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Edited by LM 4/22/22Not Apprvd


Employee Health Plans


Learn more about the AlaskaCare employee health plan benefits, coverages and monthly premiums.
Effective as of January 1,

Introduction

The health benefits that the State of Alaska provides to its eligible employees is commonly referred to as AlaskaCare. AlaskaCare Health Plans can help you and your eligible dependents pay for medical, dental, pharmacy, and vision expenses.

Aetna is the AlaskaCare Third-Party Administrator for the employee medical plan. A Third-Party Administrator (TPA) is a company the Division hires to process AlaskaCare medical claims. Aetna is one of America’s largest and most experienced providers of health care benefits and services. Their network includes over 690,000 primary care doctors and specialists and more than 5,700 hospitals.

Get the right care for your needs

Health care can be complicated. There’s a lot to know about doctors, hospitals, treatments and services. The resources below provide reliable information to help you make better decisions and choices when you need care.

Call your Health Concierge

The Health Concierge is your single point of contact for all claim, benefit and provider information related to AlaskaCare medical. Call or chat online when you have a problem or question. Find the right specialist. Understand how a claim was paid. Know about programs for specific health conditions and needs. Whether you need a quick answer, help with a difficult issue or someone to explain your benefits, you have an advocate dedicated to your needs.

Medical Plans at a Glance

AlaskaCare offers three medical plans to choose from: Standard, Economy, and Consumer Choice. The three options all cover the same services, including pharmacy benefits, but each option has different deductibles, coinsurance levels, copayments (if applicable) and out of-of-pocket maximums. You can choose the plan that is best for you based what will work best for your family’s needs.

You consider the monthly cost of each option and decide which benefits to purchase. Use the Health Plan Cost Comparison Tool to help you make an informed decision.

  1. Standard Plan

    The Standard Plan offers the lowest deductibles, lowest Out-of-Pocket Maximums, and highest coverage amounts (coinsurance). This option also has higher premiums than the other plans.

  2. Economy Plan

    The Economy Plan offers lower premiums than the Standard Plan, but also has slightly higher deductibles, lower coverage amounts (coinsurance) and higher Out-of-Pocket Maximums.

  3. Consumer Choice Plan

    The Consumer Choice Plan offers a lower-premium medical plan option with a higher deductible than medical plans traditionally offered by AlaskaCare. The Consumer Choice plan is a consumer driven health plan with an employer sponsored Health Reimbursement Arrangement (HRA).

Glossary of Important Terms

Preventive Care—At No Cost

All AlaskaCare employee medical plan options will pay covered preventive services in full when received from an network provider. In-network preventive care services are not subject to deductibles or coinsurance.

See the Preventive Care Coverage Information Flyer and the Women’s Preventive Care Coverage Information Flyer for additional information on covered preventive services.

All other covered medical benefits are subject to the deductible and coinsurance.

Premiums

AlaskaCare offers a menu of medical plan options so you can find the best fit for you and your family.

2022 ACTIVE EMPLOYEE PREMIUMS
For AVTECTA – AK Vocational Teachers (TA), APEA – Confidential (KK), APEA – Supervisory (SS),
ACOA – Correctional Officers (GC), TEAME – Mt. Edgecumbe Teachers (TM),
Employees not covered by collective bargaining (Exempt)
Plan Employee Only Employee & Family
Standard Medical Plan $125 $303
Economy Medical Plan $63 $167
Consumer Choice Plan $25 $71
Standard Dental Plan $37 $102
Economy Dental Plan $0 $0
Vision $15 $40
For MEBA – Marine Engineers (BB), IBU – Inlandboatman’s (MM) Only
Plan MEBA Employee Only MEBA Employee & Family IBU Employee Only IBU Employee & Family
Standard Medical Plan $125 $303 $125 $303
Economy Medical Plan $0 $0 $35 $95
Consumer Choice Plan $25 $71 $25 $71
Standard Dental Plan $37 $102 $37 $102
Economy Dental Plan $0 $0 $0 $0
Vision Plan $15 $40 $15 $40
Effective: Jan. 1 - Dec. 31, 2022

Introduction

The health benefits that the State of Alaska provides to its eligible employees is commonly referred to as AlaskaCare. AlaskaCare Health Plans can help you and your eligible dependents pay for medical, dental, pharmacy and vision expenses.

When you enroll in the AlaskaCare medical plan, you are automatically enrolled in pharmacy benefits. You will receive your pharmacy ID cards from OptumRx in the mail separately from your medical card.

OptumRx is the AlaskaCare pharmacy benefit manager. A pharmacy benefit manager (PBM) is a company the Division hires to process AlaskaCare pharmacy claims. Medical, vision and dental claims are processed by Aetna and Delta Dental, respectively.

You can call OptumRx at (855) 409-6999, TTY 711, for help with:

  • finding a network pharmacy near you,
  • reviewing the drug formulary,
  • enrolling in medication home delivery,
  • setting refill reminders, and more.

Retail Pharmacies

OptumRx’s retail pharmacy network includes most pharmacies in Alaska. For a list of participating pharmacies near you, use the Pharmacy Locator Tool on the OptumRx app, at OptumRx.com , or call a OptumRx representative at (855) 409-6999, TTY 711.

Medication Home Delivery

You can receive maintenance medication through the mail through OptumRx® home delivery. Enroll in OptumRx® home delivery to get up to a 90-day supply of the medications you take regularly. Your medication will come right to your mailbox. To start home delivery, log in to OptumRx.com , use the OptumRx® App or call (855) 409-6999, TTY 711.

OptumRx Specialty Pharmacy

Specialty medications can be important to maintaining or improving your health—and your quality of life. The OptumRx® specialty pharmacy, provides resources and personalized, condition specific support to help you manage your condition. Using OptumRx for your specialty needs saves you money and means the plan pays less.

Call OptumRx at (855) 427-4682 to enroll in this specialty pharmacy program.

Maximize your AlaskaCare Pharmacy Benefits

The AlaskaCare Employee Health Plan includes a three-tier pharmacy structure featuring different coinsurance and copayments for medications based on drug type:

  • Tier One: Generic Drugs—lowest cost tier
    Generic medications are therapeutically, and often chemically, identical to brand medications and are widely available at competitive prices.
  • Tier Two: Preferred Brand-Name Drugs—slightly higher cost tier.
    Preferred brand drugs are medications for which a generic is either unavailable or offered at discounted prices.
  • Tier Three: Non-preferred Brand-Name Drugs—highest cost tier.
    Non-preferred brand drugs are medications available in an equivalent generic form, or as a preferred brand drug. These drugs cost more to both the plan and the member, but a lower cost equivalent medication is available.

Members using generic medications may experience a decrease in the cost-share for their prescription. Members using a preferred brand name or non-preferred brand name medication may pay more. Be sure to check the 2018 Aetna Pharmacy Drug Guide and the Exclusion Drug List to see where your prescription is listed. You and your provider can search for a drug, ensure it is not on the exclusion list, and determine if there are lower cost alternatives.

How are drugs assigned to a tier? A tool called a “formulary” is used to assign medications to different tiers. The formulary for the employee plan is the 2018 Aetna Pharmacy Drug Guide. This guide is developed not only with overall value of the medication in mind, but based on drug safety, effectiveness and current use in therapy. Although some medications will no longer be covered (see Exclusion Drug List), the plan still covers the vast majority of prescription drugs, and you are free to choose a generic, preferred brand name or non-preferred brand name medication. Choosing a lower tiered drug when it is appropriate can provide access to the necessary medications to stay healthy, at a cost that is more affordable. Choosing a generic medication means your out-of-pocket cost will be less than if you choose a preferred brand name. Remember the lower the tier, the lower the out-of-pocket costs!

If you choose mail order your copay goes further. Choosing to fill your prescription medications through mail order when appropriate, can save you money. You can receive up to a 90-day supply for one low copayment when using mail order. You can also fill up to a 90-day prescription at a participating retail pharmacy; however, you will pay separate copays for each 30-day supply.

Compound Prescription Limitation

The AlaskaCare Employee Health Plan pharmacy benefits does not cover bulk powders/chemicals/products or other non-FDA approved drugs used in prescription compounding. Compound medications formulated from bulk powder compounds and bioidentical hormones will not be covered prescription drugs because they are not drug products approved by the FDA. Compounds that utilize at least one non-bulk, FDA-approved legend drug may be considered for coverage. If this impacts you, talk with your doctor or pharmacist about alternative options.

Prescriptions with an Over-the-Counter Equivalent

The AlaskaCare Employee Health Plan will not pay for prescription drugs when an over-the-counter equivalent is available. This applies even if prescribed or recommended by your health care provider. Talk to your doctor or pharmacist about over-the-counter alternatives that may be less expensive. Please note this does not affect over-the-counter medications required to be covered under the Affordable Care Act, such as aspirin.

OptumRx Access:

Website/App Tools:

  • Compare medication prices at different pharmacies.
  • Find lower-cost alternatives.
  • Locate network pharmacies.
  • Manage medication for covered dependents and spouses.
  • View real time benefits and claims history.
  • Transfer retail prescriptions to home delivery.
  • Track orders.
  • Refill home delivery prescriptions.
  • Access your ID card, if your plan allows.
  • View your claims history.
  • Manage medication reminders.

Introduction

The health benefits that the State of Alaska provides to its eligible employees is commonly referred to as AlaskaCare. AlaskaCare Health Plans can help you and your eligible dependents pay for medical, dental, pharmacy and vision expenses.

A dental third-party claim administrator is a company the Division hires to process AlaskaCare dental claims. Delta Dental of Alaska is the AlaskaCare dental claim administrator. Medical, vision, and pharmacy claims are processed by Aetna and OptumRx, respectively.

Contact Delta Dental of Alaska toll free at (855) 718-1768.

When you enroll in dental benefits, you’re part of the Delta Dental of Alaska family and have access to great dental care, close to home and when you’re traveling. Delta Dental of Alaska is part of the Delta Dental Association — the nation’s largest and most trusted dental benefits carrier.

Dental Plans at a Glance

AlaskaCare offers two dental plan options: the standard plan and the economy plan.

  1. Standard Plan
    The Standard Plan has greater coverage for more than just preventive dental visits, higher maximum annual benefits, includes limited orthodontic coverage, and includes Preventive services covered at 100% with no deductible for In-Network Dentists.

  2. Economy Plan
    The Economy Plan has no monthly premium, has a lower maximum annual benefit and covers Preventive services covered at 100% with no deductible for In-Network Dentists and a lower.

Premiums

AlaskaCare 2022 Dental Plan Summaries
Group Standard Economy
Monthly Plan Premiums
Employee Only $37.00 $0.00
Employee and Family $102.00 $0.00
Calendar Year Costs
Annual Maximum Benefit Per Person $1,500 $500
Deductible Per Person $25 $25
Deductible Per Family $75 $75
Service Benefit Amount Benefit Amount
Preventive 100%1 100%1
Basic 80% 10%
Major 50% 10%
Orthodontics
Eligible employees and their covered dependents 50% coinsurance up to a $1,000 lifetime maximum N/A
1 Deductible waived, does not apply to annual maximum benefit.
Premiums are subject to change.
Note that although the Preventive plan offers limited coverage for non-preventive procedures, it will still save you money by restricting the cost for those services to Delta Dental's negotiated rates. This only applies when you see a provider in the Delta Dental Premier or PPO networks.
AlaskaCare has provided the above benefit summaries. Moda Health/Delta Dental of Alaska are not responsible, in any way, for the accuracy of such information. For a more detailed description refer to your Member Handbook. If you have any questions about this information, please contact your AlaskaCare plan administrator at (800) 821-2251.
Effective: Jan. 1 - Dec. 31, 2022

Additional Programs

Oral health is an essential part of staying healthy. Studies have linked oral health to several chronic diseases, including diabetes, heart disease and stroke. Pregnant women who have periodontal disease are more likely to have a premature and underweight baby. Lower your risks by keeping up with your preventive dental services.

No cost for preventive care from network dentists!

Seeing your dentist regularly can help you avoid serious and expensive services down the road. To help you avoid costly dental care in the future, both dental plan options cover preventive care at no cost to you if you use a network provider:

  • Preventive (Class I) services, such as cleanings, periodontal maintenance, and routine oral exams, are covered at 100% when using a network provider.
  • Preventive services do not count towards your maximum annual dental benefit, giving you more to spend each year on other services that you may need.

Reduce your costs by using a network dentist!

Your dental plan lets you see any licensed dentist you want. But when you see a network provider, you’ll save money. AlaskaCare members have access Delta Dental’s broad Premier network of providers, AND to an additional, narrower network of dental providers: Delta Dental’s PPO network.

When you visit a PPO dentist, you’ll pay less out-of-pocket. You do not need to do anything to enroll in this benefit, but if you want to take advantage of the discounted services, use the dentist locator tool to search for providers who participate in the PPO network, or call Delta Dental of Alaska toll-free at (855) 718-1768.

Oral Health, Total Health Program and Benefits

If you are diabetic or pregnant in your third trimester, the Oral Health, Total Health program offers more ways to care for your teeth and mouth—and keep the rest of your body healthy, too.

If you have diabetes

Diabetes increases the risk of cavities, periodontal (gum) disease, tooth loss, dry mouth and infection. If you have been diagnosed with this disease you may be eligible for four prophylactic (preventive) cleanings or periodontal maintenance visits per year through the Oral Health, Total Health program. Protect your teeth and gums by enrolling today.

If you’re pregnant

Pregnant women who have periodontal (gum) disease are more likely to have a premature and underweight baby. Bacteria can enter the bloodstream through the mouth, and the body’s response to the infection can trigger early labor. If you are expecting, you can enroll in the Oral Health, Total Health program to help prevent gum disease. If you’ve already had two cleanings for the year, you may 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 to enroll, call Delta Dental of Alaska (MODA) toll-free at (855) 718-1768.

Vision is an optional plan offered to AlaskaCare members and their families. Vision Service Plan (VSP) is the administrator for the employee vision plan. If you enroll in the vision plan, the VSP information is located on the back of your Aetna ID card.

VSP

Most experts estimate that over 64% of adults need some sort of vision correction. Depending on how often you need new lenses, getting vision insurance may be a good financial fit.

Many hidden medical problems can be detected through an eye exam, so even those with perfect vision should have regular eye exams. If this routine exam is all you need, the vision plan may not be the right financial fit for you.

Review the premiums and the coverage offered under the vision plan before making a decision if this vision coverage is the right fit for you.

AlaskaCare 2022 Vision Plan Summary
-- Description Copay Frequency
Monthly Employee Contribution
Employee Only $15.00 --
Employee and Family $40.00 --
Well Vision Exam
WellVision Exam Focuses on your eyes and overall wellness. $10 Every calendar year
Prescription Glasses
Frame
  • $130 allowance for frames
  • 20% off amount over your allowance
  • $70 allowance at Costco
$25 (Prescription Glasses Benefit) Every other calendar year
Lenses
  • Single vision, lined bifocal, and lined trifocal
  • Polycarbonate lenses for dependent children
Included in prescription glasses Every calendar year
Lens Options
  • Anti-reflective coating – covered in full
  • Polycarbonate lenses – covered in full
  • Progressive lenses – covered in full
  • Scratch-resistant coating – covered in full
  • Average 35-40% off other lens options
Included in prescription glasses Every calendar year
Contacts
Contacts
(instead of glasses)
  • $130 allowance for contacts; copay does not apply
  • Contact lens exam (fitting and evaluation)
Up to $60 Every calendar year
Diabetic Care
Diabetic Eyecare Plus Program Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD). Retinal Screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask you VSP doctor for details. $20 As Needed
Extra Savings and Discount
Glasses & Sunglasses 30% off additional glasses and sunglasses, including lens options, from the same VSP doctor on the same day as your WellVision exam. Or, get 20% off from any VSP doctor within 12 months of your last WellVision exam.
Effective: Jan. 1 - Dec. 31, 2022

What Plan Am I In?

AlaskaCare

The following employee groups are entitled to the AlaskaCare Health Benefits provided by the State:

  • AVTECTA – AK Vocational Teachers Union (TA)
  • CEA – Confidential Union (KK)
  • APEA – Supervisory Union (SS)
  • ACOA – Correctional Officers Union (GC)
  • MEBA – Marine Engineers Union (BB)
  • TEAME – Mt. Edgecumbe Teachers Union (TM)
  • IBU – Inlandboatman’s Union (MM)
  • Employees not covered by collective bargaining (Exempt)

Union Health Trusts

The following employee groups are covered by Union health trusts and should contact the trust for details and enrollment in health benefits. Please note all trusts, except Labor Trades and Crafts, are eligible to enroll in Voluntary Supplemental Benefits provided by the state.
  • General Government (GGU)
  • Labor, Trades and Crafts (LTC)
  • Public Safety Employees Association (PSEA)
  • Masters, Mates & Pilots

New To Plan

As an active employee your State of Alaska employee benefits include health insurance and life insurance, as well supplemental insurance options that you can decide if you want to take advantage of.

Your plan is determined by what bargaining unit you are in and you are responsible to know and manage your benefits.

Getting Started

You must elect benefits within 30 days of your hire date or after a Qualified Status Change. You may also enroll or change your benefits during the annual Open Enrollment period.

Before enrolling in your new Employee Benefits or changing your current benefits, please review the different options and latest changes to the benefits and plan premiums. Then decide which benefits will be most appropriate for you and your family.

AlaskaCare Members may add, change or delete dependents covered under your health plan at any time by logging into their myAlaska account. Be sure to add eligible dependents when you are first hired and then review the dependents anytime you make future changes to your benefits; adding any necessary updates as your dependents change.

If you experience technical difficulties while trying to enroll contact the Member Service Center at:

Juneau: (907) 465-4460
Outside Juneau: (800) 821-2251
Monday - Thursday: 8:30 a.m. to 4 p.m.
Friday: 8:30 a.m. to 3 p.m. (Alaska Time)

Qualified Status Change

A Qualified Status Change is a change in your family or employment status which allows you to make changes to your coverages.

If you have a "qualified status change" during the year, you can make changes to your coverages (subject to limitations). Changes must be made within 30 days of the event. Examples of qualified status changes include the following:

  • You gain or lose a dependent, through birth or adoption, marriage, divorce, or death.
  • Your dependent is no longer eligible.
  • Your spouse terminates employment, begins an extended period of leave or layoff without pay, or begins new employment.
  • Your spouse or you change employment status from full-time to part-time or from part-time to full-time.
  • Your spouse has a significant change in his or her health coverage caused by their employment.

You may also change benefits if you move from an AlaskaCare participating group to a non-participating group.

How to Enroll

To enroll in your AlaskaCare Health Benefits, follow these instructions:

  1. Log in to your myAlaska account:
    • Go to myRnB.alaska.gov . This is the myRnB portal.
    • On the right side of the page, choose Login using myAlaska. You will be directed to the myAlaska login page, where you will login using your myAlaska ID and password. This is the same ID and password you use to register for your PFD. After you login to myAlaska, you will be redirected back to myRnB.
    • On the myRnB page, under Self-Service Tools, choose Online Benefits Enrollment, or if during an Open Enrollment period click on Open Enrollment.
  2. Review your dependents enrolled under the health plan. Click “Health Dependent Enrollment”.
    • Make sure all your eligible dependents are listed. If not, click Add Dependent, fill in the blanks, and click Save Changes.
    • If there are ineligible dependents listed, select the dependent from the list on the left side of the page. Click Edit, then Terminate Dependent.
    • If you have not yet provided the Social Security number (or other tax identification number) for each of your dependents that you have enrolled, please do so now. Select the dependent from the list on the left, then choose Addition of Missing SSN from the drop-down menu. Be sure to click Save Changes once you have added the information.
    • Once your review is complete, click Back to Benefits Enrollment at the top of the page.
  3. Check your elections and make new elections as needed.
    • Under Change Reason, select Open Enrollment from the drop-down menu, then click Change Elections.
    • Use the drop-down menus to make new elections. Certify your eligibility, then press Continue.
    • Review these elections and the updated premiums, then either click Back to edit your elections, or Submit Elections to enroll.

To enroll in Voluntary Supplemental Benefits (VSB), follow these instructions:

  1. Navigate to BenefitFocus to enroll. Click here to begin.
    • If you did not participate in last years open enrollment for VSB, you will need to create an account. If you already have an account, enter your Username and Password and click Log In.
    • Verify your demographic information, then click Save to edit your benefit elections. Follow the wizard for each benefit by selecting or declining, and adding beneficiaries.
    • Once your elections are saved, you may make changes to your VSB elections as many times as you wish until the end of your enrollment period.

Open Enrollment

Open Enrollment is the annual time of year when you can make changes to your current benefits. Typically, Open Enrollment occurs during the first three weeks of November. Unless you are a new hire or have had a Qualified Status Change, then this is the only time during the year where you may make changes to your current benefit. Open Enrollment for employees includes the following:

  • AlaskaCare Benefits: For eligible State of Alaska employees who participate in the AlaskaCare health plan to choose medical, dental, and vision benefits as well as to choose to participate in a Health Flexible Spending Account (HFSA).
  • Voluntary Supplemental Benefits (VSB): For any eligible employee of the State of Alaska or participating Political sub-divisions to choose VSB, including Life insurance, Critical Illness, and Disability insurances.

If you are unsure what plan you participate in, click here.

Benefit Highlights for

  1. Covered Drugs for : Premium Drug Formulary
    The OptumRx Premium Formulary is a list of medications, pharmacy care products, and services or supplies that have been evaluated by a team of clinical experts and chosen for their safety, cost, and effectiveness. Your AlaskaCare plan covers drugs that are listed on the Premium Formulary, and drugs that are not on the formulary will not be covered effective January 1, . You can review the AlaskaCare Employee Plan Premium Formulary beginning in November. If you have a medical need to use a drug that is not listed on the Premium Formulary, you or your doctor should contact OptumRx at (855) 409-6999 to request an exception. If you are currently taking a medication that is not on the Premium Formulary you will receive a letter notifying you of the change and alternatives to discuss and review with your physician.
  2. Get Moving with Hinge Health!
    Hinge Health can help whether you have chronic or sudden joint pain, are recovering from an injury, or just want more strength and flexibility. Hinge Health offers innovative digital care programs that connect you with a physical therapist or personalized health coach to help you manage musculoskeletal conditions such as back, knee, hip, neck and shoulder pain. Hinge Health’s programs are available at no cost to you and your family members age 18+. You can reach Hinge Health’s Member Care Advocates at (855) 902-2777. Enroll in Hinge Health Now!
  3. Updated premiums for
    Be sure to review the updated plan premiums effective January 1, . Learn more about premiums here.
  4. Behavioral Health Support at Your Fingertips
    Teladoc® now includes behavioral health consultations with a $0 copay. Their board-certified psychiatrists and licensed psychologists, social workers, and family/marriage therapists can help with depression, anxiety, stress, panic disorder, ADHD, schizophrenia, work-related issues, personal issues, and more. You can choose a therapist or psychiatrist who fits your needs and schedule visits 7 days a week, 7am to 9pm, from wherever you are most comfortable. Visit the Teladoc® website or you can call Teladoc® at (855) 835-2362 to request a consult by phone.
  5. Access to Anchorage-Area Hospitals
    Providence Alaska Medical Center and Alaska Regional Hospital are both in-network for AlaskaCare Employee plan members. If you receive care in the Anchorage-area, you will save no matter where you go. Network hospitals and facilities have partnered with AlaskaCare to keep your costs low by offering you discounted rates. We've also expanded the network to include more freestanding surgical and imaging centers in the Anchorage area. A larger network means more choice for you! Find a network provider near you with the DOC Finder Tool or call the Aetna Concierge at (855) 784-8646.
  6. Remember! You still have great access to high-quality providers at lower costs through the SurgeryPlus network.
    If you are considering elective surgeries learn how you can save money through SurgeryPlus.

For more information, please refer to the AlaskaCare Employee Open Enrollment Guide .

COBRA

For definitions of any terms used in this information page please refer to the AlaskaCare Health Plan Document. This information is only a summary. The AlaskaCare Health Plan Document will prevail whenever there is a difference in interpretation between this information page and the plan document.

Introduction

If you and/or your dependents lose coverage due to a qualifying event, you and/or your dependents may continue coverage under the plan by electing COBRA coverage and paying the required premium as described in this section. You may elect coverage under the plan that is the same or less than the level of coverage that you or your dependents had at the time your coverage terminates under the plan. For example, if you are covered under the medical plan and have elected the standard plan, you may elect COBRA continuation coverage under either the standard plan or the economy plan. Additionally, you may elect COBRA continuation coverage:

  • under the medical plan only; or
  • under the medical plan and under the dental plan and/or the vision plan

You may not elect COBRA continuation coverage under the dental plan or the vision plan without also electing COBRA continuation coverage under the medical plan.

Right to Continuation Coverage

If you are a qualified beneficiary, you may elect to continue coverage under the plan after a qualifying event. Only those persons who are covered under the plan on the day before the event which triggered termination of coverage are eligible to elect COBRA continuation coverage, except that dependent children born to or placed for adoption with you while you are on continuation coverage may be added to your coverage if the child is otherwise eligible under the plan. A qualified beneficiary is a person who is covered under the plan on the day before a qualifying event (but also including dependent children born to or placed for adoption with you during the continuation coverage) who is:

  • an eligible employee;
  • a spouse; or
  • a dependent child

The right to continued coverage is triggered by a qualifying event, which, but for the continued coverage, would result in a loss of coverage under the plan. A "loss of coverage" includes ceasing to be covered under the same terms and conditions as in effect immediately before the qualifying event or an increase in the premium or contribution that must be paid by a covered person. Qualifying events include:

  • Your death.
  • The termination (other than by reason of gross misconduct) of your employment or reduction of your hours that would result in a termination of coverage under the plan.
  • Your divorce or legal separation from your spouse.
  • Your becoming entitled to Medicare benefits under Title XVIII of the Social Security Act (42 USC § 1395-1395ggg).
  • Your child ceasing to be a dependent child under the eligibility requirements of the plan.

If a qualifying event occurs to a qualified beneficiary, then that qualified beneficiary may elect to continue coverage under the medical plan, dental plan and/or vision plan.

Election of Continuation Coverage

Continuation coverage does not begin unless it is elected by a qualified beneficiary. Each qualified beneficiary who loses coverage as a result of a qualifying event has an independent right to elect continuation coverage, regardless of whether any other qualified beneficiary with respect to the same qualifying event elects continuation coverage.

The election period begins on or before the date the qualified beneficiary would lose coverage under the plan due to the qualifying event, and ends on or before the date that is 60 days after the later of:

  • the date the qualified beneficiary would lose coverage due to the qualifying event; or
  • the date on which notice of the right to continued coverage is sent by PayFlex.

The election of continuation coverage must be made on a form provided by PayFlex and payment for coverage, as described in the notice, must be made when due. An election is considered to be made on the date it is sent to PayFlex.

Period of Continuation Coverage

Termination of Employment or Reduction in Hours

In the case of a qualifying event caused by termination of employment or reduction in hours, the qualified beneficiary may elect to extend coverage for a period of up to 18 months from the date of the qualifying event.

Second Qualifying Event

If a second or additional qualifying event occurs during the initial 18 month continuation coverage period (or during a 29 month maximum coverage period in the case of a disability), the qualified beneficiary may elect to extend the continuation coverage period for a period of up to 36 months from the date of the earlier qualifying event.

If you became entitled to Medicare within 18 months prior to a qualifying event caused by termination of employment or reduction in hours, qualified beneficiaries (other than you) may elect to extend coverage for a period of 36 months from the date of your entitlement to Medicare benefits.

Disability

If a qualified beneficiary is determined under Title II or XVI of the Social Security Act to be disabled within 60 days of the initial continuation coverage period due to termination of employment or reduction of hours (even if the disability commenced or was determined to be a disability before the first 60 days of the initial 18 month continuation coverage period), coverage may be continued for all qualified beneficiaries for a period of up to 29 months from the date of the qualifying event.

You must provide notice of a disability determination to PayFlex within 18 months of the qualifying event and within 60 days after the latest of:

  • the date of the disability determination by the Social Security Administration;
  • the date the qualifying event occurs;
  • the date you lose or would lose coverage due to the qualifying event; or
  • the date on which you are informed, via the plan or the general COBRA notice, of your obligation to provide such notice and procedures for providing such notice.

You are also responsible for notifying the Division within 30 days of the later of:

  • the date of the final determination by the Social Security Administration that you are no longer disabled; or
  • on the date which you are informed, via the plan or the general COBRA notice, of your obligation to provide such notice and procedures for providing such notice.

Other Qualifying Events

In the case of any qualifying event not otherwise described above, the qualified beneficiary may elect to extend coverage for a period of up to 36 months from the date of the qualifying event.

Health Flexible Spending Account (HFSA)

Notwithstanding the above, continuation coverage under the health flexible spending account (HFSA) will extend only until the end of the benefit year in which the qualifying event occurs.

End of Continuation Coverage

Continuation coverage will end upon the dates of the following occurrences, even if earlier than the periods specified under section 8.4, Period of Continuation Coverage

  • Timely payment of premiums for the continuation coverage is not made (including any grace periods).
  • You first become covered under any other group health plan, after the date on which continuation coverage is elected, as an employee or otherwise, unless such other plan contains a limitation (other than a limitation which does not apply by virtue of HIPAA with respect to any pre-existing condition).
  • You first become entitled to benefits under Medicare, after the date on which continuation coverage is elected.
  • The State ceases to provide any group health plan to any employee
  • You cease to be disabled, if continuation coverage is due to the disability.

Notwithstanding the foregoing, the plan may also terminate the continuation coverage of a qualified beneficiary for cause on the same basis that it could terminate the coverage of a similarly situated non-COBRA beneficiary for cause (e.g., in the case of submitting fraudulent claims to the Division).

Cost of Continuation Coverage

You are responsible for paying the cost of continuation coverage. The premiums are payable on a monthly basis. By law, premiums cannot exceed 102% of the full premium cost for such coverage (or 150% for any extended period of coverage due to disability). After a qualifying event, PayFlex will provide a notice with amount of the premium, to whom the premium is to be paid, and the date of each month that payment is due. Failure to pay premiums on a timely basis will result in termination of coverage as of the date the premium is due. Payment of any premium will only be considered to be timely if made within 30 days after the date due.

A premium must be paid for the cost of continuation coverage for the time period between the date of the event which triggered continuation coverage and the date continued coverage is elected. This payment must be made within 45 days after the date of election. PayFlex will provide you notice specifying the amount of the premium, to whom the premium is to be paid, and the date payment is due. Failure to pay this premium on the date due will result in cancellation of coverage back to the initial date coverage would have terminated.

COBRA Employee
Plan Rate
Medical, Standard $1,111.54
Medical, Economy $709.87
Medical, Consumer $614.74
Dental, Standard $58.00
Dental, Economy $25.27
Vision, Managed $13.93
Effective: Jan. 1 - Dec. 31, 2022
COBRA Employee + Family
Plan Rate
Medical, Standard $3,025.70
Medical, Economy $1,878.52
Medical, Consumer $1,608.63
Dental, Standard $154.30
Dental, Economy $59.85
Vision, Managed $34.27
Effective: Jan. 1 - Dec. 31, 2022

Notification Requirements

General Notice to Covered Eligible Employee and Spouse

The plan will provide, at the time of commencement of coverage, written notice to you and your spouse of your rights to continuation coverage. This general notice will be provided no later than the earlier of:

  • 90 days after your coverage commencement date under the plan; or
  • the date on which the Division is required to furnish a COBRA election notice.

Employer Notice to Division

Your employer will notify the Division in the event of your death, termination of employment (other than gross misconduct), reduction in hours, layoff, or entitlement to Medicare benefits within 30 days after the date of the qualifying event.

Covered Eligible Employee/Qualified Beneficiary Notice to Administrator

You must notify the Division of:

  • your divorce or legal separation from your spouse;
  • a child ceasing to be a dependent child under the eligibility requirements of the plan;
  • a second qualifying event; or notice of disability entitlement or cessation of disability.

You must give notice as soon as possible, but no later than 60 days after the later of:

  • the date of such qualifying event;
  • the date that you lose or would lose coverage due to such qualifying event; or
  • the date on which you are informed, via the plan or the general COBRA notice, of your obligation to provide such notice and the plan procedures for providing such notice.

See Election of Continuation Coverage, for timing of notices applicable to disability determinations.

You or another qualified beneficiary, or a representative acting on behalf of you or another qualified beneficiary, may provide this notice. The provisions of notice by one individual satisfies any responsibility to provide notice on behalf of all related qualified beneficiaries with respect to the qualifying event. Failure to provide timely notice will result in your loss of any right to elect continuation coverage.

Division's Notice to Qualified Beneficiary

Upon receipt of a notice of qualifying event, PayFlex will provide to each qualified beneficiary notice of their right to elect continuation coverage, no later than 14 days after the date on which PayFlex received notice of the qualifying event. Any notification to a qualified beneficiary who is your spouse will be treated as a notification to all other qualified beneficiaries residing with such spouse at the time such notification is made.

Unavailability of Coverage

If PayFlex receives a notice of a qualifying event or disability determination and determines that the person is not entitled to continuation coverage, PayFlex will notify the person with an explanation as to why such coverage is not available.

Notice of Termination of Coverage

PayFlex will provide notice to each qualified beneficiary of any termination of continuation coverage which is effective earlier than the end of the maximum period of continuation coverage applicable to such qualifying event, as soon as practicable following PayFlex's determination that continuation coverage should terminate.

Use of a Single Notice

Required notices must be provided to each qualified beneficiary or individual; however:

  • a single notice can be provided to you and your spouse if you both reside at your address; and
  • a single notice can be provided to you or your spouse for a dependent child if the dependent child resides with you or your spouse.

For more information contact the Division at (907) 465-4460 or email .

Introduction

The Health Flexible Spending Account (HFSA) provides an opportunity for you to save by setting aside money for health care on a pre-tax basis. You can then use these funds to pay for qualified health care expenses not covered by the plan.

Each benefit year, you decide if you would like to enroll in a HFSA and determine the amount you want to contribute, within the limit, on a pretax basis. During the benefit year, you file claims for eligible medical expenses, 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 account. The federal government imposes certain restrictions on HFSA plans to give you these pre-tax advantages, such as you cannot enroll in, cancel, or change your HFSA amount at any time during the year except during Open Enrollment.

You may carry forward up to $550 from year to year. Otherwise, you must spend down the account for qualified expenses in each benefit year. You have until March 31 of the following year to file claims for the current benefit year.

Premiums

2022 Health Flexible Spending Account Rates
Minimum Monthly Amount $25.00
Maximum Monthly Amount $225.00
Effective: Jan. 1 - Dec. 31, 2022

Streamlining

If you do not have any other health coverage, you can elect to have your HFSA set up to “streamline”. This means that any unpaid portion of a claim you incur during the plan year (deductible, your portion of the coinsurance, etc.) is directed to your HFSA account for reimbursement.

You may not elect streamlining if you have other coverage that will coordinate with AlaskaCare.

Your Choice: Once a Year, Every Year!

A HFSA might be a great choice for you – but here are some things to keep in mind:

  • You cannot enroll in, cancel, or change your HFSA amount at any time during the year except during Open Enrollment or a qualifying status change.
  • You must elect these benefits each open enrollment period. Your HFSA does not automatically continue from one benefit year to the next.
  • The benefit year runs from January 1 to December 31. You must budget contributions carefully.
  • You may carry over up to $550 of unused funds in your HFSA to the next benefit year, but unused amounts over $550 are forfeit.
  • Any amount you carry over to the next year will be added to any HFSA contributions you choose to make in the new benefit year.
  • Services for eligible expenses must be received while you are covered by the plan—coverage stops during most periods of leave without pay (LWOP) (your coverage will not stop if you are on FMLA and are in LWOP status) and at termination. Under HFSA, coverage also stops when you move to a bargaining unit which does not participate in the Select Benefits/AlaskaCare health plan.
  • Except for the $550 carry over in the HFSA plan, services must be received prior to the end of the benefit year, December 31.
  • Claims for the benefit year must be filed within 90 days of the end of the benefit year.

Did you know you can use your HFSA for the following common items?

  • Allergy Medicine
  • Analgesics
  • Antibiotics
  • At-home COVID-19 tests *new in 2021
  • Birth control
  • Cold medicine
  • Feminine hygiene products- include, but are not limited to: sanitary napkins, pads, liners, tampons, cups, sponges.
  • Fever reducing medicine
  • Hand sanitizer *new in 2021
  • Masks *new in 2021
  • Pain relievers
  • Sanitizing wipes *new in 2021
  • Sleep deprivation treatment

Visit payflex.com and find the entire list of eligible expenses categorized by eligible, eligible with a letter of medical necessity, and not eligible.

Submitting a Claim

You can submit HFSA claim multiple ways:

You can submit claims for any approved expenses by filling out the claim information and providing the Explanation of Benefits (EOB) or receipts. Eligible reimbursements will be paid directly to you, not your provider. You have until March 31 after the benefit year ends in which you incurred the claims to request reimbursement.

Find a Provider

Facilities

Coalition Health Centers

The Coalition Health Centers welcome AlaskaCare Employee Health Plan eligible members and dependents in Anchorage and Fairbanks. The Centers offer wellness and preventive care, as well as walk-ins for acute care (unexpected illness or injury.) Appointments are required for wellness and preventive care.

Services received at Coalition Health Centers are not subject to your plan’s annual deductible; you will only be charged a $25 co-pay for the office visit. Do not submit claims for these services. Coordination of benefits does not apply. See the AlaskaCare Employee Health Plan amendment effective March 1, 2018 for additional information.

Payment for sevices at the Centers is as follows:

  • Acute/Unexpected Illness/Injury: Co-Pay $25/Office Visit
  • Wellness & Preventive Care: Preventive $0/Office Visit

Coalition Health Center schedule

  • Monday through Friday
    7:30 a.m. – 6:30 p.m. (By appointment)
    8:30 a.m. – 4:30 p.m. (Walk-ins welcome for acute care)

Coalition Health Center locations

Anchorage Network Hospitals

Providence Alaska Medical Center and Alaska Regional Hospital are part of the AlaskaCare network beginning January 1, 2021!

AlaskaCare is committed to providing benefits to help you affordably access the care you need and stay healthy, when and where you need it. Your health care keeps getting better and better! AlaskaCare expanded the Anchorage-area network to include Providence Alaska Medical Center, Alaska Regional Hospital—offering you more convenience and choices in your area! By having both hospitals in-network, you will save no matter where you go. Preferred hospitals and facilities have partnered with the State to control health care costs by setting a fair rate for medical services. By visiting in-network facilities, you keep your out-of-pocket maximum low, and the plan will pay for more on your behalf.

It doesn’t stop there—this network expansion also adds a host of ambulatory surgical and imaging centers, helping you find the right fit for the services you require.

Providence Alaska Medical Center

Providence Alaska Medical Center, a nationally recognized trauma center and Magnet hospital, is part of Providence St. Joseph Health, a not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health services, affiliated services, and educational facilities.

Visit Providence.org for more information.

Alaska Regional Hospital

Alaska Regional Hospital is proud of the partnership with the State of Alaska and its AlaskaCare health plan members. From providing preventive healthcare and treatment to hosting free health fairs, seminars, and screenings, we are committed to providing plan members and all Alaskans with high quality, cost effective healthcare.

Visit AlaskaRegional.com for more information.

You will also have network access to many more Anchorage-area ambulatory surgical centers. To find an in-network provider, or to see if your provider is in-network, call the Aetna Concierge at (855) 784-8646, or use the online DocFind tool .

Out-of-Network Information

When you use an out-of-network facility, the plan benefit percentage for most facility fees at the out-of-network facility will be reduced by 20%, and in most cases, your annual out-of-pocket limit will double. The plan benefit percentage (coinsurance) is the allowed amount that the plan will pay after you meet your deductible.

The allowed amount for out-of-network facilities services will be 185% of Medicare rates. Remember, out-of-network facilities can charge any amount they choose. So, if the facility does not accept the 185% of Medicare rate, they can balance bill you for the rest.

Below is an example of the difference in out-of-pocket costs between using an in-network, preferred provider facility, and an out-of-network (OON) facility in Anchorage for someone who has elected the AlaskaCare economy medical plan:

2022 OUT-OF-NETWORK COSTS EXAMPLES
-- In Network Facility OON Facility
Billed Charges $27,000 $27,000
Network Facility Rate in-network or Plan Allowed $22,950 $22,950
185% of Medicare for OON
Deductible $600 $600
Coinsurance 70% 50%
Plan Coinsurance Total $15,645 $11,175
Member’s coinsurance 30% 50%
Member Coinsurance Total $6,705 $11,175
Out of Pocket Maximum (includes deductible) $2,850 $5,700
Potential Balance Bill (Billed charges – Plan Allowed) $0 $4,050 *
Member Pays $2,850 $9,750
Plan Pays $20,100 $17,250
Effective: Jan. 1 - Dec. 31, 2022

* In addition to your cost share portion of the plan allowed amount, OON facilities may balance bill you the difference between their billed charges and the plan’s Medicare-based rate for the services.

If you need emergency treatment, please go to the nearest emergency room without regard to the network. Penalties are not applied in the case of emergency treatment or for services not offered at Alaska Regional. Before receiving services in Anchorage that you believe are not offered at Alaska Regional, or if an out-of-network facility sends you a balance bill for the emergency services, contact the Aetna Concierge at (855) 784-8646 for assistance.

Information on network facilities options outside of Alaska contact the Aetna Concierge at (855) 784-8646 or visit the custom DocFind tool online. It is important to use the custom AlaskaCare DocFind tool tool when searching for facility options; Aetna’s public DocFind tool will not accurately reflect AlaskaCare’s preferred facilities.

Most Alaska hospitals and facilities outside of the Anchorage area are network providers, but outside of Alaska there are some out-of-network facilities, so its important to check before receiving services. For a list of network providers, please contact the Aetna Concierge at (855) 784-8646 or visit the custom DocFind tool to help you find a provider that is part of the AlaskaCare network.

Why out-of-network facilities are paid at 185% of Medicare

We use Medicare as our base because they are the largest payer in the county, and they have established a standard measure that accounts for differences like size, location, and the types of patients treated. The Medicare rate is set to pay facilities for their costs plus a profit.

Conquer Back and Joint Pain with Hinge Health!

Whether you have chronic or sudden joint pain, are recovering from an injury, or just want more strength and flexibility—Hinge Health can help. Hinge Health offers innovative digital care programs that connect you with a physical therapist or personalized health coach to help you manage musculoskeletal conditions such as back, knee, hip, neck and shoulder pain. The exercise therapy programs are designed to help you get back to the activities you love.

Hinge Health’s programs are available at no cost to you and your family members age 18+ who are covered by the AlaskaCare Employee Health Plan starting July 15, 2021!

Hinge Health has tailored programs to help you with:

  • Conquering musculoskeletal pain or limited movement—Whether you have an occasional dull ache or frequent sharp pain, Hinge Health can help you move freely again.
  • Recovering from an injury—Whether you were injured yesterday or years ago, get expert help and recover better than ever.
  • Keeping your joints healthy and pain free—Get expert support tailored to your specific needs.

Hinge Health provides the tools you need to get moving again from the comfort of your home. When you enroll, you will receive the Hinge Health welcome kit which, based on your care program, may include:

  • A tablet computer
  • Wearable sensors that give live feedback in the Hinge Health app
  • Access to personalized exercises

You will also be connected with a personal care team including a physical therapist or health coach who will tailor your program to your needs and work with you along the way.

How to use Hinge Health

If you or an eligible dependent would like to enroll, start by contacting Hinge Health:

Employee Assistance Program

The AlaskaCare Employee Assistance Program (EAP), administered by Aetna, provides responsive, caring and effective services to help balance your personal and professional life. Some of the areas the EAP can help with include:

  • Personal balance
  • Emotional wellness
  • Marital/relationship issues
  • Family issues
  • Communication skills
  • Stress management
  • Alcohol and drug issues
  • Work-related issues
  • Grief issues
  • Financial and legal concerns

Appeals

AlaskaCare Health & Dental Appeal Guides

The AlaskaCare health and dental plans provide members with the right to appeal claims and precertifications that have been denied by claims administrators. If your health plan denies payment for a treatment that you believe should be covered, you have the right to challenge that decision through the appeal process. AlaskaCare has added a new level to the appeals process for services or supplies received on or after January 1, 2018. Under the new appeal process, if the third party claims administrator or external review organization uphold their original denial of your appeal, you have the right to appeal to the Division of Retirement and Benefits. Should the Division also uphold the denial, you retain the legal right to take the appeal to superior court.

Opioid Guidelines

State and federal guidelines were developed to address the opioid epidemic in the United States and Alaska. New safety guidelines were adopted for the AlaskaCare plans on January 1, 2018 and were further enhanced on January 1, 2019. The guidelines limit the dispensing of opioids as follows:

  • For patients that don’t normally use opioids:
    • The plan limits the maximum dosage per day to 50 mme (morphine milligram equivalent) and only allows up to a 7-day supply every 91-days.
    • A pre-authorization is required to obtain more than a 7-day supply within any 91-day period.
  • For patients that regularly use opioids:
    • The plan limits the maximum dose per day to 90 mme and only allows up to a 30-day supply.
    • A pre-authorization is required periodically.
  • For patients age 19 or under:
    • A pre-authorization is required for cough medications that contain opioids, and the prescription is limited to a 3-day supply.

Members are encouraged to discuss the effect of the AlaskaCare opioid dispensing policy with their providers and to contact OptumRx at (855) 409-6999 for support.

Opioids are a type of narcotic pain medication. They can have serious side effects if you don't use them correctly. For people who have an opioid addiction, their problem often started with a prescription. Opioid drugs include:

  • Codeine (only available in generic form)
  • Hydromorphone (Dilaudid, Exalgo)
  • Meperidine (Demerol)
  • Methadone (Dolophine, Methadose)
  • Morphine (Kadian, MS Contin, Morphabond)
  • Fentanyl (Actiq, Duragesic, Fentora, Abstral)
  • Oxycodone (OxyContin, Oxaydo)
  • Oxycodone and acetaminophen (Percocet, Roxicet)
  • Oxycodone and naloxone
  • Hydrocodone (Hysingla, Zohydro ER)
  • Hydrocodone and acetaminophen (Lorcet, Lortab, Norco, Vicodin)

Forms & Health Brochures

AlaskaCare Employee Form 1095-B Information

State of Alaska employees eligible for health benefits will receive a Form 1095-C, and in some cases a Form 1095-B. These forms contain information about your healthcare coverage and whether your dependents were covered. It is important to keep these forms for your records.

The Affordable Care Act (ACA) includes both an individual mandate and an employer mandate. Under the individual shared responsibility provision of the ACA, individuals must indicate their enrolled dependents, as well as themselves, have had a full year of qualifying healthcare coverage (called minimum essential coverage), qualify for an exemption, or pay a penalty when filing their income taxes. The employer mandate requires that large employers like the State of Alaska, offer affordable healthcare coverage that provides minimum value to most of their full-time equivalent employees or pay a penalty.

Form(s) 1095 are the mechanism that the Internal Revenue System (IRS) will use to determine if these mandates have been met.

Supplemental Non-Emergent Surgery Coverage

AlaskaCare has partnered with SurgeryPlus to offer employees covered by the AlaskaCare Employee Health Plan and their eligible dependents convenient travel benefits for non-emergent surgeries. You get access to a network of top quality medical providers with proven experience in more than 350 procedures types across 40 states.

What’s included with this new benefit?

Surgeons of Excellence
Each board-certified provider has undergone rigorous screening, including specialized training and fellowships, reducing your risk of complications and preventable costs.

Full-Concierge Service
Your dedicated Care Advocate will locate the best-fitting provider, schedule all appointments, coordinate medical record transfers, and follow up with you post-procedure to ensure top satisfaction with your procedure experience.

Low Cost
Each procedure is covered under a bundled rate, and the only cost to you is the remaining balance on your deductible, if applicable. 100% of the coinsurance is waived.

Covered Expenses include:

  • Episode of Care received through SurgeryPlus benefits
  • Airfare for the eligible patient and a companion
  • Hotel or other approved accommodations
  • Transportation to/from airports
  • Pre-loaded debit card with $25 per diem per patient per day (or $50 per patient and companion per day)

How to use SurgeryPlus

If you or an eligible dependent needs surgery, start by contacting SurgeryPlus:

You will be assigned a dedicated Care Advocate who will assist you with:

  • Selecting a surgeon
  • Scheduling appointments
  • Coordinating and booking travel and accommodations
  • Providing a pre-loaded debit card with per diem for expenses
  • Transferring medical records
  • Reviewing benefits

Quality Healthcare at Your Fingertips

Talk to a doctor by phone or video, anywhere, anytime.

Teladoc® is already part of your AlaskaCare Employee Health Plan. You can talk to a doctor in minutes. AlaskaCare Employee Health Plan members have 24/7/365 access to health care for non-emergency conditions by web, phone or mobile app. For example, if you have symptoms of the flu, you can contact Teladoc® and a doctor can evaluate and help with next steps when necessary.

The AlaskaCare Employee Health Plan has partnered with Teladoc® since September 1, 2018 to provide you with a convenient and affordable way to receive quality medical care.

All Teladoc® doctors are board-certified, state-licensed and can treat many health issues, including:

  • Cold and flu symptoms
  • Allergies
  • Bronchitis
  • Skin problems
  • Respiratory infections
  • Sore throat
  • Sinus problems
  • Dermatology
  • Caregiving
  • Behavioral Health
  • ...and more!

How to use Teladoc®

To utilize the benefit, begin by registering your Teladoc® account. There are three ways to register:

During registration, you’ll complete your medical history so when you need Teladoc®, it will be fast and easy. Watch a short video to discover more.

Services Offered

General Medical Consultation
Teladoc® is another alternative to accessing medical care for your non-emergent symptoms 24/7/365. Teladoc® is a convenient and affordable healthcare alternative to expensive and time-consuming E.R. visits or after-hour periods where care is difficult to find. All Teladoc® doctors are board-certified, state-licensed, and can even send a prescription straight to your nearest pharmacy when medically necessary!

Fee: For General Medical Consultation, the copay is $0.

Behavioral Health Consultation

Feel like yourself again. Choose a therapist or psychiatrist who fits your needs and schedule visits 7 days a week from wherever you're most comfortable. Experts specialize in and support a wide range of needs:

  • Anxiety, stress, overwhelmed
  • Negative thought patterns
  • Depression
  • Not feeling like yourself
  • Not wanting to get out of bed
  • Relationship conflicts
  • Trauma and PTSD
  • Mood swings
  • Medication management

Fee: For Behavioral Health Consultation, the copay is $0.

Dermatology Consultation

There’s no reason to wait weeks for the skin care you need. Teladoc® can resolve your skin issues within days by web or mobile app. Licensed dermatologists can treat ongoing or complex skin conditions like psoriasis, skin infection, rosacea, suspicious moles, and many more—quickly, conveniently, and discreetly.

Fee: For Dermatology Consultation, the copay is $0. The first follow-up within 7 days of initial dermatology consultation also has a copay of $0.

Caregiver Consultation

As a caregiver for a loved one, you have enough to worry about. That’s why Teladoc® gives you a convenient and affordable way to provide care, letting you arrange a 2- or 3-way video or phone visit with a licensed doctor 24/7 for just $45/visit. Add the individual you care for to your Teladoc® account, even if they’re not covered by your health plan.

Fee: $45 for Caregiver Consultation Fee. This optional service is not covered under the plan and is the members responsibility to pay in full.

The State of Alaska Voluntary Supplemental Benefits (VSB) plan includes life insurance, critical illness, and long & short-term disability. The VSB plan is administered by MetLife and enrollment is managed by BenefitFocus.

Voluntary Supplemental Benefits offer you the opportunity to obtain additional benefits that best suit the needs of you and your family. Please take a moment to watch the video below to learn about all the options offered by the State of Alaska. Note: eligibility or benefits described in this video are subject to change. Please review the individual benefits for up-to-date information.

Eligibility

The following employees are eligible to participate in Voluntary Benefits:

  • State employees except members of the Labor, Trades and Crafts (LTC) unit, the Teachers’ Retirement System (TRS), on-call employees, temporary legislative employees, employees of the National Guard (including Emergency Guard), short term non-permanent employees, student interns, leased employees, and emergency employees hired for natural disasters, including emergency firefighters.
  • Employees of a participating political subdivision covered under the terms of the political subdivision’s participation agreement.

Enrollment in any plan is optional—choose only the plans and coverage levels that meet your needs. Premiums are paid through payroll deductions and are subtracted from gross wages before taxes are deducted – an added advantage to the plan. Please note, some restrictions apply for life insurance premiums.

You can select from the following options:

  • Life Insurances
  • Accidental Death and Dismemberment Insurances
  • Disability Benefits (short-term and long-term)
  • Critical Illness

MetLife is here to support all your VSB needs. Learn about each benefit by visiting metlife.com/stateofalaska . There you will find in depth plan information and helpful videos on each benefit. If you have questions about your VSB options or claims, please contact MetLife.

MetLife Customer Service Contacts

BenefitFocus offers benefits administration on a single platform, simplifying benefit enrollment for everyone. They also provide a mobile app for accessing your benefit information on the go. For enrollment assistance, please contact BenefitFocus .

BenefitFocus Contact Information

  • Phone: (844) 939-0543
  • Email:

Open Enrollment Information

You can change or enroll in your VSB options during an open enrollment period or within 30 days of a "qualified status change." Simply click the “Ready to Enroll in VSB? Click Here” button at the top of this page. Qualified Status changes include:

  • gaining or losing a dependent through birth, adoption, marriage, divorce, or death.
  • dependent is no longer eligible under the terms of the plan.
  • spouse terminating employment, beginning an extended period of layoff or leave without pay, or beginning new employment.
  • you or your spouse changing employment status from full-time to part-time or vice versa.


Premiums

Learn About Your Group Life Insurance Options

Life insurance is a cost-effective way to protect your family and your finances. Should something unforeseen happen to you, it helps to ensure that short- and long-term financial obligations could be met.

Group Life Insurance – Basic Life

Basic Life insurance is paid for by participating employers and not an option you need to elect. This insurance is automatically provided to permanent and long-term nonpermanent State of Alaska employees, and eligible employees of participating political subdivisions. Basic Life pays either $10,000 or $2,000, depending on your bargaining unit.

Basic Life insurance provides additional benefits to employees, such as, grief counseling, will preparation, and estate resolution services. Contact MetLife for additional information.

Select Life Insurance

As an employee of the State of Alaska you may choose to enroll in Select Life and Accidental Death & Dismemberment (AD&D) Insurance. Enrollment may occur at time of hire (within 30 days), during open enrollment, or when you have a qualifying status change. Select Life and AD&D will cover only you as the employee. Select Life insurance benefit amounts:

  • An amount equal to your basic annual earnings, rounded to the nearest $1,000.
  • Pays double the benefit amount if death is accidental.
  • Pays up to $100,000 for Supervisory and Confidential Unit employees and up to $60,000 for all others.

Voluntary Supplemental Life Insurance

In addition to Basic Life Insurance funded by the state and optional Select Life Insurance that you can choose to enroll in, you may also choose to enroll in additional Supplemental Life Insurance. Enrollment is optional, pays in a lump sum, and only covers the employee. Supplemental life insurance is available in the following volumes:

  • $10,000
  • $50,000
  • $100,000
  • $200,000
  • $300,000

Evidence of Insurability is required for $200,000 and $300,000.

Accidental Death and Dismemberment (AD&D) Insurance

Basic Accidental Death and Dismemberment (AD&D) and Travel Accident Insurance are paid for by your participating employer and are not options you need to elect. Travel Accident insurance covers State of Alaska employees while in travel status on State business. For more information on these benefits, contact MetLife.

Supplemental Accidental Death and Dismemberment (AD&D) can be added to your VSB package. If you enroll in AD&D you must enroll in a minimum of $10,000 of Supplemental Life Benefits. This plan pays benefits if your death or dismemberment is caused by an accident. It pays in a lump sum, with the benefit dependent on loss and family structure.

Learn About Your Voluntary Supplemental Benefit Options

Voluntary Supplemental Benefits offers eligible employees with additional choices that could meet the needs of your family. Visit our webpage to learn more about eligibility and options for VSB.

Disability Benefits Insurance
Disability insurance offers an affordable way to protect your income when you are unable to work due to illness or injury. Accidents and injury can happen to anyone, and it can impact your ability to earn money.

Why is having Disability insurance important?
If you are unable to work due to illness or injury, disability insurance can help pay your most important expenses. These include mortgage or rent, car payments, food, childcare/tuition, and utilities.

Short Term Disability Insurance replaces a portion of your income during a disability which could last up to 180 days. Having disability protection can help you cover your essential living expenses and help safeguard your savings, since it replaces a portion of your income lost due to a disability or illness. Short-Term Disability (STD) provides a weekly benefit of 60% of your monthly base pay.

Long Term Disability Insurance replaces a portion of your income during a disability that is expected to last for an extended period of longer than 180 days. Long-Term Disability (LTD) is available in two levels, you can elect to have either 50% or 70% of your monthly base pay covered.

Critical Illness Insurance

Critical Illness Insurance provides financial support in the form of a payment if you or a covered family member is diagnosed with a serious illness. Critical Illness Insurance works to complement your medical coverage—and pays in addition to what your medical plan may or may not cover. Upon diagnosis, it provides you with a lump-sum payment of $15,000 or $30,000 in initial benefits. The payment you receive is yours to spend however you like.

While critical illnesses are always unexpected, they don’t have to be financially devastating. Protect your family’s budget by enrolling in Critical Illness Insurance.

Page Last Modified: 05/16/22 15:23:12

© State of Alaska || || drb.alaska.gov

AkCare FAQs

Why have I received multiple ID cards?

To improve our network and customer service, AlaskaCare selected Aetna to administer all medical and pharmacy claims and Moda Health to administer all dental claims. In the past, these services had been provided by a single company. You should have received a medical ID card from Aetna and a dental ID card from Moda to use when visiting your health care provider or pharmacy.

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How do I obtain a new ID card?

You can download a digital copy of your ID card online:

You can request a new physical ID card by calling:

  • For medical ID cards contact the Aetna Concierge at (855) 784-8646.
  • For pharmacy ID cards contact the OptumRx Service Center at (855) 409-6999.
  • For dental ID cards contact the Delta Dental Service Center at (877) 277-7280.

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How can I get a copy of the Employee Insurance Information booklet?

Plan Booklets are available for all members of the AlaskaCare health plans, they are designed to help you understand your plan and the benefits it provides. You’ll find a benefit summary and information about plan coverage, how benefits are paid, travel coverage, precertification, what expenses are covered, and more.

For your convenience, the Plan Booklets are available on the AlaskaCare website. You can view the booklets online or download them to your computer.

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Will I be taxed on my health benefits?

You are not taxed on premium payments you make for your health benefits, or any contributions you may make to a Health Flexible Spending Account (HFSA). The plan meets the criteria under Internal Revenue Code §125 and its accompanying Treasury Regulations, which govern cafeteria plans as offered under the Select Benefits Health Plan. This allows for premiums that are taken from your pay check to be deducted prior to taxes being calculated.

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How do I find a network vision provider?

To find a network provider:

  • Call Aetna's Health Concierge at (855) 784-8646 or select the "Find a Doctor" button on our website, AlaskaCare.gov.
  • Call Moda/Delta Dental at (855) 718-1768 or select the "Find a Dentist" button on our website
  • Call OptumRx at (855) 718-1768 or select the "Find a Pharmacist" button on our website.

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What if my provider isn't in the network?

If your current provider is not listed as an in-network provider, you can ask your physician to contact AlaskaCare for a participation application. If you would like the provider to receive an application, please complete the Provider Nomination form . When you use a network provider, you can take advantage of the significant discounts negotiated to help lower your out-of-pocket costs for medically necessary care. This can help you get the care you need at a lower price.

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When I use an out-of-network provider, how much of the bill am I responsible for?

If you use an out-of-network provider, you are responsible for the difference between the recognized charge and the amount charged by the provider in addition to other applicable charges such as deductibles, co-payments, co-insurance and non-covered charges.

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What is balance billing?

The AlaskaCare plans limit payment of covered services to the recognized charge. The recognized charge is the maximum amount the AlaskaCare plans will pay for a covered service. Aetna and Moda/Delta Dental, and their respective network providers (sometimes referred to as participating providers), agree to a set of discounted negotiated rates for services provided. The recognized charge for network providers is the negotiated rate. For an explanation of how the recognized charge is calculated for out-of-network providers, please see the recognized charge questions under the Network and Dental sections.

An out-of-network provider has the right to bill you for the difference between the recognized charge and the actual charge. This is often referred to as balance billing. Network providers have agreed to accept, as payment in full, the negotiated charge. Therefore, you are not subject to balance billing when you use a network provider.

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How do I avoid receiving a balance bill?

You may prevent balance billing by verifying all medical providers are in the Aetna network and making sure your AlaskaCare Plan covers the services you need. For example, if you're having x-rays, MRIs, CT scans, or PET scans, make sure both the imaging facility and the radiologist who will read your scan are in the network.

Similarly, for AlaskaCare covered dental services, you may prevent balance billing by verifying the provider is in the Moda/Delta Dental network.

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What if there is no network provider available?

If your provider is not a network provider, you may ask for an estimate of charges, the codes that will be used use for billing, and the provider's zip code. When you receive this information, contact the Aetna Concierge at (855) 784-8646 or Moda/Delta Dental at (855) 718-1768. A member of the Aetna Concierge or Moda Customer Service team can review the estimated charges and will advise you if the charges fall within the recognized charge for your area. If the estimated charges exceed the recognized charge, you may request that your provider accept that amount and not balance bill you, or you may request payment arrangements with their office.

If your current provider is not listed as a network provider, you can ask your provider to contact Aetna at (800) 720-4009 or Moda at (855) 718-1768 for a participation application. Members are also encouraged to nominate their out-of-network providers to join the network. Contact the Aetna Concierge or Moda Customer Service to find out how.

In some cases, unfortunately, there will not be a network provider for the service you need in your area. The Division, Aetna and Moda/Delta Dental are working diligently to improve network access, but please understand that we cannot force providers into the network.

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Is there a "network" for durable medical equipment (DME)?

Yes, there is a network of providers for durable medical equipment. For assistance finding a network provider call the Aetna Concierge at (855) 784-8646 or search online using the Aetna DocFind tool .

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What is a recognized charge?

Recognized charge means the negotiated charge contained in an agreement the claims administrator has with the provider either directly or through a third party. If there is no such agreement, the recognized charge is determined in accordance with the provisions of this section. Except for charges related to involuntary out-of-network services, an out-of-network provider has the right to bill the difference between the recognized charge and the actual charge. This difference will be the covered person’s responsibility.

Medical Expenses: As to medical services or supplies, the recognized charge for each service or supply is the lesser of:

  • What the provider bills or submits for that service or supply;
  • Or the 90th percentile of the prevailing charge rate; for the geographic area where the service is furnished as determined by Aetna in accordance with Aetna reimbursement policies.

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Where can I get more information about recognized charges?

For more information on recognized charge in the Employee Plan, see the AlaskaCare Insurance Information Booklet , section 3.3.7 Recognized Charge

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What is Coordination of Benefits?

Coordination of Benefits (COB) is a method of ensuring that people covered by more than one medical plan will receive the benefits they are entitled to but not more than 100% of their covered expenses. The AlaskaCare health plans coordinate benefits with other group health care plans to which you or your covered dependents belong. Coordination of benefits can be very confusing, even for people who work at a physician's office.

With COB, if you are covered by more than one health care plan, the plans work together to provide benefits. One plan is considered "primary" and pays your covered expenses first. The other plan is "secondary" and pays any remaining covered expenses up to 100%. In some cases, there may be a third or fourth plan, as well.

It is important to remember that not all expenses are covered expenses.

Who sets COB rules?

Most COB rules are set by the National Association of Insurance Commissioners (NAIC). Rules for coordinating with Medicare and Medicaid are set by federal and state law. Most plans follow the NAIC rules, but there is no requirement that they do so. The AlaskaCare health plans follow standard NAIC rules to ensure ease of coordination with other plans.

What are the rules?

Here are examples of common COB situations and rules:

If You Are Covered Under… Here's How the Plans Pay
Active employee plan and retiree plan Primary: Active employee plan
Secondary: Retiree plan
Retiree plan and as dependent under another person's plan through active employment Primary: Retiree plan
Secondary: Other person's plan
Retiree plan and Medicare-eligible Primary: Medicare
Secondary: Retiree plan
Two retiree plans Primary: Plan in force the longest
Secondary: Other plan
Retiree plan, as dependent under another person's plan through active employment, and Medicare-eligible Primary: Other person's plan
Secondary: Medicare
Third: Retiree plan
Active employee plan, retiree plan, as dependent under another person's plan through active employment, and Medicare-eligible Primary: Active employee plan
Secondary: Other person's plan
Third: Medicare
Fourth: Retiree plan

If your dependent children are covered under more than one plan, in most cases, the plan of the parent whose birthday falls earlier in the year (not the oldest) is primary. If both parents have the same birthday, the plan that has covered the children longer is primary. If the parents are separated or divorced, here's how the plans pay:

  • Primary: Plan of the parent whom the court has established as financially responsible for the child's health care (the claims administrator must be informed of the court decree)
  • Secondary: Plan of the parent with custody of the child
  • Pays third: Plan of the spouse of the parent with custody of the child
  • Pays fourth: Plan of the parent who does not have custody of the child
What if none of the rules describe my situation?

If none of the above rules applies, the plan that has covered the patient the longest is primary.

How do the plans coordinate if my AlaskaCare plan is secondary?

When an AlaskaCare plan is secondary, the amount the plan pays after the deductible is met is figured by subtracting the benefits payable by the other plan from 100% of expenses covered by the AlaskaCare plan on that claim.

Will the coverage from two AlaskaCare plans always pay 100% of what the provider charges?

No, you may receive a balance bill if you use an out-of-network provider. In this case, the plan will pay up to the recognized charge for this service in your area.

I am covered under the AlaskaCare Employee Health Plan. Is there anything my spouse should consider when making elections to a State employee union health trust?

The AlaskaCare Employee Health Plan will only pay 30% of the covered charges for your dependents if your spouse, qualified same-sex partner or child(ren) are covered by a state employee health trust and that coverage:

  • Has been waived,
  • Pays less than 70% of covered expenses, or
  • Has an individual out-of-pocket maximum (including deductible) of more than $3,500.

This applies to any dependent covered by the AlaskaCare Employee Health Plan whether the plan pays as primary or secondary.

Example:

  • You incur covered expenses of $1,000. Your spouse elected limited coverage under a union health trust that pays 20% coinsurance, so your AlaskaCare Employee Health Plan will pay 30% after the deductible.
  • Spouse's plan pays: $200 (20% of $1,000)
  • AlaskaCare plan pays: $300 (30% of $1,000)
  • Total paid: $500
  • Potential balance bill amount: $500 ($1,000 - $500)
Are routine dental cleanings a covered benefit?

Prophylaxis (cleaning) or periodontal maintenance is covered up to two times in any benefit year. Additional cleaning benefits may be available if medically necessary or dentally necessary and when precertified by Moda/Delta Dental.

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What if my health condition makes more frequent cleanings necessary?

If you are diabetic or pregnant in your third trimester, the Oral Health, Total Health program offers more ways to care for your teeth and mouth.

Diabetes increases the risk of cavities, periodontal (gum) disease, tooth loss, dry mouth and infection. If you have been diagnosed with this disease you are eligible for four prophylactic (preventive) cleanings or periodontal maintenance visits per year through our Oral Health, Total Health program. Protect your teeth and gums by enrolling today.

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

For details on the Oral Health, Total Health program, refer to AlaskaCare Employee Health Plan booklet or call Delta Dental Member Services at (855) 718-1768.

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What is SurgeryPlus?

SurgeryPlus is a supplement to your employer’s medical plan that you’re already enrolled in, and is part of your benefits package. It helps you and your covered family members plan and pay for non-emergency surgeries. SurgeryPlus offers access to a top-tier network of specialized surgeons, while providing you with your very own personal assistant to handle the logistics of planning for surgery.

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How do I use SurgeryPlus?

To get started, call SurgeryPlus directly at (855) 715-1680. You will be in contact with a SurgeryPlus Care Advocate who will walk you through the steps to receive the surgery you need. SurgeryPlus will verify if you need any pre-authorizations or precertifications, schedule consultations with you and a Surgeon of Excellence, verify and collect any needed deductible amount, coordinate all the travel logistics, and provide post-surgery follow-up.

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How much does SurgeryPlus cost?

Just by being a member of your health plan, you already have access to these services. There is no additional cost to you to participate. You only need to meet your deductible, just like you would with any surgery, and SurgeryPlus takes care of the rest.

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What expenses are covered if I choose SurgeryPlus for my surgical care?

In addition to covering the cost of travel, there is no additional charge for the concierge service or coordination of care. Within the episode of care, covered expenses include, but are not limited, to the professional fees (surgeon, assistant surgeon, hospitalist, nursing staff, etc.), inpatient pharmacy, anesthesia, facility fees, some diagnostic testing, pre-op consultation and appointment, and post-operative follow-up appointment when appropriate.

Portions of the episode of care that are not covered include, but are not limited, to durable medical equipment (braces, crutches, walkers, etc.), some diagnostic testing, physical therapy, and in-home nursing care. These services vary based on the procedure type and can be covered by your traditional medical insurance, and are subject to standard costs for utilizing your traditional medical insurance.

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Do I have to use SurgeryPlus?

No, SurgeryPlus is a supplemental benefit, and participation isn’t mandatory. You can expect access to world-class surgeons that have been rigorously screened, not only for their education and training, but also for their volume and complication rates. You may also expect financial savings by using SurgeryPlus.

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What surgeries are covered?

SurgeryPlus covers hundreds of non-emergent surgery types within most of the surgical specialties including, but not limited to, the following:

  • Knee
    • Knee Replacement
    • Knee Replacement Revision
    • Knee Arthroscopy
    • ACL/MCL/PCL Repair
  • Hip
    • Hip Replacement
    • Hip Replacement Revision
    • Hip Arthroscopy
  • Shoulder
    • Shoulder Replacement
    • Shoulder Arthroscopy
    • Rotator Cuff Repair
    • Bicep Tendon Repair
  • Foot and Ankle
    • Ankle Replacement
    • Bunionectomy
    • Hammer Toe Repair
    • Ankle Fusion
    • Ankle Arthroscopy
  • Spine
    • Laminectomy/Laminotomy
    • Anterior Lumbar Interbody Fusion
    • Posterior Lumbar Interbody Fusion
    • Anterior Cervical Disk Fusion
    • 360 Spinal Fusion
    • Artificial Disk
  • Wrist and Elbow
    • Elbow Replacement
    • Elbow Fusion
    • Wrist Fusion
    • Wrist Replacement
    • Carpal Tunnel Release
  • General Surgery
    • Gallbladder Removal
    • Hernia Repair
    • Thyroidectomy
  • GI
    • Colonoscopy
    • Endoscopy
  • GYN
    • Hysterectomy
    • Bladder Repair
    • Hysteroscopy
  • Bariatric
    • Gastric Bypass
    • Laparoscopic Gastric Bypass
    • Laparoscopic Sleeve Gastrectomy
  • ENT
    • Ear Tube Insertion (Ear Infection)
    • Septoplasty
    • Thyroidectomy
    • Sinuplasty

This is not an exhaustive list. Contact a Care Advocate today at (855) 715-1680 if you would like more information about a specific procedure type.

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What is a Care Advocate?

When you call SurgeryPlus, a Care Advocate is assigned to your case. Your Care Advocate is your dedicated, personal assistant throughout the process, walking you through education about SurgeryPlus and the surgeons nearest you, medical records transfer, scheduling appointments, coordinating travel, and ensuring your satisfaction throughout the entire process.

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Can I still use SurgeryPlus if I already have a surgery planned?

Yes! Call and speak to a Care Advocate and find out if your surgeon is in our network. Should your surgeon not be a SurgeryPlus surgeon, a Care Advocate can offer you a selection of SurgeryPlus surgeons for you to see for consultation, and can help ensure your records and any workup are referred over so you to be scheduled and proceed through SurgeryPlus, as quickly as possible to accommodate your schedule.

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Do I need to obtain pre-authorization or pre-certification from my referring physician before I contact SurgeryPlus?

SurgeryPlus does not require pre-authorization for procedures beyond surgical clearance for bariatric procedures. Utilizing top surgeons ensures we have an expert review of your surgical case, so additional pre-authorization from a third-party source is not required.

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What can I do if a procedure is not pre-authorized or pre-certified? Can I still use SurgeryPlus?

Your Care Advocate can assist you with any authorization needs; however, it’s not required through the SurgeryPlus program.

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Do I have to use the SurgeryPlus surgeon?

Only participating in-network SurgeryPlus providers can be used with the SurgeryPlus benefit. SurgeryPlus surgeons are rigorously screened, and only a select few are able to pass requirements and are invited to participate, so this helps ensure you are in the "best hands."

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Do I have to travel to use SurgeryPlus?

Depending on the type of surgery you need and where you live, you may have to travel to use SurgeryPlus to access our surgeons, but the benefit covers the cost of travel and lodging for major procedures. Your Care Advocate will make all travel and payment arrangements for you if travel is needed, so that you can focus on your health and recovery.

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If my child needs surgery, does the benefit include coverage of travel costs for both parents/guardians to accompany the child?

No. The benefit will cover the eligible member receiving surgery and one companion only. If additional companions wish to accompany the member, you may coordinate with the SurgeryPlus Care Advocate, but the additional costs (airfare, hotel, etc.) must be paid by the additional companion(s).

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Why does the Pharmacy Benefit Manager change? What does this mean for me?

Periodically, the Division competitively bids these contracts through a Request for Proposal (RFP). This gives us an opportunity to seek better service at lower cost for members and the plan.

Effective 1/1/2019, the AlaskaCare plan uses OptumRx as the PBM to administer pharmacy benefits.

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How will compound medications be covered with OptumRx?

OptumRx will process claims according to the AlaskaCare plan document. Compounds will continue to be covered under the Defined Benefit Retiree Health plan.

Coverage of compounds differs for the active employee and defined contribution retiree health plans. The AlaskaCare Employee Health Plan and AlaskaCare DCR Benefit Plan only cover compound drugs if:

  1. the product contains at least one prescription ingredient;
  2. the active ingredient(s) is approved by the FDA for medicinal use in the United States;
  3. the product is not a copy of a commercially available FDA approved drug; and
  4. the safety and effectiveness for the intended use is supported by FDA approval, or adequate medical and scientific evidence in the medical literature.

OptumRx maintains a National Compound Credentialing Program (NCCP) to ensure the best compounded medication quality and effectiveness for the patients who need personalized medications. You must fill your compounded medication prescription at a pharmacy which has been credentialed with the OptumRx National Compound Credentialing Program (NCCP).

Using an NCCP pharmacy ensures that you will not be charged up front for your prescription (and required to submit your own claim for reimbursement), you will not be charged for molding or other non-covered charges, and you will not be charged for shipping if the pharmacy mails your compounded medication to you. You can find a list of NCCP-credentialed pharmacies here. You can also call OptumRx at (855) 409-6999 (TTY 711) to get help locating NCCP-credentialed pharmacies.

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How will OptumRx work with the Enhanced Group Waiver Program (EGWP) for retirees?

The pharmacy benefit for AlaskaCare retirees remains the same, and OptumRx will manage all pharmacy benefits. Medicare-eligible retirees and dependents will be automatically enrolled in the enhanced EGWP. Members will not need to do anything to enroll and do not need to enroll in an individual Medicare Part D plan.

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What happens if I don’t receive my prescription drug card in the mail?

If you need to fill prescriptions before your card arrives, you can contact the Division and we will print or email a temporary card. As of January 1, 2019, you can also get a printable ID card from the member portal, or view your card in the mobile app.

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Why did I receive more than one ID card with different ID numbers?

Please select the scenario that best describes you:

  • I am covered under a single AlaskaCare plan, and…
    • I am an active employee:
      ID cards are issued in packs of two to active employees. If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.
    • I am a retiree that is not eligible for Medicare:
      ID cards are issued in packs of two to retirees that are not eligible for Medicare. If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.
    • I am a Medicare-eligible retiree who is not covered under the enhanced Employer Group Waiver Program (EGWP):
      ID cards are issued in packs of two to retirees that are not enrolled in the AlaskaCare enhanced Employer Group Waiver Program (EGWP). If you have an eligible dependent, you can share the extra card with your dependent. If you have more than one eligible dependent, you can request additional cards through OptumRx at (855) 409-6999. Starting January 1st,1, 2019, you can also print a temporary card from the OptumRx portal, or use the OptumRx mobile app.
    • I am a retiree covered under the enhanced Employer Group Waiver Program (EGWP):
      You should have received only a single ID card with the MedicareRx logo in the lower right corner (see example below). Please contact the Division or OptumRx for additional information on why you may have received a second card.
  • I am covered under my own plan and under my spouse’s AlaskaCare plan, and…
    • Both my spouse and I are either an active employee or a retiree not yet eligible for Medicare:
      You will both receive a two-pack of ID cards with your own name and ID number. You may share one copy of your ID card with your spouse, however, you or your dependents only need to present one of these ID cards to the pharmacy. OptumRx coordinates your coverage behind the scenes.
    • Both my spouse and I are are retirees and eligible for Medicare:
      If you are both eligible for Medicare and are enrolled in the enhanced Employer Group Waiver Program (EGWP), you should each receive a single ID card that has the MedicareRx logo in the lower right (see example below). Each card will have an individual name and ID number. Although you receive only one card, when you present the card at the pharmacy you will receive the benefit of your double coverage under the plan. This means you will not be required to pay a copay at the pharmacy counter.
    • One of us is a Medicare-eligible retiree enrolled in the enhanced Employer Group Waiver Program (EGWP) and the other is either an active employee or a retiree not enrolled in EGWP:
      The retiree who is Medicare-eligible and is enrolled in the enhanced Employer Group Waiver Program (EGWP) will receive a single ID card that has the MedicareRx logo in the lower right (see example below). The card will have their individual name and ID number. Although they receive only one card, when they present the card at the pharmacy, they will receive the benefit of having double coverage under the plan. This means they will not be required to pay a copay at the pharmacy counter.

      The spouse who is not enrolled in the EGWP will receive an ID card two-pack in their own name for each layer of coverage they have (their own coverage and their dependent coverage as the spouse of a Medicare-eligible retiree). The only difference between the two packs of ID cards will be the ID number. The ID number that matches the Medicare-eligible retiree’s MedicareRx ID card will be the dependent coverage card.
  • I am covered under more than one of my own AlaskaCare plans, and…
    • I am eligible for Medicare:
      If you are eligible for Medicare and are enrolled in the enhanced Employer Group Waiver Program (EGWP), you should receive a single ID card that has the MedicareRx logo in the lower right (see example below). Although you receive only one card, when you present the card at the pharmacy you will receive the benefit of your double coverage under the plan. This means you will not be required to pay a copay at the pharmacy counter.
    • I am not eligible for Medicare:
      You will receive an ID card two-pack for each layer of coverage you have. The only difference between the different packs of ID cards will be the ID number. However, you only need to present one of these ID cards to the pharmacy. OptumRx coordinates the coverage behind the scenes.

Sample card:

OptumRx EGWP pharmacy card

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Why did I receive a new ID card from Aetna? I thought my medical benefits weren’t changing?

The transition to OptumRx does not affect your medical benefits—these continue to be administered by Aetna. However, because Aetna and their contractor CVS/Caremark no longer administer AlaskaCare pharmacy claims, all AlaskaCare members will receive updated ID cards from Aetna that reflects their medical benefit coverage. Retirees will receive two new ID cards from Aetna – one for medical coverage, and one for vision/audio coverage. You should use your Aetna ID card at your doctor’s office, and your OptumRx ID card at the pharmacy counter.

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Can my dependent use my card at the pharmacy and vice versa?

OptumRx coordinates all the layers of coverage for you and your dependents behind the scenes, so in many cases you and your dependents can use each other’s cards at the pharmacy. However, a non-EGWP dependent should not use the card that has a MedicareRx logo in the lower right corner. This card would only work if the pharmacist uses the correct person code (to identify them as a dependent rather than the policy holder). To avoid any confusion at the pharmacy, we recommend you and your dependents only use a card that has your name on it.

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I am an active employee AND a retiree. How do I know which card is for my active plan and which one is for my retiree plan?

You can tell the difference between the cards by looking at the logo on the card. One will say AlaskaCare Employee Pharmacy Plan, and the other will say AlaskaCare Retiree Pharmacy Plan. Your employee plan will typically be the primary payer.

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What happens if our new prescription cards are not received by January 1, 2019?

If you need to fill prescriptions before your card arrives, you can contact the Division and we will print or email a temporary card. As of January 1, 2019, you can also get a printable ID card from the member portal, or view your card in the mobile app.

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I received a letter from OptumRx telling me I am taking a medication that will require prior authorization to determine if it is covered. What should I do?

You can contact OptumRx at (855) 409-6999, TTY711 if you have questions about your prescriptions or any correspondence you have received from them.

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How can I tell if the Prior Authorization letter I received is accurate or not?

If you are Medicare-eligible and are taking a medication that requires prior-authorization, you may receive a copy of the letter below. You can contact OptumRx at (855) 409-6999, TTY711 if you have questions about your prescriptions or any correspondence you have received from them.

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I received a phone call from an OptumRx representative, but my caller-ID says the call is coming from United Health Care. Is this a scam?

The OptumRx home delivery unit reaches out to members to assist with setting up their home delivery accounts and to verify the prescriptions they want delivered. If you receive a call to this effect, it is not a scam. However, if you are unsure if the call is legitimate, you can always decline the call and then contact OptumRx at (855) 409-6999 to ensure the call is genuine.

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I received a check in the mail from OptumRx. What is it for?

You may have received a check from OptumRx for a variety of different reasons. To find out what the check was for and what to do next, please contact OptumRx Member Services at (855) 409-6999.

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I received a call from an OptumRx representative who stated my mail-order prescriptions have transferred over and then asked me for personal information. Is this a scam?

The OptumRx home delivery unit reaches out to members to assist with setting up their home delivery accounts and to verify the prescriptions they want delivered. If you receive a call to this effect, it is not a scam. However, if you are unsure if the call is legitimate, you can always decline the call and then contact OptumRx at (855) 409-6999 to ensure the call is genuine.

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I received a letter from OptumRx asking me to confirm my enrollment in the AlaskaCare Retiree Medicare Prescription Drug Plan within 30 days. The bottom of the letter has this document code: S8841_19_EXH-5_AKC. What should I do next?

You received this letter because the Centers for Medicare & Medicaid Services (CMS or Medicare) indicated that you have alternative prescription drug coverage under another plan that may be receiving subsidies from Medicare for providing that coverage. We encourage members to confirm enrollment in the AlaskaCare Retiree Medicare Prescription Drug Plan by calling OptumRx at (855) 235-1405. If you do not confirm your enrollment or choose not to participate in the AlaskaCare Retiree Medicare Prescription Drug Plan, you will be placed into the opt-out prescription drug program. This is highly discouraged, as it will result in higher costs for you and for the health plan.

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Can I transfer my prescriptions from my local pharmacy to the AlaskaCare home delivery service provided by OptumRx?

Yes, members may transfer prescriptions from their local pharmacy to OptumRx Home Delivery or from Home Delivery to their local pharmacy:

  1. Members may call their pharmacy and request they transfer prescriptions from the pharmacy to OptumRx Home Delivery. To start home delivery, log in to OptumRx.com , use the OptumRx app, or call (855) 409-6999.
  2. Members may call OptumRx at (855) 409-6999 and request Home Delivery prescriptions be transferred to their local pharmacy.
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