• Please Join Us for the Next Tele-Town Hall: Thursday, April 18, 2019
• EGWP Enrollees: What Do You Need to Know About IRMAA?
• Opting Out of EGWP: Get the Facts
• Keyword of the Month: Coordination of Benefits
• Know Your Benefits: Precertification
• Aetna Local Office in Juneau and Anchorage
• Frequently Asked Questions
• News from the Retiree Health Plan Advisory Board
• Health Benefit Contact Information

What is a Tele-Town Hall?

Tele-town halls are group calls hosted by the Alaska Department of Administration, Division of Retirement and Benefits for all interested AlaskaCare retirees and families to ask questions about the AlaskaCare health plans. You can join the call to learn more about your health plan and ask Division staff any questions you have about your benefits. This format gives retirees a chance to connect directly with Division staff to hear the latest news on all things AlaskaCare, raise questions, share comments, and learn more about the health plans.

When is the Next Tele-Town Hall?

Thursday, April 18, 2019 | 10 to 11 a.m. AKDT (1 hour)

How do I participate in the Tele-town hall?

If you would like to participate, please register on the AlaskaCare website. Registration opens approximately one week before each event. During the registration process you will be asked for a phone number, and when the event starts all registered participants will automatically be called at that number. To participate, just answer that call and stay on the phone! Each event is streamed live to the Division’s Facebook page and website.

If you can’t attend, but would like to catch up later, or if you missed any of the past events, you can find written summaries of the discussion and recordings of the calls on the AlaskaCare website.

Certain high-income retirees who are Medicare-eligible and enrolled in the AlaskaCare enhanced Employer Group Waiver Program (EGWP) pharmacy plan are required to pay a premium surcharge associated with Medicare Part D plans, known as an Income Related Monthly Adjustment Amount, or IRMAA. The surcharge is required by Medicare and is the same type that high-income enrollees already pay for a Medicare Part B plan. If you are an individual earning more than $85,000 per year or a married couple who earns more than $170,000 per year, you will be required to pay the IRMAA; retirees enrolled in EGWP and whose household income is below this threshold will not be subject to the IRMAA premium surcharge.

If you are required to pay the IRMAA premium surcharge, the Division will reimburse you for the amount you are charged each month through a tax-advantaged health reimbursement arrangement (HRA) account, so the EGWP plan has no additional cost to you!

Each November, Medicare-eligible individuals receive a letter from Social Security that outlines your Medicare premiums. Please submit the most recent letter you’ve received from Social Security that states you are subject to IRMAA surcharge for 2019, and at what amount, to the Division.

You can provide a copy of your letter to the Division by:

• Emailing a copy or a photo of the letter to: drb.irmaa@alaska.gov
• Faxing a copy to: (907) 465-3086
• Mailing a copy to: Alaska Department of Administration
  Division of Retirement and Benefits
  P.O. Box 11023 Juneau, AK 99811-0203

Once the Division receives a copy of your annual letter sent from Social Security, we will establish an HRA for you through PayFlex, Aetna’s subsidiary that administers the HRA on behalf of AlaskaCare. PayFlex will send you a letter that outlines how to access your HRA account information and how to set up claims for reimbursement. We encourage you to set up reimbursement on an automatic recurring basis, but you may elect to request reimbursement manually. Reimbursement can be made by check or through electronic funds transfer.

New enrollments are processed weekly after they are received by PayFlex, with a follow-up to the member within 10 business days. If you have submitted your information more than two weeks ago, but have not yet received a welcome kit, please contact PayFlex at (888) 678-8242. You can also email the Division at doa.drb.irmaa@alaska.gov to check on your paperwork.

The Centers for Medicare and Medicaid Services (CMS) require that you be given the opportunity to opt out of EGWP. The Division provides this option to opt out, but this is highly discouraged. If you are Medicare-eligible and opt out of the enhanced EGWP, you will be enrolled in a plan that is much different than the benefits offered under EGWP, or the plan for non-Medicare-eligible members. This will result in increased out-of-pocket expenses for you or your Medicare-eligible dependents.

If you are considering opting out because you are covered under another Medicare part D plan (such as a different EGWP, or another Medicare Advantage plan that includes prescription drug coverage), consider the following in lieu of opting out: if you provide a copy of your Medicare Advantage or EGWP ID card to the Division, we can remove you from the AlaskaCare enhanced EGWP and place you in the AlaskaCare standard pharmacy benefit plan instead.

If you wish to opt out of EGWP, you may call OptumRx member services at (855) 235-1405. This is a dedicated number for opt-out elections via phone. For all other questions, please contact OptumRx Member Services at (855) 409-6999 or the Division toll-free at (800) 821-2251 or in Juneau at (907) 465-4460. You can also email the Division at doa.drb.benefits@alaska.gov.

Keyword of the Month: Coordination of Benefits

The world of health care is complex and uses a lot of jargon. You don’t need to be a health care specialist to get the most out of your benefits but knowing some of the technical terms makes it a little less mysterious. This month’s keyword is Coordination of Benefits.

Coordination of Benefits (COB) is a method of paying claims when you or your covered dependents have more than one health coverage plan. The AlaskaCare health plans coordinate benefits with other group health care plans to which you or your covered dependents belong. Coordination of benefits can be very confusing, even for people who work at a physician's office.

With COB, if you are covered by more than one health care plan, the plans work together to provide benefits. One plan is considered “primary,” and pays your covered expenses first. The other plan is “secondary,” and, depending on the plan’s COB provisions, may pay a portion or may pay any remaining covered expenses up to 100%. In some cases, there may be a third or fourth plan coordinating to cover your costs.

The AlaskaCare plan is supplemental to Medicare. This means that once members become Medicare-eligible and enroll in Medicare, Medicare will pay first and AlaskaCare will coordinate to pay 100% of covered expenses, less any deductible not yet met. If a Medicare-eligible member chooses not to enroll in Medicare, the AlaskaCare plan will estimate what Medicare would have paid and deduct that amount before paying covered expenses.

It is important to remember that not all expenses are covered expenses. In addition, each plan may have its own separate deductibles that may have to be satisfied independently of each other. The plans will likely also have independent and different copayments, coinsurance rates, and annual out-of-pocket limits.

Know Your Benefits: Precertification

In January 2014, expanded precertification requirements took effect. Certain services such as inpatient stays, certain tests, procedures, and outpatient surgery require precertification by Aetna. Precertification is a process that helps you and your physician determine whether the services being recommended are covered expenses under the plan. It also allows Aetna to help your provider coordinate your transition from an inpatient setting to an outpatient setting (called discharge planning), and to register you for specialized programs or case management when appropriate. This commonly used medical management tool helps ensure you are receiving the most appropriate and effective care and supports our goal to promote evidence-based medicine.

What you need to know:

• For members receiving services from a network provider, the provider is responsible for precertification.
• If you receive services from a non-network provider, you become responsible for obtaining the precertification. If the precertification is not obtained, in many cases a $400 penalty will apply to covered expenses.
• You or your provider can receive precertification in advance by calling the Aetna Concierge at (855) 784-8646.

For a list of the types of medical expenses that require precertification, please visit our AlaskaCare page on Precertification Requirements.

Want to talk to an Aetna representative in person?

AlaskaCare members can stop by Aetna offices in Juneau and Anchorage and talk directly with an Aetna representative. The Aetna AlaskaCare offices operate on a walk-in basis. No appointment needed! 

They can assist you with questions about your benefits and services such as:

• Paper claim submissions
• Travel precertification 
• Help understanding your explanation of benefits
• Eligibility issues
• Appeals assistance
• Coordination of benefits for multiple plans
• And more…

We are updating the FAQs regularly-please keep checking back for new information! Here are some recent additions:

Why aren’t dependents covered to age 26 under the AlaskaCare retiree health plan?

The AlaskaCare retiree health plan is exempt from the Affordable Care Act requirements that expand coverage to dependents up to age 26. Dependent coverage in the AlaskaCare retiree health plan is outlined in State of Alaska statute which stipulates that qualifying dependent children are covered up to age 19, or up to age 23 if they are a full-time student. The Division of Retirement and Benefits understands that there is strong interest in expanding dependent coverage, but doing so would require a statutory change.

Does my pharmacy spending count towards the $2 million lifetime medical limit?

Pharmacy benefits do not count toward the lifetime maximum benefit; this is limited to medical charges. Please contact Aetna to determine your current benefit use and what health plan services do or do not count toward the limit. Please note that there are some pharmacy-related services that are covered under the medical plan instead and will count towards the lifetime maximum benefit, such as infusion treatments. Each explanation of benefits (EOB) includes a statement of services used compared with the lifetime maximum.

I am Medicare-eligible and have multiple insurance coverages; does my enrollment in the AlaskaCare enhanced Employer Group Waiver Program (EGWP) change the coordination between my plans?

Because the AlaskaCare enhanced EGWP is a group Medicare Part D plan, if you have multiple prescription drug coverages, the AlaskaCare enhanced EGWP will become the primary payer. If your other coverage had previously been the primary payer, it will move into the secondary payer position. Your total coverage levels will not change. Your medications will still be covered at the same benefit level as they were before.

Please note that you can only receive mail-order prescriptions through your primary prescription drug coverage’s home delivery program. If AlaskaCare is now your primary coverage, and you used to receive mail-order prescriptions through an alternate coverage, you will need to enroll in the AlaskaCare prescription home delivery program to continue to receive your medications by mail.

OptumRx provides the mail-order pharmacy for the AlaskaCare plans. Please visit Optumrx.com or contact OptumRx at (855) 409-6999 to enroll in prescription home delivery. If you receive your medication through OptumRx home delivery, your copay is $0, which may be less than the copay assessed by your other coverage.

The Retiree Health Plan Advisory Board (RHPAB) is tasked with facilitating engagement and communication among the Commissioner of Administration, the Division of Retirement and Benefits, and the community of AlaskaCare retirees. The seven-member board meets four times per year, with additional meetings of the modernization committee each quarter.

Next Quarterly Board Meeting: May 8, 2019

The next full board meeting is scheduled for Wednesday, May 8, 2019, 9 a.m. to 4 p.m., with locations in Juneau and Anchorage and teleconference provided. The agenda will include updates and in-depth discussion about the modernization project, a collection of initiatives and proposed changes to the health plan under consideration by the Division to provide updated and improved benefits for all retirees.

Members of the public are always welcome to attend and observe the meeting or listen in via phone. Each RHPAB board meeting includes time on the agenda for public comment, and written comments may be submitted to the board at AlaskaRHPAB@alaska.gov. If you want to be sure that your comments are included in the agenda packet for the next quarterly board meeting, please submit them at least thirty days in advance of the next scheduled meeting. Please see the RHPAB public comment guidelines [PDF] for more information and what to expect in a board meeting.

For more about RHPAB and upcoming meetings, including meeting locations, teleconference information, and meeting materials, please visit AlaskaCare.gov/retiree/advisory.html.

Health Benefit Contact Information

Division of Retirement and Benefits
DRB Call Center: (907) 465-4460 |Toll Free: (800) 821-2251

Medical Benefits: Aetna
Member Services: (855) 784-8646

Long Term Care Benefits: CHCS Services, Inc.
Member Services: (888) 287-7116

Dental Benefits: Moda/Delta Dental
Member Services: (855) 718-1768

Pharmacy Benefits: OptumRx
Member Services: (855) 409-6999

Specialty Pharmacy: BriovaRx
Enrollment Services: (855) 427-4682