AlaskaCare Employee News | Quarterly Newsletter | Winter 2021

• AlaskaCare Coverage for At Home Over-the-Counter COVID-19 Tests
• Do You Avoid Going to the Doctor Early in the Year Because you Haven’t Met Your Deductible Yet?
• A New Year with New Protections from Surprise Medical Bills
  • Your Rights and Protections Against Surprise Medical Bills
• New Information on Your Health Plan ID Cards Starting in 2022
• Aetna Local Office in Juneau and Anchorage Reopened to the Public
• COVID-19 Prevention
• We Value Your Feedback!
• Health Benefit Contact Information

AlaskaCare Coverage for At Home Over-the-Counter COVID-19 Tests

The federal government recently announced new guidelines for health plan coverage of over-the-counter COVID-19 tests. Effective January 15, 2022, and through the end of the national public health emergency, your AlaskaCare health plan will cover at-home over-the-counter FDA authorized COVID-19 tests, eight per month per covered person. Depending on where you obtain them, you can either get your tests without having to pay anything upfront, or you will be reimbursed up to $12 per test.

1. Where can I obtain a test kit at no cost?
   Employee plan members can obtain FDA-authorized COVID-19 test kits at Rite Aid Pharmacy, Bartell Drugs Pharmacy, Sam's Club Pharmacy, or Walmart Pharmacy. There will be no upfront cost and no requirement to submit for reimbursement. Simply go to the pharmacy counter, present your member ID card, and ask to have your OTC at-home COVID-19 test submitted to your plan for coverage. If you purchase an over-the-counter COVID-19 test from any other source, you will need to pay for the test upfront, and the plan will reimburse you up to $12 per test. Keep your receipt and submit a claim to OptumRx for reimbursement. You can submit an online claim form here.
   
   
2. How much will I be reimbursed for an at-home over-the-counter COVID-19 test if I purchase the test upfront and then submit a claim for reimbursement?
   You can purchase an FDA-authorized over-the-counter COVID-19 test kit at other stores or online retailers. Keep your purchase receipt(s) to submit to OptumRx for reimbursement. You will be reimbursed for up to eight tests per covered member, per month without a prescription. AlaskaCare will reimburse you up to $12 per covered test. You can submit an online claim form here.
   
   
3. What if I already bought and paid for at-home over-the-counter COVID-19 tests? Can I still get reimbursement for those?
   The temporary expanded coverage for at-home over-the-counter COVID-19 tests is effective January 15, 2022. If you purchased tests on or after January 15, 2022, you can submit your receipts for reimbursement. You can submit an online claim form here.
   
   
4. Is there a limit to how many tests will be covered?
   Yes. Covered members can get up to eight individual tests per month, for example, a family of four would be eligible for 32 tests a month. Please note that tests may be packaged individually or with multiple tests in one package (two tests packaged in one box count as two tests).
   
   
5. Does AlaskaCare cover over-the-counter tests used for employment?
   No. Testing may also be available through non-network pharmacies, at community testing sites, at your school or your health care provider, and at private testing sites.
   • Visit the Alaska statewide Testing Site Locator.
   • Visit covidtests.gov—Every home in the U.S. is eligible to order four free at-home COVID-⁠19 tests.

Do You Avoid Going to the Doctor Early in the Year Because You Haven’t Met Your Deductible Yet?

We want to make sure you can get care whenever you need it. If you have the Standard or Economy medical plan, you and your dependents pay a flat copay amount for in-network primary care and specialty care office visits.

Instead of paying the full cost of your office visit before you meet your deductible and a percentage of the cost (coinsurance) after you do, you will only pay a flat copay for all office visits. These copays cost less than what you would typically pay for a visit through your deductible or coinsurance. Copays do not apply to your deductible, but they do apply to your annual out-of-pocket maximum.

Find a network provider or check to be sure that your current provider is in-network by calling Aetna at (800) 821-2251 or by using the online DocFind tool.

A New Year with New Protections from Surprise Medical Bills

No Surprises Act

Beginning January 1, 2022, new federal protections will shield consumers from surprise medical bills—unexpected bills from an out-of-network provider, out-of-network facility, or out-of-network air ambulance provider for most emergency care and some instances of non-emergency care.

The No Surprises Act prevents surprise billing of patients who receive emergency services in the emergency department of a hospital, at an independent freestanding emergency department, and from air ambulances. In addition, the law protects patients who receive certain non-emergency services from an out-of-network provider at an in-network facility.

Before the No Surprises Act, if you received care from an out-of-network provider or an out-of-network facility, even unknowingly, the out-of-network provider or facility could bill you for the difference between the billed charge and the amount your health plan paid.

What Are the New Protections?

The new rules:

• Ban surprise bills for most emergency services, even if you get them out-of-network and without approval beforehand (prior authorization).
  
  
• Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for most emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
  
  
• Ban out-of-network charges and balance bills for certain additional services (like anesthesiology or radiology) furnished by out-of-network providers as part of a patient’s visit to an in-network facility.
  
  
• Require that health care providers and facilities give you an easy-to-understand notice explaining the applicable billing protections, who to contact if you have concerns that a provider or facility has violated the protections, and that patient consent is required to waive billing protections (for example, you must receive notice of and consent to being balance billed by an out-of-network provider).

Transparency in Coverage Rule

The Transparency in Coverage rule requires insurers and plans to create online consumer tools that include personalized information regarding members' cost-sharing responsibilities for covered items and services, including prescription drugs. The Price Comparison Tools have been delayed until 2023. AlaskaCare will continue to monitor the Transparency in Coverage Act and work to ensure that a price comparison tool is available consistent with the requirements.

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at a network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “Balance Billing” (Sometimes Called “Surprise Billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at a network facility but are unexpectedly treated by an out-of-network provider.

You Are Protected From Balance Billing For:

1. Emergency Care: If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
   
   
2. Certain services at a network hospital or ambulatory surgical center: When you get services from a network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. If you get other services at these network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You are never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in the network.

When balance billing isn’t allowed, you also have the following protections:

1. You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). The medical plan will pay out-of-network providers and facilities directly.
   
   
2. The plan generally must:
   • Cover emergency services without requiring you to get approval for services in advance (prior authorization or precertification).
     
     
   • Cover emergency services by out-of-network providers.
     
     
   • Base what you owe the provider or facility (cost-sharing) on what it would pay a network provider or facility and show that amount in your explanation of benefits.
     
     
   • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed and would like to submit a complaint regarding potential violations of your balance billing protections, you may contact the federal Department of Health and Human Services:

• For information and complaints, please call (800) 985-3059
• cms.gov/nosurprises/consumers

Note: Consumer functionality for complaints inquiry will be operational in January 2022.

New Information on Your Health Plan ID Cards Starting in 2022

Starting in 2022, you will notice additional information on your insurance ID card. As a result of the federal Consolidated Appropriations Act (CAA), health plans must include on the ID card the out-of-network and in-network deductibles, out-of-pocket maximum, and a phone number and website where members can get more information.

The good news is that AlaskaCare already has a phone number and website on our current ID cards. We’re including deductible and out-of-pocket (OOP) fields on new ID cards issued starting in 2022.

Here is an example from OptumRx:

You can continue to use your existing ID Card.

• A new physical ID card will be issued when a change in status triggers a new card.
• You can download a copy of your digital ID card from the online app.
  • Optum Online App
  • Aetna Navigator App

Members can request a new ID card with the new information

• For medical ID cards contact the Aetna Concierge after April 1, 2022, at (855) 784-8646.
• For pharmacy, ID cards contact the Optum Service Center at (855) 409-6999.

Your member ID card is proof that you have health insurance. Health care providers use the information from your member ID card to confirm they are part of your plan’s network and to bill your health plan for your care. Keep your member ID card handy when you:

• Go to the doctor
• Go to the hospital
• Have lab work done
• Get a prescription filled

Aetna Local Office in Juneau and Anchorage Reopened to the Public

Want to Talk to an Aetna Representative in Person?

AlaskaCare members can make an appointment to visit the Aetna office in Juneau or Anchorage and talk directly with an Aetna representative. The Aetna local offices reopened in January 2022 after being closed during 2021 due to COVID-19. They can assist you with questions about your benefits, and with services such as:

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

To schedule an appointment, contact the Aetna Concierge at (855) 784-8646. Appointments will be available:

• Monday and Wednesday afternoon from 1:30-4:30 p.m.
• Tuesday, Thursday, and Friday morning from 8:30-11:30 a.m.

If you are visiting Aetna’s Juneau office, please note that City and Borough of Juneau (CBJ) COVID-19 mandates may be in effect. For updated information visit the CBJ COVID-19 webpage.

COVID-19 Prevention

These are the best ways to protect yourself and the people around you from getting and spreading COVID-19. A layered approach — using multiple prevention methods — provides the strongest protection.

Get vaccinated and get boosted

COVID-19 vaccines reduce the risk of getting and spreading the virus and provide strong protection against severe illness, hospitalization, and death. If you've already received your initial vaccine series, it may be time to get a booster shot or an additional dose for stronger, longer-lasting protection. Learn more about getting vaccinated at covidvax.alaska.gov.

Wear a mask

Wear a mask indoors in public, especially if you are in an area of substantial or high transmission. When cases are high in your community, this is an important protective measure even if you are vaccinated. You can check the alert level in your community on the COVID-19 cases dashboard.

In general, you do not need to wear a mask in outdoor settings, but you might consider wearing a mask during crowded outdoor activities when you're in close contact with others who are not fully vaccinated.

Use caution when gathering with others

Being around others is important to our health and well-being, but keep in mind that the risk of virus transmission is higher in places like restaurants, bars, fitness centers, or movie theaters.

Protect yourself when cases are high by minimizing time indoors around others, especially in crowded spaces with poor ventilation. Spend time with others outdoors when you can. Wearing a mask when indoors around others can help protect you and those around you. Consider getting tested before or after an event, like a concert or a large family celebration, especially if it includes older adults or those with significant underlying medical conditions that put them at high risk for serious illness.

Physical distancing—staying 6 feet from others—can also be an important tool. Keeping distance from others is especially important for people who are at higher risk of getting very sick. Avoid close contact with people who are sick.

Wash your hands

Wash your hands often with soap and water for at least 20 seconds, especially after you have been in a public place, or after blowing your nose, coughing, or sneezing. If soap and water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol.

Cover coughs and sneezes

If you are wearing a mask, cough or sneeze into your mask. Put on a new, clean mask as soon as possible and wash your hands.

If you are not wearing a mask, always cover your mouth and nose with a tissue when you cough or sneeze, or use the inside of your elbow.  Immediately wash your hands.

Clean and disinfect

Clean and disinfect high-touch surfaces daily, especially if someone in your household is sick or has tested positive for COVID-19. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.

Monitor your health daily

Be alert for symptoms. Watch for fever, cough, shortness of breath, or other symptoms of COVID-19. If symptoms develop, take your temperature and follow CDC guidance. Stay home if you are sick to prevent spreading illness to others.

Focus on your overall health and wellness

Taking care of your mental and physical health can help protect you from severe illness from COVID-19 and other diseases too. Eat healthy foods, get plenty of rest, exercise regularly, and stay connected to friends and family.

We Value Your Feedback!

As an employee of the State of Alaska, your input is valued and important. Below, please see a list of ways to contact us with your feedback. Also, a full list of AlaskaCare health plan and partner contact information can be found on our website.

AlaskaCare – Plan Administrator

• Toll Free: (800) 821-2251
• In Juneau: (907) 465-4460
• TDD: (907) 465-2805
• Fax: (907) 465-3086
• Email: doa.drb.mscc@alaska.gov

Division of Retirement and Benefits
Member Services: (907) 465-4460 | Toll-Free: (800) 821-2251

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

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

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

Health Flexible Spending Accounts (HFSA): PayFlex
Member Services: (800) 416-7053

Surgery Plus
Member Care Advocate: (855) 715-1680

Vision & Audio Benefits: Aetna VSP
Member Services: (855) 784-8646

Teladoc
Member Services: (855) 835-2362