MEDICAL AND PRESCRIPTION DRUG BENEFITS
Medical Insurance
The district will continue to provide medical coverage through Highmark Blue Shield with the option to choose between the PPO Blue Plan or the PPO Blue QHDHP (Quality High Deductible Health Plan) with an HSA (Health Savings Account). Both plans give you the freedom to choose your own doctors or hospitals. You will maximize your coverage by choosing participation providers within the BlueCross/BlueShield PPO network. Under the Highmark Blue Shield Program, you do not need to select a Primary Care Physician (PCP) or need to obtain a referral for services. However, if you receive care from a provider out of the BlueCross/BlueShield network, the plan pays a lower percentage of covered services and you will have higher out-of-pocket expenses, such as lower co-insurance.
Prescription Drug Coverage
Members in both the QHDHP and the PPO Blue plan automatically have prescription coverage. Express Scripts is the prescription drug benefit manager. With Express Scripts members receive the following benefits:
- Retail pharmacies. A network of over 60,000 participating independent and chain pharmacies nationwide.
- Convenient Home Delivery services through the express Scripts Pharmacy. You can have up to a 90-day supply of most maintenance medications delivered directly to you. Maintenance medications are those taken to treat an ongoing condition, such as high blood pressure, high cholesterol or diabetes.
- Online resources. You can go to https://www.highmarkblueshield.com/home/ for useful health and benefit information, along with online pharmacy services.
- Express Scripts Customer Service. Representative are available to you by phone 24 hours a day, 7 days a week (except Thanksgiving and Christmas). Pharmacists are also available around the clock for consultation.
- Specialist Pharmacists. These pharmacists are available 24/7 by phone to help you and your doctors make sure that your medications act safely together and work well for you. Each has had specialized training in the medications used to treat a specific long-term condition, such as diabetes, high blood pressure, and asthma.
To access your prescription benefits log in to your Highmark account at www.highmarkblueshield.com.
Click on the benefits summary link below to see more information about prescription drug coverage for each plan.
HIGHLIGHTS OF EACH PLAN
QHDHP (Quality High Deductible Health Plan)
WITH AN HSA (Health Savings Account)
Annual Deductible: $1,400/single and $2,800/family.
Lower Bi-weekly Employee Cost
UASD Contribution Toward Annual Deductible: $1,150/single and $2,300/family
This contribution is deposited monthly into the members HSA account. The total contribution amount is divided by 12 months at the start of the benefit year. For enrollments after the start of the benefit year, the total contribution amount will be divided by the remaining months in the benefit year at that time.
Co-pays and prescriptions do not apply until the deductible has been met
To enroll in this plan, complete the Enrollment/Change Form, and send it to Tina Fair.
To request to contribute or change your current contribution amount into your HSA, complete the HSA Payroll Deduction Form, and send it to Tina Fair.
American Fidelity is the account holder for the Health Savings Account (HSA) for Upper Adams School District. Contact American Fidelity if you have any questions about a Health Savings Account by emailing AJ Gallagher at AJ.Gallagher@americanfidelity.com . If you decide to switch to the QHDHP insurance plan, you are still required to complete an enrollment/change form and send it to Tina Fair.
What is an HSA?
An HSA is a tax-advantaged account that is used in combination with a qualified high deductible health (QHDHP) insurance plan. The money you put into your health savings account can help pay your health insurance plan's annual deductible, as well as any other qualified medical expenses that may not be covered by your health insurance plan after you meet your deductible. Contributions to your HSA account cannot be used to pay for health insurance premiums.
HSA Support and FAQs (Frequently Asked Questions)
To learn more about the HSA, including Tax Information, Reimbursements, Eligibility, Contributions, Investments, Retirement and a Benefits Debit Card, click the HSA Support and FAQs provided by American Fidelity to answer any questions you may have about having an HSA. You can also click the tab for "HSA Eligible Expenses" on the Support and FAQ page, to find out what you can use your HSA money for.
What Expenses are Applied Toward Your Deductible?
(information below is for in-network services, information varies when using out-of-network providers). Under the QHDHP, any services received with the exception of Preventative Care, are applied towards your deductible. This includes (but is not limited to): office visits, hospitalization, emergency room visits/care, lab tests and prescription drug coverage.
Keep in mind that the deductible must be satisfied each year before the insurance company pays on any medical claims.
See more information about this plan below in "Benefits of Enrolling in the QHDHP with an HSA" article.
PPO BLUE PLAN
Annual Deductible: $500/single and $1,000/family
Higher Bi-weekly Employee Cost
UASD Contribution Toward Annual Deductible: $0
Most co-pays and prescriptions are not subject to the deductible
To enroll in this plan, complete the Enrollment/Change Form, and send it to Tina Fair.
Federal Maximum Out of Pocket, Deductibles and HSA Catch Up Contributions
- PPO Total Maximum Out of Pocket: $8,550/Single, $17,100/Family
- QHDHP Minimum Deductible: $1,400/Single, $2,800/Family
- QHDHP Maximum Total Maximum Out of Pocket: $7,000/Single, $14,000/Family
- HSA Contribution Limit (Employer and Employee combined): $3,650/Single, $7,300/Family
- HSA Catch up contribution over age 55: $1,000
Benefit Costs for 2022
Medical and prescription benefits costs will not increase for the 2022 benefit year. To view the cost of your benefits, click the appropriate benefit cost sheet below:
Administrator Benefit Cost Sheet 2022-2023
GETTING THE MOST OUT OF YOUR BENEFITS
Have You Registered for a Personal Account With Highmark?
All Highmark members can register for an account at https://www.highmarkblueshield.com/home/ . Members should use the member ID located on their member card when creating the account. Once an account has been created the member will have access to be able to:
- Use My Care Navigator to search for providers, and schedule appointments, transfer medical records, and more
- Access Virtual Medicine
- Access forms
- Access special member discounts
- Print or order a new insurance card for any member on their insurance
- View and print claim forms
- Refill mail order prescriptions (Express Scripts)
- View the Coverage Summary and full Benefits Booklet
- View the status of prior authorization
- View information about the Diabetes Prevention Program
Preventative Benefits Schedule 2022
Your Highmark plan includes coverage for most preventative services with little to no cost, from participating health care providers, such as routine annual check-ups, Colon Cancer screenings, Diabetes Screenings, Mammograms, and other screening and procedures for adults. There is also a preventive schedule for children from birth to 18 years of age. Click the 2022 Preventive Schedule for more information.
Women's Preventative Health Care
The health care reform law (Affordable Care Act) requires health plans to cover certain preventive care services for women without any cost-sharing, such as deductibles, copayments or coinsurance. The following items are included in this coverage:
- Well-woman visits (annual preventive care visit in which adult women obtain recommended preventive services)
- Gestational diabetes screening for women 24 to 28 weeks pregnant, and women at high risk
- Human papillomavirus (HPV) testing for women 30 and older, once every three years
- Annual counseling for HIV and sexually transmitted infections, plus annual HIV testing for all sexually active women
- Contraceptives and contraceptive counseling.
- Breastfeeding support, supplies and counseling
- Domestic violence screening and counseling
Be sure to check your plans specific rules before receiving care. Though plans are required to provide these services free of charge, they do have the option of using cost-control measures, such as requiring to you pay for a brand name drug if a comparable generic drug is available, or charging a copayment for preventive services received at out-of-network facilities.
Understanding How your Health Insurance Benefits Work
Click the link below for a short video that explains how you, and your health insurance company, work together to pay your medical expenses.
https://www.youtube.com/watch?v=DBTmNm8D-84
Smart Shopper Program Discontinued as of July 1, 2022
The last day members will be able to utilize the Smart Shopper feature in Highmark will be June 30, 2022. This program was offered to members at the start of the 7/1/2021 benefit year, on a trial basis. Due to the cost of the program, and the lack of member participation, the insurance committee has decided not to move forward with the program for the 2022-2023 benefit year. Members can still use the "care cost" estimator on their Highmark member portal, to calculate costs between medical doctors and health care facilities.
DENTAL INSURANCE
Upper Adams School District will continue dental benefits through Delta Dental for the upcoming plan year. Choose a PPO Dentist to receive the most out of your benefits. The Delta Dental website is easy to use and provides the most up to date and complete information for program participants:
- Locate a nearby participating provider, verify eligibility for you or a dependent.
- View benefit program and specific details
- Review claims and print ID cards.
View the full Benefits Summary Chart for PPO and Premier Dentists
Delta Dental - Virtual Consult
Virtual Consult connects Delta Dental members and dentists for real-time video appointments. Click the Delta Dental Virtual Consult flyer for more information.
Connect with a Dentist From Home with Toothpic!
Toothpic is a photo-based teledentistry app for PPO and Premier plan members that offers virtual dental screenings from a Delta Dental dentist. Click the Toothpic flyer for more information.
VISION INSURANCE
Upper Adams School District will continue to offer vision coverage through National Vision Administrators (NVA). Eligible dependents under 19 are entitled to receive a vision exam and one pair of lenses once every plan year and a frame once every two plan years or contact lenses and contact lens evaluation/fitting once very plan year. If you choose a frame, you will not be eligible for contact lenses for two plan years.) Eligible members and dependents 19 & over are entitled to receive a vision exam and one pair of lenses and a frame or contact lenses and contact lens evaluation/fitting once every two plan years.
The NVA website is easy to use and provides the most up to date and complete information for program participants:
- Locate a nearby participating provider by name, zip code, or City/State
- Verify eligibility for you or a dependent
- View benefit program and specific details
- Review claims
- Print ID cards.
View the full National Vision Administrators Plan Specific Details.
DO YOU HAVE QUESTIONS ABOUT YOUR BENEFITS?
Contact the appropriate vendor directly for questions regarding benefits, claims processing, choosing a doctor, ID cards and copayments and deductibles.
Highmark Blue Shield
Member Service: 1-866-727-4943
Blues on Call: 1-888-258-3428
Website: www.highmarkblueshield.com
Claims Address: Highmark Blue Shield
PO Box 890173
Camp Hill, PA 17089-0173
All insurance cards are sent to the member directly from Highmark. The member must contact Highmark to request a new card if it is lost or stolen. The card also includes the information to fill/refill prescriptions at the pharmacy.
Prescription - Express Scripts
Phone: 1-800-903-6228
To access your information, and your prescription coverage, visit the Highmark website at www.highmarkblueshield.com.
American Fidelity
Contact: AJ Galagher at 484-643-2881or by email at: aj.gallagher@americanfidelity.com
Delta Dental
Customer Service: 1-800-932-0783
Website: www.deltadentalins.com
Claims Address: PO Box 2105
Mechanicsburg, PA 17055-6999
National Vision Administrators (NVA)
Customer Service: 1-800-672-7723
Claims Address: PO Box 2187
Clifton, NJ 07015
Website: www.e-nva.com
Delta Dental and NVA do not send insurance cards to members. Members can print cards from their member account.
