CAT Tracks for July 29, 2005

Cairo Association of Teachers - Newsletter

CAT Tracks for July 29, 2005

PRINCIPAL HEALTH INSURANCE

Getting the bugs out...

Hopefully your summer has gone well...with no occasion to use the District's group health plan. (Want to keep those renewal rates down!)

Unfortunately, whenever change is instituted, glitches can be expected. A few have arisen and Kenny Johnson has been diligently working to smooth out the bumps.

I have personally experienced the "refilled too early" glitch...having to pay full price rather than the $10, $25, or $40 copay...a SIGNIFICANT difference. We had this same problem with BCBS...until Kenny negotiated a "fix".

A new glitch (for us, I think) is when the member insists on a "name brand" prescription when a generic is available...causing the member to pay FULL PRICE. Kenny assures me that this is STANDARD PRACTICE in the insurance business...an effort to contain costs...and, subsequently, reduce renewal premiums.

If generics are okay with you, then do nothing and that's what you will receive at the everyday low price of $10. HOWEVER, sometimes the patient does NOT get the same benefit from the generic for whatever reason. OR...the patient WANTS the name brand pill...for whatever reason. DO NOT PANIC...a solution is available. Contact your doctor...have the doctor rewrite the prescription to indicate that it is to be "DISPENSED AS WRITTEN"...with NO substitution. Most doctors will prescribe to their patient's preference.

In an e-mail, Kenny Johnson enclosed "language" that had been discussed with The Principal representatives. Specifically:

“..the prescription plan that we implemented at Cairo Schools is a 'mac B' plan which allows for scripts to be filled as requested by the ordering physician. In other words, if the physician writes the script for 'dispense as written', it will be covered at the co-pay level for that particular drug (tier 1,2,or 3) and will not require the insured to pay the difference between the generic drug pricing and the brand name pricing. However, should the physician not indicate 'dispense as written' and a generic is available, it will be filled with the generic drug or the insured will be required to pay the difference in the retail price between the generic and brand pricing in addition to the generic copay of $10.00”.

Again...hopefully, you have NOT run into any "bugs, bumps, snags, or glitches" with our new health insurance program...because you have been having a safe, healthy, enjoyable summer!!! However, if you should experience a "stumble", feel free to contact Kenny Johnson by phone...he encourages this! (If you have misplaced his number, feel free to contact me or the District Office to obtain it.)

Okay...back to your summer enjoyment!