Health, Rx, Dental, Flexible Spending & Buy Out / Buy Down Elections
Contact: Karen DelPriore Phone: 315-635-4545 Email: firstname.lastname@example.org
ANNOUNCEMENT: Change of pharmacy service provider-
Beginning on January 1, 2017 Excellus has contracted Express Scripts to be the new provider of retail pharmacy benefit
management services, replacing MedImpact/FLRx. This change affects all retail (in-store) prescription claims processing.
It is anticipated that most pharmacies that currently participate in the MedImpact network will also participate in the new Express Scripts network.
Express Scripts became the Excellus mail order pharmacy benefit management service provider earlier this year on January 1, 2016.
As a result of this change, all subscribers will be issued new Excellus Identification Cards in early November 2016. The new ID cards
will list the new pharmacy information needed to process claims through Express Scripts beginning January 1, 2017.
Subsciber ID numbers will remain unchanged. Note: You should continue to use your current ID card through through December 31, 2016.
Over the next couple of months Excellus will enhance the 'Prescription Drug' section of their website to offer services
to view drug benefits and claims, compare drug costs and locate participating pharmacies.
MEDICAL INSURANCE INFORMATION:
Open enrollment for Medical Insurance is in September for an effective date of October 1.
CUSTOMER SERVICE - EXCELLUS (BlueCross BlueShield)
♦ PHONE: 1-800-499-1275
♦ CLAIMS: EXCELLUS, P.O. BOX 22999, ROCHESTER, NY 14692-2999
COVERAGE WHEN TRAVELING ABROAD :
♦ BlueCard Worldwide Information - How your healthcare benefits work outside of the United States. Requires use of BlueCard Worldwide claim form.
AGE 26 LAW:
♦ Age 26 Information - Federal Health Care Law that allows for the enrollment of eligible young adults to age 26 as a dependent on a parent's medical coverage. Use the enrollment and change form above.
AGE 29 LAW:
♦ Age 29 Information - NYS law that allows for the enrollment of eligible young adults to age 29 on their own individual plan at 100% of the premium cost.
♦ Age 29 Enrollment Form - Mail form & payment directly to Excellus
COORDINATION OF BENEFITS (COB):
♦ COB Information ♦ COB Questionaire Form
MARKETPLACE - Notice to Employees of Health Insurance Marketplace
EXCELLUS CYBER ATTACK September 9, 2015
The District was informed today that Excellus BlueCrossBlueShield has experienced a cyberattack that may have affected the personal information of 7 million subscribers including our employees. Stay informed with status updates posted on Excellus' website www.excellusbcbs.com.
Cyber Attack Letter: www.excellusfacts.com/index.html
Cyber Attack FAQ's: www.excellusfacts.com/faq.html
Buy Out / Buy Down Election Forms: Election forms must be submitted to the Human Resources Office for approval. Requests for changes to medical coverage must be submitted to the Benefits Office before payroll deductions and coverages can be updated.
♦ BTA ♦ BESPA ♦ CSEA
|Medical Self Service Web Account (Excellus)
♦ First time users can register on site (Click on Register at top right of screen), available 24/7
♦ View your plan benefits, request ID cards, check claim status, view authorizations, and more
|Medical Provider Search or by phone at 1-800-810-2583
♦ Search the Excellus national Blue Card network to find a participating doctor, hospital, urgent care, etc. The BluePPO prefix is VYA; Classic Blue is VYW.
PRESCRIPTION INSURANCE INFORMATION:
Enrollment in pharmacy benefit is concurrent with medical plan participation.
DENTAL INSURANCE INFORMATION:
Open enrollment for Dental Insurance is in September for an effective date of October 1.
|EXCELLUS - Use your Excellus Member ID card for prescription purchases.
Retail Pharmacy (local / in-store)
MedImpact / FLRx Network
Pharmacy Help Desk 1-800-724-5033
For a list of participating pharmacies in your area, visit www.ExcellusBCBS.com or contact the Pharmacy Help Desk.
To manually submit a pharmacy claim, complete and submit the Pharmacy Claim (retail) Form.
|Mail Order Pharmacy
Member Services: 1-855-315-5220
How to get started? Set up a Mail Order Member Acccount online at www.Express-Scripts.com or by calling Member Services at 1-855-315-5220. Express Scripts Mail Order Welcome letter.
How to send in a new prescription:
By Mail - Send in paper scripts from your doctor along with a completed Rx Mail Order form to the address provided on the mail order form.
By Fax - Bring the Mail Order Doctor Fax form to your next doctor visit. Doctor must complete and fax the form.
By e-Prescribe - Ask your doctor to electronically submit a script to Express Scripts.
|Formulary Guide: Use the Excellus Formulary Guide (drug list) to determine the tier level of your medication. The specific copayments of drug tiers is contractually determined and is available in the Plan Comparisons / Documents in the green Medical section above. The formulary also lists medications that are subject to prior authorization and step therapy requirements.
|CUSTOMER SERVICE - Lifetime Benefit Solutions - Dental TPA (formerly EBS-RMSCO)
♦ PHONE: 1-888-800-0922 or 315-671-9812
♦ CLAIMS: Lifetime Benefit Solutions, Dental TPA, P.O. Box 780, Liverpool, NY 13088-0780
♦ Plan 1 - Premium plan
♦ Plan 2 - With orthodontic coverage - 50% & $1,500 lifetime maximum (children and adults)
♦ Plan 1 - Premium plan (100/100/80% and $2,000 calendar year maximum) No orthodontics.
♦ Plan 2 - Orthodontic plan (100/80/60/50% and $1,250 calendar year maximum)
STUDENT CERTIFICATION - Requirements for dependents age 19 to 25
Employee premium cost, per pay period, for dental coverage
♦ 2016-17 School Year Rates - Dental Rate Sheet
FLEXIBLE SPENDING ACCOUNT (FSA) INFORMATION:
Open enrollment for Flexible Spending is in November for an effective date of January 1.
1. FSA Health Spending Visa Card - Use card to directly debit from your account at point of service. No claim forms needed, but all receipts must be maintained.
2. FSA Website - Submit form & receipts on line.
3. Fax - Submit form & receipts by fax at 1-877-256-7228.
4. Mail - Submit form & receipts by mail to: Lifetime Benefit Solutions, Claims Dept,
P.O. BOX 6509, Syracuse, NY 13217
FSA CUSTOMER SERVICE - Lifetime Benefit Solutions
♦ PHONE: 1-800-327-7130 ♦ FAX: 1-877-256-7228
♦ CLAIMS: Lifetime Benefit Solutions, Claims Dept, P.O. BOX 6509, Syracuse, NY 13217