Quick Reminders: 1095-C and Medicare Part D Out-of-Pocket Maximum

1095-C Reminder

Form 1095-C for the 2020 tax year is available electronically in Workday at https://sso.tamus.edu.  Once in Workday, click the Benefits Worklet. Select “My ACA Forms” in the View column. Please see our ACA Help page for more information. 

Medicare Part D Out-Of-Pocket Maximum

If you are enrolled in the A&M Care 65 Plus plan and the Medicare Part D Prescription Drug plan, your out-of-pocket maximum restarted on January 1, 2021. Please contact your Benefits Office if you have any questions.

Prescription Programs and your A&M System Prescription Drug Benefits

There are many prescription programs in place to ensure you are getting the best use of your prescription benefits. Sometimes, there is a generic alternative that might save you money on your prescription, there may be a therapeutic alternative to treat the same condition for a lower cost, or manufacturers may offer rebates on certain brands.

Express Scripts and Blue Cross and Blue Shield of Texas (BCBSTX) – How They Work Together

Express Scripts administers the prescription drug part of the BCBSTX A&M Care plans. When you receive a prescription and fill it at a participating pharmacy, the pharmacy knows to bill Express Scripts when you provide your BCBS insurance card or Express Scripts ID card. The plan includes a $50-per-person annual deductible (with a 3-person maximum). This deductible applies to the first $50 in prescription drugs that each covered person buys, whether at a retail pharmacy or through mail order. After you meet the deductible, you pay the applicable copayments for any remaining eligible drug purchases through the end of the plan year. Some of the prescription programs listed below assist with the amount of those copayments.

Express Scripts has a mandatory drug substitution policy. This means, when you are prescribed a brand name drug by your physician, and a generic substitute is available, you’ll automatically be given the generic version. You may choose to request the brand-name drug, but you will pay the difference in cost between the generic and brand-name drug as well was the brand-name formulary or non-formulary copayment. If you cannot take the generic drug for a documented medical reason, your doctor can call Express Scripts to request a medical override for the brand-name drug. If this is approved, you will receive the brand-name drug and will pay only the formulary or non-formulary brand-name copayment. This must be done in advance of the prescription being ordered and filled.

Prescription Care Management (PCM)

In addition to our prescription benefit plan, the Prescription Savings Program by PCM is a program that works with employees/retirees and covered dependents, their doctors and pharmacies to save the member money on prescription drugs. PCM offers you a choice to switch from higher cost drugs to a lower cost, equally-effective therapeutic alternatives. As a plan participant, no action is required unless PCM contacts you. PCM will contact your physician first to ask if the alternative will work with your medical history and for approval to make the change. If approved, then PCM will contact you for your permission to change medications. PCM will answer your questions and take care of the work involved to change your prescription at the pharmacy. This program does not change the pharmacy benefits offered by the A&M System and administered by Express Scripts. Should you receive a call from PCM, contact their member services department at 1-800-281-7050 with any questions or concerns.

SaveOn SP

SaveOn SP is an Express Scripts program that lowers the cost of a number of specialty drugs for both the members and the plan by taking advantage of manufacturer assistance programs. The specialty drugs are in specific medication categories such as Hepatitis C, Multiple Sclerosis, Oncology, Rheumatoid Arthritis, and a few others. If you participate in this program, you will have a zero cost for certain specialty medications. Your prescriptions will still be filled through Accredo, your existing specialty mail pharmacy.

  • The cost of these drugs will not count towards the annual out-of-pocket maximum, and
  • All plan members must use the Accredo specialty pharmacy for all specialty fills.

SaveOn is not available to the 65 Plus plan. If you have any questions or concerns, please contact SaveonSP at 1-800-683-1074 Monday – Thursday 7:00 a.m. – 7:00 p.m. Central and Friday 7:00 a.m. – 5:00 p.m. Central.

First Things First: New Fiscal Year Benefits Checkpoints

Check your deductions

Your new benefits plan year began September 1, 2020. It is important to log into Workday through Single Sign On (https://sso.tamus.edu/) and verify the accuracy of the benefits you elected for FY21 by clicking on the Benefits worklet, then “Benefit Elections” in the View column. If you find an error in your benefit elections, contact your human resources office before October 15, 2020.

Dependent SSN Reminders

As part of compliance with the Affordable Care Act (ACA), the A&M System Benefits Administration Office is required to request Social Security Numbers (SSNs) for covered dependents. This information will remain confidential. If you have dependents covered through your A&M System health plan for whom you have not provided an SSN or if you are unsure as to whether you have previously provided your dependent’s SSN(s), go online to Workday (http:// sso.tamus.edu/) to check and enter an SSN. After logging into Workday, click on the Benefits worklet. On the Benefits screen, select “Dependents” in the Change column. Click on the Dependent record you would like to edit. Visit the Workday Help website for assistance.

FY20 Flexible Spending Account Deadlines

If you have remaining funds in your FY20 healthcare or dependent daycare Flexible Spending Account (FSA), the grace period has been extended due to COVID-19. You may file eligible claims with a date of service of September 1, 2019 through December 31, 2020 to use your remaining FY20 FSA funds. All claims related to your FY20 FSA must be filed by December 31, 2020.

Medicare Part D Updates – Annual Communications

If you are enrolled in the A&M Care 65 Plus plan, you will be receiving an annual communication from Express Scripts regarding Medicare Part D in early October. Express Scripts is required to send these details to you on a yearly basis. You do not need to take action at this time and there will be no changes to your prescription drug plan. The annual enrollment period for our group differs from that of the general Medicare population. Your Medicare Part D Prescription Drug Out-of-Pocket Maximum will restart on January 1, 2021. Please contact your Benefits Office if you have any questions.

Getting Ready for Open Enrollment 2020

Open Enrollment is right around the corner and it is a great time to review your benefits. How often did you go to the dentist this past year? Are you filling maintenance prescriptions that might be cheaper through mail order? Did you complete your two-step wellness incentive tasks? These are questions to consider when thinking about next year’s benefit elections.

IMPORTANT: All Open Enrollment meetings will be virtual this year!

Due to COVID-19, System Benefits Administration has made the decision to conduct virtual open enrollment meetings by Webex Presentations throughout the month of July. A calendar is posted on the Open Enrollment website and below with information on how to attend your virtual Open Enrollment meeting. Please record this information in advance so you are ready to either call in or log into your meeting by computer.

Here are plan updates for September 1:

  1. The A&M Care full-time premiums are remaining the same for the 5th year in a row; however, other plan premiums, including part-time premiums and the graduate student plan premiums, are changing. Please review the premium sheets found on the A&M System Benefits Open Enrollment website.
  2. Family, group, and marriage counseling will now be covered by the A&M Care, J and 65+ health insurance plans.
  3. A new coverage tier is being added to the A&M Care 65 Plus and A&M Care Plans. Blue Cross and Blue Shield of Texas-designated Blue Distinction Centers have a proven record of delivering specialty care and results. Blue Distinction Center care includes the following categories: bariatric surgery, cardiac care, knee/hip replacement, spine surgery, and transplants. This tier will be covered at 90% coinsurance for inpatient services. The benefits of the Blue Distinction Centers are available to 65 PLUS plan members, but there is no plan savings since, in most cases, Blue Cross and Blue Shield pays what Medicare does not pay for inpatient hospitalizations.
  4. Polycarbonate lenses and standard anti-reflective lenses are now covered in full for participants and dependents enrolled in the vision plan.
  5. The vision premium will have a small increase $.60 per month for employee only and $1.72 for employee and family and include the above additional coverage.
  6. Every 6 years, the A&M System Benefits Administration office is required to bid the insurance plans. This year, during the Request for Proposal process, a new Life Insurance carrier was selected. The Hartford will be the new carrier for FY21, however, there will be no plan changes.
  7. The MDLIVE Virtual Visits copay will decrease from $20 to $10 for the A&M Care, J, and 65 Plus plans. Virtual Visits is a way to conduct doctor’s or behavioral health appointments for non-emergency conditions by phone, video, or the MDLIVE app 24/7. To register for MDLIVE, go to MDLIVE.com/bcbstx and enter the information found on your ID card.
  8. Dependent Life Insurance Plan B has been split into Spouse Life B and Child Life B. This change has not changed the coverage amount and slightly lowered the premium for some enrollees. The premium is now: Spouse Plan B – $1.05; Child Plan B – $0.32 (for one or multiple children).
  9. The Healthcare Flexible Spending Account maximum annual election will increase from $2,700 to $2,750.
  10. The credit hour requirements for voluntary graduate students will be changed from 6 to 5 hours. Continuation coverage for the Graduate Student employee Plan (Grad Plan) will be reduced from 6 months to 3 months.
  11. During a recent records audit, we determined there is no provision to name an alternate beneficiary for Dependent Life Insurance. The beneficiary is the employee or retiree, and if deceased as well, the benefit will go to the estate.
  12. Livongo for diabetes and hypertension, Omada for pre-diabetes and pre-hypertension, and Hinge Health for musculoskeletal conditions are being added as Blue Cross and Blue Shield partner programs. These programs are based on eligibility or diagnosis, and include digital tools to assist with these chronic conditions such as a scale or virtual therapy courses. There will be more information provided about these programs after September 1.

 

Virtual Open Enrollment Calendar and Meeting Presentation Schedule

July 1 – July 31

Below you will find the morning, afternoon, and Retiree Meeting presentation schedules. If your campus or agency meeting is shown on the calendar in the AM, use the AM Presentation schedule for reference. You may join the Webex at any time during the meeting to listen to the vendor presentation for which you are most interested. Click the calendar above, and click on your campus or agency name to quickly get to the Webex meeting for your event. You may also drop off the meeting at any time. You will need the Webex information below to dial in. You may also have received this information from your benefits office via email invite. Please record this information ahead of your meeting.

Call-in Information: 1.855.282.6330 (toll free)
Password: benefits

Access Codes:

TAMIU:  145 341 0876
TAMUCC: 145 785 9574
TAMU-HSC: 145 382 8386
TAMU-K: 145 824 7915?
TAMU (7/13): 145 609 6860
TAMU (7/14): 145 315 7150
TAMUS: 145 679 8555
AgriLife: 145 158 5324
TEEX/TFS/TTI: 145 241 9072
TEES/COE: 145 679 3032
Retiree Meeting: 145 623 6773
WTAMU:145 385 2677
PVAMU: 145 500 0676
TAMUSA: 145 440 6709?
TAMUCT/TAMUT: 145 959 8925
TAMUC: 145 261 3887
Tarleton: 145 863 7222

Need a New ID Card?

Misplacing your insurance ID cards can be a pain when trying to go to an appointment or get a prescription! You can follow the steps for each insurance plan below to get a new ID card, and then keep them all in one place. MyEvive also has the ability to save images of multiple ID cards, so all you need is your phone and the MyEvive app the next time you need your card. 

Blue Cross and Blue Shield of Texas
1. Log in to your Blue Access for Members account at https://bcbstx.com/tamus
2. From your dashboard, click the image of the ID card on the left hand side.
3. You can print a paper copy of your ID card, or order one from this page!
4. If ordered, a new ID card will be mailed to the address on file within two weeks.

Express Scripts
Retirees on the 65 plus plan and their spouse will have separate ID Cards.
1. Log into your Express Scripts account.
2. Select the Account tab from the main menu.
3. Click Member ID Card.
4. Download your card from this screen.

Superior Vision
Although you are not always required to present your vision ID card, it is good to keep for your records.
1. Go to Superiorvision.com and select “Member Log in” in the top right.
2. Log in using your username and password.
3. From the home page, select Print ID Card from the menu.

All of these accounts can also be linked to MyEvive with single-sign-on capability! This means, once you log in through MyEvive once, you can go straight into your vendor account from the MyEvive app.

 

Using Express Scripts Mail Order

Express Scripts mail-order is a convenient way to get your prescription drugs delivered to your home and ensure you stay adherent to your medication by planning in advance. You will also receive reduced copays for getting a 90-day supply via mail-order rather than purchasing a 60-day supply at retail for eligible drugs.

Benefits of Using Mail-Order Services

One of the greatest problems associated with maintenance medications is adherence. Maintenance drugs are medications prescribed for chronic, long-term conditions that are taken on a regular, recurring basis. Using a mail-order service to refill your maintenance prescriptions is a convenient way to ensure you have enough of the medication delivered directly to your home. Express Scripts mail-order service provides the following benefits:

  • Get up to a 90-day supply of each covered medication for a lower co-payment – two copays rather than three (subject to plan limitations, rules, and state regulations, such as controlled substances).
  • Registered pharmacists are available 24 hours a day, 7 days a week.
  • Order refills online, by mail, or by phone – anytime day or night. To order online, register at www.express-scripts.com. Refills are usually delivered within 8 days after Express Scripts receives your order.
  • Choose a convenient payment option – check, money order, credit card, or Express Scripts automatic payment program
  • Automatic Refills
  • Standard shipping is free

Submitting a Prescription through Mail Order

Your 90-day mail-order prescription should be sent to:

Express Scripts, Inc. P.O. Box 650322 Dallas, Texas 75265-0322

Or, you may ask your doctor to call 1-888-327-9791 for instructions on how to fax the prescription to Express Scripts (ESI). Your doctor will need to use your social security number or ESI member ID number to complete the transaction. (Only doctors can fax prescriptions to ESI.)

Order Delivery Times

First-time orders arrive within 8 to 11 days. Refills usually arrive in less time – 7 to 9 days, however, you can call to request expedited delivery. At www.express-scipts.com you can review detailed order status information. The best time to reorder is when you have about a 14-day supply of your medication remaining. This will help ensure that the medication is received when it is needed.