2021: What You Need to Know
PrudentRx Copay Program for Specialty Drugs
There are over 400 specialty medications available today, and that number is rapidly growing. These medications typically cost several hundred dollars monthly as they may require unique methods of administration such as injections or infusions. The Health Plan has partnered with PrudentRx to reduce specialty costs through an innovative copay program, effective January 1, 2021.
Copay assistance is a process in which drug manufacturers provide financial support to patients by covering all or most of the patient cost share for select medications. PrudentRx is integrated with CVS Specialty Pharmacy and will work directly with members and drug manufacturers to get copay card assistance when available.
Even if your specialty medication has no copay card available, your out-of-pocket cost will be $0 if you are enrolled in the PrudentRx program. PrudentRx has a team of Member Advocates available Monday through Friday from 8 a.m. to 8 p.m. EST that can be reached by calling 1-800-578-4403.
If you have a prescription for a specialty medication and do not contact a Member Advocate, they will reach out to you via phone. If you do not answer or return the call to enroll in the copay card program, you will be responsible for 30% of the cost of your specialty medications. Take advantage of this amazing program and opt-in today!
Exclusive Provider Organization (EPO) Update
Effective January 1, 2021, the Medical Plan joined an exclusive provider organization (“EPO”) through Blue Cross Blue Shield of Massachusetts. An EPO is a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in the case of an emergency).
By joining the EPO, out-of-network services are eliminated other than for emergency care. You will not be required to have a primary care physician or obtain a referral to see a specialist and will retain coverage under the Blue Cross national PPO network for emergency medical care. The Medical Plan service area remains nationwide — meaning there are preferred network providers available throughout the United States through all local Blue Cross Blue Shield plans. To find EPO network providers, call Member Services at 1-800-401-7690 or visit BlueCrossMA.org.
Blue Distinction Centers
In the building trades, it is very common for members to have a high degree of musculoskeletal injuries due to the kind of work performed. Based on the high utilization of such injuries or chronic conditions, the Health Plan has joined the Blue Cross Blue Shield Blue Distinction Specialty Care Program for spine surgery and knee and hip replacement, as well as for bariatric surgery.
The program will work with members and ultimately recommend an appropriate center of excellence for the type of surgery required — one where the value of the care is the greatest and complication and readmission rates are the lowest. Even more, the Trustees have lifted the hospitalization coinsurance if members elect to have surgery performed at one of these centers of excellence. For more information call Member Services at 1-800-401-7690 or visit BlueCrossMA.org.
Fitness and Weight Loss Reimbursements
The deadline to submit for Fitness and/or Weight Loss Reimbursements is March 31, 2021; BCBS now allows for submission online through MyBlue.
Retirement Plan Investment Update
The Annuity & Savings Plan offers participants the option to invest in the AllianzGI Dividend Value Fund. Effective on or about February 1, 2021, Allianz Global Investors (AllianzGI) Funds will be renamed Virtus Funds to reflect acquisition by Virtus. The Fund lineup will be updated to reflect the new investment name: Virtus NFJ Dividend Value Fund. There will be no impact to participant accounts and no action is required.
Routine Health Screenings & DOT Physicals
The Health & Welfare Plan, in accordance with the Affordable Care Act (“ACA”), covers many preventive services annually. The beginning of the year is a perfect time to plan ahead — it’ll save you time and trouble down the road.
Many preventive care services are available at no cost to eligible members:
- After the age of 50, cancer screenings via sigmoidoscopy are covered every five years or colonoscopy every ten years.
- Women’s preventive health services, including well-women visits, contraceptive counseling, and domestic violence screenings, are covered annually.
- For participants 36 and older, breast cancer screenings are covered annually.
- Routine immunizations are covered annually for adults, as well as diabetes screenings, blood and metabolic panels.
Participants may substitute their Department of Transportation (DOT) physical in lieu of their covered annual physical. A subscriber reimbursement form is available on the Funds’ website to submit DOT physical claims to Blue Cross Blue Shield of Massachusetts.
Meet the Funds Office Collections Department
Don Christy, Jr.
Collections Department Manager
The Collections Department works with members to ensure all hours worked have been received by the Funds Office, as well as payment for all contributions. Members should check the bi-annual Report of Contributions mailed by the Funds Office that lists all hours, contributions, and employers a member has worked for during the calendar year.
It’s important to make sure all contributions have been remitted by your employer, as pension and vesting credits, eligibility for health insurance coverage, annuity, and 401(k) deferrals can be directly affected by any non-payment. The Collections Department performs routine payroll audits of all contributing employers to be sure that all members are receiving all the fringe benefits that they have worked so hard for.
If you think you may be missing contributions, please contact the Collections Department as soon as possible by calling 1-508-533-1400.
