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Summer 2011 - Alberta Blue Cross

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Summer 2011 - Alberta Blue Cross Powered By Docstoc
					                                                    SUMMER 2011




                                                                                        BULLETIN


     Serving plan members who reside outside Alberta
         To ensure efficient service to plan      bill Alberta Blue Cross directly for your   reminder notice along with an
         members who reside outside of            out-of-province employees’ eligible         out-of-province provider direct-bill
         the province, Alberta Blue Cross         claims. The service provider is then        reference card for plan members to
         has arrangements with pharmacies         paid directly for the claim and the plan    present to providers when they have
         and dental offices across Canada to      member only needs to pay for any            a prescription filled or when receiving
         enable them to submit claims directly    portion of the claim not covered by         dental services. Alberta Blue Cross
         to Alberta Blue Cross at the time        the plan.                                   is sending this reminder notice
         of service through our pay-direct                                                    and provider reference card to all
                                                  To support plan members who reside
         electronic claim adjudication network.                                               plan members located outside of
                                                  outside of Alberta whose benefit
         If your benefit plan provides direct-                                                the province. The information will
                                                  plans provide direct-bill prescription
         bill prescription drug benefits and/or                                               inform them how to work with
                                                  drug benefits and/or dental coverage,
         dental coverage, these providers can                                                 providers to ensure a smooth direct
                                                  Alberta Blue Cross has developed a
                                                                                              bill claim process.
                                                                                              Alberta Blue Cross plan members who
                                                                                              reside outside Alberta are encouraged
                                                                                              to make the pharmacy or dental office
                                                                                              aware of the pay-direct billing features
                                                                                              of their plan by presenting the
                                                                                              provider card along with their Alberta
                                                                                              Blue Cross identification card.
                                                                                              Plan members will be encouraged to
                                                                                              present both cards whenever they
                                                                                              visit a pharmacy or dental office.
                                                                                              If the pharmacy or dental office is not
                                                                                              already connected to Alberta Blue
                                                                                              Cross, it’s easy for them to connect to
                                                                                              us. To accommodate the pay-direct
                                                                                              billing of claims to Alberta Blue Cross,
                                                                                              pharmacies or dental offices simply
                                                                                              contact Alberta Blue Cross to activate
                                                                                              an electronic billing connection.
                                                                                              Presentation of the provider
                                                                                              reference card provides the
                                                                                              pharmacy or dental office with the
                                                                                              information they need to facilitate
                                                                                              pay-direct billing of eligible claims.


	in           •	 Top	12	drug	lists                                      •	 Confirming	over-age	dependents	
this          •	 Advantages	of	preauthorized	debit                      •	 Convenience	of	direct	billing
issue:        •	 Travel	plans	updated                                   •	 Focus	on	Scott	Builders
TOP DRUGS
For your information, here is a list of the products most   TOP 12 DRUGS FOR 2010
prescribed in 2010 to Alberta Blue Cross employer group
plan members and a list of those products that carried
                                                            (BASED ON AMOUNT PAID)
the highest cost to group benefit plans. These lists are    1.   REMICADE 100 MG/VIAL INJECTION
based on a representative sample of our group book of       2.   BLOOD GLUCOSE TEST STRIPS
business, profiling the claims experience of the largest    3.   HUMIRA 40 MG/ 0.8 ML INJECTION SYRINGE
employer groups with direct-bill drug benefit plans
                                                            4.   NEXIUM 40 MG DELAYED RELEASE TABLET
across the province.
                                                            5.   CRESTOR 10 MG TABLET
                                                            6.   ENBREL 50 MG/ML INJECTION SYRINGE
                                                            7.   COPAXONE 20 MG/ML INJECTION SYRINGE
                                                            8.   SYMBICORT 200 TURBUHALER METERED
                                                                 INH POWDER
      TOP 12 DRUGS FOR 2010                                 9.   APO-LANSOPRAZOLE 30 MG DELAYED
                                                                 RELEASE CAPSULE
      (BASED ON NUMBER OF CLAIM LINES)
                                                            10. CYMBALTA 60 MG DELAYED RELEASE
      1.   BLOOD GLUCOSE TEST STRIPS
                                                                CAPSULE
      2.   CRESTOR 10 MG TABLET
                                                            11. LIPITOR 20 MG TABLET
      3.   VENTOLIN HFA 100 MCG/DOSE METERED DOSE
                                                            12. SINGULAIR 10 MG TABLET
           AEROSOL
      4.   TYLENOL NO. 3 WITH CODEINE TABLET
      5.   NASONEX 50 MCG/DOSE AQUEOUS NASAL SPRAY
      6.   MISCELLANEOUS COMPOUND PRESCRIPTION
      7.   NOVAMOXIN 500 MG CAPSULE
      8.   RATIO-LENOLTEC NO. 3 TABLET
      9.   APO-LANSOPRAZOLE 30 MG DELAYED RELEASE
           CAPSULE
      10. SYMBICORT 200 TURBUHALER METERED INH
          POWDER
      11. NEXIUM 40 MG DELAYED RELEASE TABLET
      12. APO-HYDRO 25 MG TABLET
Overview of top drugs
APO-HYDRO 25 MG TABLET
Used	in	the	treatment	of	high	blood	pressure.
                                                                                                                   Travel plans
APO-LANSOPRAZOLE 30 MG DELAYED RELEASE CAPSULE
Used	for	the	treatment	of	acid	reflux	(heartburn).                                                                 updated
BLOOD GLUCOSE TEST STRIP                                                                                           Alberta Blue Cross group
A	chemically	treated	strip	to	which	a	drop	of	blood	is	applied.	It	is	used	in	blood	glucose	monitoring	            benefit plans are constantly
with	a	special	device	to	test	the	sugar	level.	Used	by	diabetics	for	home	monitoring	of	sugar	levels.	             evolving along with the needs
COPAXONE 20 MG/ML INJECTION SYRINGE                                                                                of Alberta businesses. Based on
Used	in	the	treatment	of	relapsing-remitting	multiple	sclerosis.                                                   member feedback, Alberta Blue
                                                                                                                   Cross standard group travel
CRESTOR 10 MG TABLET
Used	in	the	treatment	of	high	cholesterol	and	lipid	levels.
                                                                                                                   plans have been updated.

CYMBALTA 60 MG DELAYED RELEASE CAPSULE                                                                             Later this summer the new
Used	for	the	treatment	of	depression,	as	well	as	the	treatment	of	neuropathic	pain	(nerve	pain).                   updates will automatically be
                                                                                                                   applied to all standard group
ENBREL 50 MG/ML INJECTION SYRINGE
An	 injection	 used	 to	 treat	 certain	 joint	 conditions	 (rheumatoid	 arthritis,	 psoriatic	 arthritis,	 and	   travel plans.
ankylosing	spondylitis)	as	well	as	skin	conditions	(plaque	psoriasis),	and	Crohn’s	disease.                        An Important Notice will be
HUMIRA 40 MG/ 0.8 ML INJECTION SYRINGE                                                                             sent in June to all group
An	 injection	 used	 to	 treat	 certain	 joint	 conditions	 (rheumatoid	 arthritis,	 psoriatic	 arthritis,	 and	   plan sponsors with standard
ankylosing	spondylitis)	as	well	as	skin	conditions	(plaque	psoriasis),	and	Crohn’s	disease.                        group travel plans outlining
LIPITOR 20 MG TABLET                                                                                               the updates. Until a formal
Used	in	the	treatment	of	high	cholesterol	and	lipid	levels.                                                        contract update is issued,
MISCELLANEOUS COMPOUND PRESCRIPTION                                                                                the notice will serve as a
Compounds	 are	 mixtures	 of	 ingredients	 prepared	 by	 pharmacists.	 Dermatologists	 often	 order	               contract amendment to each
compounds,	such	as	creams,	ointments	or	lotions,	to	meet	the	specific	needs	of	an	individual	patient.              Alberta Blue Cross group policy
                                                                                                                   contract.
NASONEX 50 MCG/DOSE AQUEOUS NASAL SPRAY
Used	to	treat	the	symptoms	of	allergies,	specifically	the	runny	nose	that	accompanies	this	condition.	
It	may	also	be	used	along	with	antibiotics	for	sinus	infections.
NEXIUM 40 MG DELAYED RELEASE TABLET
Used	for	the	treatment	of	acid	reflux	(heartburn).
NOVAMOXIN 500 MG CAPSULE
Antibiotic	used	for	the	treatment	of	various	infections	including	infections	of	the	chest,	urinary	tract	
and	skin.
RATIO-LENOLTEC NO. 3 TABLET
                                                                                                                   Keep it
                                                                                                                   legible
For	the	relief	of	moderate	pain	in	a	wide	variety	of	conditions,	e.g.	dental	pain,	headaches,	pain	
following	operative	procedures.	
REMICADE 100 MG/VIAL INJECTION
An	injection	used	to	treat	certain	joint	conditions	(rheumatoid	arthritis	and	ankylosing	spondylitis),	            When faxing forms or documents
and	inflammatory	bowel	disease	(ulcerative	colitis	and	Crohn’s	disease).                                           to Alberta Blue Cross, please
                                                                                                                   ensure the information you send
SINGULAIR 10 MG TABLET
Used	for	the	treatment	of	asthma	and	nasal	allergies.	It	is	taken	daily	to	prevent	the	symptoms	of	these	
                                                                                                                   is readable. Unfortunately, many
conditions.                                                                                                        faxes we receive are not legible
                                                                                                                   and require us to call individuals
SYMBICORT 200 TURBUHALER METERED INH POWDER
                                                                                                                   to decipher and confirm the
A	dry	powder	inhalation	device	used	to	treat	asthma	in	adults	and	children	12	years	and	older.	Reduces	
and	prevents	inflammation	in	the	airways	of	the	lung	and	widens	the	airways.                                       information. Ensuring that your
                                                                                                                   faxes are legible and easily
TYLENOL NO. 3 WITH CODEINE TABLET                                                                                  readable will prevent unnecessary
For	the	relief	of	moderate	pain	in	a	wide	variety	of	conditions,	e.g.	dental	pain,	headaches,	pain	
                                                                                                                   delays in processing.
following	operative	procedures.	There	are	a	number	of	products	available	with	the	same	ingredients.	In	
the	competitive	market	place,	pricing	of	the	“brand	name”	product	is	comparable	to	other	alternatives.
VENTOLIN HFA 100 MCG/DOSE METERED DOSE AEROSOL
Used	for	the	treatment	of	asthma	and	COPD. 	Relaxes	the	airways	to	reduce	wheezing	and	chest	
tightness.
Customer profile

Benefit plans to support flexibility…
and service to support easy plan administration
When Red Deer-based Scott Builders           Alberta Blue Cross customer, however,          a good benefit plan they can tailor to
took its group benefits to market in 2008,   Scott Builders was also able to introduce      their family needs and their life situation.”
its intent was to support its positioning    a “flex arrangement” with three different
                                                                                            Formed in 1971, Scott Builders currently
in the upper quartile of companies           benefit modules to meet the differing
                                                                                            operates out of six full-service branches
that offer great benefit programs to         interests and priorities of its employees.
                                                                                            across Alberta and Ontario—and keeps
their employees. This employee-owned
                                             “Our employees make Scott Builders             more than 100 employees busy. In 2010,
company is a leader in commercial,
                                             what it is,” says Rhonda Hall, controller      thanks to providing an outstanding place
industrial and institutional low-rise
                                             and accounting manager at Scott                to work and its great support of many
construction markets and has always
                                             Builders. “So it is important for us to have   local charities, Scott Builders was named
had a benefit plan. Upon becoming an
                                                                                            Red Deer Business of the Year.
                                                                                            In addition to helping Scott Builders
                                                                                            design and implement a flexible benefit
                                                                                            plan that includes drug, health, dental,
                                                                                            life and disability coverage and a health
                                                                                            spending account, Alberta Blue Cross
                                                                                            supports Rhonda as she administers
                                                                                            these benefits for her company’s
                                                                                            employees. She has seven-day-a-week
                                                                                            access to web-based services that
                                                                                            allow her to submit employee eligibility
                                                                                            information, check the status of recent
                                                                                            updates to employee files, order new
                                                                                            Alberta Blue Cross identification cards,
                                                                                            view her plan’s invoices and more. At the
                                                                                            same time, our secure online services
                                                                                            for plan members allow Scott Builders’
                                                                                            employees to find quick answers to their
                                                                                            questions about their coverage or claims.
                                                                                            “Alberta Blue Cross provides excellent
                                                                                            service to Scott Builders,” states Rhonda.
                                                                                            “I use the plan administrators’ web site
                                                                                            a lot because it is very easy to use and
                                                                                            provides all the information I need. On
                                                                                            top of that, I always know if I encounter
                                                                                            a problem, the team at the Alberta Blue
                                                                                            Cross Red Deer office is there to help me.”



        “Our employees make Scott Builders what
        it is, so it is important for us to have a good
        benefit plan they can tailor to their family
                                                                                             If you would be willing to be featured in
        needs and their life situation.”                                                     an upcoming issue of the Connection
                                                                                             Bulletin, please let us know by e-mail to
        Rhonda Hall,                                                                         connection@ab.bluecross.ca, by fax to
        controller and accounting                                                            780-498-8096, or via mail to Corporate
        manager at Scott Builders                                                            Communications, Alberta Blue Cross,
                                                                                             10009-108 Street, Edmonton, AB T5J 3C5.
Enjoy the convenience of                                                                           Included with
                                                                                                   this issue of the
provider direct billing
Today, nearly 90 per cent of claims             pay or deductible amounts. This service
                                                                                                   Connection Bulletin…
processed by Alberta Blue Cross are             is available at no cost to all Alberta Blue        Included with this issue of the
submitted electronically by providers at        Cross plan members and providers across            Connection Bulletin is a copy of
the time of service. This provides a level of   Alberta.                                           the For Your Benefit newsletter for
convenience unparalleled in the benefits                                                           group plan
                                                After Coordination of Benefits, if a plan          members. We
industry.
                                                member has a Health Spending Account               encourage
Online claims submission allows                 (HSA), any eligible amount remaining will          you to
providers to submit vision, chiropractic        automatically flow to the HSA.                     photocopy
and physiotherapy claims online at the                                                             and
                                                A paperless age
time of service through an easy-to-use                                                             distribute this
secure web site created and maintained          Alberta Blue Cross is at the forefront of
                                                developing and applying technology                 newsletter
by Alberta Blue Cross. The secure web                                                              to your
site allows providers to check patient          in support of health benefit program
                                                administration.                                    employees.
coverage and determine the amount
Alberta Blue Cross will pay to their office     The names of optical, chiropractic and             The For
on the plan member’s behalf, as well as         physiotherapy providers participating              Your Benefit
the amount—if any—their office needs to         in online claims submission are listed on          newsletter
collect from the plan member. Processing        our web site at www.ab.bluecross.ca and            provides
is completed and results are displayed          are also available through our Customer            helpful information to group plan
immediately.                                    Services department.                               members—to help your employees
                                                                                                   make the most of their benefits.
Alberta Blue Cross also provides direct         We are currently in the process of setting         Copies of the For Your Benefit are
billing capabilities to pharmacies,             up electronic direct billing capabilities for      also available on the Alberta Blue
dental offices and ambulance service            massage therapy services, which we expect          Cross web site in PDF format, in case
providers.                                      to introduce later                                 you would rather download a PDF




                                                               7
Less out-of-pocket                              this year.                                         version to forward by e-mail to your
This means plan members no longer                                                                  employees.
need to pay out-of-pocket for the portion                                                          We welcome your comments about
covered by their plan. Plan members are                                                            For Your Benefit, as well as your
still responsible for payment of any co-                                                           suggestions of topics for future
                                                                                                   issues. Please send your feedback to
                                                                                                   connectionbulletin@ab.bluecross.ca.
                 www.ab.bluecross.ca




Experience the advantages of preauthorized debit
Make your work easier by enjoying               bank to pay bills.                              receive a statement each month.
the convenience of a preauthorized
                                                To enjoy this convenience, simply               If preauthorized debit doesn’t suit your
debit plan. With the convenience of
                                                complete the Preauthorized Debit                needs, there are a number of other easy
preauthorized debit, your monthly
                                                Agreement application available on the          and convenient ways you can pay your
Alberta Blue Cross payments can be
                                                Alberta Blue Cross web site at                  bill including online banking, electronic
drawn automatically from your bank
                                                www.ab.bluecross.ca/pdfs/80415.pdf              funds transfer, telephone banking and by
account the first working day of every
                                                (also available from Alberta Blue Cross         cheque.
month. This eliminates the need to
                                                Group Administration) and return it with
write cheques each month for your                                                               For more information about payment
                                                a void cheque to Alberta Blue Cross. We
Alberta Blue Cross group benefit                                                                options, please contact Alberta Blue
                                                will send you a letter confirming the
plan payments—as well as no longer                                                              Cross Group Administration at
                                                agreement before we begin to deduct
having to remember due dates, submit                                                            1-866-498-5925 (toll free).
                                                your payment and you will continue to
payments by mail or stand in line at the
Confirming over-age
dependents
Each July, Alberta Blue Cross must clarify whether over-age
dependents are still eligible to remain covered under family plans.
Thousands of over-age dependent documents are sent out to plan
administrators each summer asking for confirmation that over-age
dependents are either still going to school or medically qualify to
remain covered dependents. If they are no longer an eligible over-
age dependent, they will be terminated from the plan.
                                                                                                                       pic of 18-20 year
Don’t photocopy
When you receive your over-age dependent notice this summer,                                                           old
please do not photocopy the notice and distribute it to your
employees. All of the contact numbers and information on the
notice are for plan administrators’ use only, not for plan members.
Confirming coverage
Please have your employees inform you of the status of over-age
dependent eligibility and you in turn can update your files. If you
have any questions you may call the Alberta Blue Cross Group
Administration department at 1-866-498-5925 (toll free) or e-mail
groupeligibility@ab.bluecross.ca.

Be aware of specific numbers
Please be aware that the phone number listed on the back of the
over-age dependent declaration form regarding privacy is not
to be called if you have questions about over-age dependent
eligibility. The privacy number is only to be used if you have
questions or concerns about privacy matters. Calling this number
will not direct you to someone who can answer your questions and
will only slow down your request.



If you have any questions, call the                                            New cards for new adults
Alberta Blue Cross Group Administration                                        When dependents approach the age of 18, new Alberta Blue
                                                                               Cross ID cards are sent out. This is an automatic process that
department at 1-866-498-5925 (toll free)                                       occurs as the dependent reaches the age of majority. It does
or e-mail groupeligibility@ab.bluecross.ca.                                    not mean there are any changes in benefits or alterations to
                                                                               family coverage.


We value your feedback
The Connection Bulletin is published to communicate with
                                                                  For more information about topics in
Alberta Blue Cross employer group plan sponsors on a variety of   Connection Bulletin, please call your Alberta
topics relating to your plan.
We appreciate your feedback regarding the Connection Bulletin,
                                                                  Blue Cross group sales or service representative.
and welcome any comments you may have about the newsletter
or suggestions of topics for upcoming issues. Please send your
feedback via e-mail to connection@ab.bluecross.ca, by fax to
780-498-8096, or via mail to Corporate Communications,
Alberta Blue Cross, 10009-108 Street, Edmonton, AB T5J 3C5.
Back issues of the Connection Bulletin may be found on the
Alberta Blue Cross web site at                                           www.ab.bluecross.ca
www.ab.bluecross.ca/gp_grpadm.html.

                                                                        ®The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross
                                                                        Plans, an association of independent Blue Cross plans. Licensed to ABC Benefits Corporation for
                                                                        use in operating the Alberta Blue Cross Plan. ABC 82847 (2011/05)

				
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