Annual Enrollment for the 2010 / 2011 benefit year is from March 15 through April 9 unless your agency uses eBenefitsNow and has been approved for an alternative enrollment period. IMPORTANT As a requirement of new legislation establishing the Comprehensive Wellness Initiative (“CWI”) ALL employees and their covered dependents will be moved to the 70/30 Basic plan effective July 1, 2010. During Annual Enrollment employees have the opportunity to elect the 80/20 Standard plan for the 2010/2011 benefit year if they attest that:
1) they and any family members who will be covered on July 1, 2010 do not use tobacco products, or 2) they and/or their family member(s) who will be covered on July 1, 2010, do use tobacco products BUT
are participating in a tobacco cessation program
The Attestation (either completed electronically or on paper) is a legally binding document that all employees must complete each year to enroll in the 80/20 Standard plan.
If an employee does not take action during Annual Enrollment, they will remain in the 70/30 Basic plan for the 2010/2011 benefit year. If an employee chooses to remain in the 70/30 Basic plan by choice or due to tobacco use status, they do not have to do anything during Annual Enrollment unless they want to add or remove dependents or update their personal information.
Employees claiming an exemption due to participation in a tobacco cessation program must complete a Physician Certification Form. The completed form must include a dated physician, nurse practitioner or physician assistant’s signature or be obtained through QuitlineNC. Employees should keep the original, completed certification form for their records, as the Plan may request it at any time. The date on the Physician Certification Form must be prior to the date of the request for submission of the Physician Certification Form. Please note: Employees and, if applicable, their covered spouses, who enroll in the 80/20 Standard plan may be randomly selected to participate in a tobacco use verification test or be asked to submit a copy of their Physician Certification Form. More detailed information on the tobacco verification process will be available on the State Health Plan Web site once the vendor is selected. COMPREHENSIVE WELLNESS INITIATIVE SUPPORTS The State Health Plan has the following tools and resources available to help members succeed in quitting tobacco use:
NC Tobacco Use Quitline
1-800-QUIT-NOW (1-800-784-8669). QuitlineNC offers tobacco cessation coaching and free over-the-counter generic nicotine replacement therapy patches to members, subject to specific limitations.
QuitlineNC is available 8:00 a.m. to 3:00 a.m., 7 days a week, in English and Spanish. In addition, a completed Physician Certification Form can be obtained from QuitlineNC free of charge.
Tobacco Cessation Counseling
Counseling by a physician, nurse practitioner, physician assistant, behavioral health provider and QuitlineNC is covered.
Nicotine Replacement Therapy patches: $10 generic copay; $5 over-the-counter generic copay
Bupropion (generic for Zyban): $10 generic copay
Nicotrol Nasal Spray, Nicotrol Inhaler, Varenicline (Chantix): $35 copay.
On January 1, 2010, the Plan began providing coverage for four (4) nutritional visits, in-network at the primary care copayment, for all members per benefit period as an additional support for the CWI. Coverage includes nutritional visits with a licensed dietitian or physician. (Members with a diagnosis of diabetes will continue to have coverage for six (6) nutritional visits at 100% per benefit period.)
RATES Effective July 1, 2010, there will be an 8.9% rate increase for coverage on the State Health Plan. The 2010 / 2011 rates can be found on the State Health Plan Web site at KEY DATES February 15
Enrollment kits, Attestation and Physician Certification form
Postcard mailed to all enrolled member homes – announcing
Webinars for HBRs will be conducted on Annual Enrollment and
the Comprehensive Wellness Initiative – there will be multiple webinars scheduled. The schedule will be sent via e-mail next week
PowerPoint presentation with voice narration (Brainshark) on
Annual Enrollment and the Comprehensive Wellness Initiative will be available for employees to view
Annual Enrollment kits will be mail dropped
Employees who did not receive an Annual Enrollment kit can call
All forms due to BCBSNC for agencies still using the paper
Agency review period for 70/30 Basic plan enrollments
Bariatric Surgery (Surgery for Obesity)
Beginning July 1, 2010, bariatric surgery must be performed at a Blue Distinction Center (also sometimes referred to as a Quality Centers or Centers of Excellence) to be a covered benefit. For a listing of Blue
Distinction Centers (BDC), employees may visit the State Health Plan atick on “Find a Doctor” and select “Obesity Surgery”.
Dependent Eligibility Verification
The State Health Plan will conduct an eligibility verification of all dependents covered on the Plan beginning in July 2010. The Plan awarded the contract to Secova to perform the Dependent Eligibility Verification. Secova is an HR and Health Benefits Services company with extensive experience working with public sector entities. Please note: Employees are not required to submit documentation during Annual Enrollment to verify the eligibility of their covered dependents. Secova will begin requesting documentation from all subscribers with dependent coverage in July and will provide detailed information on the process, along with a list of acceptable documentation.
Questions For detailed information on the Comprehensive Wellness Initiative and additional resources and supports available to members, please visit the State Health Plan Web site ator call Customer Services at 1-888-234-2416.
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