Teamsters Local 631 Security Fund

Teamsters Local 631 Security Fund for Southern Nevada
P.O. Box 26509
          Las Vegas,  Nevada   89126-0509 

Important Notice

NEW COBRA Rates

 

Effective June 1, 2004, the new COBRA rates listed below will apply beginning from the first month of COBRA coverage.  The Trustees have eliminated the subsidized lower rate for the first six (6) months.

Core Benefits (Medical/Rx Only)            $586.48

Core + (Medical, Rx, Dental & Vision)   $700.29 (Which is $586.48 for Med/5 and $113.81 for D/V) 

The rate for the Disability extended COBRA benefit (19th - 29th month) will be as follows: 

Core Benefit (Medical/Rx Only)             $862.47

Core+ (Medical, Rx, Dental & Vision)  $1029.84  (Which is $862.47 for M/Rx & $167.47 for D/V) 

 

the following are plan changes which directly affect the Indemnity Participants of the Plan.  Please read this notice carefully and familiarize yourself with the changes and updated material:           

Added Dental Benefit for Cancer Patients  - Effective June 1, 2004 

Participants actively undergoing chemotherapy and/or radiation treatments for cancer will now be allowed (teeth cleaning) prophylaxis and topical applications of fluorides up to four (4) each calendar year instead of two per year.  Medical proof of chemotherapy and/or radiation treatments may be necessary prior to claims being paid. 

 

  Prescription Drug Changes with Express Scripts

Effective July 1, 2004

 

The Trustees adopted several new Rx programs with Express Scripts, your prescription drug vendor.  These changes may affect the drugs you are currently taking and your physician may need to be alerted to how to prescribe your medication in the future.

 

A.           Step Therapy Program 

Step Therapy is a clinical, point-of service program, which requires members to try a lower-cost (often generic) medication referred to as a “step-one” medication, before using a more expensive drug or a “step-two” drug. 

For certain medical conditions, your doctor first prescribes a “step-one” medication. Usually, this means a generic drug – a safe, effective version of a brand-name drug that provides the same medical benefits but that costs less.  

If your doctor would rather you use a “step-two” drug, he or she needs to contact Express Scripts for a prior authorization. Express Scripts will check to see if the drug will be covered under your plan’s coverage guidelines. If it’s covered, you could pay a higher co-payment than for a step-one drug. Some examples are: Elidel, Protopic, Humira, Singulair, Accolate, Bextra, Vioxx, and Celebrex.  

Your pharmacist could also play a role. When you hand in a new prescription, your pharmacist looks at your prescription plan. If it says that you’re to try a step-one medication, your pharmacist or you may need to contact your doctor to make sure you try a covered, step-one drug.  Or you can get your written prescription filled as is, even if the medication isn’t covered in your plan – and you pay the full cost for it. 

Call (800) 206-4005, Express Scripts to find out if your medication is subject to step therapy guidelines. 

 

B.           Drug Quantity Program 

The Plan will now include a “Drug Quantity Management” program.  Certain prescription drugs will have a new quantity limit of the amount that you get at one time. Quantity limits are usually the highest doses proven to be appropriate for most people.  This program helps reduce stockpiling and waste. When you stick to quantity limits, you aren’t able to buy too much of a medication, and you’re sure that your money is well spent.   

If your medication is subject to the new quantity limits, refills are covered at the maximum quantity limit. But if your prescription calls for more, your pharmacist can fill it up to the quantity limit or ask your doctor to request an exception to the limitation by calling the Express Scripts

Pre-authorization line at (800) 417-8164.

 

C.           Generic Preferred Program 

The Plan has adopted a “generics preferred” program. This means that the next time you need a refill for a brand-name drug, your pharmacist will see if a generic drug is available.  As you know, generics are brand name drugs which have lost their patent protection and their active ingredients are chemically identical to the brand drugs.  Choosing the generic will save you money.   

Your co-payment will be less than for a brand-name drug.  If you choose the brand-name when a generic is available, you’ll pay your co-payment plus the difference in cost between the generic and the brand-name drug.

 

D.           Prior Authorization

Prior Authorization will be required for certain medications. These medications require that the prescribing physician provide a letter of medical necessity and diagnosis.  Medications requiring prior authorization are: Actiq, Oxycontin, Duragesic Patches, MS Contin, Kadian and Avinza.  Other pain medications (Class II and Class III Narcotics) may be subject to exclusion after a 30 day fill at retail. (i.e. Percocet, Vicodin)

If you are currently prescribed any of these medications, you must have your physician call the Express Scripts Prior Authorization Department at (800) 417-8164. If approved, prior authorizations will be set up immediately. If the doctor can not call, he/she may fax a letter of medical necessity, which includes a diagnosis, to (866) 357-9577. Please allow 2 business days for faxed requests to be processed. If the diagnosis meets approved criteria for that medication and the diagnosis is within the scope of coverage of the plan, prior authorization will be set up so your prescription can be filled under the plan. 

 

It is important that the Administrative office has your correct address, to keep you updated about your benefit plans.  If this notice was sent to a wrong address, you must contact the Administrator’s office to report your address change as soon as possible. Also, note that changing a beneficiary on your health enrollment records does not constitute a change on your pension or union death benefits.  You should always remember to keep that current as well.

 

You may also visit our website at www.swadmin.com

 

  

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