FPU Health Plan Changes

FPU Health Plan Changes – Good News/Bad News/Good News
As you are undoubtedly aware, health care costs across the country are on a steep upward trajectory. And yes, the university is looking at some unavoidable increases.  However our new provider is also offering opportunities to save some money on both prescriptions and preventive health care services! The following is a summary of the changes:   
Voluntary Maintenance Choice® is designed to help keep prescription costs down and to offer you convenience and choice.  Soon you and your family can choose to receive 90-day supplies of your long-term medications either through CVS Caremark Mail Service Pharmacy or to pick them up at a CVS/pharmacy near you.  Choose the option that works best for you.  Either way, your copay will be the same, your mail order copay for your 84-day or 90-day supplies.  The program is convenient and easy-to-use.  Once you make your selection online or by phone, CVS Caremark will handle the rest for you.  Plus, you can order refills and manage your prescriptions anytime at www.caremark.com.
Members have the option of filling their maintenance prescriptions in 90-day supplies at CVS/pharmacy or CVS Caremark Mail Service Pharmacy to benefit from a lower copay.  Members may choose to continue filling 30-day supplies at retail without penalty.
Changes to your prescription copays

Up to a 30-day supply
Any network pharmacy

84-day to 90-day supply
CVS/Pharmacy or CVS Caremark
Mail Service Pharmacy

Generic drugs

Preferred brand drugs

Non-preferred brand drugs

Incentive to ‘go generic’
A generic incentive is going in place that will require a plan member to pick up the cost difference when they choose a brand for which there is a generic substitute allowed and available. 
Our medical benefits are also changing as we attempt to maximize the advantages our new association with Networks By Design can bring to our health plan.

The In-Network Individual and Family Deductible will change from $0 to $150
The In-Network Out of Pocket Maximum will change from $1,000 to $1500
The In-Network Coinsurance will change from 80% to 75%
The Out-of-Network Individual Deductible will change from $1,000 to $2,500
The Out-of-Network Family Deductible will remain at $3,000
The Out-of-Network Out of Pocket Maximum will change from $2,500 to $3000
The Out-of-Network Coinsurance will remain at 60%
The Emergency Room Co-Pay will change from $100 to $250
The Chiropractic Visit Co-Pay will change from $25 to $35

Monthly Premium Changes 
The last time our monthly rates changed was more than two years ago, in June 2011. At that point we experienced a 10% increase in premiums.
Effective August 1, 2013, the monthly medical insurance rates will increase by 5% in an effort to maintain a minimal impact on our employees and families. 

Monthly Premium
Old Rate
New Rate
Increase Amount

Employee only

Employee plus one

Employee plus two or more

The Affordable Care Act   
Offsetting some of these unavoidable increases, the plan will begin covering preventive services without charging you a copayment.  For example, well baby and well child check-ups are currently covered at 80%; but starting in August these preventive services will be covered at 100%, saving you the 20% out-of-pocket cost per visit. This is good news! 
For more information on preventive care benefits, visit the healthcare.gov website.   Go to All Topics, and then Prevention.   http://www.healthcare.gov/
Please contact us if there is any confusion regarding any of these benefit changes. We will be glad to provide whatever assistance we can.  You are also welcome to contact our Brokers (Robert Kolbert and Chuck Spencer) for assistance or to contact the staff at Combined Benefits Administrators.
Our goal is to make the transition to these changes as easy as possible. Toward that end, you will be receiving several communications via email directly from CVS Caremark over the next several weeks.
Please let us know if you have any questions!
Dick Herrinton, Interim Vice President of Finance & Business Affairs
Marylou Miller, Executive Director of Human Resources