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Frequently Asked Questions

Non State Group Employees

HealthQuest

Where can the HealthQuest blog be found?

On the website www.healthquestkansas.com

What are the differences between the Nurse Line and LifeLine and the Health-Lifestyle Coaching Line?

• The Nurse Line will be offered through our wellness vendor and is available to help employees and family members with self-care or medical situations such as a splinter in the index finger of the dominant hand, a child that won't stop crying, a fever, or minor medical type questions. Use this number for anything you would like to discuss with the nurse in your doctor's office.
• The Health-Lifestyle Coaching is a service of our wellness vendor and is available to assist employees with lifestyle issues such as exercise, diet, nutrition, weight management, handling stress, etc., or to assist members with handling chronic conditions such as diabetes or asthma or heart disease.
• LifeLine is our Employee Assistance Program and provides a number of services. There is personal counseling available with up to four face-to-face visits with a counselor to assist you in dealing with short term crises or stressors. LifeLine also provides assistance with services such as elder care and counseling, child care and counseling, legal and/or financial situations. The personal counseling and service counseling is also available via telephone if face-to-face visits are not required.

What is the quality of the advice provided by the LifeLine program?

All of the counselors are professionally credentialed in their field. Like anything else in life, sometimes you have to shop around to find a counselor that fits your needs and personality. After you have a session with a counselor you can call LifeLine again and get a referral to a find a counselor with whom you feel comfortable.

If a person enrolled in the Tobacco Cessation program for 2009 and received the premium discount, can they re-enroll in the program for 2010 and get the discount again?

Yes. The requirement for a tobacco user to receive the discount is that they enroll and complete the tobacco cessation program each year. There is no requirement that they actually stop using tobacco.

Will employees be better informed of what is involved in completing the program next year?

Many employees were surprised and angry when they lost their discount because they thought they had done everything required of them. We will be contracting with a new wellness vendor in 2010 and will have a new tobacco cessation program. As we get this contract finalized and get more information about the tobacco cessation program, details will be posted on the web.

If an employee did not complete the program and lost the discount in 2009, can they re-enroll for 2010?

Yes, every year they will have the opportunity to earn the discount.

Can we use paper forms for the tobacco status update?

Only new employees (in the SHaRP system on or after September 10, 2009) will be able to declare their tobacco use status on a paper form - it has been added to the enrollment form. All other employees will need to use the Open Enrollment website to declare their tobacco status.

When they go on-line, can they just do the tobacco declaration?

When they go online, the system will walk them through a series of steps asking if they want to declare their tobacco status, change their health plan, enroll in the Flexible Spending Account, etc. The system will guide them through the process.

How many people lost the Non Tobacco User's Discount during the 2009 plan year?

As of August 31, 2009, 1,563 employees had not complied with the requirements and lost their discount.

What percent of employees who enrolled completed the Tobacco Cessation program?

So far 2,185 employees have completed the program. As of August 31, 2009, 41% of those who enrolled, report that they have quit using tobacco.

Will the appeals process for loss of the Non Tobacco Users Discount be the same next year?

We heard a great deal of dissatisfaction from employees this year about the process and how long everything took. The appeals process will remain the same. However, with the new vendor, we anticipate that the expectations and requirements of the tobacco cessation program will be more thoroughly and clearly communicated to employees when they enroll in the program. This should make the entire process run much more smoothly.

Some of my employees received telephone calls or letters from a "Wellness Vendor" relating to their personal health condition. This made them very nervous. How can this be justified? Why is information being provided to a third party?

The wellness program is part of our overall health plan with the goal of improving the health status of employees and thereby lowering the cost of our premiums. All of the information is protected by HIPAA privacy and security guidelines. The outreach calls and mailings from our wellness vendor will continue to be made to employees. The purpose of this outreach is to offer information and the assistance of a personal coach in managing health conditions.

If employees do not want their health information to be sent to the wellness vendor, how do they opt out?

Claims data from the medical and drug plans will be sent to the wellness vendor. If an employee is contacted, either by telephone or by mail, they may opt out of the programs at that time and no additional contact will be made to that member.

If this outreach by the wellness vendor is going to continue - will you at least tell the employees in advance that this may happen?

We are in the process of contracting with a new wellness vendor and we believe that the new company will be much better at helping us manage expectations by the employee and/or covered dependents who may receive outreach calls or letters in the future.

How long is the gift card valid?

Most retail gift cards do not have expiration dates. If a merchant did have an expiration date, that information was provided in the "terms and conditions" when the employee selected their card and again on the materials that arrived with the card.

Quest/Lab Card

If a doctor has his own lab, but will send the sample to Quest for his patient, who pays for the draw fee?

Generally, the drawing fee will be bundled into the cost of the office visit. If there is a separate line item charge it will be processed by the medical plan as appropriate with the plan's physician protocols, and subject to deductible and coinsurance.

Will lab work associated with the preventive care well woman/well man exam still be covered at 100% even though it is not sent to Quest?

Yes, for the 2010 plan year, the lab work associated with a preventive physical exam will still be covered at 100%.

Will all doctors send the lab work to Quest?

No. There are some physicians who own their own labs and will not participate with the Quest Lab Card program. Is there still a way to use the program? The Quest program is voluntary. If your doctor does not use Quest and you would like to receive the higher coverage available through the Lab Card, ask your doctor to write the orders for the lab work and have the sample drawn at one of the Quest Patient Service Centers that are listed on the website. Any work billed by the physician's office will be subject to deductible and coinsurance.

What if you want to have lab work done prior to a doctor's visit so you can discuss the results with the doctor?

The physician's office can either draw the sample and send to Quest or can write the orders and send the member to a collection site. Most routine tests are processed within 24 hours. However, sometimes cultures have to be developed. Quest recommends that the lab work be done 3-4 days prior to the scheduled doctor's visit in order for all the results to be back to the doctor in time for the consultation.

Administrative Issues

Do we still need to send dependent documentation in to KHPA?

Yes, and remember that various documents can become separated in transmission so it is important to have the employee name and ID number on each piece/page of dependent documentation that is submitted.

Any projection on when the 60-day waiting period will be changed?

The regulation change is in process but has not been completed yet. The process has been started and agencies will be notified when it has been completed.

Have additional salary tiers been considered?

A fourth tier was discussed, as was the elimination of the tiers altogether. The decision for 2010 was to make a modest adjustment in the salary tiers to maintain the current bell curve.

Will a list be provided to the Non State Group with employees that need to provide dependent documentaion?

Yes, as always, we will send you as many lists as we can think of to assist you in getting the Open Enrollment process completed smoothly and efficiently.

The system requires social security numbers, can we still use 999-999-9999 for non US citizens?

Many non US Citizens receive a Social Security Card when they apply for their long term visa. However, for those who do not have an SSN, the system can accommodate all nines.

Last year we had employees who received a request for documentation, they supplied the papers requested, and then got a second letter requesting the information again. How will this process be managed this fall to ensure that employees are not sent requests for things they have already provided?

This process has been revised to facilitate the obtaining and input of information. This should result in fewer duplicate requests for information. However, as in any process, there may be requests that cross in the mail. If the member has already provided the requested documentation, they should call Member Services directly to confirm receipt of the documentation.

For those doing paper forms - do they just mark changes or complete the entire form?

To ensure enrollment in the benefits that are desired, it is recommended that the entire form be completed.

What materials will we receive for open enrollment?

The employee power point will be posted for downloading. Open Enrollment books will be drop shipped to agencies for distribution. The Comparison chart is in the book this year. All employees were sent a post card reminding them that Open Enrollment is coming.

Dental

For new employees, will they only have basic coverage for the first year?

No. New employees will be given a one year grace period to get their routine cleaning on the Delta records and will have the enhanced benefit level for any restorative work done during that grace period.

What about new employees adding dependents?

Newly added members will be given the one year grace period. The value based design is based on the individual so, it will be possible for different members of the same family to have different benefit status.

With the new value based plan design, will all members of the family have the same benefits or will it be possible for some members to be on basic coverage and some on enhanced coverage?

The value based design is based on the individual so yes, it will be possible for different members of the same family to have different benefit status.

Vision

Is Lasik eye surgery covered?

No, however, Superior Vision has a network of providers who offer discounts and many of the medical plans also have vendors who provide discounts for this service.

Will the vision plan cover computer glasses?

Prescription glasses for reading or using the computer are covered by the vision plan. The assistive eye wear that a person can buy at the grocery store or pharmacy can be covered by the Health Care FSA, but would not be covered by the vision plan.

Medical

For well-baby checks - is it only the first visit each year that is covered in full?

Our plans follow the United States Preventive Care Task Force guidelines for well baby care. All of the 'scheduled' visits for an infant to the second birthday, should be covered with no office visit copay.

Drug Plan

Will asthma and diabetes medications continue at the reduced coinsurance with the cap?

Yes.

For the new Performance Drug list, an employee who has a history with Caremark of generic use within the last 24 months will be allowed to purchase the non preferred product. What if the attempt to use a generic was longer than 24 months ago?

The physician may call Caremark to request an override by providing additional history of the patient's attempt to use the generic.

How does a person get the discount for the drugs on the 'Discount Tier' such as allergy medications?

In order to get the discount, members must be purchasing prescription drug items and present their ID card at the pharmacy at the time of purchases.

Retirees

What will be the Open Enrollment time period for Retirees?

OE will coincide with the CMS Medicare OE period this fall and will run from November 15 through December 31. Obviously, someone making selections late in December will not have new ID cards by January 1.

Any Plans to lower rates for retirees in the future?

Retirees pay the entire cost of the health care so the premiums charged are based on what the coverage costs. The SEHP does offer several cost effective options for Medicare eligible retirees that allow them to reduce their premium if they so desire.

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