AlaskaCare Employee News | Quarterly Newsletter | December 2022

• New in 2023
  • Making the Precertification Process Easier
  • More Network Providers—More Savings
• Welcome Airlift Northwest to the Aetna Network
• Please Welcome the Following Providers to the Aetna Network!
• 2022 Health Fairs: Thank You for Making them a Success!
• Get Ready for Flu Season
• Health Flexible Spending Account (HFSA)
• We Value Your Feedback!
• Health Benefit Contact Information

New in 2023

Making the Precertification Process Easier

AlaskaCare is removing penalties and benefit reductions for failure to precertify services! This means if you or your provider did not obtain a required precertification, but your care is otherwise eligible for coverage, you won’t have to pay more.

Precertification is a pre-service review process to confirm that certain services, such as inpatient stays, certain tests or procedures, or specific outpatient procedures being recommended by your provider are covered expenses under the terms of the AlaskaCare Employee Health Plan (Plan) and are medically necessary.

Effective January 1, 2023, the AlaskaCare plan is removing the penalties and benefit reductions for failure to obtain precertification for certain services received from out-of-network providers, making it easier for members to access their benefits. Here’s what you need to know.

Medical Services

Staying In-Network?

• You do not need to precertify services provided by a network provider; they agree to precertify services on your behalf.
• Since precertification is the provider’s responsibility, there is no additional out-of-pocket cost to you if your network provider does not obtain a required precertification.

Going Out of Network? Know before you go!

• If you visit an out-of-network provider, though the provider may obtain precertification on your behalf, you are ultimately responsible for obtaining the required precertification.
• Currently, if precertification is not obtained for certain out-of-network services, the Plan’s benefits will be reduced or limited, even if the services are otherwise covered by the plan.
• Beginning in 2023, if precertification is not obtained for certain out-of-network services, your benefits will not be reduced. If the services meet the Plan’s coverage criteria, they will be paid in accordance with the terms of the plan.
• Check with Aetna to determine if you need precertification. This is important information to know before you receive care.
• If you do not obtain a required precertification prior to receiving care from an out-of-network provider and the services are not covered, you are responsible for the expenses.

The full list of services requiring precertification can be located here or by calling the Aetna concierge at (855) 784-8646.

Travel

Planning to travel to receive care? Your AlaskaCare health benefits provide coverage for eligible travel expenses to help cover your costs. Whether you are staying in-network or going out-of-network, you are responsible for precertifying your travel ahead of time to determine the maximum payable benefit you are eligible to receive.

• Currently, if you do not precertify your travel expenses before you depart, no travel benefits will be paid.
• Beginning in 2023, if you do not precertify your travel in advance, up to $500 of your eligible expenses will be covered.

To maximize your benefits, it's recommended that you precertify your travel by calling the Aetna concierge at (855) 784-8646 before you depart.

See Section 3.5.24 Travel in the AlaskaCare Employee Insurance Information Booklet for more information.

More Network Providers—More Savings

The Aetna provider network for the AlaskaCare Employee Plan is expanding in 2023! This means more quality providers to choose from — and lower out-of-pocket costs when you stay in the network for care.

There are many important factors to consider when choosing your medical care providers. To maximize your AlaskaCare benefits you should choose a provider well-equipped to deliver the services you need, and you should consider whether or not that provider participates in the Aetna network of preferred providers.

Network providers have contracted with Aetna to deliver medical services and supplies at a pre-agreed-upon price and have also agreed not to bill you for any amount over that price. Out-of-Network providers have not agreed to a price for your services in advance, and often charge a higher rate than your health plan has determined to be reasonable. In some circumstances, out-of-network providers can bill you for any amount between how much they have billed and how much your plan will pay. This is called balance billing. Remember, using a network provider is an easy way to avoid balance bills and save money!

Beginning on January 1, 2023, the AlaskaCare Employee Health plan is changing how much it will pay out-of-network providers. You’ll still be able to seek care from out-of-network providers. However, when you do, your costs may be higher.

You can find a network provider in your area through Aetna’s Find a Provider tool, or by calling the AlaskaCare Aetna Concierge at (855) 784-8646.

Welcome Airlift Northwest to the Aetna Network

Effective December 1, 2022, Airlift Northwest will be a network provider for the AlaskaCare health plans!

Airlift Northwest joins LifeMed Alaska and Medevac Alaska as network providers for the AlaskaCare Plans and accepts Aetna’s reimbursement as payment-in-full for our members.

Each year, thousands of Alaskans find themselves in sudden, unexpected health situations that require emergency medical transportation, commonly referred to as medevac. Life-saving air medical transportation and fixed-wing emergency medical transportation flights in Alaska can cost tens of thousands of dollars.

If the emergency medical transport service provider is in-network, the provider and the plan have already agreed on prices for services, and your costs are fully covered under the plan subject to standard cost sharing and applicable to plan provisions. You won’t be balance billed from network providers for any difference between what they bill and what the plan pays.

Medically necessary emergency air ambulance services are a covered benefit under the AlaskaCare plan, subject to the requirements for a medical emergency and all plan provisions.

Medically necessary emergent and non-emergent ground ambulance services are also an AlaskaCare plan benefit, subject to plan provisions.

Use an in-network provider when possible.

LifeMed Alaska, Medevac Alaska, and Airlift Northwest are in-network providers for AlaskaCare members that service individuals located in Alaska.

• Contact LifeMed at (855) 907‑5433 or (907) 249‑8358 or lifemedalaska.com
• Contact Medevac Alaska at (877) 985-5022 or medevacalaska.com
• Contact Airlift Northwest at (888) 835-1599 or uwmedicine.org

For more information, contact the AlaskaCare Aetna Concierge at (855)-784-8646, and watch the Airlift Alaska video. 

Please Welcome the Following Providers to the Aetna Network!

Aetna continues to expand the list of network providers. Please welcome the following providers added to the network in 2022.

2022 Health Fairs: Thank You for Making them a Success!

After a two-year hiatus, the Health Fair events were back in 2022. AlaskaCare partnered with the Pacific Healthcare Coalition (PHC) to host several events all over the state this fall. Events were held in Palmer, Fairbanks, Soldotna, Anchorage, and Juneau over a period of three weeks in September and October, and the events were a great success.

Altogether, over 2,000 comprehensive lab tests and almost 900 flu vaccines were administered to State of Alaska retirees and employees at no cost to our AlaskaCare members. Representatives from Aetna, Optum, Delta Dental, and other AlaskaCare vendors were on hand to assist with registration tasks and answer member questions. And perhaps best of all, our AlaskaCare team was able to interact with many of our members face-to-face and get to know you even better. These types of interactions were greatly missed during the pandemic, and we were pleased to see so many familiar faces in attendance.

We would like to thank everyone that came out to help make these events so successful and we hope to be able to do it all again in 2023.

Get Ready for Flu Season

Influenza (flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness. Serious outcomes of flu infection can result in hospitalization or death. Some people, such as older people, young children, and people with certain health conditions, are at high risk of serious flu complications. There are two main types of influenza (flu) virus: Types A and B. The influenza A and B viruses that routinely spread in people (human influenza viruses) are responsible for seasonal flu epidemics each year.

You can take Action to Protect Against the Flu

1. Get a flu shot
   The best way to prevent the flu is by getting vaccinated each year. It can reduce flu illnesses, doctors’ visits, and missed work and school due to flu.
   
   
2. Preventive Steps
   Take action every day to help stop the spread of germs. Avoid close contact with people who are sick. Stay home when you are sick. Washing your hands often will help protect you from germs. Avoid touching your eyes, nose, and mouth.
   
   
3. Treatment
   Most people with the flu have mild illness and do not need medical care or antiviral drugs. If you get sick with flu symptoms, in most cases, you should stay home and avoid contact with other people except to get medical care. If, however, you have symptoms of the flu and are in a high-risk group or are very sick or worried about your illness, contact your healthcare provider. There are prescription medications called antiviral drugs that can be used to treat flu illness.

The CDC's comprehensive website with general information on influenza transmission, symptoms, prevention, treatment, and more can be found here. 

Health Flexible Spending Account (HFSA)

The AlaskaCare Health Flexible Spending Account (HFSA) provides an opportunity for you to save by setting aside money for health care expenses on a pre-tax basis. You decide the amount you want to contribute each month, up to the Internal Revenue Service (IRS) limit. You can also use your HFSA to pay for qualified healthcare expenses not covered by your insurance.

How an HFSA Works
During each benefit year, you contribute a predetermined amount from each paycheck to the account. When you incur medical expenses, you file claims and are reimbursed with tax-free dollars from the account. You benefit from reduced taxes because you don’t pay taxes on the dollars you contribute to your accounts.

How to Enroll in an HFSA
Setup of an HFSA is offered during the annual Open Enrollment period or a qualified status change event. You must elect this benefit each year to continue from one year to the next.

How to Receive Reimbursement
To be reimbursed for eligible medical expenses, claims for reimbursement to the HFSA may be submitted in one of the following ways:

• Streamlining
  If you do not have any other health coverage, you can elect to have your HFSA set up with “streamlining.” Streamlining automatically sends the unpaid portion of your eligible medical claim (deductible, your portion of the coinsurance, etc.) directly to your HFSA account for reimbursement.
• Non-Streamlining
  Direct Claims Submission With this option, you submit your claims to PayFlex on the Request for Reimbursement form after receiving your EOB from the plan or any other health plan in which you participate.
• Over-The-Counter (OTC) Claims Submission
  With this option, you submit claims to PayFlex on the HFSA OTC Claims form regardless of whether you have elected streamlined or direct claims submission.

Great Reasons to Enroll in an HFSA

• You contribute pretax dollars from your paycheck (up to the IRS limit) throughout the year, but your full contribution is available for use at the start of the plan year.
• If you and your spouse both have an HFSA, you can each contribute up to the IRS limit.
• You can use the funds to pay for qualified health care expenses for you, your spouse, and/or your tax dependents.
  
  Such expenses may include:
  • Copays, coinsurance, and deductibles
  • Dental expenses like orthodontia and crowns
  • Vision expenses like laser eye surgery and contacts
  • Over-the-counter (OTC) items prescribed by your healthcare provider

Things to Keep in Mind

• At the end of a benefit year, you may carry over up to $550 of unused funds in your HFSA to the next benefit year, but unused amounts over $550 are forfeited.
• Services for eligible expenses must be received while you are covered by the plan—coverage stops during periods of leave without pay and at termination. Your HFSA coverage also stops when you move to a bargaining unit that does not participate in the Select Benefits/AlaskaCare health plan.
• Services must be received prior to the end of the benefit year, December 31, and claims for the benefit year must be filed within 90 days of the end of the benefit year.
• You can view the IRS contribution limits, a list of common eligible expense items, and full instructions for seeking reimbursement on the PayFlex member website.

Questions? you can call PayFlex directly at (888) 678-8242, Monday - Friday 4 a.m. – 4 p.m. AST, and Saturday 6  – 11 a.m. AST, or visit payflex.com.

We Value Your Feedback!

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