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Important Plan Changes Effective July 1, 2019

The NY44 Health Trust Announces Plan Changes for July 1, 2019

The NY44 Health Trust’s primary objective is to provide quality health coverage at affordable rates for educational organizations and their employees.  As healthcare costs continue to soar, the Trust is faced with the task of carefully balancing plan design and cost effectiveness.  In order to mitigate contribution increases for our participating districts, and ultimately, reduce the cost to our enrollees, the Board of Trustees has approved plan changes effective July 1, 2019. 

What are the changes, and how will they impact your benefits?

Emergency Room Copayments

Emergency room care is expensive.  Over the years, the Trust has put in place alternatives to emergency room visits.  Urgent care facilities carry a $0 copayment; you are encouraged to seek medical care at an urgent care facility when not faced with a life-threatening situation.  Both Independent Health/ Nova and MVP offer a 24-hour Nurses’ Hotline, where enrollees can seek medical advice before going to an urgent care facility or an emergency room.  Finally, the Trust has partnered with Well Now (formerly 247 Online Care) to provide enrollees with 24-hour access to telemedicine.  Well Now has a staff of certified medical professionals that can advise, diagnose and prescribe medications via computer access.  

To decrease Emergency Room misuse and encourage our enrollees to seek the appropriate medical care, beginning July 1, 2019, emergency room copayments will increase to $300 for those enrollees in the Traditional Plan and $400 for those enrollees in the Core Plan.  This copayment will be waived if you are admitted to the hospital from the emergency room.

Non-Preferred Brand Medications

Pharmacy is another area of healthcare that has seen dramatic increases over the past few years.  It is also an area that is more difficult to apply cost control measures to without significantly impacting members’ prescriptions.  One area that offers a bit of room for controlling costs pertains to non-preferred brand drugs.  Non-preferred brand medications have a generic equivalent available and are prescribed as “dispense as written” or “do not substitute” by physicians.  A generic equivalent must have the same medicinal properties, dosage and efficacy as the non-preferred brand, so the effects are the same as the brand.  Differences between non-preferred brand and a generic equivalent may be as simple as what type of filler or dye has been used in the pill.  For members and their providers who elect to receive a non-preferred brand medication rather than a generic equivalent, the member will pay the difference in cost between the non-preferred brand and the generic equivalent, plus the tier copayment.  If there is a medically necessary reason for a member to receive the non-preferred brand, the provider can submit a Prior Authorization form to Pharmacy Benefit Dimensions, and if approved, the member will not have to pay the difference between the non-preferred brand and generic equivalent.

Healthy Living Program

National studies indicate participation in rewards and reimbursement programs tends to average between 20-40%, and of those participating, most would continue to participate without the reimbursement incentive.  NY44 Health Trust data supports this.  Last plan year, an average of only 28% of the Trust’s enrollment participated in the Healthy Living program.  To maximize the nearly $1M dollars spent on the program, the Board of Trustees has approved the termination of both the Activity Reimbursement and Annual Physical Rewards, effective July 1, 2019.  With the termination of the program, those dollars can be better used to contain contribution costs to districts and enrollees, benefitting 100% of the Trust’s enrollment. 

Enrollees have until July 15, 2019 to submit claims and required documentation for the 2018/2019 plan year.