Changes Happening to the 2017 Humana Drug Lists

Starting January 1, 2017,* some of the medicines covered by Humana’s prescription drug plan may change. 

What do these changes mean? Some medicines will have new requirements. (Specific state regulations may apply.) These requirements include:

  • Prior Authorization: The member’s doctor must contact Humana to get approval before he or she fills or refills a prescription for any medicine that requires prior authorization. His or her plan benefits won’t cover this medicine without prior authorization, and he or she will pay the entire cost of the medicine if he or she decides to buy it.
  • Step Therapy: Sometimes there’s more than one medicine that works to treat a health condition. Some medicines may cost less but work just as well. Before a prescription is filled for a medicine that costs more, the member may be asked to try at least one other medicine first.

If the member’s doctor thinks the other medicine isn’t right for him or her, he or she will need to request approval from Humana to use the medicine that costs more. His or her plan benefits won’t cover this medicine without approval, and he or she will pay the entire cost of the medicine if he or she decides to buy it.

  • Quantity Limits: A member has a limit on the amount of some medicines he or she can fill during a period of time. These limits can be placed on some drugs because of safety concerns and help prevent misuse of these drugs. If the member’s prescription is over the limit, there are two choices:He or she can get the amount of medicine that’s covered by his or her plan benefits and then pay out of pocket for any medicine that’s over the limit.

OR If his or her doctor thinks more medicine is needed, he or she can ask for approval from Humana for the amount of medicine that goes over the limit.

  • Tier Changes: The member’s medicine(s) is grouped into different tiers. For each tier, he or she will pay a different amount. If a member fills or refills a prescription for a medicine that’s moving to a different tier, he or she may have to pay more or less.
  • Not Covered: Starting January 1, 2017,* some medicine(s) will no longer be on the member’s Drug List. If a member fills or refills a prescription for any medicine that isn’t covered under his or her benefit plan, he or she will have to pay the full cost of the prescription.

The member’s doctor can ask Humana to make an exception to cover his or her drug if it’s not on our Drug List. Generally, Humana will only approve a request for an exception if the alternative covered drugs wouldn’t be as effective in treating his or her health condition and/or would cause adverse medical effects. To ask for an exception, the doctor can contact HCPR at 1-800-555-2546 between 8 a.m. – 6 p.m., Monday – Friday.

Why is Humana making these changes? 
Humana reviews and updates the Drug List to help ensure safety and offer cost-effective choices for drug benefits. Updates to the drug list can happen when medicines have changes in dosing and prescribing guidelines. The selection of available medicines may also change. This can happen when a drug is removed from the market by the Food and Drug Administration (FDA) or a drug’s manufacturer, or a new drug becomes available and is added to the drug list.

Next steps
Visit Humana.com/Druglist after October 15, 2016 to review the latest Drug Lists and changes in 2017. If you have questions, please contact your Humana Sales Representative.

Humana clients and their employees will receive notification from us explaining these changes.

*For Texas, Louisiana, and Puerto Rico Fully Insured groups, these changes start on each group’s renewal date in 2017

Paying your insurance premium on-time

 

We cannot stress how important it is to pay your insurance premiums on-time.

IF YOU FAIL TO PAY YOUR PREMIUM OR DO NOT PAY THE CORRECT PREMIUM AMOUNT, YOUR COVEREAGE WILL BE CANCELED BY THE INSURANCE CARRIER.

If your coverage is canceled, you will not be able to purchase another insurance plan for the remainder of 2016. You will be responsible for all incurred medical bills AND you will still have to pay the tax penalty at the end of the year.

WORRIED ABOUT FORGETTING A PAYMENT?

Worried about forgetting a payment? We recommend you set early reminders or take advantage of the automatic bank draft option for payments.

 

Let us know how we can help!

 

Special Enrollment period

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You may be eligible to enroll for insurance even after the January 31st deadline if you qualify for the special enrollment period. The special enrollment period is a period outside of open enrollment where you can get insurance coverage due to qualifying life events.

You may qualify for the special enrollment period if you have:

  • Married or divorced
  • Moved to another state
  • Had a baby or adopted a child
  • Changed jobs
  • Had changes in your income that affect the coverage you qualify for
  • Became a U.S. citizen
  • Left incarceration
  • Had a change of dependency status of someone on your plan
  • Had a death of a covered member of your household
  • Turned 26 and aged off your parent’s plan
  • Lost employer group coverage

Bringing in the new year

Open enrollment will end Jan. 31, 2016. If you would like to change your plan, call our offices to discuss a plan that meets your needs and your budget. We want help you choose the right plan for you!

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If you don’t enroll in a  2016 health plan by Jan. 31 2016, you can’t enroll in a plan for 2016 unless you qualify for a Special Enrollment Period.

You may qualify for a Special Enrollment Period if you have:

  • Had a baby and/or adopted a baby
  • Married/divorced
  • Changed jobs
  • Lost previous employer group coverage
  • Lost dependent status
  • Recently moved to a different state
  • Had a change of immigration status

Humana dental digital member ID cards

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Humana Dental commercial group members now have the convenience of a digital member ID card.

Why is a digital card better than a paper card? Here are a few reasons:

  1. By accessing a digital ID card, members don’t have to keep the paper version in their wallet anymore
  2. Online means up-to-date. As soon as an account with Humana Dental is updated, the digital ID card is updated
  3. Members can email or fax a copy of the card to a provider
  4. Members can print copies to give to providers
  5. A digital ID is environment- friendly by reducing the production of a plastic products

How to access the card?

All members: To access a PDF or print or email a Humana Dental ID card, sign in to MyHumana. Once signed in to MyHumana, access the digital card from the Access ID Card link. If the member is not registered with a password and user ID yet, it’s simple to follow the steps to set this up from Humana.com

Smartphone users: Is a smartphone user, members can view or fax an ID card from the MyHumana mobile app. To search for the app, visit an app store and search by typing “MyHumana.” Once you launch the app and securely sign in, a Humana Dental ID card will appear on the phone under the tooth icon.

Still want a card?

You can still get a physical card. Here’s how:

  1. Members can go to MyHumana and locate the card from the Access ID Card link and print directly from the site.
  2. The Benefit Administrator can print the card via Employer Portal.

What if a member can’t locate the card or find the app?

Contact Humana via MyHumana secure email or through their toll-free number, 1-800-233-4013.

Humana & Blue Cross digital doctor visits

TELEMEDICINE

Group employees can talk to a telemedicine doctor for $40 or less

Based on the medical plan, the copayment or retail clinic benefit cost for your employees may be less. A trip to the emergency room or urgent care can be costly – especially for minor injuries or illnesses.

But with telemedicine, your employees can quickly connect by video and see a board-certified doctor using a smartphone, tablet or computer. Whether it’s an after-hours consultation or during travels, Humana’s telemedicine benefit is access to care that is easy, convenient and more affordable for your employees to get the right type of care to stay healthy.

What is telemedicine?

Humana’s two pillars of telemedicine are eVisits and Remote Monitoring with a primary focus on expanding access and delivering integrated care to our members where and when they need it.

eVisits allow real-time secure video to enable doctor visits for certain, non-emergency care; think of an eVisit like secure Skype™ or Facetime™ session.

Telemedicine is a video on-demand, 24-hour service to access care from board-certified physicians

  • Video visit with a physician from one of Doctor On Demand’s U.S. board-certified doctors
  • Immediately video visit with a doctor 24 hours a day, 7 days a week from any location
  • Members can share notes from their telemedicine visit with their primary care doctor
  • If medically necessary, a Doctor On Demand can send a prescription to a preferred pharmacy

What can be treated by telemedicine?

Telemedicine should be considered when a primary care doctor is unavailable, after-hours or on holidays for non-emergency needs. Doctor On Demand physicians can treat ailments, such as:

  • Colds, sore throat and flu symptoms
  • Upper respiratory infections
  • Allergies and sinus infections
  • Ear and eye problems
  • Skin conditions

This service is not for emergency situations such as chest pain, abdominal pain or shortness of breath.

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Individual and employees can talk to a telehealth doctors online.

Blue Cross members are able to access telehealth services in their quests for affordable and convenient quality medical care. LiveHealth Online has saved Blue Cross members between two and three hours of time from traditional office visits, giving them more time for work, friends, family, or whatever things that they like best.  With telehealth apps like LiveHealth Online, getting hold of a doctor is now easier than ever. Whether you are a college student, young professional, a family, or an empty nester who likes to travel, we can all appreciate products that make life easier.

Sign up for LiveHealth Online and have a face-to-face conversation on your computer or mobile device. Download the app or sign up online today.

Sometimes you just need a doctor. And thanks to the Internet, you can connect to one anytime, anywhere – whether it’s the middle of the night or the middle of a road trip.

Select a doctor, and he or she can answer questions, assess your condition and even provide a prescription* if needed.

Log in and you’ll see a list of doctors available and ready to talk 24 hours a day, 7 days a week just in case something happens.

*Prescription availability is defined by physician judgment and state regulations.

Apple LiveHealth Online download

Android LiveHealth Online download

 

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