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible (referred to as “cost-sharing amounts”). You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in the Plan’s network.
“Out-of-network” means providers and facilities that aren’t contracted with your Plan’s network to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and does not count toward your deductible or annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You’re protected from balance billing for:
If you have an emergency medical condition and get emergency services (other than ground ambulance services) from an out-of-network provider, facility, or air ambulance, the most they can bill you is the Plan’s in-network cost-sharing amounts. You can’t be balance billed for these emergency services. This includes services you may receive after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you receive services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is
the Plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you receive other types of services at an in-network facility, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in the Plan’s network.
When balance billing isn’t allowed, you also have these protections:
- You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). The Plan will pay any additional costs to out-of-network providers and facilities directly.
- Generally, the Plan must:
- Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) for these services on what the Plan would pay an in network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or these out-of-network services toward your in-network deductible and out-of-pocket limit.
If you have questions about this Notice or balance billing, contact the Fund Office at: 303-935-2475 or toll free 833-935-2475
If you think you’ve been wrongly billed, contact the Department of Health and Human Services (HHS) via its toll-free number at 1-800-985-3059.
Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
* These items apply to those employees who are covered for Dental and Vision benefits. Dental and Vision benefits are offered as optional coverage’s on an employer by employer basis.
AM I ELIGIBLE FOR DENTAL BENEFITS?
Dental benefits are optional on an employer-by-employer basis. If your employer elected to provide dental benefits, then you are eligible for them. Please check with your employer to verify if you have this coverage.
HOW DO I GET STARTED?
Enrolling in Delta Dental’s PPO plus Premier or the Alpha Dental’s Discount plan is easy. See your employer for enrollment information.
HOW DOES THE CALENDAR YEAR MAXIMUM WORK?
A calendar year refers to a period of January 1 through December 31. Under the Delta Dental Plan, your coverage maximum starts fresh each January 1. These totals are not pro-rated: The full coverage maximum applies, no matter your start date. There are no maximum coverage limits under the Alpha Dental Plan.
WHAT IF SOMEONE IN MY FAMILY HAS ANOTHER DENTAL INSURANCE PLAN?
When someone has additional dental coverage, one plan is usually primary. This means that your dentist sends the claim for service to the primary insurance plan and may also submit it to a secondary plan. Delta Dental will coordinate benefits if a subscriber has coverage under more than one dental plan. Alpha Dental is a discount plan where services are paid for at the time of service and there is no coordination of benefits.
WHAT IF I RESIDE OR HAVE AN EMERGENCY OUTSIDE THE UNITED STATES?
You will need to pay the bill at the time of service. Send your receipt and claim to Delta Dental at P.O. Box 173803, Denver, CO 80217-3803 or email to firstname.lastname@example.org. Alpha Dental has no Out of Network benefits.
WHAT IS AVAILABLE ON YOUR WEBSITE?
Both Delta Dental’s and Alpha Dental’s websites allow you to locate participating dentists, view benefits, view your claims, print explanation of benefits, find dental health information, take a dental risk assessment and much more.
DO I NEED AN ID CARD?
An ID card is not required to access services under Delta Dental Plan. Once you are enrolled with Delta Dental, you can print a customized ID card by registering for Subscriber Connection on the Delta Dental website www.deltadentalco.com You will receive a separate ID card for your coverage through Alpha Dental.
WHAT IF I AM IN THE MIDDLE OF ORTHODONTIC TREATMENT?
Delta Dental will “takeover” the orthodontic treatment. We will calculate the treatment based on the dentist’s original treatment plan as if the treatment was started under the Delta Dental PPO plus Premier Plan. We will deduct any down payment or payments that we would have paid if we started the case and pro-rate the remaining payments. For Alpha Dental contact Beta Health at betaplans.com.
WHAT HAPPENS IF I VISIT A NON-PARTICIPATING DENTIST?
If dental services are received from a dentist who does not participate with Delta Dental, you will be responsible for paying the difference between the Delta Dental Maximum Plan Allowance and what the dentist actually charges. Many non-participating dentists will ask you to pay the full fee up front. In addition, reimbursement for covered services will be paid directly to you, and you will be responsible for paying your dentist. Alpha Dental has no Out of Network benefits.
HOW DO I FIND A DENTIST?
Delta Dental has the largest dental network in the country, with over 130,000 dentists nationwide. Finding a participating dentist in your local area is easy. Simply visit www.deltadentalco.com, or call 1.800.610.0201. Alpha Dental has a network of over 900 providers in Colorado. To find a participating dentist go to betaplans.com
WHERE DO I FILE MY DENTAL CLAIMS?
If you have the optional Delta Dental benefit, all dental claims are processed by Delta Dental Plan of Colorado; P.O. Box 173803, Denver, CO 80217-3803. Telephone (303) 741-9305 or 1-800-610-0201. The Group number for Hour Bank (plan B) Participant’s is W0717-0001 and for Monthly Contribution (Plan C) Participant’s is W0717-0002. Alpha Dental is a discount plan and all services are paid for at the time of service, there will not be any outstanding claims.
MAY I VISIT ANY DENTIST?
If you have Delta Dental coverage, yes. You have the freedom to see any dentist. A participating PPO dentist will maximize your savings. A participating Premier dentist accepts a discount off their submitted charges and provides balance billing protection to the member. You may also see a non-participating dentist. You will be responsible for the difference between the out- of-network Maximum Plan Allowance and the full fee charged by the dentist. There is no coverage for out of network dentists under the Alpha Dental plan.
WHY CHOOSE THE DELTA DENTAL PPO PLUS PREMIER PLAN?
Delta Dental has negotiated substantial discounts from participating dental providers. This means that your dollars go much further. If you choose to have no dental insurance, charges are at the dentist’s fee for service which are not discounted. Dental insurance also helps you budget for those larger unexpected expenses. Delta Dental participating dentists will file your claim and, only charge you for any deductible or coinsurance (your portion) and will bill Delta Dental for the covered portion.
Life and Accidental Death and Dismemberment (AD&D)
WHO DO I CONTACT FOR ADDITIONAL DETAILS ON THE LIFE AND AD&D BENEFIT THROUGH CHT OR IF I NEED TO FILE A CLAIM?
Contact the CHT administrative offices at 303-935-2475 or 1-833-935-2475.
WHAT ARE THE EXCLUSIONS THAT ARE APPLICABLE TO THE AD&D BENEFIT?
Please refer to the Summary Plan Description for a list of Exclusions.
HOW MUCH AD&D COVERAGE DO I HAVE AS AN EMPLOYEE (NO COVERAGE FOR SPOUSE OR DEPENDENTS)?
You are covered under the policy as an employee, however your spouse and dependents are not covered by the AD&D portion of the policy. Please refer to the Life Insurance and Accidental Death and Dismemberment section of your Summary Plan Description.
WHO IS THE BENEFICIARY OF THE LIFE INSURANCE BENEFIT UPON DEATH?
The Employee designates the Beneficiary of the Life Insurance benefit. The Beneficiary will be the person(s) named in writing to receive any amount of the insurance payable due to a death. Please refer to your Summary Plan Description for more information related to Beneficiary for Life Insurance.
IS THERE ANY ADDITIONAL OPTIONAL LIFE INSURANCE COVERAGE AVAILABLE IF I DECIDE TO PAY ADDITIONAL FOR IT?
Not at this time. Your employer may have optional Life coverage available through separate policy (not through CHT).
IS EVIDENCE OF INSURABILITY REQUIRED FOR LIFE INSURANCE?
No. You are accepted on the day your coverage becomes effective.
AT WHAT AGE CAN I COVER MY DEPENDENT CHILDREN FOR THE LIFE INSURANCE BENEFIT?
Children are covered from 14 days of age up to age 26.
HOW MUCH LIFE INSURANCE COVERAGE DO I HAVE (MYSELF AND DEPENDENTS)?
The amount of coverage is also specific to Employee, Spouse and Child. Please refer to the Life Insurance and Accidental Death and Dismemberment section of your Summary Plan Description.
WHEN IS MY LIFE INSURANCE AND AD&D COVERAGE EFFECTIVE?
Your coverage is in effect on the same day as your medical coverage.
WHO IN MY FAMILY IS COVERED FOR LIFE AND AD&D INSURANCE COVERAGE?
You are covered for Life Insurance as an employee and dependents are also covered under the policy. Only employees are provided coverage for AD&D benefits (no coverage for spouse or dependents).
IS GROUP LIFE INSURANCE OR ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) OFFERED THROUGH CONTRACTORS HEALTH TRUST(CHT)?
Yes. Group Life insurance and AD&D coverage is automatically included as part of your CHT medical coverage.
IF MY ATTENDING PHYSICIAN IS A PARTICIPATING IN-NETWORK (PPO) PHYSICIAN, ARE ALL OTHER RELATED CHARGES FILED WITH THE PLAN COVERED UNDER THE PPO BENEFIT SCHEDULE, SUCH AS PATHOLOGY CHARGES, RADIOLOGY CHARGES, ANESTHESIA CHARGES, ETC.?
No. It is your responsibility to make sure each provider of service is a PPO provider. Each provider of services is considered separately. Example: If you have surgery scheduled with a PPO Physician, his/her charges are covered under the participating Physician contract. However, services for an assistant surgeon, Physician’s assistant, pathology, radiology, etc., are considered depending on whether or not each provider is a participating PPO provider.
CAN I COVER MY DEPENDENTS WHEN THEY CEASE TO BE ELIGIBLE FOR BENEFITS AS DEFINED BY THE PLAN?
Yes, temporarily. The Administrative Office must be notified within 60 days from the date the Dependent ceased to meet the definition of a Dependent. The Dependent may continue in the Plan for a limited time under COBRA continuation by making monthly self-payments of the total required premium.
ARE MY DEPENDENT CHILDREN COVERED AFTER AGE 26?
In qualifying cases after age 26, dependent children who are incapable of self-sustaining employment by reason of mental retardation or physical handicap and such incapacity commenced prior to the date the Dependent child’s coverage would have otherwise terminated under this Plan. Application for this coverage must be filed with the Administrative Office within 31 days after coverage would have otherwise terminated.
WHAT DO I DO IF I HAVE COVERAGE UNDER THIS PLAN AND ANOTHER PLAN (SUCH AS MEDICARE) FOR MYSELF AND/OR MY DEPENDENTS?
You must submit the claims to both this Plan and the other plan; we recommend that you file your claims with both plans at the same time. When your primary Plan has processed your claim and has provided you with their “Explanation of Benefits” (EOB), send a copy of their EOB to the Administrative Office where benefits payable from this Plan will be determined.
You must meet the timely claim filing requirements of this Plan. The Administrative Office must receive billings for medical services no later than one (1) year from the date services were rendered. If your other plan fails to provide you with an EOB by the timely claim filing limitation of this Plan and we have not received notification from you of these charges, benefits will not be payable by this Plan.
WHAT HAPPENS WHEN MY SPOUSE IS ALSO EMPLOYED?
You must provide the Administrative Office with the complete name and address of your spouse’s employer. In the event your spouse has other insurance coverage through his/her employer, the following will apply: Your spouse’s carrier is always the primary payer of your spouse’s claims.
If your spouse covers Dependent children, the Plan will determine who is the primary payer based on which parent’s birthdate falls earlier in the calendar year.
DO I HAVE TO COMPLETE A CLAIM FORM WITH EACH CLAIM FILED WITH ANTHEM?
You will not need to complete a claim form with each In-Network claim filed. For Out-Of-Network claims a claim form must be submitted.
WHAT IF I NEED MEDICAL CARE OUTSIDE OF THE STATE?
You are covered for medical services incurred anywhere in the world, subject to Plan benefits and exclusions and limitations.
DO I HAVE TO PRECERTIFY ALL MEDICAL CARE?
No. Only if you are going to be confined in a Hospital or facility as an inpatient or receive an outpatient MRI, CT scan, PET scan or outpatient surgery. Emergency admissions must be reported to Anthem 1-800-832-7850, within two working days after the admission. Failure to report such services will subject you to a $200 penalty. Note: all mental health and substance abuse treatment must be provided through and/or referred by the EAP.
Your doctor or the Hospital may contact Anthem, but it is ultimately YOUR RESPONSIBILITY to obtain timely precertification/authorization. You may contact Anthem by calling 1-800-832-7850.
HOW MUCH CAN I BE EXPECTED TO PAY OUT-OF-POCKET EACH YEAR?
Out-of-pocket maximums “cross accumulate” between the in-network and out-of-network Plans. If Preferred Providers are utilized, your out-of-pocket expense can be reduced. Please note, any charges that are not covered by the Plan are your responsibility in addition to the out-of-pocket expenses.
Please refer to the Summary Plan Description to determine your specific out-of-pocket maximum.
WHAT IS A COPAYMENT?
A Copayment is a fixed dollar amount you are responsible for paying when you incur an Eligible Medical Plan expense for certain services. For information about copayments that apply to specific services, refer to your Schedule of Medical Benefits in your Summary Plan Description.
If you are enrolled in a High-Deductible Plans (Trust 3000 or Trust 5000) once your deductible has been met you are not required to make an office copayment.
Please refer to the Plan Summary Description for specific deductible information and for office visit copayment information.
WHAT CHARGES APPLY TO MY OUT-OF-NETWORK DEDUCTIBLE?
All out-of-network charges are subject to the calendar year deductible.
Out-of-Network routine preventative care services are NOT covered.
WHAT CHARGES APPLY TO MY IN-NETWORK DEDUCTIBLE?
Most Medical Plan benefits are subject to the calendar year deductibles. Such charges include but are not limited to covered Hospital charges, therapy, medical supplies and prosthetic devices when prescribed at the direction of a Preferred Provider Physician (PPO) and most Non-Preferred Provider (Non-PPO) charges. Ancillary charges such as x-ray and laboratory must be billed by the same Physician providing the office visit services. Other services performed in the Physician’s office at the time of the office visit, such as minor surgical procedures, will be subject to the deductible. Ancillary services performed outside the Physician’s office or by any other provider will be subject to the deductible.
The deductible does not apply to routine preventative care, such as physical examinations, routine mammograms, prostate screening, routine nursery care of a newborn child, routine hearing care, and Physician office visit charges, including ancillary charges. For a complete description of covered preventative care go to: http://www.healthcare.gov/law/about/provisions/services/lists.html.
WHAT IS A DEDUCTIBLE?
Your deductible is the fixed amount of eligible Medical Plan expenses during a calendar benefit period you are responsible for paying before the Plan begins to pay benefits. Plans have both individual and family deductibles established. Deductibles may vary between In-Network and Out-of-Network providers. If you have a question on your deductible amount, contact customer service at 303-935-2475 or 1-833-935-2475.
ARE PRESCRIPTION DRUGS COVERED?
Yes. Please refer to the Summary Plan Description to determine specific copayments or deductible amounts that will be applicable to your prescription drugs.
HOW ARE NEW DEPENDENTS COVERED?
You must complete an enrollment card, adding your new Dependent (spouse, natural child, stepchild, legally adopted child or child for whom permanent custody is court ordered) under your coverage within 31 days of the date acquired. Please refer to the Summary Plan Description for Dependent coverage enrollment requirements, effective date of coverage and eligibility requirements. An enrollment card must be received by the Administrative Office within 31 days of marriage, birth, adoption or court order, otherwise your Dependent’s coverage will be delayed or may be subject to preexisting condition limitations.
Proof of dependency should be included with your enrollment card such as marriage records, birth certificates and court approved permanent custody documents or other applicable documents.
Please note: If the enrollment request is not received within 31 days, your dependents cannot be enrolled until Open Enrollment which occurs January 1 or each year.
WHO IS EXPRESS SCRIPTS?
Contractors Health Trust Contracts with Express Scripts to manage your prescription drug benefit. Express Scripts makes the use of prescription drugs safer and more affordable for tens of millions of consumers through thousands of employers, government, union and health plans.
WHAT IS HOME DELIVERY FROM THE EXPRESS SCRIPTS PHARMACY?
Home Delivery from the Express Scripts Pharmacy provides an affordable way to obtain your maintenance medications, by allowing you to order up to a 90-day supply by mail. It’s the most cost effective way to fill prescriptions — and helps you and your employer save money.
WHAT ARE THE BENEFITS OF HOME DELIVERY?
- Savings ― Save money by ordering up to a 90-day supply of your maintenance medications for just one Home Delivery copayment.*
- Safety ― Express Scripts’ licensed pharmacists check every prescription for accuracy and potential drug interactions, and are available to answer your questions confidentially by phone — 24 hours every day.
- Service ― Talk confidentially to a pharmacist 24-hours a day, every day. A Patient Care Advocate (PCA) can connect you to a pharmacist at your request.
- Convenience ― Prescriptions are delivered right to your door, eliminating trips to your retail pharmacy. It’s easy to sign up and order refills online, by mail or by phone. Plus standard shipping is always free.
*Savings estimates are based on previous prescription-drug history. Estimates will vary depending on the prescription drugs you are taking and your plan’s Home Delivery benefit.
HOW DO I ORDER PRESCRIPTIONS THROUGH HOME DELIVERY?
There are four ways to start using the Express Scripts Pharmacy:
- Phone – If you are using Home Delivery for the first time, contact the Express Scripts Member Choice Center (MCC) at 1-877-697-7088. An MCC representative will set up a Home Delivery profile for you and contact your doctor to obtain a 90-day prescription.
- Online – Visit www.StartHomeDelivery.com. After logging in, click on Save on My Prescriptions to get started. The Express Scripts Pharmacy will contact your doctor for you to obtain a 90-day prescription.
- Mail – Ask your doctor to write a prescription for up to a 90-day supply of medication (plus refills for up to one year, if appropriate). Complete a Home Delivery order form. If you don’t have a form, you can print one online at www.express-scripts.com, or request one from a Patient Care Advocate (PCA) by calling the toll-free number on the back of your member ID card. Mail the completed order form, your original prescription and payment information to:
- Express Scripts PO Box 52123 Phoenix, AZ 85072-2123
- Fax – From Your Doctor* Ask your doctor to fax a prescription for up to a 90-day supply of your medication (plus refills for up to one year, if appropriate) to the Express Scripts Pharmacy at 800-613-5628.
*Faxes must be sent from the doctor’s office. Faxes sent from a member’s home or workplace will not be accepted. Be sure to include your full name, date of birth, mailing address, home phone number and member ID number with all prescriptions.
WILL I BE REMINDED WHEN IT’S TIME TO REFILL?
Yes – through the communication method you choose. You may also enroll in our auto refills feature online or by calling a patient care advocate.
HOW LONG WILL IT TAKE TO PROCESS MY ORDER?
When you fill a prescription through the Express Scripts Pharmacy for the first time, you can expect delivery of your order within 2 weeks from the time they receive the prescription from your doctor. We recommend that you have a 30-day supply of your medication on hand at the time of your order. Refills typically take 3-5 days to process and ship.
WHICH MEDICATIONS CAN I FILL THROUGH THE EXPRESS SCRIPTS PHARMACY?
You can fill the prescriptions you take regularly for ongoing conditions. The Express Scripts Pharmacy will send a 90-day supply of these“maintenance medications” to your home with free delivery.
MY WRITTEN PRESCRIPTION WAS RETURNED TO ME BY EXPRESS SCRIPTS. WHY?
A prescription may be delayed due to incomplete prescription information, clinical intervention or backorder issues. Approximately 25% to 30% of all new prescriptions received require an Express Scripts pharmacist to contact the doctor or prescriber.
If there is a clinical or administrative concern about your prescription, Express Scripts will attempt to contact your doctor or prescriber up to two times within two business days. If necessary, the Express Scripts Pharmacy will hold the order until the end of the second day, awaiting a response. If a response is not received by the end of the second day, you will receive a letter explaining the situation. When appropriate, the prescription will also be returned to you.
HOW WILL MOVING MY PRESCRIPTIONS TO HOME DELIVERY AFFECT MY USE OF RETAIL PHARMACIES?
You can continue using your retail pharmacy for acute medications, such as antibiotics. You can also use your retail pharmacy for those maintenance medications that are not included in Home Delivery (your standard retail copayment will apply). Remember, you can always speak with a licensed pharmacist at the Express Scripts Pharmacy by calling the toll-free phone number on the back of your member ID card. A Patient Care Advocate (PCA) can connect you with a pharmacist upon request.
HOW LONG IS A WRITTEN PRESCRIPTION VALID?
A prescription is valid for one year from the date it is written, unless it is for a controlled substance, such as narcotics or other addictive medications. A prescription for a controlled substance is valid for six months.
- Class II controlled prescriptions are only valid for a one-time fill.
- Class III to Class V (more highly-addictive) controlled prescriptions are valid for five refills, in addition to the initial fill.
WHERE DO I CALL WITH ADDITIONAL QUESTIONS OR FOR HELP?
You can contact the Express Scripts Patient Care Contact Center at the toll-free number on the back of your member ID card. A Patient Care Advocate (PCA) will assist you and, if needed, can connect your call directly to a licensed pharmacist who will answer any questions, 24 hours a day. You can also find additional information at www.express-scripts.com.
HOW WILL I KNOW IF I HAVE AN OUTSTANDING BALANCE?
You will receive an invoice with each order processed by Express Scripts, as well as monthly statements with any outstanding balances.
WHAT HAPPENS IF MY MEDICATION IS ON MANUFACTURER BACKORDER?
Express Scripts will notify you by phone if a manufacturer is experiencing supply difficulties, and cannot furnish a date of availability. You will be offered several options:
- If you sent a check with your order, you may receive a credit on file to use toward future prescription orders.
- If you would like a refund check, you may request one from a Patient Care Advocate (PCA) by calling the toll-free number on the back of your member ID card.
- If your prescription was included with an order for other medications, we will process those not affected by the backorder.
WHAT IS THE DIFFERENCE BETWEEN A CHEMICALLY-EQUIVALENT GENERIC MEDICATION AND A THERAPEUTICALLY-EQUIVALENT GENERIC MEDICATION?
Chemical equivalence occurs when a brand-name and generic drug are made up of the same molecule. For example, Prilosec® and the generic omeprazole are chemical equivalents; the active ingredient in both products is the molecule omeprazole.
Therapeutic equivalence occurs when a brand-name and generic drug provide the same effect on the condition for which they are being taken. For example, Nexium® and the generic omeprazole are different molecules, but are essentially identical in terms of clinical effect.
WILL I GET BRAND-NAME OR GENERIC PRESCRIPTION DRUGS?
You and your doctor can decide what’s best for you. Where permitted by applicable law, FDA- approved generic equivalents may be dispensed when appropriate and permitted by your doctor. These generic medications may save you money. If you prefer, you may submit a note with your prescription to have your order filled only with a brand-name drug. However, this may increase your copayment.
IS HOME DELIVERY AS SAFE AS USING A RETAIL PHARMACY?
Yes. The Express Scripts Pharmacy has a higher accuracy rate (99.9%) than retail pharmacies (98.3%). Automated processes and workload consistency ensure these high levels of safety.
HOW DO I KNOW EXPRESS SCRIPTS WILL FILL MY ORDER CORRECTLY?
Licensed pharmacists check every prescription to make sure it is filled accurately and promptly. The same level of care is exercised at shipping, including special handling for temperature- sensitive prescription drugs.
HOW DO I REFILL MY PRESCRIPTIONS?
Express Scripts now offers Auto Refills, a Home Delivery service enhancement designed to assist you in never running out of your medication. After enrolling your maintenance prescriptions in the program, Express Scripts will automatically calculate your prescription usage and day’s supply remaining. When it’s time to refill your prescription, Express Scripts will fill your maintenance prescriptions automatically for you and mail them to your home. Through your preferred method of communications, we will send you notification 7 days before we begin processing your next refill. You can change the next processing date or cancel the prescription from the automated refills service anytime before processing begins.
There are 3 convenient ways to enroll according to your preference:
- Visit our Web site at www.express-scripts.com, click on “Refill Prescriptions” and select the prescriptions you would like to have automatically refilled.
- At the time of refilling your prescription, we ask you if you want to enroll the prescription in Auto Refills. If you answer yes, there is nothing more for you to do. We will begin automatically refilling your prescription on all future refills.
- You can speak directly to an Express Scripts patient care advocate to enroll your prescription(s) in the program.
If you choose not to enroll in Auto Refills, you may order refills by the following methods:
- Online Use the Express Scripts website: www.express-scripts.com.
- Mail Send the refill request form included in your initial prescription package to:
- Express ScriptsPO Box 52123Phoenix, AZ 85072-2123
- Phone (24-hours a day) Call 877-551-8811 to use our Interactive Voice Response (IVR) system. You may then choose to speak with a Patient Care Advocate (PCA) or use your touch-tone phone to enter your refill information.
CAN I HAVE MY PRESCRIPTION SENT OVERNIGHT?
Overnight delivery may be requested with additional shipping and handling charges, although standard processing times still apply. For more information on availability and rates, contact an Express Scripts Patient Care Advocate (PCA) at the toll-free number on the back of your member ID card.
MY MEDICATION NEEDS REFRIGERATION. HOW WILL IT BE MAILED?
The Express Scripts Pharmacy uses special packaging and coolant packs for handling and shipping refrigerated prescription drugs. These processes maintain temperature within the range approved in the product’s labeling. We also adjust for current and forecasted climate conditions, as well as the package destination area.
HOW WILL MY ORDER BE MAILED?
Orders are sent by First-Class Mail in unmarked, tamper-proof packaging ― there is no indication on the package that it is from a pharmacy. They are delivered by your regular carrier, unless the medication requires special handling (such as refrigeration). At your request, we can mail prescriptions to a secondary address.
HOW LONG WILL IT TAKE TO PROCESS MY ORDER?
For first-time orders, please allow 10 to 14 days from the time Express Scripts receives your order for delivery. When mailing a first-time order, we recommend you have at least a 30-day supply of medication on hand. If Express Scripts needs to contact you or your prescribing doctor for information, delivery could take longer. For your first order, we also advise you to get two signed prescriptions from your doctor:
- The first prescription is for an initial 30-day supply of medication to be filled at your participating pharmacy.
- The second prescription is for up to a 90-day supply of medication with appropriate refills, and should be sent to the Express Scripts Pharmacy.
Members should allow two to three weeks to receive their order when Express Scripts has to contact their doctor to obtain a new prescription for Home Delivery. If the doctor cannot be reached, you will receive either a letter or a phone call.
Once we have processed your first order, subsequent refills will be shipped within three to five days from the time the refill request is received.
HOW DO I PAY FOR MY PRESCRIPTIONS?
All orders should include payment information to allow processing without delay. Orders may be paid by:
- Flexible Spending Account (FSA) debit card
- VISA®, MasterCard®, American Express® or Discover®
- Bank-issued debit card
- Personal check or money order
- Bill Me Later® – offering payment flexibility with pay-now or pay-later options
CAN I SEND IN MORE THAN ONE PRESCRIPTION AT A TIME?
Yes. Express Scripts will process all of the prescriptions according to your benefit.
DO I NEED TO COMPLETE A NEW HOME DELIVERY ORDER FORM EACH TIME I SEND IN A PRESCRIPTION?
No. The form is only necessary the first time you order medication, unless any of your information changes. List all the medications you take, so they can be reviewed for potential interactions. Provide additional information on separate paper, if necessary.
ARE THERE ANY EXCEPTIONS TO THE TYPES OF MEDICATIONS I CAN RECEIVE THROUGH HOME DELIVERY?
There are possible exceptions affecting Home Delivery of certain medications at this time. These medications may be filled through Home Delivery from the Express Scripts Pharmacy, if you prefer. For information, contact an Express Scripts Patient Care Advocate (PCA) at the toll-free number on the back of your member ID card.
WHAT MEDICATIONS ARE INCLUDED IN THIS PROGRAM?
The maintenance medications you take regularly for ongoing conditions, such as high blood pressure, high cholesterol and asthma, are included. To find out if a specific prescription drug is considered a maintenance medication on your employer’s prescription-drug plan, please contact an Express Scripts Patient Care Advocate (PCA), using the toll-free number on the back of your member ID card.
WHAT IF I’D PREFER TO GET SOME OF MY MAINTENANCE MEDICATIONS AT MY RETAIL PHARMACY?
You have many opportunities to select which prescriptions you receive through Home Delivery, and those you would like to receive from your retail pharmacy. If you wish to make a change to your current Home Delivery plan, simply call the Express Scripts Member Choice Center (MCC) at 1-877-697-7088, at any time throughout the year and Express Scripts will help you through this process.
I WAS ALERTED ABOUT THIS PROGRAM BEING AVAILABLE BY MY RETAIL PHARMACY. WHY IS THIS?
Information on Home Delivery was provided several ways ― through the mail and in open enrollment materials. Express Scripts also routinely sends a letter and makes a phone call explaining the benefits of Home Delivery after you fill a maintenance medication at a retail pharmacy.
Vision benefits are offered as optional coverage on an employer by employer basis. Check with your Employer to verify coverage.
AM I ELIGIBLE FOR VISION BENEFITS?
Vision benefits are optional on an employer-by-employer basis. If your employer elected to provide vision benefits, then you are eligible for them. Please check with your employer to verify if you have this coverage.
HOW DO I OBTAIN VISION BENEFITS?
USING YOUR BENEFIT IS EASY!
Contact VSP at 1-800-877-7195 or create an account on vsp.com to view your in-network coverage, find the VSP network doctor who’s right for you, and discover savings with exclusive member extras. At your appointment, just tell them you have VSP.
A Network Provider will submit your claim to VSP and VSP will pay the provider directly.
If you receive services from a non-network vision provider, you must pay the provider and file a claim for reimbursement from VSP.
WHAT IS MY COST FOR VISION BENEFITS?
Your share of the cost will depend on the services you receive and whether you obtain them from a VSP Network Provider or a non-network provider.
VSP Network Provider
Services from a Network Provider are subject to a $25.00 copay. The vision examination is paid in full thereafter. Eyeglass lenses are paid in full less a $25.00 copay. An eyeglass frame allowance up to a $150 wholesale value is covered. For frames with a higher wholesale cost, you will receive a 20% off any overage. An allowance of $150 is provided for contact lenses in lieu of eyeglasses. You will be responsible to pay the provider for the deductible, any extras and any amount over Plan allowances. The Network Provider will submit a claim to and be paid by VSP for the covered services.
Non-network vision provider
Get the most out of your benefits and greater savings with a VSP network doctor. Call Member Services for out-of-network plan details.
|Exam||up to $45|
|Frame||up to $70|
|Single Vision Lenses||up to $30|
|Lined Bifocal Lenses||up to $50|
|Lined Trifocal Lenses||up to $65|
|Progressive Lenses||up to $50|
|Contacts||up to $105|
You will be responsible for paying the non-network provider for all services. You will need to submit an itemized statement of the amounts you paid to VSP. You will be reimbursed up to a maximum per service.
HOW FREQUENTLY CAN I OBTAIN VISION BENEFITS?
You may obtain vision benefits as frequently as follows:
Vision Examination – Once every twelve months
Eyeglasses (Lenses and Frame) – Once every twelve months
Contact Lenses (in lieu of eyeglasses) – Once every twelve months