• Proposed Plan Amendment
• Benefit Clarification for Rehabilitative Care
• The Division's Website Gets a New Look!
• Preventive Care Coverage for Maternity and Newborn Care
• Aetna Maternity Program
• Delta Dental Oral Health Total Health Program (DVA Standard Plan)
• Support Resources
• Join the Conversation – Retiree Town Hall Events
• Please Welcome the Following Providers to the Aetna Network!
• We Value Your Feedback!
• Health Benefit Contact Information

Proposed Plan Amendment

The 60-day public comment period regarding a proposed plan amendment to the AlaskaCare Defined Benefit Health Plan (Plan) is now closed. Thank you to those members that provided feedback!

The Plan Administrator is reviewing the public comments and, if adopted, the final Plan Amendment will take effect June 1, 2022. It will be posted to the website and incorporated into the 2023 printed version of the Retiree Health Insurance Information Booklet.

Frequently Asked Questions

Are covered services being added or removed from the Plan as a result of this Amendment?

• No. The services covered by the Plan are not being expanded or altered as a result of this amendment. Rather, the proposed changes to Section 3.3.1 Medical Necessity clarify that, consistent with the Division’s historical practice:
  • Claims are initially evaluated for medical necessity according to the medical necessity standards outlined in the plan booklet and detailed through the Claims Administrator’s clinical policy guidelines and bulletins, which are publicly available.
  • If a member disagrees with the Claims Administrator’s initial adjudication and coverage determination, the final decision as to whether a service is eligible for coverage under the terms of the plan rests with the Plan Administrator. The Plan Administrator’s evaluation of a claim occurs through the appeals process, specifically when a Third Level appeal is submitted to the Division.

The proposed language changes reiterate the factors that the Plan Administrator will consider when evaluating a claim.

Why is the Division proposing this Plan Amendment?

• The Retired Public Employees of Alaska, Inc. (RPEA) and the Division of Retirement and Benefits (Division) agreed to this amendment as part of the final settlement agreement negotiated to resolve two lawsuits: one related to the AlaskaCare retiree medical plan, and the other related to the AlaskaCare retiree dental-vision-audio plan.

What does the Plan Amendment do?

The amendment is intended to clarify certain parts of the Plan’s medical necessity provisions as follows:

• Confirms that as Plan Administrator, the Commissioner of Administration or their designee has final authority to determine if a claim should be paid under the terms of the plan.
• Restates the factors that the Plan Administrator will consider when evaluating a claim. The Plan Administrator’s evaluation of individual claims occurs through the appeals process, specifically when a member reaches the third level appeal to the Division.

The amendment includes some additional changes, outlined below:

• Replaces the name of the current medical Claims Administrator (Aetna) with a neutral term (Claims Administrator), recognizing that the entity contracted to provide this service has, and will, change over time as the Division engages in competitive procurements.
• Provides a link to the Claims Administrator’s clinical policy bulletins at the front of the booklet.
• Defines “Plan Administrator,” “Claims Administrator,” and “Aetna.”
• Capitalizes “Plan Administrator” and “Claims Administrator” to reflect the added definitions.
• Provides lawsuits against the State arising from the plan may be brought in any judicial district in the State of Alaska.

What does “Plan Administrator” mean?

• The AlaskaCare Plan Administrator is the Commissioner of the Department of Administration. The Commissioner may identify a designee to act on their behalf as the Plan Administrator. For example, the Commissioner has, in the past, designated the Division of Retirement and Benefits to act as the Plan Administrator. The Plan Administrator is responsible for maintaining and managing the health care benefits available to AlaskaCare retirees. The Plan Administrator sets the terms of the Plan and has the final authority to determine what the Plan covers, and whether a claim or service is covered.

What does “Claims Administrator” mean?

• A Claims Administrator is a company that the Plan Administrator hires to assist with the health plan's operations. The plan receives over 3 million medical, pharmacy, and dental claims per year, and the Division has always contracted with one or more Claims Administrators to process claims, make initial medical necessity determinations, and assist with day-to-day operations.
  
  Different Claims Administrators service different parts of the AlaskaCare plans. Currently, Aetna is the Claims Administrator for medical, vision, and audio claims, OptumRx is the pharmacy Claims Administrator, and Delta Dental of Alaska administers dental claims.

Does the Settlement Agreement affect the protections against diminishment afforded by the Alaska Constitution?

• No. The Settlement Agreement with RPEA specifically provides that it shall not affect any protections afforded by the Alaska Constitution, Article XII, Duncan v. Retired Public Employees of Alaska, Inc., and/or State, Department of Administration v. The Retired Public Employees of Alaska, Inc.

Does this Plan Amendment change the current appeals process?

• No. The only proposed change to the current appeals process language is to capitalize “Plan Administrator.” All other appeals-related Plan language remains the same.

Does this Plan Amendment change my deductible?

• No. This Plan Amendment does not make any changes to members’ deductibles, copayments, or any other cost-share provision.

Benefit Clarification for Rehabilitative Care

Your AlaskaCare retiree health plan currently covers outpatient rehabilitative care designed to restore and improve bodily functions lost due to an injury or illness. This care is considered medically necessary only if significant improvement in body function is occurring and is expected to continue (see Section 3.3.12 Rehabilitative Care in the AlaskaCare Retiree Insurance Information Booklet).

What are some examples of rehabilitative services?

• Rehabilitative care includes physical therapy, chiropractic care, occupational therapy, speech therapy, and certain rehabilitative counseling services.

Is there an annual limit on the number of rehabilitative services I can receive?

• The Plan does not contain an annual service or visit limit for outpatient rehabilitative care.

How does the Plan currently verify that I’m experiencing significant improvement in body function?

• After the 20th claim in a year for rehabilitative services from the same provider for a specific episode of care, the Claims Administrator (currently Aetna) will request clinical records that demonstrate you continue to experience significant improvement.
  
  
• Starting at the 26th visit, Aetna will begin to pend claims until they receive clinical records demonstrating significant improvement in accordance with the established clinical criteria.
  
  
  • If sufficient records are not provided within 45 days, or if the records fail to demonstrate significant improvement, the services are denied.

Benefit Clarification

As part of a settlement agreement with the Retired Public Employees Association of Alaska, Inc. (RPEA), the Plan has issued a benefit clarification related to rehabilitative services for musculoskeletal conditions.

The benefit clarification states: When the medical necessity review is performed after the 25th visit for therapy visits for musculoskeletal disorders for a specific episode of care, if the treatment is determined to be maintenance care, the beneficiary will receive coverage for up to 10 additional visits per year for that specific episode of care.

This means that each year, members can receive up to 25 rehabilitative care visits for an episode of care to treat a musculoskeletal condition before a review of the clinical notes must be conducted. After that point, if the review determines that the services do not meet the clinical policy standards, the Plan will authorize up to 10 additional visits for maintenance care.

The Division's Website Gets a New Look!

The Division of Retirement and Benefits unveiled a redesigned website on May 3, 2022. The new website has a similar look and feel as the main State of Alaska (SOA) and most SOA department and division websites, with a streamlined layout designed to be easy to use and navigate.

You will find the new Division website at drb.alaska.gov. You can still go right to the health plans at AlaskaCare.gov.

Our team has been working to bring you an improved user experience. Some of the new features include:

• An interface designed for you, the user. You can access the information you need based on whether you are an employee, a retiree, or an employer.
• No hidden or buried pages. All the information on the website is available from the drop-down menus at the top of the home page. Quick links and helpful tools are also available from the right-side fly-out menu. Access this menu by clicking the hamburger icon ( ☰ ) on the upper right side of your browser window.
• No duplicate information. The website contains the same helpful information organized in a way that is easier to find.
• ADA-accessibility. The State of Alaska and the Division are committed to serving all Alaskans. We use the Web Content Accessibility Guidelines 2.1, Level AA as our guide in making our website more accessible for everyone and our content easy to use and understand.
• More responsive design for mobile devices. You should see improved usability on your phone or tablet.

Questions? Contact our Member Service Center toll-free at (800) 821-2251 or in Juneau at (907) 465-4460 or by email at doa.drb.mscc@alaska.gov.

Preventive Care Coverage for Maternity and Newborn Care

The AlaskaCare plan expanded preventive care coverage to the Retiree Defined Benefit health plan effective January 1, 2022.

Join us in 2022 as we explore the preventive care benefits offered by your AlaskaCare Retiree Insurance Plan. Each month from January through June, we will take a closer look at some of the preventive services. If you missed the previous newsletters, find a copy here.

This month we are featuring preventive maternity and newborn care.

Preventive Care Coverage for Maternity and Newborn Care

While most AlaskaCare retiree plan members are planning for grandchildren, rest assured that if you are expecting a new addition to the family, AlaskaCare has you covered.

Your AlaskaCare health plan provides coverage for maternity and newborn care, before and after your baby is born. Preventive services include office visits for prenatal care and well-baby check-ups plus comprehensive lactation support, counseling, and breastfeeding equipment. Preventive care also includes screening tests for anemia, gestational diabetes, hepatitis B, and a blood condition known as Rh incompatibility. New moms can also get information about services to help with things like identifying and treating postpartum depression, stopping smoking, preventing violence, and more.

If you have any questions about your AlaskaCare preventive care benefits, contact the Aetna Concierge at (855) 784-8646.

Aetna Maternity Program

The Aetna Maternity Program is staffed by nurses with maternity experience. Once you’ve enrolled in the program, maternity support may include:

• Educational materials (available in English and Spanish) on prenatal care, labor and delivery, and newborn care
• A pregnancy survey to help determine whether risk for certain complications exists
• A preterm labor program to support high-risk women
• Access to specially trained nurses for high-risk mothers-to-be
• One-on-one counseling to help pregnant women quit smoking

For more information on the Aetna Maternity Program contact the Aetna Concierge at (855) 784-8646.

Delta Dental Oral Health Total Health Program

DVA Standard Plan

If you are a retiree plan member in the DVA Standard Plan and are expecting, you can enroll in the Oral Health, Total Health program to help prevent gum disease. Pregnant women who have periodontal (gum) disease are more likely to have premature and underweight babies. Bacteria can enter the bloodstream through the mouth, and the body’s response to the infection can trigger early labor.

If you’ve already had two cleanings for the year, you’ll be eligible for another cleaning or checkup during your third trimester. This added preventive (prophylactic) visit is covered regardless of normal plan frequency limits. That way, you can receive a dental cleaning during the third trimester, no matter what.

To learn more or enroll in the Oral Health, Total Health program:

1. Fill out the form by logging in to myModa at modahealth.com Once you’ve signed in, simply click on “Oral Health, Total Health” in the myHealth tab.
   
   
2. Call Delta Dental of Alaska toll-free at (877) 277-7280.

Support Resources

Do you have questions about your AlaskaCare health plan or need assistance with your benefits? Here are some helpful resources that can provide you with more information and make navigating through the health care maze easier.

Division of Retirement and Benefits Member Service Center

The Division of Retirement and Benefit’s Member Service Center provides essential support to our membership which includes employees, retirees, and other benefit recipients. We provide education and assistance relating to retirement, medical, and other optional benefits.

The Division’s Member Service Center team has comprehensive knowledge of the retirement systems and has dedicated team members that are experts on the AlaskaCare health plans. We are here to answer questions ranging from benefit enrollment for newly hired employees, to application for retirement, to the AlaskaCare health plan, and beyond.

You can reach us at (907) 465-4460 or toll-free at (800) 821-2251. Hours of operation are Monday through Thursday 8:30 a.m. to 4 p.m., and Friday 8:30 a.m. to 3 p.m., Alaska Time.

Aetna Concierge and Local Offices

An Aetna concierge can help you understand your benefits and give you the tools to make more informed decisions about your health care. A concierge can help you:

• Locate providers in your area
• Understand your benefits
• Plan for upcoming treatments
• Find out what it would cost to see an in-network doctor versus an out-of-network doctor

Contact the Aetna Concierge at (855) 784-8646.

AlaskaCare members can make an appointment to visit the Aetna local office in Juneau or Anchorage and talk directly with an Aetna representative. To schedule an appointment, contact the Aetna Concierge at (855) 784-8646. The local offices can assist you with questions about:

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

Free Nurse Advice Line

You can talk to a nurse when you have health questions. You can call the nurse line 24 hours a day, 7 days a week. Even better, this service is provided at no cost to you. Simply call the nurse line number at (800) 556-1555.

The nurses can be a resource in considering options for care or helping you decide whether you or your dependent needs to visit your doctor, an urgent care facility, or the emergency room. The nurse can help you with:

• Deciding whether to visit a doctor or urgent care center
• Understanding your symptoms
• Managing chronic conditions
• Learning about treatment options and medical procedures

You can call the nurse line anytime to discuss any health concerns at (800) 556-1555.

Help Finding a Network Provider

Aetna, OptumRx, and Delta Dental have nationwide networks of providers that accept your AlaskaCare health plan. If you need help finding a network physician, pharmacy, hospital, or dentist near you that is in the AlaskaCare network, here are some helpful resources.

• Find a Pharmacist: Use OptumRx's Pharmacy Locator or call OptumRx at (855) 409-6999
• Find a Doctor: Use Aetna’s DocFind or call the Aetna Concierge at (855) 784-8646
• Find a Dentist: Use Delta Dental's search tool or call Delta Dental at (855) 718-1768

Join the Conversation—Retiree Town Hall Events

Retiree Town Hall Events 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.

Town hall events occur on the third Thursday of each month and you can pre-register now online. We want to hear from you!

The next Town Hall Event will be:

• Thursday, June 16, 2022, at 10 a.m. Alaska Time

Please Welcome the Following
Providers to the Aetna Network!

Aetna continues to expand the list of in-network providers. Please welcome the following providers to the network.

Health Benefit Contact Information

Division of Retirement and Benefits
Member Service 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