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 Home  Health & Welfare  Retiree H&W

Retiree H&W - Frequently Asked Questions

General Questions (for all retirees)
 

Preferred Provider Questions (for retirees not eligible for Medicare)
 

 

 

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How many times do I have to fill out the Annual Medical/Dental Update form?

The Plan requires that an Annual Medical/Dental Update Form be updated once every twelve months or whenever the patientís information changes.  . If you cannot remember when each family memberís form expires, and you anticipate using the Plan within the coming year, you may download the form in January and fill one out for each covered family member.

An updated Annual Medical/Dental Update Form for the patient must be on file at the Administrative Office for any claims to be processed.  If the Annual Medical/Dental Update Form is not current, the participant will be requested to fill one out and the claim will be not be paid until the form is completed.  The most common cause for a delay in processing a claim is that the patient does not have a current Annual Medical/Dental Update Form on file.

 

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How long do I have to file a claim?

The Plan accepts claims for medical services for one year from the date of service.

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What is pre-authorization and why does my procedure need to be pre-authorized?

The Plan will only cover procedures and treatments that are medically necessary.  Pre-authorization is a medical review by an independent group of physicians to determine whether a procedure or treatment is medically necessary.  The Plan has contracted with Aetna to perform this function.

Click on the link below for more information:

Medical Pre-Authorization

To pre-authorize your procedure, have your physician or health care provider call Aetna at 1-888-632-3862 option 3.

 

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Must I use Caremark for my prescription drugs?

Yes, effective January 1, 2003, all retirees are required to use the prescription drug plan in order to take advantage of lower negotiated rates at the Caremark network of pharmacies.  Click here to learn how to save money by using Caremark.

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Do my prescription co-pays apply to my medical deductible?

No, your prescriptions DO NOT apply to your medical deductible.

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How do I mail order prescriptions?

Mail order is a cost-effective way to obtain medications you take on an on-going basis. Mail order prescriptions are filled in 90 day increments (even if the script is for a year).  To fill a new prescription, you must submit a Mail Order Form and provide an original doctorís script which indicates whether a brand name drug or a generic is appropriate. 

When you need a refill, simply call Caremark at (866) 818-6911 or log on to their website, www.caremark.com to reorder. Your prescription will be sent to you via the US Postal Service or through a delivery service if special handling is required.

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Why should I use generic drugs instead of brand name drugs?

Once a drug patent has expired, other companies may start to sell the same drug under another name.  The generic drugs are not normally advertised, helping to keep their costs to a minimum. Generic drugs are required by the federal Food & Drug Administration to have the same quality, strength, purity, and stability as brand name drugs. 

By using generic drugs when they are available, you can receive the same quality of health care for less money - and these savings can be used to offset other health care expenses to help keep premiums low.  Please ask your doctor and pharmacist if a generic is available for your prescription.

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Are travel expenses covered?

Travel to the nearest facility will be reimbursed by the Plan if treatment is unavailable locally and it is medically necessary.  If the member traveling is a minor, the Plan will reimburse travel for one parent or guardian to accompany the minor.  The Plan will also reimburse travel for one companion to assist an adult member if the member is incapacitated due to a medical condition and will need assistance. 

Please note that the Plan does not reimburse for ground transportation or room and board. This means that car rentals, motels/hotels, parking, and cab fares are not covered expenses.

For reimbursement for travel expenses, you must submit a letter of medical necessity from your current physician, a copy of the ticket(s) with the dates and costs of travel, and the boarding pass(es) as proof that the travel took place.  Travel benefits are subject to medical deductible and eligibility requirements.

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If You or Spouse are Eligible for Medicare

Part A of Medicare covers general hospital expenses and Part B covers physicians and medical expenses. If you are eligible for Medicare and fail to enroll, BENEFITS UNDER THE RETIREE MEDICAL PLAN(S) WILL BE REDUCED AS THOUGH YOU WERE ENROLLED IN BOTH PARTS A AND B OF MEDICARE. This means benefits would be paid on assumption that you are enrolled in both parts A and B of Medicare; and if you have not enrolled, you could incur significant uncovered out-of-pocket expenses. We strongly encourage all retirees to contact Social Security to determine the procedures and timetables for enrollment in Medicare.

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May Medicare-eligible participants use the Wellness and Minor Care program?


Expenses normally covered by Medicare are not covered under the Wellness and Minor Care Plan. 

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What is the penalty for using a non-preferred provider (within the Municipality of Anchorage)?


If you use a health care provider within the Municipality of Anchorage that is a not a preferred provider, the Plan will base your reimbursement on the preferred provider rate and will then reduce your regular reimbursement rate by 20%.  In addition to these reductions, a $1,000 penalty will be imposed to each inpatient admission to a non-preferred provider.

For example, you live in Anchorage and need to have a certain treatment.  The preferred provider charges the Plan $100 for this type of treatment.  A non-preferred provider in South Anchorage charges $200 for this type of treatment.  You have already met your deductible for the year and the Plan usually reimburses at 75%.

If you have this treatment at a preferred provider, the Plan will pay $75 ($100 X 75%).  Your out-ofĖpocket expense will be $25.

If you have treatment at the non-preferred provider, the Plan will pay $55.  First, the $200 expense is marked down to the preferred provider rate of $100, then the reimbursement rate is reduced by 20%. ($100 X 55%)  Your out-of-pocket expense will be $155.

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Who are my preferred providers in the Municipality of Anchorage?


Your preferred providers within the Municipality of Anchorage are as follows:

 Service Needed     Preferred Provider
Inpatient hospital stays            Alaska Regional Hospital
Outpatient lab and x-ray services  Alaska Regional Hospital
Physical therapy services Chugach Physical Therapy

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What area does the Municipality of Anchorage include?


The Municipality of Anchorage is comprised of the area from Girdwood to the Knik River Bridge including the Anchorage bowl area.

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How do I know where my labs and x-rays are being sent?

Ask! It is your responsibility, as a plan participant, to educate your physician(s) and medical care providers, as well as your dependents, regarding your preferred providers.  Let your physician know who your preferred providers are and he/she will make arrangements for labs and x-rays to be performed at your preferred provider.

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What is Aetna's Choice POS II ?

Aetna's Choice POS II  is a nationwide group of contracted preferred providers that offer considerable discounts to the Plan for use of their facilities, groups, and doctors. When you select a preferred provider from the Aetna's Choice POS II network, you , your dependents, and the Fund will have access to discounted pricing from providers that are part of the Aetna network.  You may review Aetna's Choice POS II website, to find a provider near you.

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What is the penalty for using a non-preferred provider (outside the Municipality of Anchorage)?

The Plan uses Aetna's Choice POS II. If you use a facility that is not Aetna's Choice POS II and it is within 25 miles of a Aetna's Choice POS II provider, the Plan will reduce your reimbursement rate by 20%. You can search for a Aetna's Choice POS II provider near you on Aetna's Choice POS II website

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