6 months ago

Employer Admin Guide

Special Benefit Programs

Special Benefit Programs In addition to medical and hospital benefits, ConnectiCare plans include coverage for prescription drugs as well as certain value-added programs. These special programs are outlined in this section. Some of them are described more fully in the Membership Agreement or other Plan document for your plan or The ConnectiCare Guidebook. Prescription Drug Program ConnectiCare has a prescription drug program which uses an incentive drug list. This helps to keep prescription drugs and health insurance affordable without sacrificing quality. A drug list includes those medications that have been chosen for their safety and effectiveness. If your plan includes prescription drug benefits, coverage applies only to drugs obtained from a participating pharmacy. If a member fills a prescription at a non-participating pharmacy, he/she must pay the entire cost of the prescription. How the Pharmacy Program Works The ConnectiCare drug list is based on a tiered system and is designed to give members an incentive to use drugs that are listed on the drug list on Tier 1 or Tier 2. Prescription Drug Pre-authorization Drugs that require pre-authorization are identified on the drug list with a “PA” or “ST” next to their names. Members should make sure their physician contacts ConnectiCare before prescribing these medications. Mail Order Medications Most members covered under the Prescription Drug Program can order up to a three-month supply of medications by mail. For details about mail order medications, call 1-800-369-0675. VIEW OUR DRUG LIST ONLINE To review ConnectiCare’s Prescription Drug List, visit us online at and click on Pharmacy Center. 36

ConnectiCare Touchpoints DRIVING RESULTS A wealth of ways to take a more hands-on approach to managing health care costs At ConnectiCare we know that employees are the driver of any business. That’s why employers have always wanted to provide them with the best health care coverage available. More recently, employers have realized that encouraging employees to take advantage of the programs, tools and services available through their plans is equally important. That’s why we’ve introduced ConnectiCare Touchpoints — to help your employees easily find and utilize everything their ConnectiCare health plan offers so they can stay healthy and continue to drive the health of your business. ConnectiCare Touchpoints is a comprehensive program of Health and Wellness tools, resources and services all designed to help your employees — those in good health as well as those with health conditions — take a proactive role in their health. As ConnectiCare members, your employees can take advantage of everything in the Touchpoints program at no cost beyond their monthly premium — no matter which ConnectiCare health plan they are enrolled in. Employee Health and Your Company’s Bottom Line Health care costs in the United States continue to rise every year. The average annual premium in 2011 is $15,073 for family coverage. Since 2010, average premiums increased 9% for family coverage. The 9% increase for family premiums between 2010 and 2011 is significantly greater than the 3% family premium increase between 2009 and 2010. 1 There are a number of reasons for rising costs, but two stand out in particular: • increased demand for medical services • increased incidence of certain chronic conditions How bad is the situation? Consider four conditions currently in the news, and their economic burden on the health care system: CONDITION COST TO HEALTH CARE SYSTEM Diabetes $ 174 billion Obesity $ 147 billion Heart disease $ 444 billion Asthma $ 18 billion Total $ 783 billion • More than 25.8 million Americans have diabetes. 2 • In 2007-08, more than 34% of adults aged 20 years or older were obese, and 17.1% of children and adolescents 2-19 years of age were obese. 3 • More than 82 million Americans currently live with a cardiovascular disease. 4 • 29.9 million Americans have Asthma. 5 1 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2011 2 American Diabetes Association 3 Centers for Disease Control and Prevention 4 American Heart Association 5 Centers for Disease Control and Prevention 37

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