AlaskaCare Retiree Health News | Monthly e-newsletter | December 2022
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AlaskaCare Retiree Health News
| Volume 55| December 2022 |
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Network Benefits for Members Requiring Gene Therapy Treatment Gene therapy is on the brink of something big. With the promise of treating or curing conditions that were once thought incurable, gene therapy is expected to transform the healthcare industry over the next few years. Gene-based, Cellular, and other Innovative Therapies (GCIT) are a relatively new and rapidly advancing area of medical treatment that works by replacing or repairing defective genetic material within a cell. There are a number of gene therapy Food and Drug Administration (FDA) approvals already on the market and even more to come. But these high-cost therapies can carry big price tags. Effective January 1, 2023, your AlaskaCare health plan has partnered with Aetna to provide these services through the Gene-based, Cellular, and other Innovative Therapies (GCIT) network. The GCIT Network is a national network of providers of GCIT products and related services . Only a small number of members may ever need gene therapy, but for those who do, it can be a complicated and expensive process. The GCIT network benefit is designed to support members by offering care coordination, clinical support, additional travel benefits, and some financial protections. Clinical Support The clinical support team will help AlaskaCare members with the pre-certification process and ensure the member seeking treatment finds the most appropriate facility and provider. Manufacturer-approved providers help to ensure that members receive GCIT services from providers that have the right skills and capabilities to safely administer these therapies. Some GCIT products require personalization and specialist care available at a select few sites around the country. Travel Benefits Covered travel benefits when receiving GCIT services include travel and lodging expenses (lodging: $50 per night per person) up to $10,000 per course of treatment for the member and a companion if the care must be administered away from the patient’s home. Care Coordination The care coordination team will work directly with hospitals on claims and provide answers to any questions that arise. Financial Protection The Plan only provides medical plan coverage for GCIT services received from a provider or facility in the GCIT network. 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. For more information about GCIT benefits contact the Aetna concierge at (855) 784-8646. 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 Retiree 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?
Going Out of Network? Know before you go!
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.
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 Retiree Insurance Information Booklet for more information. |
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in the Regulations of the Department of Administration, Division of Retirement and Benefits |
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The Department of Administration, Division of Retirement and Benefits (Division) has proposed changes to regulations in Title 2 of the Alaska Administrative Code, pertaining to the AlaskaCare retiree Dental-Vision-Audio (DVA) and major medical (medical) insurance plans. These changes articulate the process that the Division will use to make changes to the benefits provided by the DVA plan and medical plans, and to amend the description of DVA and major medical insurance coverage published in the plan booklet. The proposed regulatory changes include the following:
You may comment on the proposed regulation changes by submitting written comments to the Division of Retirement and Benefits at P.O. Box 110203, Juneau, AK 99811-0203, by fax at (907) 465-3086, and by electronic mail at doa.drb.alaskacare.retiree.plan@alaska.gov. Comments may also be submitted through the Alaska Online Public Notice System by accessing this notice on the system and using the comment link. The comments must be received not later than 4:30 p.m. Alaska Time on February 28, 2023. A public teleconference will be held on January 26, 2023, at 2 p.m. Alaska Time. To participate, join the conference call at (907) 202-7104, Access code: 231 346 231#. If you are a person with a disability who needs a special accommodation to participate in this process, please contact Teri.Rasmussen@alaska.gov or (907) 465-4460 not later than January 13, 2023, to ensure that any necessary accommodation can be provided. A copy of the proposed regulation changes is available on the Alaska Online Public Notice System and by contacting AlaskaCare, Division of Retirement and Benefits at P.O. Box 110203, Juneau, Alaska 99811-0203, or by visiting AlaskaCare.gov. After the public comment period ends, the Division of Retirement and Benefits will either adopt the proposed regulation changes or other provisions dealing with the same subject, without further notice, or decide to take no action. The language of the final regulation may be different from that of the proposed regulation. You should comment during the time allowed if your interests could be affected. Written comments received are public records and are subject to public inspection. Statutory authority: AS 14.25.004; AS 14.25.005; AS 22.25.027; AS 39.35.004; AS 39.35.005. Statutes being implemented, interpreted, or made specific: AS 14.25.168; AS 22.25.090; AS 39.30.090; AS 39.35.535. Fiscal information: The proposed regulation changes are not expected to require an increased appropriation. |
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Welcome Airlift Northwest to the Aetna Network
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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. Airlift Northwest is a program of the University of Washington School of Medicine and Harborview Medical Center and provides flight transport via helicopter and fixed-wing aircraft for patients needing intensive medical care in Washington, Idaho, Montana, and Alaska. 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.
For more information, contact the AlaskaCare Aetna Concierge at (855) 784-8646. |
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EGWP Enrollees: 2022 IRMAA Submission Reminder
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Certain high-income retirees are required to pay an extra premium surcharge, known as an Income Related Monthly Adjustment Amount, or IRMAA. This is similar to the surcharge for high-income enrollees in the Medicare Part B plan. If you are an individual or a married couple earning more than the threshold, you will be required to pay an extra surcharge for being enrolled in the AlaskaCare Employer Group Waiver Program (EGWP) because it is a group Medicare Part D plan. Retirees whose household income is below this threshold will not be subject to the IRMAA premium surcharge. If you are subject to the Medicare Part D IRMAA surcharge, you will be reimbursed. For all Medicare plans, the IRMAA will be deducted directly from your monthly Social Security check (if you qualify for Social Security) or will otherwise be invoiced to you directly each month. If you are charged a Medicare Part D IRMAA for your prescription drug coverage, the Division of Retirement and Benefits will reimburse you for the full cost of the Medicare Part D premium surcharge each month, through a tax-advantaged Health Reimbursement Arrangement (HRA) account. If you receive a bill from Medicare, you should pay the bill timely, and contact the Division to learn about your reimbursement options. The Division of Retirement and Benefits has partnered with OptumRx and Optum Bank to create an efficient way for members to receive reimbursement for their Part D IRMAA surcharge. What do you need to know?
If you have any questions on how to submit your IRMAA documents online or if you do not have internet access and would like to submit paper documentation, please contact OptumRx at (855) 409-6999 or email alaskacare_irmaa@optum.com. |
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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 healthcare 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 applications 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:
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:
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:
You can call the nurse line anytime to discuss any health concerns at (800) 556-1555. |
