New Insurance Plan Year Effective October 1

 First, thanks to everyone for your patience as we adjust to new insurance coverage, new rules, and new on-line enrollment.  We're looking forward to a good working relationship with both OEBB and The ODS Companies.

 What is OEBB?  OEBB stands for the Oregon Educator Benefits Board, which governs the new state-wide school employee benefits pool.

 What is ODS?  ODS is our insurance carrier under the new OEBB plans. You now only need one ODS member ID card to access medical, vision, prescription, and dental coverage.

 Most employees have received their ID cards for the new insurance plan year, effective

October 1, 2008.  If you haven't yet received your card, and enrolled by the September 15 deadline, call ODS Medical Customer Service (see next column).  Late enrollees may experience a delay in receiving their cards.

Several items to remember:

• Bring your new card to all provider visits, including the 4J Wellness Clinic, as well as prescription purchases at the pharmacy.

• The clock resets: deductibles, annual out-of-pocket maximums all start over October 1, and continue through September 30, 2009.

• The first payroll deduction for your new plan choice will be October 31. Insurance deductions for any month always occur at the end of the month.

• Be sure to stay within the ODS provider panel for the maximum benefit.­ Your coinsurance costs greatly increase for services outside the ODS panel. If you want to check on a particular provider, see next column for on-line and telephone contacts.

Customer Service Contacts

ODS Customer Service

 Medical:  1-866-923-0409

Dental:  1-866-923-0410

Pharmacy:  1-866-923-0411

OEBB Information: 1-888-4MYOEBB

On-line information:

http://www.odscompanies.com/oebb/

http://www.4j.lane.edu/hr/classifiedbenefits

New Pharmacy Benefits:

A Quick Review

Here's a summary of our new ODS pharmacy benefits.  Your pharmacy benefit is processed at the  point of service:  Once you have given your new ODS insurance information at the pharmacy, you will only pay the copayment amount for prescriptions.

For a 30-day supply,

Generic drugs: you pay up to a  $5 maximum

Preferred Brand: you pay up to a $25 maximum

Non-Preferred Brand:  you pay 50% of the cost, up to a $50 maximum.

Annual pharmacy maximum (10/1 - 9/30):  If your pharmacy copays reach $1,000 within the plan year, coverage is at 100% for the remainder of the plan year.

New Mail Order Pharmacy:  Cost-Saving Incentive

Our new pharmacy plan does allow a price advantage for a 90-day mail order supply through Wellpartner, an Oregon-based home delivery pharmacy.

You will receive a 90-day supply for the cost of two monthly co-pays.  You may want to consider this option for any medications you are taking on a long-term basis.

Mail  Order  Rx Tips:

**If you are running low on a prescription, fill a 30-day local prescription first.  This will give you time to set up a mail order account.**

1) Set up an account:  You will need to have your ODS ID Card to set up your mail order account.  You can set up your account by calling Wellpartner toll free at 1-866-680-4672.  You can also enroll on-line at Wellpartner's secure web site:

www.wellpartner.com

You will need to provide a debit or credit card on file, in order to process mail order co-payments.

2) Get new prescriptions:  You will need a new prescription from your provider for a 90-day supply (with appropriate refills).  Don't try to transfer a current mail order prescription.  Your provider can FAX prescription(s) directly to Wellpartner at 1-866-624-5797  after you have set up your account.

According to Wellpartner, you can expect to receive your prescription 4 to 7 business days after your order is received.  Please allow more time for new prescriptions.

Out-of-Area Student Coverage:  Register With ODS

In order for out-of-area students to receive the higher level of "in-network" coverage, you need to register them with ODS.   

This will ensure that dependent students who seek care within a 30-mile radius of their "out of area" residence will receive the in-network benefits.  Please note that the ODS in-network reimbursement would be limited to the maximum plan allowance (the maximum they will normally pay to an in-network provider)

To register your out-of-area dependent student, give ODS a call at 1-866-923-0409.

ODS does have networks in other states.  Customer service representatives can tell you whether there are in-network physicians near your child's college. 

Free Flu Shot Clinics

In the Education Center Auditorium

3:00-5:30 p.m

Thursday, October 16

Wednesday, October 22

Tuesday, October 28

Bring your insurance card if you have one!

Who's eligible for Flu Shot Clinics?

• All employees, regardless of benefits eligibility, including substitutes, student teachers, etc.
• All benefits-eligible dependents of employees

Children ages 10 - 16 with parent only; under age 10 see your pediatrician.

Sorry, 4J Wellness Clinic has a limited supply of flu vaccine for high-risk patients only.

Alternative Care:  Summary of Benefits

All of our ODS medical plans allow for alternative care within certain limitations.  Each plan pays for the services of licensed chiropractors, naturopaths, and acupuncturists.

Care by these alternative care providers is limited to a total plan maximum of $2,500 per patient, per plan year.  The benefit is also subject to the medical plan year deductible.  Services ordered by alternative care providers are subject to the medical plan's standard rate of reimbursement.

As is the case with medical providers, staying within the ODS network of alternative care providers gives a much higher level of benefit.

There are also limits on prescribed vitamins and minerals.  They must be considered medically necessary, the substance(s) must be approved by the Board of Naturopathic Examiners, and prescribed and dispensed by a naturopath. 

It's important to be aware that all services provided by, and ordered by alternative providers are subject to the $2,500 per patient plan-year cap.

If you have questions about your alternative care benefits, you can research on-line, or contact ODS Customer service.  (See above for contact information)

This newsletter is reviewed and edited each month by the District 4J and OSEA representatives of the Classified Joint Benefits Committee (JBC).  The information in this newsletter is summarized,  and is not intended as advice or counsel.