Now that you’ve enrolled, it’s time to focus on the road ahead. And there are things you need to do now to use your benefits successfully when they take effect.
Here’s your to-do list:
Know How Your Prescription Drug Plan Works
Your prescription drug coverage is provided through your pharmacy benefit manager, who sets the rules for how medications are covered.
The pharmacy benefit manager could be a separate prescription drug company. Associates who enrolled under Aetna,
Blue Cross Blue Shield of Texas, Cigna, or UnitedHealthcare will have their pharmacy benefits managed by OptumRx. All other carriers will manage their own prescription drug coverage.
Check the Formulary
A formulary is a list of generic and brand name drugs that are approved by the Food and Drug Administration (FDA) and are covered under your prescription drug plan. Check with your carrier to make sure your drug is listed on the formulary before you fill it. If it isn’t, you’ll pay more.
Generic drugs meet the same standards as brand name drugs, but they typically cost less. And, because brand name drugs can be expensive, some pharmacy benefit managers don’t cover them at all if a generic is available. Ask your doctor if a generic drug is available for you.
Mail-order service can save you a trip to the pharmacy and may reduce your costs. To set up mail order with a new pharmacy benefit manager, you’ll likely need a new 90-day prescription from your doctor. Because mail-order can take a few weeks to establish, it’s a good idea to ask your doctor for a 30-day prescription to fill at a retail pharmacy in the meantime.
Track your to-dos and get organized! Print the Prescription Drug Transition Worksheet (PDF).
“Transition of Care” Setup
Are you or a covered family member pregnant? Will you or your covered family member continue needing treatment for an ongoing medical condition?
If you will have a new medical insurance carrier and you answered “yes” to either question, you may be able to temporarily continue that care with your current provider once your new medical coverage begins. This is true even if your provider isn’t in the new insurance carrier’s network.
If you think this applies to you, call customer service at your new medical insurance carrier as soon as possible to ask for help with “transition of care.”
Give your new insurance carrier information about your treatment and the providers you use today.
Will you have a new dental plan? Will you or your child(ren) continue receiving ongoing orthodontic treatment? Call customer service at your new dental insurance carrier as soon as possible to ask for help with “transition of care.”
Track your to-dos and get organized! Print the Transition of Care Worksheet (PDF).
Avoid Unexpected Out-of-Network Costs
It’s very important to know whether your doctor participates in your medical insurance carrier’s network.
You Could Pay a Lot More for Out-of-Network Care
Your medical insurance carrier could pay a much lower benefit if you see an out-of-network doctor—leaving you to pay the rest.
For instance, you will pay more through a higher out-of-network deductible and higher coinsurance. You'll also have to pay the entire amount of the out-of-network provider's charge that exceeds the maximum allowed amount, even after you've reached your annual out-of-network out-of-pocket maximum.
Each medical insurance carrier can determine its maximum allowed amounts for out-of-network providers. For example, among other ways, carriers may use what's considered "reasonable and customary" and/or a Medicare-based calculation to determine the maximum allowed amount.
For example, let's say you will have an out-of-network surgery that costs $5,000 and you will pay 40% coinsurance. The maximum allowed amounts could be different across carriers:
- If one carrier has a maximum allowed amount of $2,000, you would owe 40% of $2,000 and 100% of the remaining $3,000, for a total of $3,800.
- If a second carrier has a maximum allowed amount of $3,000, you would owe 40% of $3,000 and 100% of the remaining $2,000, for a total of $3,200.
Take These Steps to Protect Yourself
If you didn’t check your doctor’s status before you enrolled or you want to look up a different doctor, do it now—before making an appointment with that doctor.
You can check the provider directory through NMGbenefits.com, your medical insurance carrier's website, or get assistance with your Health Pro.
Important! Do not rely on your provider’s office to know the carriers’ network(s). If you have any uncertainty or, for instance, you will cover out-of-area dependents, you need to call the insurance carrier to confirm whether a provider participates in a carrier’s network.
Even if you’re keeping the same insurance carrier, the provider network could be different. Always check the provider directories before making a decision.
If your doctor is out-of-network and you still want to see him or her, check the cost with your doctor before you get care. Then ask your doctor to confirm the portion that will be covered by your medical insurance carrier and the portion for which you’ll be responsible. That way you’ll be prepared for any potentially significant costs.
When to Expect New Cards
If you enroll in medical coverage with Aetna,
Blue Cross Blue Shield of Texas, Cigna, or UnitedHealthcare, you will have a medical ID card and separate prescription drug ID card from OptumRx. If you enroll in medical coverage with another insurance carrier, you will have one ID for both medical and prescription drugs.
Note: Many dental insurance carriers also issue ID cards. If you receive one, simply present it when you get dental care during the new plan year.
For questions about ID cards, contact the insurance carrier. If you need an ID card immediately, go to your insurance carrier’s website, register online, and print a temporary ID card.
Contributing to an HSA?
If you enrolled in the Bronze or Bronze Plus coverage levels, you had the option to elect to contribute to an HSA.
If you decided to put money in an HSA for the first time, you’ll receive a welcome letter and HSA debit card in the mail. If you decided to put money in your HSA and you’ve previously contributed to the HSA, you’ll continue to use your existing debit card. New money added to your account will be accessible through your current debit card.
HSA vs. FSA: Which One Should You Use?
Heads up: If you enrolled in an HSA and a Health Care Flexible Spending Account (FSA), you must follow IRS guidelines on how to use each account:
Your HSA can be used for medical, dental, and vision expenses.
Your Health Care FSA will be “limited purpose” and can only be used to pay for eligible dental and vision expenses.
If you currently have money in a Health Care FSA, use it before you begin contributing to your HSA. This includes any “grace period” that applies during a new plan year (generally before April).