TO: Fresno Unified School District Employee Health Care Plan Participants in Plan Options A and B
DATE: May 1, 2017 (Updated June 30, 2017)
The Joint Health Management Board (JHMB) has updated the Summary of Benefits and Coverage (SBC) for Plan Options A and B effective July 1, 2017. Please take note of the following updates to the SBCs for Plan Options A and B enclosed in this packet.
CHANGE TO MEDICAL PLAN SCHEDULE OF BENEFITS
Elimination Of Out-Of-Network Benefits For Outpatient Surgery And Preventive Care Services
In its continued effort to ensure the sustainability of the Plan, the JHMB has approved the elimination of benefits for out-of-network outpatient surgery and preventive care for Plan Options A and B, including:
Outpatient Services
- Ambulatory Surgical Center
(including Hospital Outpatient)
Preventive Care Services
- Annual Physical Exam Benefit
- Women’s Annual Health Benefit
- Well Baby Care
Instead, members are urged to seek in-network providers for these services when possible to ensure lower out-of-pocket expenses. In those cases where there is no service provider within the 30-mile service area of the member’s home address, benefits still apply but only in those specific instances. Non-California residents retain a limited benefit, as there is no provider network available outside of California.* For more information, please review the updated Plan Amendments available online at the Your Benefits page.
* – UPDATE: June 1, 2017 – Original announcement did not include language regarding Non-California residents.
CHANGE TO PRESCRIPTION PLAN SCHEDULE OF BENEFITS
Adherence to the Envision Rx90 Maintenance Drug Program
NOTE: This change does NOT apply to the EnvisionRx Plus Medicare Part D Prescription Plan or Plan C Kaiser Participants
Effective July 1, 2017, EnvisionRx and the JHMB will implement Rx90, a new maintenance drug program. For those members taking maintenance prescriptions this new program will require that you adhere to the following two steps to avoid paying the full cost of your maintenance medication(s):
- 1. Ensure your physician writes a prescription for any maintenance drugs to be filled in 90-day supplies (not 30), AND
- 2. ONLY use a pharmacy in the Rx90 Network for maintenance medications (EnvisionMail, Rite Aid, Walgreens or Costco retail pharmacy).
The plan will allow two (2) courtesy fills after July 1, 2017.* Thereafter, all maintenance medications must be filled for a 90-day supply and at an Rx90 network pharmacy. These changes were made in coordination with EnvisionRx in our continued efforts to provide better prescription coverage while managing the rising costs of prescription medications.
NOTE: Envision Rx Prescription Drug Plan members do not need to have non-maintenance prescriptions filled within the Rx90 network; members can continue to fill non-maintenance prescriptions at any network pharmacy.
* – UPDATE: May 4, 2017 – Original announcement indicated only one (1) refill will be allowed after July 1, 2017.
Download the Rx90 Program FAQ for More Details
For more information about the upcoming changes and how they may affect you, please review the FAQ available by download below.
ENVISIONRX PLUS MEDICARE PART D PRESCRIPTION PLAN MEMBERS
The Envision Rx90 Maintenance Drug Program does NOT apply to the EnvisionRx Plus Medicare Part D Prescription Plan. If you have the prescription drug ID card shown on the right, this change does NOT apply to you as an individual.
A Special Note About Your Summary of Benefits & Coverage
The SBC provides you with a quick snapshot of what your plan covers and what it costs. This includes important answers regarding your deductibles, out-of-pocket limits, common medical events, and the types of services covered or excluded from the plan. The SBC also includes your rights to continue coverage, grievance and appeals rights, and coverage examples.
Please keep in mind the SBC is a summary illustration of your benefits plan. The Benefits Plan Booklet is the official governing document for your benefits plan. Review the Benefits Plan Booklet for specific details about your benefits plan. The Plan Booklet is accurate as August 2012, and any amendments to the Plan Booklet are available online at www.JHMBHealthConnect.com/your-benefits. As amendments are made available, you should make them a part of the Plan Booklet.
For More Information
As a reminder, you may visit www.JHMBHealthConnect.com/your-benefits to review the Benefits Plan Booklet and related amendments. If you are unable to access the website, you can contact the District’s Benefits Office to request a copy.
FUSD Benefits Office
2309 Tulare Street
Fresno, California 93721
Phone: (559) 457-3520
