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Edited by LM 3/31/22Not Apprvd


Retiree Health Plans


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

The State of Alaska retirement systems provide extensive and valuable benefits for you and your family including hospitalization, medical, surgical, maternity care, and other services necessary for the diagnosis and treatment of an injury or disease. Your health care coverage is good worldwide. These benefits may change from time to time.

Defined Benefit Retiree Health Plan: Public Employees’ Retirement System Tier I, II and III and Teachers’ Retirement System Tier I and II and their eligible dependents can participate.

Defined Contribution Retiree Health Plan: Public Employees’ Retirement System Tier IV and Teachers’ Retirement System Tier III and their eligible dependents can participate.

Please check the current AlaskaCare Retiree Insurance Information booklet for the most up-to-date and complete information about health benefits and eligibility.

Defined Benefit Retiree Health Plan Premiums

Tier II/III retirees without system-paid medical
Coverage Level 2021 Monthly Premium 2022 Monthly Premium
Retiree Only $704 $704
Retiree and Spouse $1,408 $1,408
Retiree and Child(ren) $995 $995
Retiree and Family $1,699 $1,699
Effective: Jan. 1 - Dec. 31, 2022

Defined Contribution Retiree Health Plan Premiums

Retiree and Spouse (if applicable) are Medicare Age Eligible
Coverage Level 2021 Monthly Premium 2022 Monthly Premium
Retiree Only $320.79 $320.79
Retiree and Spouse $641.58 $641.58
Retiree and Child(ren) $849.66 $849.66
Retiree and Family $1,170.45 $1,170.45
Retiree and Spouse (if applicable) are not Medicare Age Eligible
Coverage Level 2021 Monthly Premium 2022 Monthly Premium
Retiree Only $1,094.46 $1,094.46
Retiree and Spouse $2,188.92 $2,188.92
Retiree and Child(ren) $1,623.84 $1,623.84
Retiree and Family $2,718.30 $2,718.30
When only the Retiree or the Spouse is Medicare Age Eligible
Coverage Level 2021 Monthly Premium 2022 Monthly Premium
Retiree and Spouse $1,415.25 $1,415.25
Retiree and Family $1,944.12 $1,944.12
Effective: Jan. 1 - Dec. 31, 2022

Introduction

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.

In addition, you can accomplish these tasks by setting up your online account at OptumRx.com , or downloading the OptumRx app.

OptumRx streamlines the Medicare Part D/EGWP Annual Notices, which means less paperwork for you! Each calendar year Medicare requires OptumRx provide AlaskaCare enhanced Employer Group Waiver Program (EGWP) members with an Evidence of Coverage booklet. It tells you how to use your Medicare prescription drug coverage through our plan, explains your rights and responsibilities, what is covered, and what you pay as a member of the plan. Instead of automatically mailing a copy to all members, Medicare is allowing OptumRx to provide the document electronically through the online OptumRx member portal. You can still receive a paper copy of the Evidence of Coverage booklet upon request.

There are two ways to get an updated Evidence of Coverage booklet for your plan:

  • Visit OptumRx.com and download a copy of the Evidence of Coverage from the “Programs & Forms” page (found under the “Information Center” tab).
  • Call OptumRx at the number listed on your member ID card to request to have a copy mailed to you.

Members can still expect to receive the Annual Notice of Changes in the mail, along with instructions on how to request further information.

Are you currently outside of the United States? You can contact OptumRx from another country by:

  • Dialing the USA direct access code for the country you are currently in. You can find a complete list of access codes here .
  • Dialing OptumRx at (855) 409-6999.

AlaskaCare Retiree Plan Formulary

AlaskaCare Defined Benefit Retiree Plan Formulary

AlaskaCare Defined Contribution Retiree Plan Formulary

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.

OptumRx.com: Your Digital Tool

OptumRx.com is a fast, easy and secure way to get the information you need to make the most of your pharmacy benefit.

Website features and tools:

  • Compare medication prices at different pharmacies
  • 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
  • Order medications you take regularly online and make fewer trips to the pharmacy.
  • Get three-month supplies and you could pay less. Orders are sent using free standard shipping.

Learn how to register with HealthSafe ID™ .

OptumRx On the Go!

Access your pharmacy benefits and manage your prescriptions from your smartphone or tablet with the OptumRx App.

  • Find drug prices and lower-cost alternatives
  • View your claims history
  • Locate a pharmacy
  • Access your ID card, if your plan allows
  • Manage medication reminders
  • Transfer retail prescriptions to home delivery
  • Refill or renew home delivery prescriptions

Take care of your home delivery prescriptions at any hour, from anywhere, using the new OptumRx App. This application makes it easier than ever to refill and renew existing home delivery pharmacy prescriptions, sign up new prescriptions for home delivery, compare medication prices and more.

The My Medicine Cabinet feature contains key information for all medications you take. With At-a-Glance functionality you can easily see when you need to take action such as refilling home delivery medications or tracking orders.

Download the OptumRx App from the Apple® App Store or Google Play™.

Authorization to Use and Disclose Protected Health Information

If you or a loved one needs assistance from a representative in receiving pharmacy benefits, you must submit a completed Authorization to Use and Disclose Protected Health Information (PHI) form to OptumRx. Use this form to request authorization for the release of PHI, including a patient profile or prescription records, to your authorized representative(s).

Please mail the completed form to:

OptumRx
Attn: Commitment and Follow Up Team
6860 West 115th Street
Mail Stop: KS015-1000
Overland Park, KS 66211-2457

or fax to (866) 889-2116.

Manual Pharmacy Claim Form for Member Reimbursement

To submit a manual claim form to OptumRx for reimbursement of a prescription paid out-of-pocket, please fill out the prescription drug claim form below and mail or fax it to OptumRx.

OptumRx Prescription Drug Claim Form

  • Send completed form with pharmacy receipt(s) to:
    OptumRx Claims Department
    P.O. Box 650629
    Dallas, TX 75265-0629

OptumRx Medicare Part-D (EGWP) Prescription Drug Claim Form

  • Send completed form with pharmacy receipt(s) to:
    OptumRx Claims Department
    P.O. Box 650287
    Dallas, TX 75265-0287

Enhanced Group Waiver Plan (EWGP)



EGWP: An opportunity for AlaskaCare to maintain existing pharmacy benefits for Medicare-eligible members and achieve cost savings for years to come.

Effective January 1, 2019, AlaskaCare implemented an Employer Group Waiver Plan for all Medicare-eligible members covered under the AlaskaCare retiree health plan. An Employer Group Waiver Plan, known as an EGWP or “Egg Whip,” is a program offered by the federal government that increases federal subsidies for prescription drugs for the retiree health trust. The pharmacy benefit for AlaskaCare retirees remains the same.

AlaskaCare was already receiving a federal subsidy for the retiree health prescription drug benefit. Moving to an EGWP plan means the retiree health trust will receive significantly higher subsidies than we used to, saving the trust up to $20 million annually and providing $40-$60 million each year in additional State savings through a reduction in the unfunded liability. The Division must manage the health plan to ensure retirees can access their earned benefits throughout the entire course of their life, and an AlaskaCare EGWP allows the State to keep existing pharmacy benefits for Medicare-eligible members, while increasing federal reimbursement of existing costs, reducing the State’s direct costs for these benefits in the long-term.

More than 90% of states that provide drug benefits to Medicare retirees have already implemented EGWPs. As Alaska, along with the rest of the U.S., faces rising health care costs, EGWPs are a proven win-win for maintaining high quality coverage for today’s and tomorrow’s Alaska retirees.

An AlaskaCare EGWP is just one way the Division looks to reduce the cost of health care while maintaining or improving benefits for retirees and their families. Because of EGWP, the Division was able to add preventive care in 2022! As part of the ongoing retiree health plan modernization project, the Division is evaluating adding more benefits like enhanced travel and removing the lifetime maximum. 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.

If you have questions or concerns about the EGWP, we want to hear from you!

You may contact the Division of Retirement and Benefits at:

Alaska Department of Administration
Division of Retirement and Benefits
P.O. Box 110203
Juneau, AK 99811-0203

You can also send comments via email to or reach the Division by phone toll-free at (800) 821-2251 or in Juneau at (907) 465-4460.


Upon retirement, AlaskaCare retiree beneficiaries may choose to participate in a voluntary Dental-Vision-Audio (DVA) plan to provide coverage for themselves and their eligible dependents. The Division of Retirement and Benefits is dedicated to providing affordable, valuable, and sustainable benefits to retirees. The AlaskaCare retiree Dental-Vision-Audio plan is fully funded by members’ monthly premium payments, and the Division works hard to maximize the benefits members receive while keeping premiums affordable.

Dental-Vision-Audio Premiums

The dental plan monthly premiums are set to reflect the overall value of each plan across all enrolled members. The value of each plan varies based on differences in benefit design, network access, and how much the plan pays out-of-network providers. The rates are not impacted by how many people elect one plan or the other.

Retiree Dental/Vision/Audio Coverage
Coverage Level Standard Legacy
Retiree Only $66 $73
Retiree and Spouse $131 $145
Retiree and Child(ren) $119 $132
Retiree and Family $187 $207
Effective: Jan. 1 - Dec. 31, 2022

Dental Benefits

Effective in plan year 2020, AlaskaCare began offering two retiree dental plan options, the Legacy Dental Plan, and the Standard Dental Plan. The plans have different dental coverage provisions and different monthly premium rates. The Retiree Dental Benefit Comparison may help you compare the plans and decide which is a better fit for you and your family. The AlaskaCare Retiree Insurance Information Booklets will contain the complete benefit provisions for both the standard and legacy dental plans.

For information about dental benefits contact: Delta Dental of Alaska toll-free at (855) 718-1768.

Network Providers

You have access to more than 300 licensed dentists across Alaska and 204,000 office locations nationwide. You will want to stay in the Delta Dental networks to get high quality care at a lower price. Through Delta Dental PPO and Premier networks, limits are set on what dentists can charge for certain services. It’s a way of connecting you with great care at even better rates. To find a provider call toll-free at (888) 558-2705 or you can use the online search tool.

Member Dashboard—Information at your Fingertips

Your Member Dashboard, myModa, gives you a real-time view into your dental claims and benefits. You’ll also have access to online tools and resources to manage your dental care needs.

Vision and Audio Benefits

VISION PLAN HIGHLIGHTS

  • You pay no deductible under this plan.
  • The plan covers one complete eye examination, including a required refraction, per year.
  • The plan covers two lenses during each calendar year.
  • The plan covers one set of frames during every two consecutive calendar years.
AUDIO PLAN HIGHLIGHTS
  • The Audio Plan pays up to $2,000 for each person in a covered rolling 36-month period.
  • You pay no deductible under this plan.
  • The Plan pays 80% of the recognized charge for audio services.

For information about Vision and Audio benefits contact Aetna Concierge toll-free at (855) 784-8646.

The State of Alaska is pleased to offer a voluntary Long-Term Care (LTC) Plan for benefit recipients and their spouses. The options available under the LTC plan provide a range of health and social services for people who need assistance with the basic activities of daily living.

Silver, Gold, Platinum (SGP): You must apply for this coverage before appointment to your first benefit from any retirement system.

Bronze: Available only to benefit recipients who retired prior to February 1, 2000.

CHCS Services, Inc. is the claims administrator. You may contact them at (888) 287-7116 for questions or to initiate a claim. CHCS has made a portal available where members may view which plan they are in enrolled in, review plan documents, and obtain a claim submission packet. Members can also use the portal to view claims and receive messages from their case manager.

LTC Enrollment

You must apply for this coverage before appointment to your first benefit from any retirement system. To meet this deadline, your Retiree Health Benefits Enrollment/Waiver form must be postmarked or received by the retirement application deadline. If you do not apply for coverage at this time, you waive your right to apply for this coverage at a later date.

You can send in the form separately, but most often this form is completed as part of the retirement packet.

Adding a new spouse: Use the Retiree Health Dependent Change form to add your new spouse to your health plans. The request must be received by the Division within 120 days of marriage.

Plan Comparison Chart

Bronze Option Silver Option Gold Option Platinum Option
Deductible 90 days of covered long-term care 90 days of covered long-term care 90 days of covered long-term care 90 days of covered long-term care
Benefit Eligibility Inability to perform 2 of 5 activities of daily living Inability to perform 2 of 6 activities of daily living or cognitive impairment Inability to perform 2 of 6 activities of daily living or cognitive impairment Inability to perform 2 of 6 activities of daily living or cognitive impairment
Lifetime maximum benefit $200,000 all services
$50,000 home health care
$400,000 all services $300,000 all services $300,000 all services
Nursing home daily benefit $125 in Alaska
$75 outside Alaska
$200 in and out of Alaska $200 in and out of Alaska $200 in and out of Alaska
Assisted living facility daily benefit Covered in lieu of other services if approved $150 in and out of Alaska $150 in and out of Alaska $150 in and out of Alaska
Home health care daily benefit $75 in Alaska
$40 outside Alaska
$125 in and out of Alaska $125 in and out of Alaska $125 in and out of Alaska
Hospice daily benefit Not Covered $125 in and out of Alaska $125 in and out of Alaska $125 in and out of Alaska
Respite care daily benefit amount Not Covered Up to $200 in and out of Alaska, maximum of 14 days Up to $200 in and out of Alaska, maximum of 14 days Up to $200 in and out of Alaska, maximum of 14 days
Inflation protection None None Simple at 5% of original benefit each year. Applies to lifetime and daily benefit amounts. Compound at 5% of the prior year's benefit each year. Applies to lifetime and daily benefit amounts.

Existing option closed to new entrants after 1/31/2000

Inflation protection stops at age 85. Please see the plan booklet for more information.

Premiums

Premiums are based on your age at retirement and while all premiums may increase, your premium will always be based on your age on the date you retired. If you elect coverage for your spouse, you pay a separate premium based on their age at the time of your retirement.

Monthly Rates
Age at enrollment Silver Option
$400,000 maximum
No inflation protection
Gold Option
$300,000 maximum
Simple inflation protection
Platinum Option
$300,000 maximum
Compound inflation protection
≤ 40$26$76$148
41$27$77$150
42$28$78$153
43$30$79$155
44$31$81$158
45$33$82$161
46$35$84$164
47$37$85$167
48$39$89$170
49$41$92$172
50$44$96$175
51$46$100$177
52$49$103$180
53$52$109$184
54$56$114$188
55$60$120$192
56$63$126$195
57$67$131$199
58$75$143$212
59$84$156$225
60$92$168$237
61$100$181$250
62$108$193$263
63$123$212$281
64$137$231$300
65$151$250$319
66$166$269$338
67$180$288$357
68$201$313$381
69$222$339$404
70$244$364$428
71$265$389$451
72$286$414$475
73$314$444$502
74$343$474$529
75$371$503$556
76$399$533$584
77$427$563$611
78$471$609$654
79$515$654$698
80$559$700$741
81$603$746$784
82$646$791$828
83$731$887$923
84$815$982$1018
≥ 85$900$1078$1113

Inflation protection increases annually until the covered member reaches age 85.

Monthly Rates
May 1, 2000 Age Premium (in dollars)
< 5016.10
50-5421.45
55-5926.80
60-6448.25
65-6980.45
70-74128.70
75-79193.05
80-84294.95
≥ 85412.90

Definitions

Cognitive Impairment
A measurable deterioration or loss in intellectual capacity requiring substantial supervision or verbal cueing by another individual in order to protect the impaired and others from serious threats to health and safety.

Deductible
the amount you must pay before the plan pays benefits.

Activities of Daily Living
The Silver/Gold/Platinum options include bathing, continence, dressing, eating, toileting, and transferring. The Bronze Option includes dressing, toileting, transferring, eating, and walking.

Actuarial Valuations

Archived Booklets

Defined Benefit

Defined Contribution

Certain high-income retirees are required to pay an extra premium surcharge, known as an Income Related Monthly Adjustment Amount, or IRMAA. This is similar to the surcharge for high-income enrollees in the Medicare Part B plan. If you are an individual or a married couple earning more than the threshold, you will be required to pay an extra surcharge for being enrolled in the AlaskaCare Employer Group Waiver Program (EGWP) because it is a group Medicare Part D plan. Retirees whose household income is below this threshold will not be subject to the IRMAA premium surcharge.

If you are subject to the Medicare Part D IRMAA surcharge, you will be reimbursed.

For all Medicare plans, the IRMAA will be deducted directly from your monthly Social Security check (if you qualify for Social Security) or will otherwise be invoiced to you directly each month. If you are charged a Medicare Part D IRMAA for your prescription drug coverage, the Division of Retirement and Benefits will reimburse you for the full cost of the Medicare Part D premium surcharge each month, through a tax-advantaged Health Reimbursement Arrangement (HRA) account. If you receive a bill from Medicare, you should pay the bill timely, and contact the Division to learn about your reimbursement options.

The Division of Retirement and Benefits has partnered with OptumRx and Optum Bank to create an efficient way for members to receive reimbursement for their Part D IRMAA surcharge.

What do you need to know?

  • You need to set up your HRA account every year, since IRMAA surcharges are based on your annual income and your income may change from year to year.
  • If you are not assessed a 2022 IRMAA surcharge this does not apply to you this year.
  • The deadline for submitting your 2021 IRMAA for reimbursement is December 31, 2022.

Medicare Overview

Medicare is a health insurance program for:

  • People age 65 or older
  • People under age 65 with certain disabilities
  • People of all ages with end-stage renal disease

The AlaskaCare Retiree Health Plan assumes that you and your eligible dependents are enrolled in both Parts A and B of Medicare at age 65. Once enrolled, AlaskaCare coordinates with Medicare to pay most of your medical expenses. Medicare coverage includes different categories: Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and Medicare Part D (prescription drugs).


State of Alaska Medicare Information Office

The Medicare Information Office offers one on one personalized Medicare Counseling and Medicare Seminar events by webinar. Please call for more information and to schedule.

(907) 269-3680 | Toll-free (800) 770-8973 | TTY: (800) 770-8973

550 W 7th Ave., Suite 1230
Anchorage, AK 99501
.

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 Retiree Form 1095-B Information

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.

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. The Division will provide members under age 65 access to an electronic version of form 1095-B online. Forms will be available online in March. You can access your 1095-B form in your MyRNB account under myDocuments.

If you would like to request a printed copy of your Form 1095-B, please reach out to the Member Service Center.

Page Last Modified: 05/24/22 11:50:09

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

AkCare FAQs

Why have I received multiple ID cards?

You should have a medical ID card from Aetna and a pharmacy ID card from OptumRx. If you elected the DVA plan you will also have a dental ID card from Delta Dental/Moda and a vision card from Aetna. You can use your ID cards when visiting your health care providers or pharmacy.

Aetna

Delta Dental

OptumRx

How do I obtain a new ID card?

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

To request a new physical ID card via phone, visit our Partner Contacts page.

Why aren't dependents covered to age 26 under the Retiree health plan?

The rule requiring health plans to extend dependent coverage up to age 26, regardless of financial dependency, student status, employment or marital status, doesn't apply to AlaskaCare retiree health benefits because the plan is exempt from Affordable Care Act requirements. The Division of Retirement and Benefits understands that there is strong interest in adding these benefits to the retiree health plan and is exploring options to do so while remaining cost neutral.

Learn More

What is 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.

Where can I get more information about recognized charges?

For more information on recognized charge in the Retiree Plan, see the Retiree Insurance Information Booklet , section 3.1.4 Recognized Charge.

I'm a retiree; why should I use a network provider?

Using "network" providers can provide substantial benefits to members through the elimination of what's known as "balance billing." It can also generate substantial savings to members through negotiated provider discounts.

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.

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.

If I have a procedure or service at a network facility, can I be balance billed?

You may find that not all providers at a "network" facility are part of the Aetna network. For example, if you have a surgical procedure performed at a network hospital, you may find that the hospital and surgeon are in the network, but the anesthesiologist is out-of-network. When you get your bill, you'll see that it reflects the negotiated network rates for your hospital and surgeon. The anesthesiologist, however, may charge what they choose since they have no negotiated contract with Aetna. If the anesthesiologist claim exceeds the recognized charge, you may receive a bill for the balance.

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. If you're planning surgery, ask whether the anesthesiologists are in the network. If available, the facility should accommodate your request to use a network provider for your services.

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

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.

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 .

Why do I need to purchase Medicare Part B?

The AlaskaCare Retiree health plan was created by statute to provide health coverage to eligible retirees and their dependents in 1975. Alaska Statute Sec. 39.35.535(b) requires that the retiree health plan become supplemental to federal old age benefits available at age 65. This statute has been in effect since 1975. The Retiree Insurance Information Booklet section titled, "Effect of Medicare", states: "If you do not enroll in Medicare coverage the estimated amount Medicare would have paid will be deducted from your claim before processing by this plan."

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Do I need to get Medicare part D?

If you are currently eligible for Medicare, or when you become eligible for Medicare, you will be automatically enrolled in the AlaskaCare EGWP plan (a group Medicare Part D plan) by the Division of Retirement and Benefits. You do not need to enroll in an individual Medicare Part D plan.

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Do I need to get Medicare part C?

You are not required to take part in Medicare part C. Part C plans are Medicare Advantage plans provided by private insurers for members who live outside the State of Alaska. They cover the same services as Medicare Part A and B combined as well as some supplemental benefits. The AlaskaCare plan acts as a supplemental plan for Medicare eligible retirees.

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Do I need to sign up for or purchase Medicare part A?

Most people are eligible for premium-free Part A. After members apply for Medicare Part A & B, they will receive a decision letter from Social Security notifying them if they qualify for premium-free Part A. Members who do not qualify for premium-free Medicare Part A, should not enroll in Part A, they must provide a copy of the Social Security letter to the AlaskaCare health claims administrator and the Division of Retirement & Benefits, and AlaskaCare will continue to pay as your primary plan for Part A services.

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Who is eligible to participate in this retiree health plan?

Members of the Defined Contribution Retirement plan (Public Employees’ Retirement System Tier IV and Teachers’ Retirement System Tier III) and their eligible dependents can participate. To be eligible for medical coverage you must have:

  • 10 years of service and be Medicare age eligible, or
  • Be any age with 25 years of service for peace officers/firefighters or;
  • Be any age with 30 years of service for all others.
  • Must have worked the prior 12 months and retire directly from the system.

How do I know if I am PERS Tier IV or TRS Tier III?

Specific information on your individual tier status can be obtained through the Division of Retirement and Benefits Member Services Contact Center at or by calling (907) 465-4460 in Juneau or (800) 821-2251 toll-free Monday through Thursday from 8:30 a.m. to 4 p.m. or Friday from 8:30 a.m. to 3 p.m.

In general, if you are a member of the Public Employees’ Retirement System (PERS) and first entered service after June 30, 2006, you are Tier IV. If you are a member of the Teachers’ Retirement System (TRS) and first entered the system after June 30, 2006, you are a Tier III.

Who is considered an eligible dependent?

  • Your spouse. You may be legally separated but not divorced.
  • Your children from birth (exclusive of hospital nursery charges at birth and newborn care) up to 23 years of age only if they are:
  • your natural children, stepchildren, foster children placed through a State foster child program, legally adopted children, children in your physical custody and for whom bona fide adoption proceedings are underway, or children for whom you are legal, court-appointed guardian (if child is not your natural-born child);
  • unmarried and chiefly dependent upon you for support; AND
  • living with you in a normal parent-child relationship.
    • This provision is waived for natural/adopted children of the benefit recipient who are living with a divorced spouse, assuming all other criteria is met. Stepchildren must live with the retiree 50% or more of the time to be covered under this plan.
  • In addition, if they are between the ages of 19 and 23, they must be attending school regularly on a full-time basis.

Children incapable of employment because of a mental or physical incapacity are covered even if they are past age 23. However, the incapacity must have existed before age 23 and the children must continue to be unmarried, rely chiefly on you for support and living with you in a normal parent-child relationship. You must furnish the claims administrator evidence of the incapacity, proof that the incapacity existed before age 19, and proof of financial dependency. Children are covered as long as the incapacity exists and they meet the definition of children, except for age. Periodic proof of the continued incapacity may be required.

Why aren't dependents covered to age 26 under the Retiree health plan?

The definition of retiree dependents limiting coverage to age 19 (or age 23 if a full-time student) comes directly from Alaska statute.

Expanding dependent coverage to age 26 is one of the provisions in the Federal Patient Protection and Affordable Health Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA) that became effective March 2010. This provision affects employee plans and retiree-only health plans differently.

On June 14, 2010, the U.S. Departments of Health and Human Services, Labor, and Treasury issued regulations on Grandfathered Health Plans under PPACA. In the preamble to the Interim Final Rule, the Secretaries clarify that it is not their intent to apply the PPACA coverage to retiree-only health plans. This means DCR medical plan, is not subject to the expanded dependent coverage provisions of PPACA.

Why have I received three ID cards?

To improve our network and customer service, AlaskaCare selected Aetna to administer all medical, pharmacy, vision, and audio claims, and Moda Health to administer all dental claims. You should have received a medical ID card, and if you elected the Dental-Vision-Audio plan you should have also received a vision/audio ID card from Aetna and a dental ID card from Moda to use when visiting your health care provider or pharmacy.

Aetna

Delta Dental

I am newly retired and my ID card hasn't arrived, what should I do?

Medical/Rx ID Card
If your ID card hasn't arrived, you can view and print your Medical/Prescription ID card or download the mobile app that displays the ID card on your smartphone. Note: Aetna Navigator registration required.

You can use your Social Security number to register or call the Aetna health concierge at (855) 784-8646 for assistance. Aetna

Dental ID Card
To print your Moda Health/Delta Dental of Alaska ID card or download the MyModa mobile app, register on the MyModa website or call Moda at (855) 718-1768.

Delta Dental

How much will I need to pay to have major medical and pharmacy coverage?

Employees do not contribute to the DCR health trust while they are actively working.

When the employee retires, the DCR medical plan requires Medicare-eligible participants to pay a percentage of the monthly premium. Prior to Medicare eligibility, retirees pay 100 percent of the DCR medical plan cost. After Medicare eligibility, retirees pay a percentage of the plan cost based on years of service:

Years of Service Retiree Contribution Percentage
10-14 30%
15-19 25%
20-24 20%
25-29 15%
30+ 10%
What is recognized charge?

A recognized charge is the maximum amount that AlaskaCare's Medical, Vision and Audio plans will pay for a covered service. The term recognized charge is sometimes referred to as the usual, customary and reasonable (UCR) charge or the maximum allowed charge. The recognized charge is determined differently for professional (provider) services, facility services, and pharmacy services.

An out-of-network provider, facility, or pharmacy, has the right to bill you for the difference between the recognized charge and the actual charge. This is sometimes referred to as balance billing.

When you use a network provider, facility, or pharmacy, you are not subject to balance billing for covered services. In other words, the provider, facility, or pharmacy, has agreed to accept, as payment in full, the recognized charge for the service provided. You are only responsible for payment of other applicable charges such as deductibles, co-insurance, and/or non-covered charges. This is an important financial consideration when choosing a provider, facility, or pharmacy.

The facility recognized charge for services or supplies is the lesser of:

  • The amount the facility bills, or
  • The percentage of Medicare fee schedule that most closely reflects the aggregate contracted rate with the preferred hospital (currently 185% of Medicare).

The pharmacy recognized charge for prescription drugs is the lesser of:

  • The amount the provider bills, or
  • 110% of the average wholesale price or other similar resource.

The provider recognized charge for medical, vision, and audio services or supplies is the lesser of:

  • The amount the provider bills, or
  • The 90th percentile of the prevailing charge rate for the geographic area where the service is furnished. The 90th percentile of the prevailing charge rate means the charge that is at or below 90% for all of the charges reported for a service within a specific geographic area.

For assistance with determining a specific recognized charge, call Aetna's Health Concierge at (855) 784-8646 or use the Consumer Cost Lookup tool.

How does Medicare impact the recognized charge?

The recognized charge when Medicare is primary and you are receiving a Medicare covered service is assumed to be the Medicare allowed rate and will be determined by Medicare. If you are receiving services that are not covered by Medicare, the provider has the right to bill you for the difference between the recognized charge as determined by the AlaskaCare plan and the actual charge. If you receive services with a provider that has opted out of Medicare, neither Medicare nor the plan will pay benefits for their service.

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How is the provider recognized charge amount determined?

The recognized charge for out-of-network providers is the 90th percentile of the prevailing charge rate for the geographic area where the service is furnished. The AlaskaCare plans establish the percentile (i.e., 90th percentile) to be applied to the prevailing charge rate; however, the prevailing charge rate is reported by FAIR Health, an independent not-for-profit corporation. FAIR Health collects charge data from claims received by insurance plans and health plan administrators across the country for charges billed by physicians, hospitals, and other healthcare providers. Charges reported are the full fees that healthcare professionals report to insurers as part of the claims process—not the negotiated rates that apply when visiting a network provider. Charges reported are maintained by FAIR Health in its database which is comprised of billions of claims for billed medical procedures from across the United States. New charge data are continually added to the FAIR Health database.

How does FAIR Health validate their data?

FAIR Health has audit and validation programs in place to ensure the integrity of its data. Part of the validation process entails testing the data with statistical algorithms and examination by FAIR Health's in-house statistical and technology experts. A team of healthcare researchers from leading academic institutions advise FAIR Health on the best methods for analyzing its national claims data. FAIR Health is also advised by an independent Scientific Advisory Board of prominent researchers who review Fair Health's statistical methods and data. FAIR Health also seeks input from other stakeholders such as consumer and patient advocacy groups, healthcare providers, actuaries and federal officials.

How are services identified in the FAIR Health database?

Each specific service, procedure or supply in the FAIR Health database has a unique Current Procedural Terminology (CPT) code. CPT codes are numbers assigned to medical services and procedures. CPT codes are part of a uniform system of coding maintained by the American Medical Association and are used by providers, facilities and insurers. Each CPT code is unique. There are currently over 10,000 medical services and procedures classified by CPT code. Most CPT codes are very specific. For example, the CPT code for a 15-minute office visit is different from the CPT code for a 30-minute office visit.

How are the geographical areas determined?

FAIR Health organizes its data by geozip— and a geographical area is usually defined by the first three digits of the U.S. zip codes. Geozips may include areas defined by one three-digit zip code or a group of three-digit zip codes. Geozips generally do not include zip codes in different states. The State of Alaska is currently defined by five geozips:

  • 995—including Anchorage, Bethel, etc.
  • 996—including Homer, Kodiak, etc.
  • 997—including Fairbanks, Kotzebue, etc.
  • 998—including Juneau, Sitka, etc.
  • 999—including Ketchikan, Prince of Wales, Wrangell, etc.

What if there are not enough occurrences of a procedure in a particular geozip?

When the volume of claims is insufficient to create a benchmark based on actual data, geozips 995 and 997 and geozips 996 and 998 will be combined. If the volume of claims is still insufficient, the benchmarks will be derived.

If there are fewer than nine occurrences of a procedure in a geographic area, the plan uses FAIR Health's "derived charge data" instead. This data is based on the charges for comparable services, multiplied by a factor that takes into account the relative complexity of the service. If this information cannot be obtained locally, then national data is used.

What factors can affect the recognized charge?

The following factors can affect the recognized charge:

  • Billing errors: when a provider makes a mistake on either the procedure code or zip code.
  • Multiple procedures: when a provider performs multiple surgical procedures during a single session. The standard practice in such cases is to bill 100% for the primary (largest) procedure, 50% for the secondary procedure and 25% for all others. However, incidental items that require little or no additional time should not have an additional fee.
  • Unbundling: when a provider shows separate codes on the bill for related or incidental services. For example, instead of being billed separately, related blood tests performed at the same time should be billed under a single General Health Panel code.

How can I make sure an out-of-network provider's rate will be within the recognized charge?

You can verify whether an out-of-network provider's charges are within the recognized charge by calling the Aetna Concierge and providing the following information:

  1. The procedure code,
  2. The zip code where the service is to be performed, and
  3. The projected cost.

Aetna will use this information to estimate whether the proposed amount is within the recognized charge. Remember, if you use an Aetna network provider, those providers have already contracted with Aetna to offer discounted fees and those discounted fees are deemed to be within the recognized charge.

What should I do if my out-of-network provider charges more than the recognized charge?

If the out-of-network provider's claim exceeds the recognized charge, and you have already paid your out-of-network cost-sharing amount, wait for the provider to send you a bill, since the out-of-network provider may adjust their charges after reviewing the claim payment. If not, ask the out-of-network provider to:

  1. Consider reducing or waiving their fee to meet the recognized charge amount;
  2. Review the bill to ensure the correct procedure code and amount was used (and if not, submit a corrected bill to the plan);
  3. Confirm that the out-of-network provider charged their normal fee for the service, or if the out-of-network provider increased the charge due to unusual circumstances. If so, ask the out-of-network provider to either submit a corrected bill to the plan or provide a written explanation so you may file an appeal with the plan.

What are Aetna's policies for claims reimbursement?

Aetna's claim reimbursement policies address the appropriate billing of services, taking into account factors that are relevant to the cost of the service such as:

  • The duration and complexity of a service;
  • Whether multiple procedures are billed at the same time, but no additional overhead is required;
  • Whether an assistant surgeon is involved and necessary for the service;
  • Whether follow up care is included in the price of the service;
  • Whether there are any other characteristics that may modify or make a particular service unique; or
  • When a charge includes more than one claim line, whether any service described by a claim line is part of or incidental to the primary service provided.

These claim reimbursement policies are based on:

  • Policies developed for Medicare;
  • Peer-reviewed, published medical journals;
  • Available studies on a particular topic;
  • Evidence-based consensus statements;
  • Expert opinions of health care professionals;
  • Guidelines from nationally recognized health care organizations.

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

If you or your dependent are not Medicare age eligible and 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, any applicable penalties, and non-covered charges. If you or your dependent is Medicare age eligible, Medicare is the primary payer and AlaskaCare network considerations are not applied, so you should be sure to use a provider who accepts Medicare.

How can I appeal a recognized charge determination for an out-of-network provider?

You may appeal a recognized charge determination by providing additional information to indicate why the recognized charge was not correct, such as incorrect procedure codes, an incorrect zip code, etc.

Where can I get more information about recognized charges?

Specific plan language regarding recognized charges is available in the AlaskaCare Retiree Health Insurance Information booklet for DCR Plan Retirees.

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How do I avoid recognized charge issues?

See a network provider if one is available. When you receive services from a network provider, the provider has agreed to accept the amount the plan will pay for services, and they may not bill the patient for any amount beyond that (excluding any cost sharing amounts such as deductible, the member’s coinsurance, and any other applicable copayments).

To find out whether your doctor is a member of the Aetna network, call Aetna's Health Concierge at (855) 784-8646. To find out whether your dentist is a member of the Moda/Delta Dental network call Moda/Delta Dental at (855) 718-1768.

How will I know if I have to pay an IRMAA, and how much it will be?

Each year, if you are Medicare-eligible, you will be notified by the Social Security Administration about your plan. This includes if you are required to pay an IRMAA and at what amount. The Social Security Administration uses your Modified Adjusted Gross Income (MAGI) to determine if the IRMAA applies to you and, if so, how much you will have to pay. MAGI is the sum of:

  • Adjusted Gross Income (AGI), which can be found on the last line your IRS 1040 tax form (line 37 on form 1040, line 21 on form 1040A, or line 4 on form 1040EZ), plus
  • Any tax-exempt interest income (line 8b on form 1040).

The Social Security Administration requests income information from the IRS for the tax year that is two years prior to the surcharge year. IRMAA is automatically re-determined each year as long as you file an income tax return. The below table shows the IRMAA for . The MAGI and IRMAA is subject to change from year to year.

Please review the table below to see if your income qualifies you to be assessed an IRMAA surcharge based on your Modified Adjusted Gross Income (MAGI) from the 2020 tax year.

Part D IRMAA Amounts

Individual Modified Adjusted Gross Income (MAGI) Household Modified Adjusted Gross Income (MAGI) Monthly Part D IRMAA Surcharge
Less than or equal to $91,000 Less than or equal to $182,000 Not assessed a surcharge
Greater than $91,000 and less than or equal to $114,000 Greater than $182,000 and less than or equal to $228,000 $12.40
Greater than $114,000 and less than or equal to $142,000 Greater than $228,000 and less than or equal to $284,000 $32.10
Greater than $142,000 and less than or equal to $170,000 Greater than $284,000 and less than or equal to $340,000 $51.70
Greater than $170,000 and less than or equal to $500,000 Greater than $340,000 and less than or equal to $750,000 $71.30
Greater than $500,000 Greater than $750,000 $77.90
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How do I establish a HRA account or Setup Direct Deposit?

OptumRx will handle all your IRMAA needs. Follow these steps to establish your Part D IRMAA reimbursement account online:

  • Register and/or log in to your OptumRx.com account either online or through the mobile app.
  • Navigate to forms by clicking on the "Information Center" tab on the Navigation bar at the top, select "Programs and Forms", “AlaskaCare Reimbursement and Exception Forms”, then click “IRMAA HRA Enrollment Form”.
  • Complete the online IRMAA HRA Enrollment Form.
  • Upload as an attachment a copy or image of your letter from Social Security or a Medicare Bill that shows what your Part D IRMAA surcharge will be.
  • OptumRx will confirm your eligibility and set up your Health Reimbursement Account (HRA) with Optum Bank within 5 to 7 business days of receipt.
  • Once your HRA has been set up with Optum Bank, they will send you a Welcome Packet within 5 to 7 business days, which will include information on signing up for Direct Deposit. (If you currently have Direct Deposit set up with OptumBank, that information does not need to be submitted again).
  • Once you receive your Welcome Packet, log in to OptumBank.com to view your HRA account status/balance or to sign up for Direct Deposit.

If you have any questions on how to submit your IRMAA documents online or if you do not have internet access and would like to submit paper documentation, please contact OptumRx at (855) 409-6999 or email

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What are my options if I am required to pay the extra surcharge?

If you receive notice that you are required to pay the IRMAA surcharge for the enhanced EGWP, follow the steps listed above to request reimbursement. The Division will fund a tax advantaged HRA account that can be used to reimburse you the Part D IRMAA surcharge amount by paper check or through electronic funds transfer to a bank account of your choosing.

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How long do I have to submit a claim to the Health Reimbursement Arrangement (HRA) account?

To receive reimbursement for the Part D IRMAA surcharge, you should submit the HRA claim as soon as possible, but not later than 12 months after the date you incurred the expenses. Retroactive reimbursements will not be issued for claims received beyond 12 months. Example: if you are assessed a Part D IRMAA surcharge in 2020, you will have until December 31, 2021 to file the HRA claim for reimbursement.

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What if I refuse to pay the extra surcharge?

If you refuse to pay the extra surcharge for your Medicare Part D coverage, Medicare will cancel your enrollment in the AlaskaCare enhanced EGWP plan. This will be treated as an opt-out from the plan, and you will be placed in a prescription drug program that is much different than the plan prescription drug benefits offered today. This alternative plan may result in increased out-of-pocket expenses for you or your Medicare-eligible dependents. Please contact the Division if you have concerns about this surcharge or would like assistance with understanding the options available to you.

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Who can I call if I need assistance understanding the surcharge?

For general questions about your pharmacy benefits, contact OptumRx, the AlaskaCare pharmacy benefits manager at (855) 409-6999. For questions related to your IRMAA surcharge, you may contact Social Security at (800) 772-1213. For more information about the HRA account options, contact the Division at (907) 465-4460 or toll-free at (800) 821-2251.

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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 OptumRx member portal, or view your card in the mobile app.

Visit Site
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.

Visit Site
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.

Visit Site
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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