Needs Review Not Apprvd
June 2020, Issue 34
What Your AlaskaCare Health Plan is Doing for You
In response to the COVID-19 national public health emergency declared on January 31, 2020 and the State of Alaska public health disaster emergency declared on March 11, 2020 by Governor Mike Dunleavy, the Division of Retirement and Benefits has implemented temporary administrative changes and suspensions in the AlaskaCare health plans. Please note, these temporary changes are the result of Federal and State health mandates, suspension orders, and other guidance. The Division’s compliance with these various requirements is temporary in nature and does not create a vested benefit in relation to these changes. All temporary administrative changes will be automatically rescinded upon the expiration of relevant enabling documents.
Effective March 9, 2020 through the end of the public health disaster or as mandated by the Federal CARES Act, the AlaskaCare retiree health plans are waiving member cost share (e.g. deductible, co-insurance) for laboratory tests ordered to diagnose and treat COVID-19. To qualify for waived deductible and co-insurance, laboratory tests must be deemed medically necessary under the terms of the plan and they must be FDA-approved. The co-insurance and deductible are also waived for the office visit if the primary diagnosis code for the visit is COVID-19 or the diagnostic tests are billed with the office visit.
Influenza Vaccine (Flu Shots)
Effective March 6, 2020 through the end of the public health disaster, the AlaskaCare retiree plans will temporarily cover Trivalent and Quadrivalent influenza vaccines received at a network pharmacy. If a retiree plan member receives an influenza vaccine from an out-of-network pharmacy, the AlaskaCare retiree plans will cover the cost up to the recognized charge; the member will be responsible for paying the total amount of the prescription at the time of purchase and must submit a paper claim for reimbursement. If a retiree plan member receives an influenza vaccine from a healthcare provider, the standard costs will apply for the vaccine and the office visit. Reimbursement for members that obtain services from an out-of-network provider may result in balance billing if the provider charges above the recognized charge.
Pneumococcal Vaccine (Pneumonia Shot)
Effective March 13, 2020 through the end of the public health disaster, the AlaskaCare Retiree Plan will temporarily cover pneumococcal vaccines consistent with the guidelines published by the Centers for Disease Control (CDC). The pneumococcal vaccine will be covered at 100% if administered at an in-network pharmacy. If a retiree plan member receives a pneumococcal vaccine from an out-of-network pharmacy the AlaskaCare retiree plans will cover the cost up to the recognized charge; the member will be responsible for paying the total amount of the prescription at the time of purchase and must submit a paper claim for reimbursement. If a retiree plan member receives a pneumococcal vaccine from a healthcare provider, the standard costs will apply for the vaccine and the office visit. Reimbursement for members that obtain services from an out of network provider may result in balance billing if the provider charges above the recognized charge.
Aetna Crisis Response Line
We know that the uncertainty around COVID-19 may cause stress and anxiety. If you are someone you know is experiencing a mental health crisis, please know that help is available. Aetna is temporarily providing support for AlaskaCare retiree health plan members through the Employee Assistance Program (EAP) . EAP staff is available 24 hours a day, 7 days a week, 365 days a year. To speak with a counselor contact AlaskaCare EAP at (855) 417-2493. You can also contact Alaska’s suicide prevention and Someone To Talk to Line at (877) 266-help or text 4help to 839863.
Waiving Cost Share for COVID-19 Inpatient Hospital Services
If you need inpatient treatment for COVID-19, AlaskaCare is here to help with the cost. Effective March 25, 2020 through August 31, 2020, the AlaskaCare retiree health plans are temporarily waiving applicable cost sharing provisions including deductible, coinsurance, and co-pays up to recognized charge for inpatient admissions and medically necessary transportation for in-network charges related to COVID-19 and related diagnoses.
Expanded Coverage of Telemedicine
AlaskaCare is making it easier for you to connect with your regular health care providers remotely during the COVID-19 public health emergency. Effective March 4, 2020, through September 2, 2020 or to the end of the public health disaster, whichever is sooner, the AlaskaCare retiree health plans are temporarily expanding coverage of telemedicine services delivered by your regular providers in alignment with Medicare temporary telemedicine expansions. If you or your provider are unsure which telehealth services are eligible for coverage, please contact Aetna at (855) 784-8646 for more information.
Effective March 10, 2020 through the end of the public health disaster, AlaskaCare retiree health plan members will have temporary access to Teladoc general medical services with a $0 copay. Teledoc doctors can evaluate your risk for COVID-19 and help with next steps when necessary. Teladoc can also fulfill other health care needs unrelated to COVID-19 and is a convenient and affordable way to receive care whenever you need it from wherever you are within the United States. Using telemedicine can help you and your family members avoid unnecessary contact.
- Register or Login: Teladoc.com/Aetna
- Mobile App: Teladoc.com/mobile
- Phone: (855) TELADOC or (855) 835-2362
Suspension of Disenrollment
Worried about paying your premiums? We will work with you to help you keep your health coverage.
Effective April 1, 2020 in accordance with federal guidelines, AlaskaCare is temporarily suspending disenrollment for members continuing their coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) who fail to pay health benefit COBRA premiums timely. Please contact the Division to learn about your options. All missed premium payments are due in full 60 days following the termination of the national public health emergency per IRS regulations.
Effective March 4, 2020, through July 2, 2020 the AlaskaCare employee and retiree plans temporarily lifted restrictions on early medication refills. Members may obtain an additional 90-day supply of valid prescriptions. This does not apply to opioid medications.
Effective July 3, 2020 members requiring additional early medication refills due to reasons associated with the COVID-19 health emergency should ask their pharmacist to contact OptumRx.The preceding temporary administrative changes are prospective in nature and shall remain in effect until earlier of the date of: 1) the termination of the suspensions contained in the applicable COVID-19 Disaster Order of Suspension; 2) the termination of the Declaration of Public Health Disaster Emergency issued by Governor Mike Dunleavy; or 3) the national public health emergency is terminated by the Secretary of Health and Human Services; including any extensions or amendments thereof. The temporary administrative changes listed above are in response to a State of Alaska and federally recognized health emergency and do not provide a vested right to coverage for any individual. The Division of Retirement and Benefits retains the sole discretion to rescind or modify these temporary administrative changes depending on the circumstances.
For up-to-date information on COVID-19 you can visit the following webpages:
We are all in this together
Everyone can play their part in slowing the spread of COVID-19, protecting our most vulnerable Alaskans, and making sure our health care delivery systems can handle this pandemic. What we do to practice social distancing now will save people’s lives.
Take Everyday Precautions
Take everyday preventive actions:
- Wear a cloth face covering in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.
- Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing, or having been in a public place. If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
- To the extent possible, avoid touching high-touch surfaces in public places – elevator buttons, door handles, handrails, handshaking with people, etc. Use a tissue or your sleeve to cover your hand or finger if you must touch something. Wash your hands after touching surfaces in public places.
- Avoid touching your face, nose, eyes, etc.
- Clean and disinfect your home to remove germs: practice routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks, and cell phones).
- Avoid crowds, especially in poorly ventilated spaces. Your risk of exposure to respiratory viruses like COVID-19 may increase in crowded, closed-in settings with little air circulation if there are people in the crowd who are sick.
- Stay informed – keep up-to-date with the latest guidance from federal, state, and local health organizations.
Need Help Managing Your Chronic Medications?
The use of numerous prescription and over-the-counter medications is common among seniors. To get the greatest benefit from those medications, it is important to take each one exactly as your doctor prescribes. It may seem like an overwhelming task, but a little information, organization, and help can keep you on your medication schedule and away from unanticipated drug interactions.
The Medication Therapy Management Program (MTMP) offered by OptumRx can help. MTMP is focused on improving therapeutic outcomes for Medicare Part D members taking eight or more chronic medications. The program includes:
- A review of medications to assess medication use and identify medication-related problems. This review may be conducted person-to-person, “behind the scenes” by a qualified provider, or using computerized, clinical algorithms.
- An interactive, person-to-person consultation performed by a qualified provider at least annually to all MTMP-eligible members.
- An individualized, written summary of the consultation for the member, including but not limited to, a personal medication list (PML), a reconciled medication list, an action plan, and recommendations for monitoring, education, or self-management.
To see if you qualify, or to register for the program, contact OptumRx Member Services at (855) 409-6999.
Retiree Town Hall Events
Join the Conversation
Town Hall Events are group calls hosted by the Alaska Department of Administration, Division of Retirement and Benefits for all interested AlaskaCare retirees and families to ask questions about the AlaskaCare health plans. You can join the call to learn more about your health plan and ask Division staff any questions you have about your benefits. This format gives retirees a chance to connect directly with Division staff to hear the latest news on all things AlaskaCare, raise questions, share comments, and learn more about the health plans.
For those of you who have participated, thank you for joining us, you have asked some great questions! Town Hall events are held on the third Thursday of the month.
Subscribe to the Monthly Retiree Health Plan Newsletter
Retiree newsletters are sent electronically to Health Plan members that have subscribed to receive updates. Each month we feature an article that helps you Get to Know your Benefits, provides you with updates about the Health Plan, and information about health events and resources. You can subscribe or unsubscribe at any time by managing your preferences.
Giving a Family Member or Caregiver Permission to Call on Your Behalf
Would you like for a family member or caregiver to be able to call Medicare on your behalf? Medicare can’t give your personal health information to anyone unless they have permission in writing first. There are two ways to give permission:
- Print and fill out the Medicare form CMS-10106: “Authorization to Disclose Personal Health Information” and mail it in to the address listed on the form.
- Submit the form online at mymedicare.gov You can call 1-800-MEDICARE (1-800-633-4227) for more information.
Enhanced Group Waiver Program
An Employer Group Waiver Program, known as an EGWP or “Egg Whip,” is a program offered by the federal government that increased federal subsidies for prescription drugs for the retiree health trust. The Division implemented an EGWP in the AlaskaCare retiree plan effective January 1, 2019. During the first year, EGWP has brought $32.9 million in net savings to the retiree health trusts. The AlaskaCare EGWP represents an administrative change to how pharmacy benefits are managed for Medicare-eligible retirees and dependents. The Division must manage the health plan to ensure retirees can access their earned benefits throughout the entire course of their life, and the AlaskaCare enhanced EGWP allows the State to maintain pharmacy benefits for Medicare-eligible retirees and beneficiaries, while increasing federal reimbursement of existing costs, reducing the State’s direct costs for these benefits in the long-term. An AlaskaCare EGWP is just one way the Division has reduced the cost of health care while maintaining or improving benefits for retirees. Our goal is to improve, protect, and sustain the health plan as it continues to offer high quality benefits for current and future generations of retirees. Realizing savings from the AlaskaCare EGWP would not have been possible without the support of AlaskaCare retirees— thank you!
What You Need to Know About IRMAA Reimbursement
Certain high-income retirees who are Medicare eligible and enrolled in the AlaskaCare enhanced Employer Group Waiver Program (EGWP) pharmacy plan are required to pay a premium surcharge associated with Medicare Part D plans, known as an Income Related Monthly Adjustment Amount, or IRMAA. This is required by Medicare and is the same type of surcharge that high-income enrollees already pay for a Medicare Part B plan.
For 2020, if you are an individual earning more than $87,000 per year or a married couple who earns more than $174,000 per year, you will be required to pay the IRMAA; retirees enrolled in EGWP and whose household income is below this threshold will not be subject to the IRMAA premium surcharge.
If you are subject to the Medicare Part D IRMAA surcharge, you will be reimbursed.
For all Medicare plans, the IRMAA will either be deducted directly from your monthly Social Security check (if you qualify for Social Security) or will be invoiced to you directly each month. If you are charged a Medicare Part D IRMAA for your prescription drug coverage, the Division of Retirement and Benefits will reimburse you for the full cost of the Medicare Part D premium surcharge each month, through a tax-advantaged Health Reimbursement Arrangement (HRA) account. If you receive a bill from Medicare, you should pay the bill timely, and contact the Division to learn about your reimbursement options
Follow the steps below to establish your 2020 IRMAA reimbursement account:
- Scan, copy, or take a photo of your Social Security letter or Medicare bill that shows what your 2020 Part D IRMAA surcharge will be.
- Complete the PayFlex Claim form.
- Mail, fax, or email your completed form and documentation to:
Division of Retirement and Benefits
PO Box 110203
Juneau, AK 99811-0203
Fax: (907) 465-3086
The Division will coordinate with PayFlex on your behalf to establish your 2020 HRA account. Please allow up to three weeks for processing. For more information, contact PayFlex at (800) 416-7053. HRA claims for dates of service in a benefit year must be submitted within 90 days of the close of that benefit year. For example, claims for reimbursement of 2020 IRMAA surcharges must be received by March 31, 2021. Retroactive reimbursements will not be issued for claims received beyond 90 days after the close of the benefit year.
Note: Due to the COVID-19 public health emergency, claims for reimbursement for 2019 IRMAA surcharges were accepted until June 30, 2020.
AlaskaCare 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 do not normally use opioids
- The plan limits the maximum dosage per day to 50 mme 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.
- 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)
Recommendations that influenced the AlaskaCare opioid dispensing policies:
- Alaska Opioid Policy Task Force (AOPTF)
- Center for Disease Control (CDC) updated their Guideline for Prescribing Opioids for Chronic Pain on 8/29/17
- The FDA released an action plan to help address the opioid crisis:
- FDA Opioids Action Plan
- Timeline of Selected FDA Activities and Significant Events Addressing Opioid Misuse and Abuse
- OptumRx: Current AlaskaCare Pharmacy Benefit Manager complies with the CDC and FDA guidelines
- Aetna: Previous AlaskaCare pharmacy benefit manager published their five-year plan to help fight the opioid epidemic
Coordination of Benefits Explained
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?
Examples of common COB situations and rules:
|If You Are Covered Under...||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 AlaskaCare 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
Pays 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
Pays third: Medicare
Pays 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 is how the plans pay:
- Primary: The 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: The plan of the parent with custody of the child
- Pays third: The plan of the spouse of the parent with custody of the child
- Pays fourth: The 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. For more information on how recognized charges are calculated, see the Recognized Charges FAQ on the AlaskaCare website.
Alaska Quit Line
Smoking Cessation Programs
Quitting smoking isn’t easy, but it’s worth it. The good news is that once you stop, your body starts healing right away. Carbon monoxide levels normalize in just 12 hours, and your risk for heart disease can drop significantly after just 12 months as a non-smoker. Why wait when you can make a clean start today?
We Value Your Feedback!
As an AlaskaCare Retiree member, your input is valued and important. Below, please see a list of ways to contact us with your feedback.
Send us a letter:
State of Alaska
Division of Retirement and Benefits
P.O. Box 110203
Juneau, AK 99811-0203
Come visit us:
State Office Building
333 Willoughby Avenue
Juneau, AK 99801
The Retiree Health Plan Advisory Board Represents You, the Retirees
The Retiree Health Plan Advisory Board (RHPAB) was created through Administrative Order No. 288 on September 29, 2017 to facilitate engagement and coordination between the State of Alaska’s retirement systems’ members, the Alaska Retirement Management Board, and the Commissioner of Administration regarding the administration of the retiree health plan. The seven-member board is a group of individuals that represent you, the retirees. The Board consists of:
- An ARMB trustee,
- A human resources official or financial officer employed by a political subdivision participating in the State’s retirement systems,
- A Public Employees’ Retirement System (PERS) retired member, selected from a list of three individuals nominated by retiree groups that represent PERS members,
- A Teachers’ Retirement System (TRS) retired teacher or member selected from a list of three individuals nominated by retiree groups that represent TRS members,
- A member of the State’s retirement systems who is a retired member under PERS Tiers I, II, or III, TRS Tiers I or II, or the Judicial Retirement System (JRS),
- An active or retired member of PERS or an active or retired teacher or member of TRS who is vested in the PERS Tiers I, II, or III or TRS Tiers I or II retiree plans, and
- A public member who is not a member or beneficiary of the PERS, the TRS, or the JRS.
The board members may be nominated by retiree stakeholder groups and are appointed by the Governor. The Governor may choose from the nominee lists, request further solicitation, or make an appointment of the Governor’s choosing.
The RHPAB provides valuable input and has been instrumental in evaluating new proposals that would help modernize the retiree health plan while sustaining the benefit level. The modernization effort undertaken between RHPAB and the Division is intended to help align the plan with the current healthcare environment. An example of a recent change is the roll-out of the enhanced Employee Group Waiver Program (EGWP) for Medicare-eligible retirees. Implementing this change has maintained prescription drug coverage for EGWP participants, expanded coverage of certain vaccines to all AlaskaCare retirees, and will save the retiree health trusts millions of dollars annually. The board voted in favor of implementing EGWP effective January 1, 2019.
We invite you to attend or listen to any or all the meetings; members are always welcome. The meeting dates are posted to Online Public Notices and to AlaskaCare.gov. If you would like to offer public comment for the board to review, send an email to .
Access Your Form 1095-B Online
Beginning March 6, 2020
Form 1095-B is a tax form that reports the type of health insurance coverage you have, any dependents covered by your insurance policy, and the period of coverage for the prior year. The Division of Retirement and Benefits has provided this form to members under age 65 to verify on your tax return that you and your dependents have at least minimum essential health insurance coverage.
Since this information is already provided to the Internal Revenue Service (IRS) by Medicare, it is no longer necessary to have a printed copy of form 1095-B in order to file your taxes. Starting March 6, 2020 for the 2019 tax year, the Division will provide members under age 65 access to an electronic version of form 1095-B online. You can access your 1095-B form in your MyRNB account under myDocuments. If you are 65 or older, contact Medicare at (800) MEDICARE to obtain a copy of your form 1095-B.
Health Benefit Contact Information
Division of Retirement and Benefits
Division of Retirement and Benefits
Medical Benefits: Aetna Concierge
Member Services: (855) 784-8646
Dental Benefits: Moda/Delta Dental
Member Services: (855) 718-1768
Pharmacy Benefits: OptumRx
Member Services: (855) 409-6999
Specialty Pharmacy: BriovaRx
Enrollment Services: (855) 427-4682
Long Term Care Benefits: CHCS Services, Inc.
Member Services: (888) 287-7116
The information provided on this page may or may not be up-to-date. If you are unsure, please contact us.