Recently, a number of changes were announced for the Health Plan. To ensure you are aware of changes that may affect you, below is a recap of Health Plan changes taking effect through February 2019, along with links to the applicable Spotlight on Benefits newsletters where you can read full details.
| December 14, 2018 |
- The time allowed for submitting additional information on a medical claim that has been denied pending receipt of such information is extended from 45 days to 180 days.
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| January 1, 2019 |
- The minimum earnings for Choice coverage in the Health Plan adjusts to $35,000 effective with earning periods beginning on or after January 1, 2019. Under the new threshold, you must earn a minimum of $35,000 during any 12-month period beginning January 1, April 1, July 1 or October 1.
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- The list of drugs requiring prior authorization or step therapy for coverage under the Health Plan expands to ensure participants receive the most effective and cost-efficient treatments. Have your doctor contact Express Scripts on or after January 1, 2019.
- Certain specialty drugs that currently may be obtained from your doctor or hospital will be covered under the Health Plan only when obtained through Express Scripts’ specialty pharmacy, Accredo. Affected medications include many self-administered, rare disease, or clinician-administered infusion therapies.
- Express Scripts updates its list of covered medications effective January 1, 2019. The complete 2019 list of excluded medications along with preferred alternatives is available at www.dgaplans.org/2019_Formulary.
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- The All-Inclusive Network Out-of-Pocket Limit, which sets a maximum on the amount you pay out of pocket for network benefits per calendar year increases to $7,900 per individual and $15,800 per family.
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