Agenda - 10-03-2006-5e - Laserfiche WebLink

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Attachment 1 Page 1 of 3 ~~ What's EnhancecU What's Different The simple response to why the new County Health Plan is not exactly the same as the former is that the Plan is no longer being administered by BCBSNC. When our plan transitioned from one claims payer and pharmacy benefits manager to another, we attempted to replicate the basic plan designs and coverages. This is what we did during this move and why we stand behind the statements made that your "plan design" is the same. Every nuance of the claims paying operation, list of participating providers, and items such as disease management programs. will not be exactly the same as before. Clearly, the NCACC had to make choices based on our membership and most were based on our primary goal of reducing costs and creating our own program. We are dealing with very different claims and service providers whose operations are not the same. However, below we have outlined same of the more prevalent items that are different and/or enhanced with the new program. Below are the items that the County Health Plan has elected to enhance or add to the program for you: • Additional disease management programs offered are Lower Back Pain and Chronic Obstructive Pulmonary Disease • Outpatient labs and mammograms are paid at 100% whether rendered alone or with other procedures. • Ambulance Services are covered at the in-network coinsurance level even if the hospital you are delivered to is out of network. • Comprehensive vision exam is covered at the same level (after a deductible equal to your PCP co-payment) regardless of whether or not the health care provider is in-network. (May require a patient to pay in full up front and be reimbursed by CIGNA if the provider is not in- network, but BCBS paid $0 for out of network vision care) • Transplants are covered at 100% rather than co-insurance at in- or out-of-network levels. • Dental Coverage includes a Brush Biopsy and Oral Health Maternity Program • Prescription Smoking Cessation Drugs are now covered • Mail Order Program allows for 90 days supply for reduced co-pay and better rebates for mail order. • Quantity Limits on Drugs - we only limit sleep aids, Stadol and erectile dysfunction drugs, as does BOBS. However, we limit far fewer drugs than BCBS. • Prior Authorization for Drugs - We require prior authorization on just Arava, Growth Hormones and Anti-fiingal which are far fewer drugs on the PA list than BCBS so fewer lassies for you and your physician. • Enhanced Reporting -With the purchase and implementation of MedStat, our program will provide a higher degree and frequency of useful claims reports for your group.