Plan Year 2010 Information
for Retiree/Direct Bill Members
Highlights and Reminders for 2010
The Non Tobacco User Discount is offered again for Plan Year 2010!
- Non tobacco users on either Plan A or Plan B will receive a total premium discount of $40 per month.
- Tobacco Users who enroll in and successfully complete the Tobacco Cessation Program offered thru HealthQuest will also receive the discount. If you tried the program last year and were not successful, you can try again!
What's New in 2010
New Coverage Codes:
1 = Member Only
2 = Member and Spouse Only
3 = Member and Children Only
4 = Member and Family (Spouse AND Children)
B = Medicare Member Only
What's Changing in 2010:
Please review the tabs below to learn more about these changes.
Changes to Plan A in 2010:
- The annual deductible maximum will increase from $50 to $150 per person and from $100 to $300 per family for services. Copayments for office visits do not count toward the annual deductible.
- The annual coinsurance maximum will increase from $1,100 to $1,200 per person and $2,200 to $2,400 per family. After the coinsurance maximum is met, eligible services are covered at 100 percent for the remainder of the calendar year.
- The Quest Lab Card, which provides a way to save you money on outpatient laboratory tests, is now included on Plan A as well as Plan B.
Changes to Prescription Drug Coverage:
Caremark for Plans A & B
- The State is implementing the Performance Drug List for certain high blood pressure (ACE/ARB's), stomach acid reducers (PPI) and cholesterol lowering (HMGs) drugs.
- For these three classes of drugs, you must try a generic drug before you can be approved for a non preferred brand name drug. The claim system will review each member's history to determine if a generic has been tried.
- Those currently using a non preferred drug affected by this change will be notified by Caremark.
Changes to Dental Coverage:
- Plan deductible is increased to a maximum of $50 per person and $150 per family. The deductible now applies to both basic and major restorative care.
Basic restorative services are now covered by a new value-based plan design! This plan design encourages members to seek preventive care services. Basic benefits are 50% for all basic restorative services regardless of the provider. However, those who have had at least one preventive or office visit for cleaning or exam of their teeth in the preceding 12 month period will qualify for the enhanced benefit level.
- For members that qualify for the enhanced benefit level, coinsurance for basic restorative services is 20% when performed by Delta PPO providers and 40% for Delta Premier and non network providers.
- New Billing Vendor - EDS
- Split Medicare Enrollment
- Members can opt out of Delta Dental Coverage. Important Note: Once a member opts out of dental coverage, the member will not be able to re-enroll in dental coverage at a later date.
- If you elect not to take Prescription Drug coverage under the State plan, you will not be allowed back in, so be sure to select some type of prescription coverage from the private market.
