[Ucrea] Health Plans - Support for those affected by California Wildfires
Cristina L Otegui
cristina.otegui at ucr.edu
Tue Aug 17 08:23:13 PDT 2021
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August 17, 2021
To:
UCR Emeriti & Retirees
From:
HR Benefits Office
Re:
Health Plans - Support for those affected by California Wildfires
With the early start to the California wildfire season, our health plans are offering the following resources to ensure impacted members have immediate and easy access to care.
Anthem Blue Cross
Anthem members directly impacted should contact Anthem Health Guide and IngenioRx teams for their medical and pharmacy needs.
* Anthem Health Guide: (844) 437-0486 | Monday - Friday, 5:00 a.m. - 8:00 p.m. (PT)
* IngenioRx: Members (833) 261-2463, available 24/7
In addition, if a member attempts to fill a prescription for lost or damaged medication, and it is rejected as too soon to refill, the pharmacy should call the IngenioRx Retail Helpdesk for assistance at (833) 296-5038 - this number is specifically for pharmacists use.
Health Net
Health Net plan members may use the following FAQs for all wildfire emergencies. Health Net's call center is trained on how to handle member calls.
* Health Benefits Navigators: (800) 539-4072, Monday - Friday, 8:00 a.m. - 8:00 p.m. (PT)
* MHN - (800) 663-9355 | Monday - Friday, 8:00 a.m. - 8:00 p.m. (PT)
1. How can members obtain refills drugs?
Affected members may immediately receive authorization to refill prescriptions for the duration of the state of emergency or such other date that may be reasonable under the circumstances. The usual restrictions on frequency of refills will be waived. The members' usual cost-share will apply. Refills may be subject to a prescriber's approval.
2. If a member needs an authorization to have their drugs refilled who should they call?
Affected members may contact the pharmacy to obtain authorization for an early refill. The pharmacy will contact Health Net to obtain authorization. Refills may be subject to a prescriber's approval. Members may also call Health Net directly to obtain authorization for a refill.
3. If there is no network pharmacy near the member, can they use an out-of-network pharmacy?
Yes. Members will be reimbursed for covered medications as described in member benefit materials for medically necessary prescriptions dispensed at out-of-network pharmacies when members cannot obtain covered prescriptions at an in-network pharmacy. Some limits may apply. Members may be required to pay the full cost of the drug at an out-of-network pharmacy and submit the claim with their original pharmacy receipt for reimbursement.
4. What if the member was expecting a mail order refill but they have been evacuated or relocated?
Members may obtain the maximum health plan extended-day supply per their benefit plan at a retail pharmacy for their normal mail order copay.
5. What copayment will the member pay?
Members will pay their usual cost-share if they use an in-network pharmacy. Members may be required to pay the full cost of the drug at an out-of-network pharmacy and submit the claim with their original pharmacy receipt for reimbursement.
6. I lost my medications due to the fire. I don't have my prescriptions. What should I do?
Go back to the pharmacy that filled your original prescription(s) and ask them for an emergency refill. Ask the pharmacist to contact Health Net to authorize an immediate refill. The pharmacy may be required to contact your doctor for authorization.
Note: Have the member ask the pharmacist to call the Pharmacy Help Desk/Prior Authorization number located on the member's ID card.
7. What if my doctor's office is closed?
Go back to the pharmacy that filled your original prescription and discuss your situation with the pharmacist.
8. What if I can't get to my original pharmacy?
Go to any Health Net contracted retail pharmacy and ask them to contact your doctor for an emergency prescription.
9. What if I lost my ID card?
The pharmacy can process your prescription under the subscriber's social security number or you can call Health Net Customer Service to obtain your ID number for the pharmacy.
10. Will I have to pay another copayment/coinsurance?
Your usual copayment or coinsurance will apply to these emergency refills.
11. What should I do if I receive my prescriptions through mail order?
Contact your doctor's office and ask them to send a new prescription to a local Health Net contracted retail pharmacy to provide you with an emergency supply of your drug(s). Medicare members will be allowed to obtain up to a 90-day emergency supply through a retail pharmacy (if the pharmacy is contracted to provide a 90-day supply).
12. Who can I contact for behavioral health support following a state of emergency or disaster?
Contact Managed Health Network, Health Net's behavioral health provider at (800) 227-1060 for timely access to covered behavioral health care services, including referrals to the Employee Assistance Program, mental health counselors, resources, or telephonic consultations to help cope with stress, grief, loss or other trauma resulting from a disaster/declared state of emergency.
Kaiser Permanente
Kaiser Permanente has provided the following general guidelines below for their members:
* Appointments: For many non-urgent appointments and health care needs, members should use telehealth options - including phone, email, and video - so members can get care without an in-person visit. Members with questions about scheduled appointments should contact the Appointment and Advice Call Center at:
o Northern California - (866) 454-8855 (24 hours a day, 7 days a week)
o Southern California - (833) 574-2273 (advice 24/7, appointments during local business hours)
* Prescriptions: Members who need a non-urgent prescription or refill can sign up on the Kaiser Permanent website at https://healthy.kaiserpermanente.org/southern-california/front-door to use the mail order service. For urgent prescription needs, members can go to any open Kaiser Permanente pharmacy. If there is no Kaiser Permanente pharmacy nearby or if other assistance is needed, including redirecting mail order prescriptions, members should call the Kaiser Permanente Pharmacy Call Center at:
o Northern California - (888) 218-6245 (M-F 8:00 a.m. - 8:00 p.m., Saturday 8:00 a.m. - 6:00 p.m., Sunday 9:00 a.m. - 6:00 p.m.)
o Southern California - (866) 206-2983 (M-F 7:00 a.m. - 7:00 p.m.)
Optum Behavioral Health
Members may call for free emotional support.
* For UC Kaiser members - (888) 440-8225 (24 hours a day, 7 days a week)
* For non-Kaiser members - (866) 342-6892 (24 hours a day, 7 days a week)
United Health Care
In compliance with CMS provisions, UnitedHealthcare has taken the following actions as part of its commitment to helping retirees, care providers, and employees in the areas impacted by the wildfires.
* Access to Care: Members who may have been displaced from their homes or whose network provider or medical facility is inaccessible may access care anywhere, as needed, and it will be covered at their in-network benefit level.
* Prescription Medications: Members who need help obtaining early prescription refills may work with their pharmacy who can obtain an override on their behalf, or they can contact the Customer Care number on the back of their ID card. For mail-order delivery service to affected areas or any other questions related to their prescriptions, members can contact the pharmacy number on the back of their ID card and discuss their situation for assistance, obtaining a local supply, if necessary, and more.
* For Additional Assistance: Members can call the Customer Care number on the back of their medical ID card, if they need additional assistance. If they have misplaced their medical ID card, they can call (866) 633-2446, 8 a.m. - 8 p.m. (in the local time zone), Monday through Friday, or visit www.uhcretiree.com to request a new ID card and print a temporary ID card to use while waiting for their new ID card to arrive.
Help For the broader community
Free Help Line: Optum is offering a free emotional-support help line to affected individuals - the toll-free number is (866) 342-6892. This line will be open 24 hours a day, seven days a week, for as long as necessary. The service is free of charge and open to anyone. Callers may also receive referrals to community resources. Along with the toll-free help line, emotional-support resources and information are available online on the Optum website at: https://www.liveandworkwell.com/content/en/public.html.
Emergency resources can be found at UCnet: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/emergency-resources.html
The medical plan response summarizes the latest information from Anthem, Health Net and Kaiser Permanente regarding the waiver of cost-sharing for services related to COVID-19 - all changes are highlighted in yellow.
Plan members may visit their plan website for more information.
Anthem Blue Cross
https://www.anthem.com/ca/coronavirus/
Health Net
https://uc.healthnetcalifornia.com/important-updates.html
Kaiser Permanente
https://healthy.kaiserpermanente.org/health-wellness/coronavirus-information
* Standard cost sharing will apply for positive COVID-19 admissions beginning on or after August 1, 2021.
* Regarding treatment for Medicare, Kaiser Permanente's National Benefit Policy to waive member out-of-pocket costs for treatment related to a positive COVID-19 diagnosis will expire at the end of the Public Health Emergency or on December 31, 2021 at midnight, whichever is earlier.
United Health Care
https://www.uhcretiree.com/uc
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