Human Resources » Medical and Prescription Insurance

Medical and Prescription Insurance

The District participates in the Bucks Montgomery County Schools Healthcare Consortium, a management-labor consortium of schools and entities which have joined together in a unique self-funded arrangement as a large group purchaser of medical insurance, prescription drugs and other employee benefits. The purpose of the arrangement is for consortium members to group together to get the best price possible for health care and employee benefits while also focusing on collectively improving employee health and wellness, potentially leading to even greater cost savings. 
 
Website info: http://www.bmshc.org/
 
Trustees: 
  • Felicity Hanks, Management Trustee
  • Chris Sterman, Labor Trustee
 
As a member of the consortium we have access to resources like:
  • Teledoc - Reach a doctor 24/7 by phone or video
  • Healthcare Blue book - find a fair cost facility for a procedure and earn $$$
  • Asset Health - commit to wellness and earn Amazon gift cards
 
Questions regarding medical benefits should be directed to Elizabeth Jones, Benefits Secretary at Ext. 4001.
 

*IMPORTANT INFORMATION ABOUT YOUR JULY 1, 2020 PREMIUM RATES:

 

Projections for our medical claims for the 20-21 school year show an increase of 4.7%.  Projections for prescription claims increased substantially, by 16.8%. At the time of this final budget projection, the overall increase in rates for the 20-21 school year would be 7.1% which equates to over $1 million dollars in increased costs for medical and prescription insurance.  The School District has a contingency fund balance thorough the Bucks Montgomery County Healthcare Consortium and the decision has been made to apply $1 million of that fund balance to reduce this increase for the 20-21 school year.  You may recall that in 16-17 this method was used to reduce the rate increase from 9% to 4.5%.  During 18-19 and 19-20 (coming in May) we used over $1 million each year to provide a one-month premium holiday. 

 

This means that your rates for the 20-21 school year (effective July 1) will only see a very small increase.  However, you must understand that this rate reduction is superficial. We are self-insured which means that the cost of your claims –every time you use your insurance-is paid in full by the District with the costs shared by you. While the rates for 20-21 are flat, all employees must understand that our medical and prescription claims still increased 4.7% and 16.8%, respectively.  If those claims continue to increase throughout the 20-21 school year, the rate increase for the following 21-22 school year could be very high.  Please read letter below from Consortium Trustees explaining the rate suppression.  We all have to do our part. 

Open Enrollment is an eligible employee's annual opportunity to join a District insurance plan, change a plan, leave a plan, or add or remove eligible dependents. This window typically occurs in May of each year.  Such changes are prohibited during the rest of the year unless there is a qualifying life event
 
It is the Employee’s responsibility to notify Human Resources of any “life event/status change” such as marriage, divorce, birth/adoption of child(ren), death of a family member who is covered by district insurance, etc.  There is a 30 day window from the date of a “life event” to make changes to your coverage.  Changes not made within the 30-day window have to wait until the next open enrollment.
 
 

Open Enrollment Memos and Enrollment Forms Medical/Rx

Medical and Rx Plan Summaries
Medical and Prescription plans are tied together as listed below. 

Medical                                               Rx

BMCS Point of Service (POS)           10/15 or 10/15/30 (Depending on Bargaining Unit)       

BMCS Open Choice 1                        5/20/35
BMCS Open Choice 2                        5/35/50
BMCS Open Choice 3                        5/35/50
 
Please review the Medical Plan Summary Comparison Chart for a side by side comparison of the plans including most frequently used services.  More specific information is included in the plan summaries. Summaries for Medical and Rx plans are attached below. 
Pharmacy Benefit Manager - Express Scripts
 
Express Scripts is the Consortium's Pharmacy Benefit Manager. 
 
You can continue to obtain 90-day maintenance prescriptions by going to a CVS pharmacy through the CVS Smart 90 program (see flyer below), or through home delivery or mail order.  There is no enrollment requirement for the CVS Smart 90 program, you just have to fill your 90 day prescription at a CVS.
 
Effective September 1, 2020, all Specialty Prescriptions must be filled exclusively at Accredo, which is Express Scripts Speciality Pharmacy.  Impacted employees should be contacted directly from Express Scripts. 
 

Lab Work Cost Comparisons:

Know before you go: All members should be aware of the costs associated with lab work.  Members on the Open Choice 3 should especially be cognizant of the different costs that may be incurred based solely on where the work is done. 

Quest Diagnostics and LabCorp. are Aetna’s preferred lab vendors which allows Aetna members to receive low contracted rates.   Check out these comparisons showing that the same test at an area in-network hospital may be a thousand ($1,000) dollars more than at a Quest lab.  

Remember to use the member payment estimator tool located in Navigator (Aetna’s secured member portal) to research lab services as well as many other lower cost options for MRIs, CT scans, etc. 

Pet "Insurance"
 

A “PAW-FECT” New Perk: Prescription Drug Savings for Your Pets

If you are a pet parent, you know nothing can replace the love of our furry family members. However, just like humans, health care costs for pets can be expensive. Especially if you are dealing with expenses for prescriptions treating chronic conditions such as diabetes, anxiety, arthritis, or heart disease, it can be a real burden to your budget.

That’s why, as a new perk for you, we have partnered with Inside RxSM Pets, a prescription savings program to provide pet parents discounts on brand and generic human medications prescribed for pets at 40,000 participating retail pharmacies.

Inside Rx Pets provides you with:

  • 77% average savings on the cost of generic medications*
  • 15% average savings on the cost of brand medications*
  • Easy access to savings at one of 40,000 participating retail pharmacies.

We are providing this perk to our “pet parent” employees as a value-add support, with no cost or obligation for you.

If you are interested, you can benefit from Inside Rx Pets savings right way. Simply present the card along with the prescription from your veterinarian at a participating pharmacy to save!

Click below to get started today!

 

https://insiderxpets.com/rxsave2

 

* Savings based on cash price for eligible users of Inside Rx Pets card.  Over 50% of purchasers receive stated discounts.  Actual savings will vary.  See Insiderx.com for eligibility information, terms and restrictions. Currently, the Inside Rx Pets card can be used with human medications for pets. It cannot be used to purchase medications that are prescribed exclusively for animals, such as certain types of parasiticides or vaccines.

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The Inside Rx Pets card is not insurance and cannot be used with any insurance benefit or copay assistance programs.  Only for use with prescriptions written and dispensed for animals at a participating pharmacy (see website or call no. below for pharmacy listing). You are responsible for the cost of your pet’s prescription(s) when using the card. Inside Rx is not offering advice, or recommending or endorsing any prescription drug, pharmacy or other information. Use of card is subject to additional terms and conditions at www.insiderx.com. Inside Rx does not make payments to providers. The Inside Rx card is administered by Inside Rx, LLC, 100 Parsons Pond Drive, Suite 300D, Franklin Lakes, NJ 07417.  All trademarks are the property of their respective owners.

HEALTHCARE BLUEBOOK:  Did you know that in-network prices for the same procedure can vary by over 500%, depending on the facility you choose? Join the effort to reduce costs without impacting care by using Healthcare Bluebook and you may qualify for rewards!  Healthcare Bluebook allows you to compare facility costs for certain services. You can search by location, procedure, doctor or facility.   If you have a qualifying service performed at a fair cost facility you will receive a check in the mail.   Please watch the Healthcare Bluebook Introductory Video to learn more about this valuable resource for members.

 

Sign up at healthcarebluebook.com/cc/bmshc or through their mobile app, code bmhsc

TELEDOC: Have a sinus infection, flu, rash, routine illness, or other non-emergency condition?  We are excited to announce that we now have access to Teledoc, a quick and convenient alternative to an office visit for routine matters.  Teledoc provides access to physicians by phone or video 24/7 with no co-pay .  Create an account at Teledoc.com/Aetna or download the mobile app.  Refer to the  Teledoc attachment for an explanation of the service and how to sign upEnter your text here...
GET YOUR $50.00 WELLNESS GIFTCARD:  Sign up with Asset Health, the Consortium wellness vendor, to take advantage of wellness resources and qualify for a $50.00 gift card by completing the wellbeing assessment and visiting your PCP for a biometric screening.  Incentive is eligible through 6/30/19.  Sign up at assethealth.com/bmcs and see the attached flyer.