Health Insurance Changes for FY06

Things to Keep in Mind....

• Health plans for dependents of employees increase 4%.

• Dental, Vision, Major Injury Protection, Hospital Indemnity, and Short-Term Disability Income Protection Plan contributions each increase 5 percent.

• Emergency room copayments increase from $100 to $150

• Implemented a step-therapy and pre-authorization program for Cox-2 Inhibitors, Non-Sedating Antihistamines, and Proton Pump Inhibitors (PPIs).

• Implemented a formulary for prescriptions used by the current pharmacy benefits manager, Prescription Solutions. This change will move some medications from Tier 3 to Tier 2, and others from Tier 2 to Tier 3. Members who are affected by this change will be sent a letter from Prescription Solutions.

• The FlexExpress Enrollment System has been enhanced to capture and record not only your primary life beneficiaries, but also your contingent life beneficiaries. You are strongly encouraged to update both your primary and contingent beneficiaries during this enrollment period.

• The State has contracted with Mayo Clinic and facilities in Rochester, Minnesota as our out-of-state preferred provider. Members are encouraged to utilize these facilities when comparable services cannot be obtained in South Dakota. If you choose to receive care in another out-of-state facility, you should seek prior authorization from Health Care Medical Technology Inc. (HCMTI). When you seek care at a non-contracted facility, you are responsible for charges above usual, customary, and reasonable charges (UCR).  You may choose to receive services at other out-of-state facilities. However, you will be responsible for more out-of-pocket costs, and UCR charges will be applied. Contact HCMTI prior to receiving services if you or a covered family member are referred to an out-of-state provider.

Administrative Changes

Plan members should have received new Health Identification cards (ID). Be sure to present your new ID card each time you require health or pharmacy services. Your new ID card shows an Alternate ID number which replaced your Social Security number. The Alternate ID number is the policy number your claims should be filed under, and the number you should use in enrolling in benefits. If you need a replacement ID card, please contact Dakotacare.