Employer Group Waiver Program Sponsored By Presented By

EGWP The State Employees’ Health Insurance Plan (SEHIP) and Local Government Health Insurance Plan (LGHIP)EGWP is a Medicare prescription drug plan, also known as an approved Medicare Part D plan The SEIB will reference the SEHIP and LGHIP EGWP Medicare Part D plan as BlueRx

Why was the BlueRx program implemented? At its June 20 th meeting, the SEIB agreed to begin providing the BlueRx in an effort to better manage healthcare costs. This decision allowed the SEHIP and LGHIP to offer additional pharmacy benefits to Medicare eligible retirees, and their covered Medicare eligible dependents while creating significant savings the SEIB.

Members Affected Those who will benefit from the Blue Rx program include retirees who are: Covered under BCBS Groups and 30000; and Are Medicare eligible; and Their Medicare eligible dependents.

Income Threshold

BlueRx Premium Increase Refund Members who experience an increase in premiums due to income will receive a refund. Forward premium increase letter from Social Security to the SEIB office.

Health and Dental Benefits Medicare Parts A & B will continue to be your primary medical coverage (Blue Rx will not interfere with Parts A & B) Blue Cross Blue Shield (BCBS) will be secondary to Medicare Parts A and B for medical coverage All dental benefits will continue as primary through BCBS (Some LGHIP retirees may not be eligible for dental coverage under Group 30000)

Pharmacy Benefits All pharmacy benefits for Medicare eligible retirees and their Medicare eligible dependents will be available through the new Blue Rx program began January 1, 2013.

Pharmacy Copay Structure Generic (Tier 1)* $5.00 copay Preferred Brand (Tier 2)* $25 copay Non-Preferred Brand (Tier 3)* $55 copay Specialty Drugs (Tier 4)* $55 copay *30, 60, and 90 day supplies are available Copays for medications filled at non-participating pharmacies will vary

Formulary Facts Prior to BlueRx, your drug formulary was determined by BCBS Pharmacy Board Under BlueRx, your drug formulary is determined by Medicare Formularies change consistently Medications are not guaranteed to stay on one Tier

Additional BlueRx Benefits The formulary for the BlueRx will be more extensive than that under the regular BCBS 90-day supplies available (90 day supplies will be determined by your physician) There is no coverage gap or “doughnut hole” in the BlueRx as is with most Part D plans

Covered Medications For updated information on the Blue Rx formulary and the tier of which your medication is classified, visit the SEIB website at Or Call BCBS member services at Group (800) (TTY 711) Group (800) (TTY 711)

What If Your Medication Is Not Included In The New Formulary? Formulary exception requests are available by having your physician submit Formulary Exception Request Form If your medication is approved, it will be classified as a Tier 3 or Tier 4 medication Formulary exceptions will only be considered for Medicare Part D drugs. Part B drugs will not be considered. Contact BCBS member services at for alternatives to your current medications.

Provider Network The provider network under BlueRx will fall under the BCBS pharmacy network. Therefore, your providers will remain the same.

Members Who May Choose To Decline Coverage in the BCBS Groups and and Blue Rx Members who are enrolled in TRICARE for Life Anyone who is enrolled in another Medicare Part D plan Enrolling in more than one Medicare Part D plan is not allowed Members who have other coverage available through a spouse or other employer

Members With VA Benefits VA pharmacy benefits and BlueRx are both Part D plans. The BlueRx cannot be used at the VA pharmacy. BlueRx should be used anytime VA pharmacy benefits are not available.

Other SEIB Plans Members who opt out of the BCBS Group (Blue Rx) may be interested in other plans offered through the SEIB. These plans include: BCBS Supplemental Southland Optional Each of these plans are offered in lieu of BCBS and are free for the member and their eligible dependent(s)

New Insurance Card Present the new BlueRx card to your pharmacy/pharmacist for prescription and pharmacy benefits provided on or after January 1, 2013 SEHIP and LGHIP members will continue using their same card for their health and dental services.

Do’s and Don’ts Do Use your new card for pharmacy benefits only Consult with your physician and pharmacist on added benefits for medications you are currently taking Talk with your SEIB benefits advisor with questions or concerns regarding your Blue Rx and any other benefits offered through the SEIB Consistently refer to formulary for updates Do Not Opt out of the Blue Rx without other pharmacy benefits in place Do not enroll in a Medicare Part D program to coordinate with your Blue Rx. An additional Part D plan will forfeit benefits under your Blue Rx Do not enroll in the BCBS Supplemental if your only primary medical coverage is with Medicare

Blue Cross Blue Shield Member Services Group (TTY 711) Group (TTY 711) Marsha Abbett Tonya Campbell Connie Grier Kerry Schlenker Rick Wages