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5.4. ERMUSR 10-10-2006
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5.4. ERMUSR 10-10-2006
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City Government
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ERMUSR
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10/10/2006
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2007 Health Plan Amendments <br />• Office Visit Copay: The office visit copay will increase from $15 to $20. <br />• Emergency Room Copay: The hospital ER copay will increase from $60 to $75. <br />• Out of Pocket Maximums: For network medical services, the out of pocket maximum <br />will decrease from $2,500 to $1,500 per calendar year. The prescription drug out of <br />pocket maximum will change from $500/person to $500/person, $1,000/family. <br />• Prescription Drug Copay Change: The drug benefit will change to a three-tier copay <br />design. The copays are listed below. If a brand name drug is chosen when a generic is <br />available, the cost difference between them plus the copay amount is payable by the <br />member. <br /> Copay at a Copay for <br />Drug Type Retail Pharmacy Mail Order/90DayRx <br /> U to 31-da su 1 U to 90-da su 1 <br />Generic Dru s $0 Co a $0 Co a <br />Brand Name Formular $35 Co a $70 Co a <br />Brand Name Non-formular $50 Co a $125 Co a <br />Over the Counter (OTC) Drugs $0 Copay Not available <br />Applies only to Proton Pump Inhibitor A prescription from <br />(Prilosec) and antihistamine drug (Clarion) your provider is <br />classes. Covered OTC drugs will serve as required. <br />replacements for some prescription drugs <br />that will no longer be covered in these <br />classes. Visit www.bluecrossmn.com for a <br />list o covered OTC dru s. <br />• Pharmacy Network Change: On January 1, 2007 your plan will use the Select Drug <br />Network. This network is very similar to the current one and offers a broad nationwide <br />access and additional cost savings. <br />• Specialty Drug Benefits: Some drugs used to treat complex or rare conditions (including <br />multiple sclerosis, rheumatoid arthritis, hepatitis C, hemophilia, and others) must be <br />obtained from the Specialty Pharmacy Network. <br />• Lifetime Benefit Maximum: The lifetime maximum benefit of your plan is increasing to <br />$5 million dollars from all providers. <br />• Minnesota Comprehensive Health Association (MCHA): Any eligible employees <br />currently covered under an MCHA plan may enroll in your group health plan at this time <br />for an effective date of January 1, 2007. <br />Health Plan Cost Control Options <br />The following options for cost reduction control are available: <br />A. Change plan products within the Cooperative <br />Option 1: BOBS CMM $25 Copay Plan (see attached benefit summary) <br />Avg Rates: $388.00/Single, $815.50/Single + One, $1,242.00/Family <br />Option 2: BCBS $300 Deductible CMM Plan (see attached benefit summary) <br />Avg. Rates: X274.00/Single, .$786.50/Single + One, $1,198.50/Family <br />
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