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KEHP Vendor Updates 

The Kentucky Employees’ Health Plan (KEHP) provides a vairety of top-notch benefits in partnership with our multiple vendors. KEHP's goal is to provide you with the best possible level of coverage, administration, and customer service.  See our vendor partners listed below:

Anthem.png 

Medical Anthem Blue Cross Blue Shield (Anthem)has operated in Kentucky for more than 75 years and is the largest insurance carrier in the Commonwealth. We are excited to work with this partner, who offers a large network of providers, excellent service and technology, and opportunities to help hold down costs.

 

 CVS.png

PharmacyCVS/Caremark networkincludes more than 67,000 pharmacies nationwide, including chain pharmacies and 20,000 independent pharmacies. It is important to know that you do not have to use a CVS pharmacy and may continue to use your existing retail, grocery store, independent pharmacy, etc
 

WageWorks.png  

FSA/HRA/COBRA WageWorks is a leader in administering Flexible Spending Accounts (FSA) and Health Reimbursement Arrangements (HRAs).  WageWorks is solely dedicated to administering pre-tax spending accounts which empower employees to save money on taxes. They also provide COBRA administration services. They make benefits programs easier to understand and use so that everyone can take advantage of pre-tax savings and focus on what matters most.

 

 

TransparencyVitals SmartShopper KEHP’s transparency vendor allows you to earn a cash reward for choosing a cost-effective option for your healthcare needs. It’s easy and free to shop the Vitals list of services and lower your out-of-pocket costs and earn rewards.

Go365 logo w csnumber.png    

 

Wellness Go365 is a wellness and rewards solution that motivates action and inspires  healthy changes. KEHP members earn rewards for healthy lifestyle activities, such as walking, staying current with preventive care and more!

 

 

 

 

 

 

We have provided answers to some frequently asked questions (FAQs) below, which will be updated as new information is made available.

What is the Kentucky Employees' Health Plan (KEHP) and who do they cover?
KEHP is the Commonwealth of Kentucky sponsored health plans covering nearly 300,000 public employees and their families. Members include Kentucky school boards, state employees, various quasi-governmental agencies, and public retirement systems. 

What type of services does a medical plan administrator provide?
KEHP is your self-insured health plan—meaning the KEHP determines your benefit plan designs, not a third party insurance company.  A third party insurance company does however contract with the KEHP to administer our medical plans—for example they process claims and maintain a medical network.  

Why was a new vendor selected?
As required under state law, the KEHP medical administration contract was advertised for competitive bid. As a result, a new vendor was selected through the state procurement process.

Who is the new medical plan administrator?               

Anthem Blue Cross and Blue Shield of Kentucky, Inc. (Anthem).                

What services will the new medical plan administrator provide?               

Anthem will provide medical claims administration, medical network access, medical customer support, disease management, utilization management, case management and claim subrogation.                

When will the Anthem contract be effective?
Jan. 1, 2015. 

Does this change impact my current 2014 health plan benefits?
No. 

Will my health plan options change?
The KEHP benefits will not be negatively impacted by changing vendors—the KEHP designs your health plan choices, not the vendor. 

Will the open enrollment process change?
No.  As usual open enrollment will be this fall. Typical communications channels, including local benefit fairs and a benefit selection guide will be available to assist you in selecting a health plan.

What can I do to prepare for this change?
No action is required at this time.  As we move toward open enrollment, you can expect to learn more about the new medical administrator, and other vendors that will assist KEHP in providing your health and wellness benefits in 2015. 

Will the vendor change result in cost savings?
Our number crunchers predict significant opportunities to help hold down costs, while offering a larger network of providers.

When was the last time RFPs were released for KEHP?
The KEHP contracts were last bid through the Commonwealth procurement process in 2005 with a Jan. 1, 2006 effective date.

Why were the RFPs released at this time?
The current contract was nearing its maximum allowable number of renewals and was required to be bid under the guidelines of the Commonwealth. Humana has maintained the contract from Jan. 2006-Dec. 31, 2014.

What is the maximum allowable number of contract renewals for third-party health administrator?               

The initial term of the contract(s) shall be for a period of three (3) years. The contract(s) may be renewed at the completion of the initial contract period for seven (7) additional one year (12 month) periods upon the mutual agreement of the parties.                 

What services does the current medical plan administrator provide?               

The current vendor provides the following services: medical claims administration, medical network access, medical customer support, disease management, utilization management, case management, claim subrogation, FSA/HRA administration, and COBRA.                

What other RFPs were released?
Other RFPs issued include the pharmacy benefits manager, wellness, transparency, and FSA/HRA/HIPAA/COBRA. These RFPs are still under review. 

Will there be changes in provider networks for members?
The Anthem network will be as broad and comprehensive, if not more, than the current network. KEHP anticipates similar staffing levels for customer service and disease management programs.

Will members involved with a nurse support program be transitioned to new nurses; how will that happen?
KEHP members will be transitioned to similar programs offered by Anthem.

What will happen to members currently undergoing specialized and ongoing treatment regimens – cancer, pregnancy, dialysis, MS, etc., - how will they be transitioned to new care?
KEHP members will be transitioned to similar programs offered by Anthem.

Will members involved with the Go365 program be impacted by this change?
No. Wellness benefits are separate from the medical administrator vendor.

What will happen to stand-alone or embedded Health Reimbursement Accounts (HRA)?
There will be no impact to HRA accounts, any remaining funds will continue to rollover from previous plan years.

Where can I fill a prescription with CVS Caremark?               

Your prescription plan offers three ways to get your medication:               

      1. Retail network (short-term medications)
        Use a CVS Caremark participating retail pharmacy when filling prescriptions for medications such as antibiotics. Our network includes more than 67,000 pharmacies nationwide, including chain pharmacies and 20,000 independent pharmacies.  It is important to know that you do not have to use a CVS pharmacy and may continue to use your existing retail, grocery store, independent pharmacy, etc.

      2. Retail maintenance network (long-term medications)
        Similar to the current program, certain retail pharmacies have agreed to dispense 90-day supplies of medication at the Mail service co-pay.

      3. Mail service pharmacy (long-term medications)
        You also have the option to use the CVS Caremark mail service pharmacy to fill your long-term prescriptions.

Will I have online access to my pharmacy information?
Yes.  CVS Caremark has online tools for ordering prescription refills and checking drug costs. They also have a mobile app to help you manage your family's health anywhere, anytime. Caremark.com (available later this year) is an easy way to make the most of your prescription benefits:
View and print your booklet and benefit ID card
Visit the savings center to explore lower-cost options
Sign up to receive alerts by e-mail, phone or text message
Access the latest health and wellness information 

Will my prescription drug be on the formulary list with CVS Caremark?
CVS Caremark's formulary of preferred drugs contains some differences in drug classification from your existing formulary.  Some members will experience a lower co-pay with the new formulary, while others may experience either a higher co-pay or need a prior authorization for a current medication.  If this is the case, you will receive a letter later this year about any changes.

What will happen to members currently taking specialty medications?
If you require a specialty drug to treat chronic, complex diseases such as cancer, multiple sclerosis, or rheumatoid arthritis, you must obtain it from CVS/caremark Specialty Pharmacy. KEHP will allow you to receive your initial specialty medication fill through a retail participating pharmacy. However, after the initial prescription is filled, all remaining prescriptions must be filled by CVS/caremark Specialty Pharmacy. Your specialty drugs will be delivered to your home. For more information, call CVS/caremark at 866-601-6934..

How do I get more information on the CVS Caremark prescription benefit plan?
In December, you will receive a mailed welcome kit that includes more information about your new prescription benefit plan.  Or, you can also visit www.caremark.com. Currently, the CVS website will only provide general information about CVS.  Closer to open enrollment in October more specific KEHP information will be available.

2014 CVS/caremark Formulary list               

CVS/caremark drug list that will be removed in 2015               

If I’m on a drug that I take daily what are my options?
Purchasing a 90-day supply of maintenance drugs – drugs you take regularly to maintain your health status – allows you to pay at a reduced cost. You may receive your 90-day supply through participating local retail pharmacies, or through CVS/caremark mail order. To qualify for this benefit the drug must be listed on CVS/caremark’s maintenance drug list. You can view more information about the maintenance drug list at www.caremark.com or call 866-601-6934.

What type of services will WageWorks provide?
Starting in January 2015, WageWorks will provide KEHP members the ability to use pre-tax dollars to pay for eligible medical and daycare expenses through the Healthcare and Dependent Care FSAs, or pay for eligible medical expenses through the employer funded HRAs. Members will have the ability to enroll in these benefits during Open Enrollment in October 2014.

If you are currently a KEHP COBRA participant, or elect COBRA in the future, WageWorks will administer your COBRA account – collecting premiums and providing customer service for healthcare and pharmacy benefits.               

What impact will the change in vendors create with my HRA and/or FSA funds?
There will be no negative impact to you or your ability to use your funds.

Will my current HRA funds carry over to 2015 with the new vendor?
Yes. The remaining balance of your HRA funds can carry over to the 2015 plan year, as long as you continue to elect a CDHP plan or waive coverage with an HRA.

How do you pay for or get reimbursed for eligible expenses?               

WageWorks offers a variety of methods to pay for and verify your eligible expenses.               

                  • Swipe and Go: You will receive a new WageWorks Healthcare Visa Card, a convenient payment method tied to WageWorks healthcare FSA and HRAs to make healthcare purchases at the doctor’s office, pharmacy, optician, dentist, and other healthcare providers.          

                  • Online: Reimbursement forms are readily available online. You can upload your receipt directly to your account. When accessing your account online, you can also setup the Pay My Provider service to pay many of your eligible healthcare and dependent care expenses directly from your spending account (similar to online banking).           

                  • Mobile App: WageWorks offers a mobile app that allows you to take a picture of your claim receipt or Explanation of Benefits (EOB) and send it to your WageWorks online account. They will use the receipt to validate any receipts needing verification. The mobile app enables you to log in to your account and check your balances, submit claims, snap photos of receipts, get alerts by text or email—all on the go!          

                  • Fax/Mail: You can also print the needed forms from the WageWorks website and submit via fax or mail.          

Where can I find more information on WageWorks?
You can go to WageWorks.com to learn more about the company and their services. Information specific to the KEHP will be available during Open Enrollment later this year.

What type of services will Vitals provide?               

Vitals SmartShopper will continue to provide KEHP members the opportunity to earn cash incentives and lower your out-of-pocket costs by using cost-effective options for certain medical conditions.               

Will there be changes from how I use Vitals SmartShopper today?.               

There will be no negative impact to you o your ability to shop for lower cost medical procedures.                

You can still shop your medical service and receive information on high-quality, cost-effective service providers in your area by calling Vitals at 855-869-2133 or going online at www.Vitalssmartshopper.               

What type of medical services can I shop?               

Examples include mammograms, colonoscopies, MRI's, ear tubes, knee surgery, etc. To view a complete list of services with the incentives available click here.               

Where can I find more information on Vitals?               

Currently you can go to LivingWell.Ky.gov and select the Vitals link or go directly to www.Vitalssmartshopper to learn more about how to receive cash rewards for certain medical procedures that your doctor may recommend for you.               

               

For questions on the transition from HumanaVitality to Go365, please click here.