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EIP Direct
A Publication of the South Carolina Budget & Control Board Back
April 2011 EIP Direct
SHP Members Must Preauthorize Maternity Benefits to Avoid Penalty

Please remember that a woman covered under the State Health Plan must preauthorize her maternity benefits during the first three months of her pregnancy. To do so, she can call Medi-Call at 800-925-9724 or enroll in “Coming Attractions” online through her Personal Health Record.

If a member fails to preauthorize her maternity benefits, she will pay a $200 penalty for each admission to the hospital for a maternity-related condition. This is in addition to the $200 penalty she will pay if she fails to preauthorize the hospital admission, a requirement whether the admission is maternity-related or not. As a result, she could pay two $200 penalties for each maternity-related admission:
 
  • The first for failure to preauthorize her maternity benefits
  • The second for failure to preauthorize the specific admission.
Also, if she fails to preauthorize her maternity benefits or her hospital admission, the coinsurance she pays after she reaches her annual deductible will not count toward her out-of-pocket coinsurance maximum.
Qualify for Free Generic Drugs through the Wellness Incentive Program

State Health Plan subscribers and dependents who are not eligible for Medicare and do not have other primary coverage may be eligible for the Wellness Incentive Program. As part of the program, members who have diabetes, cardiovascular disease (which includes hyperlipidemia and high blood pressure) or congestive heart failure can qualify for a copayment waiver for certain generic drugs if they participate in the BlueCross BlueShield of South Carolina (BCBSSC) Health Management Program and complete other steps.

Once a member qualifies for the waiver, he will no longer be responsible for copayments for qualified generic medications.
 
Members who are eligible to participate in the Wellness Incentive Program will receive a letter from BCBSSC inviting them to participate in the Health Management Program and explaining how to qualify for the waiver. To qualify, a member must:
 
  1. Complete the BCBSSC Health Management Survey for his condition. To do so, follow the instructions on this flyer. After a member logs in to his Personal Health Record, his assessment will be listed under My Activity Center in a yellow box labeled “My Assessments.”
  2. See a doctor for his condition. This visit can be to a medical doctor (M.D.), a Doctor of Osteopathy (DO), a Physician Assistant (PA) or an Advanced Practice Registered Nurse (APRN).
  3. Have any applicable lab tests performed.
  4. A member may be asked to complete four phone calls with a BCBSSC health coach. As an alternative, members with diabetes may participate in Prevention Partners’ Club Sugar or an American Diabetes Association (ADA) or American Association of Diabetes Educators (AADE) approved diabetes class. Members with cardiovascular disease may complete a phase 2 cardiac rehabilitation prescribed by a physician.
More information about the Wellness Incentive Program is available on the EIP website under “FAQ.”
 

If you think you qualify for the Wellness Incentive Program but have not been invited to participate or if you need to reach a health coach, call 800-868-2500, select 1 and then extension 49043.
MetLife Makes Payment Easy with EFT for Retirees

MetLife makes it easy for retirees to assure their life insurance premiums are paid on time by offering the option of electronic funds transfer (EFT) payments. Life insurance premiums must be paid no later than the due date, or the subscriber will lose coverage. By authorizing MetLife to automatically draft payments, retirees eliminate the hassle and worry of paper bills, and they can rest easy that while they are out enjoying retirement, their benefits are secure.

To authorize EFT payments, contact MetLife’s Life Recordkeeping Customer Service for retirees at 866-492-6983.
Ladson Elementary Team First to Make the Grade

Ladson Elementary School has become the first school to complete Prevention Partners’ Biggest Loser weight loss contest.

As part of a team effort, 40 teachers and staff members at the Charleston-area school lost 279 pounds during the six-week program. The winner was Barbara Saverino, who lost 22.6 pounds. Shirell Bivens, who lost 18 pounds, took second place, followed by Kelly Acer, who lost 17.2 pounds. Julie McIntyre, R.N., the school nurse, coordinated the program.
 
Participating in a wellness program that requires attending a number of classes can be particularly challenging for school employees, says Diane Conte, Prevention Partners manager. Faculty and staff members have to get to work very early. They are not free at lunch. Meeting after school is the only option, but that can be difficult, too. Many teachers have to take care of their own children. They also may have to grade papers, coach, tutor, meet with parents and attend staff meetings.
 
Conte attributes Ladson’s success to a variety of factors. It is a close-knit school with a “very dedicated, well-organized” school nurse. McIntyre “kept the enthusiasm high by offering opportunities between meetings, such as making smoothies and providing recipes for the participants.”
 
“The staff was ready to do something for themselves,” McIntyre says. “It was really a team effort. They encouraged each other. And they loved Diane. They loved her meetings.”
 
McIntyre is at the school three days a week. She kept enthusiasm high by providing a healthy snack, such as fruit or vegetable smoothies or muffins, complete with recipes, every day she was there. She also gave a small prize to the person who lost the most weight each week.
 
Saverino says she didn’t sign up for the program in hopes of winning the prize that was created with the enrollment fees. She needed to learn more about nutrition and thought $10 was a great price for the quality of information McIntyre and Conte provided. The program’s personalized approach was very helpful. In the past, she says, “I just ate what I ate.” The program “really helped me look at and think about why I am eating what I’m eating.”
 
As a kindergarten teacher, Saverino is on her feet constantly and is tired at the end of the day. For that reason, she focused on nutrition and took “small steps” to increase her physical activity. She also drank more fluids and got more sleep. “It was a combination of all the things that Julie and Diane taught us and talked about,” she says. “I wanted something that would be a lifetime change and that I would maintain.” Saverino is close to her initial goal, losing 25 pounds, “and is still going.”
 
The Ladson staff and teachers conducted “Biggest Loser II” on their own in March. Conte will be back in April with more Prevention Partners activities.
 
Benefits administrators or wellness coordinators who would like to host a Biggest Loser program at their workplace may contact Conte at dconte@eip.sc.gov or 803-737-3822.
 
More information about health programs offered through the Employee Insurance Program is on the Prevention Partners section of the EIP website.
Some Brand-name Drugs Expected to Go Generic This Year

Several brand-name prescription drugs are expected to lose their patents and become available as generics in late 2011. State Health Plan members who take these drugs should take advantage of the generic forms of these drugs so they can save money when they do become available.

If you do not buy the generic version of the drug when it is available, you will be subject to the pay-the-difference policy. This means you will be charged the generic copayment plus the difference between the allowable charge for the brand and the generic drug. For more information about this policy, see pages 65-66 of the 2011 Insurance Benefits Guide.

Here is a list of the drugs that are expected to become available in generic form later this year:

  • Lipitor®
  • Femara®
  • Caduet®
  • Xalatan®
  • Tazorac®

Also, Allegra® and Allegra-D® began to be sold over-the-counter in early March. As this change continues, the prescription versions of these drugs will be removed from the market.

To prepare for this change, you may wish to ask your doctor if he will begin to sign on the "Substitution permitted" line on your prescriptions for these drugs. If he doesn't, your pharmacist will have no choice but to give you the brand-name drug when a generic version is available. 

By switching to the generic version when it comes on the market, you will save money. For example, for Standard Plan and Medicare Supplemental Plan members, the copayment for 30-day supply of Lipitor®,a Tier-3 brand drug, is $50. It will cost $9 as a generic drug. (A Savings Plan member pays the allowable charge for drugs until he reaches his annual deductible. However, the allowable charge for a generic drug is generally lower than it is for a brand drug.)
 
By using generic and over-the-counter drugs, you also save the State Health Plan money. The State Health Plan, like all health plans offered through the Employee Insurance Program (EIP), is self-insured. EIP does not pay premiums to an insurance company. Subscribers’ monthly premiums and employers’ contributions are placed in an account to pay claims and administrative costs. By saving your plan money, you can help EIP offer affordable premiums.
 
For more information about your prescription drug benefits, contact Medco Health Solutions by phone at 800-711-3450 or through its website.
EIP Will Require Documentation for New Dependents

In an effort to control costs, the Employee Insurance Program (EIP) will begin auditing subscribers who cover dependents to ensure that only eligible dependents have coverage through EIP.

The initial audit cycle is expected to take 18 to 24 months to complete. At some point during the audit cycle, all subscribers who cover dependents will receive a letter from EIP asking them to submit documentation to verify the eligibility of each of their covered dependents. If the subscriber does not provide documentation within 60 days of the audit request, his dependent will be dropped from coverage.

Beginning May 2, 2011, EIP will also require documentation at the time of enrollment for dependents of new hires and dependents added during open enrollment or due to a special eligibility situation.

Different documentation is required for enrollment and for the dependent verification audit. Click the different links to see what documentation is required for each event.

Dependent eligibility verification audits have been used by Fortune 500 companies for more than a decade.

According to most experts, 4 to 8 percent of the dependents covered under an employer-sponsored plan are ineligible for coverage. These dependents are often divorced spouses, grandchildren or other family members who are not eligible for benefits.

About 187,000 dependents have health coverage through EIP. Based on these estimates, 7,500 to 15,000 may not be eligible for this coverage.

In 2009, the average cost per dependent under the State Health Plan was more than $2,600. If only 4 percent of covered dependents turn out to be ineligible, conducting this audit will save our self-insured plan more than $19 million a year.
Wellness Walk Set for April 22

Lace up your tennis shoes – it’s time for Prevention Partners’ annual Wellness Walk.

This year’s walk will kick off with refreshments and door prizes at noon on April 22 at Riverfront Park in Columbia. Participants are invited to walk all, or part, of the scenic, 2½-mile Columbia Canal during the event. The rain date for the walk is April 25.

Although all worksites are encouraged to participate on April 22, benefits administrators and wellness coordinators may plan wellness walks and other activities to encourage fitness at any time.

To find out how to host a Wellness Walk at your workplace, go to the Employee Insurance Program website, www.eip.sc.gov, and select "Prevention Partners" and then “Coordinators.”  The Wellness Walk Materials Information Packet is under “Coordinator Materials.” T-shirts are available for only $5.
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Benefits administrators and others chosen by your employer, who may assist with insurance enrollment and adjustments, retirement or termination and related activities, are not agents of the Employee Insurance Program and are not authorized to bind the Employee Insurance Program.

This publication contains information about insurance benefits. Complete descriptions of the health and dental plans are contained in the Plan of Benefits documents. Their terms and conditions govern all health benefits offered by the state. If you would like to review these documents, contact your benefits administrator or the Employee Insurance Program.