BENEFITS


 

Health, Rx, Dental, Flexible Spending & Buy Out / Buy Down Elections
Contact:  Karen DelPriore    Phone:  315-635-4545     Email:  kdelpriore@bville.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.
S
ubsciber 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.
 

MEDICAL FORMS

Enrollment & Change Form - Updates must be done within 30 days of date of eligibility or status change (birth, divorce, medicare eligibility, loss of coverage, etc.)   
Claim Form - Medical - Use to manually submit a medical claim
Claim Form - Vision  - Use to manually submit a vision care claim (Blue PPO only)
Claim Form - BlueCard Worldwide - Use to submit claims incurred outside the U.S.
Medicare Eligibility Form - Use to notify of an insured's medicare eligibility for any reason (Age, Disability or ESRD). Copy of medicare card required.  
Privacy Authorization Form - For access to claims of spouse and dependents age 18 and older.
Student Certification - Currently not required for medical coverage.
MEDICAL CONTACT
INFORMATION

CUSTOMER SERVICE - EXCELLUS (BlueCross BlueShield)  
    ♦ PHONE: 1-800-499-1275
    ♦ CLAIMS: EXCELLUS, P.O. BOX 22999, ROCHESTER, NY 14692-2999

MEDICAL
PLAN INFORMATION

SUMMARY PLAN COMPARISONS:
    ♦ BTA as of 02/01/2015
    ♦ BESPA as of 10/1/2016
    ♦ BAPIS
    ♦ CSEA as of 05/01/2015
    ♦ Non Aligned Staff as of 10/01/2015
    ♦ Administrators as of 10/01/2015
    ♦ BTSSA
    ♦ PUBLIC LIBRARY as of 07/01/2013
    ♦ RETIREE - Senior Plans & Medicare            RETIREE - Senior Plans FAQ's
      
Updated 10/30/12                

PLAN DOCUMENTS: 
    ♦ BTA         BluePPO (16)     Classic Blue (15)
    ♦ BESPA     BluePPO (7)     Classic Blue (1)
    ♦ CSEA       BluePPO (6)     Classic Blue (3)
     Non Aligned Staff BluePPO (8)     Classic Blue (2)
    ♦ BAPIS,  BTSSA & ADM   BluePPO (5)     Classic Blue (9)
    ♦ PUBLIC LIBRARY     BluePPO (4)

RATES:
Employee premium cost, per pay period, for medical and prescription coverage
    ♦ 2016-17 School Year Rates - Medical Rate Sheet
 

OTHER
 

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
LINKS
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.
 
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
Express Scripts
    

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.
 
DENTAL INSURANCE INFORMATION:
Open enrollment for Dental Insurance is in September for an effective date of October 1.
 
DENTAL
FORMS
Dental Enrollment Form - For initial dental enrollments
Dental Change Form - Add dependents, switch plans, change address, etc
Dental Cancel Form - Cancel a subscriber and/or dependent(s)
Student Certification Form - Dependents Age 19 to 25 must be full time students
Claim Form - Use to manually submit a dental claim
Privacy Authorization Form - For access to claims of spouse and dependents age 18 and older.
DENTAL
CONTACT
INFORMATION
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

DENTAL
PLAN INFORMATION
PLAN SUMMARIES:
    ♦ Plan 1 - Premium plan
    ♦ Plan 2 - With orthodontic coverage - 50% & $1,500 lifetime maximum (children and adults)
PLAN DOCUMENTS:
    ♦ 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 

RATES:
Employee premium cost, per pay period, for dental coverage
    ♦ 2016-17 School Year Rates - Dental Rate Sheet
DENTAL LINKS
    ♦ Website   http://www.lifetimebenefitsolutions.com
    ♦ Direct link to Dental Web Portal   https://lbs-mesa.javelinaweb.com/
          - Log on or create an account, available 24/7
          - View your plan benefits, claim status, and payment status, request ID cards, etc.
          - View and download your Explanation of Benefits (EOB) forms
   ♦ Dental Provider Search
          - Direct link 
http://www.rmscoinc.com/pages/search.aspx 
          - Scroll down to Dental Prime + Dental Prime SCH31

 
FLEXIBLE SPENDING ACCOUNT (FSA) INFORMATION:
Open enrollment for Flexible Spending is in November for an effective date of January 1.
 


FLEXIBLE SPENDING ACCOUNT
FORMS

Enrollment Kit  - For Flexible Spending Accounts (FSA) in calendar year 2017
Enrollment Form
- For initial FSA enrollments - medical and dependent care. 
REIMBURSEMENT FORMS:  Use to manually (fax or mail in) submit claims.
    ♦ Medical Reimbursement Form 
    ♦ Dependent Care Reimbursement Form 
    ♦ Claim Terms & Conditions
Data Change Form - Use to update your address, name changes, etc.
Direct Deposit Form - Use to have reimbursements directly deposited into your bank account.
Medical Necessity Form - Some services and products are only eligible for reimbursement when certified medically neccessary by a doctor or other provider.
Privacy Authorization Form - Use to allow access to account information to a spouse, etc

FSA  
CLAIMS

REIMBURSEMENT METHODS:
    1.  FSA Health Spending Visa CardUse 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
CONTACT
INFORMATION

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
FSA
PLAN INFO

PLAN DOCUMENTS:     
    ♦
FSA Summary Plan Description
    ♦ FSA Listing of Eligible Expenses 
FSA LINKS
    ♦ Website   http://www.lifetimebenefitsolutions.com
    ♦ FSA Web Portal  https://ebrparticipant.lh1ondemand.com/Login.aspx?ReturnUrl=%2f   
         - Log on or create an account, available 24/7
         - View your account summary, track contributions and and payment status   
    ♦ FSA Store - https://fsastore.com//
         - Use your flexible spending account and discover surprisingly FSA eligible products
         - Quickly determine FSA eligible products - with and without a doctor's prescription.
         - Competitive pricing and discounts, free shipping over $50 and a quick turnaround. 
         - Pay with your FSA debit card as well as all major credit cards. 
 
Links

Last updated on 11/1/2016