Advanced Control Specialty Formulary
Starting January 1, 2016 CVS Caremark’s Advanced Control Formulary will be implemented for specialty pharmacy drugs. If you are prescribed a non-preferred specialty product under certain specialty classes, CVS Caremark will contact your doctor to request consideration of a drug list product or generic equivalent. An established evidence-based protocol must be met before a non-preferred specialty drug will be covered. Examples of some specialty classes include Autoimmune, CML, Hematology, Hepatitis C, Growth Hormone, Multiple Sclerosis, Osteoarthritis, Osteoporosis, Prostate Cancer, Pulmonary Arterial Hypertension, and Transplant.
Generic Step Therapy Program
The medicines you and your family need to stay healthy can be costly. The good news is there are over 10,000 lower-cost, generic medicine options available. Trying a generic medicine makes sense because for almost everyone, they work as well as brand-name medicine-and usually cost much less. Generic medicine can help you stay healthy and save money.
Many health conditions have treatment options that vary in cost. Generic step therapy is a program that helps make sure the generic medicines that work well and cost less are used first. For certain conditions, your plan will require you try these lower-cost, generic options before some brand-name medicines will be covered. Generic step therapy helps lower costs for you and your plan while providing quality treatment.
Contact CVS Caremark at (888) 202-1654 with questions regarding the Generic Step Therapy Program.
Specialty Drug Step Therapy Program
The step therapy program for specialty drugs is similar to the Generic Step Therapy Program noted above however, it requires insured’s to try a preferred brand drug before the non-preferred brand drug can be dispensed. This program impacts users of prescription drugs in the Auto- Immune and Multiple Sclerosis drug class. An established evidence-based protocol must be met before a non-preferred specialty drug will be covered.
Contact CVS Caremark at (800) 237-2767 with questions regarding the Specialty Drug Step Therapy Program.
Formulary Drug Exclusion Program
A formulary is a list of medicines that are covered by your prescription benefit plan. A formulary is also called a drug list. A team of doctors and pharmacists evaluate formulary medicines based on medical guidelines first, then cost. Certain non-preferred brand-name medicines may not be covered by your plan or may only be covered after you and your doctor meet certain medical requirements. The good news is there are alternative “preferred”, covered options available. These options are “preferred” because they provide quality treatment and are cost effective.
If according to (your) physician you need to receive any of these brand name drugs, they will need to submit request for a prior approval. Without a request for prior approval, the drug will not be covered by the University’s prescription drug plan and you would be responsible for the full cost of the drug. If medical necessity is approved thru the prior approval process, the drug will be covered under the University’s plan and you would pay the brand non-formulary copay (third tier).
Check the list of drugs impacted by the Formulary Drug Exclusion Program.
If you are currently using one of the drugs, ask your doctor to choose one of the generic or brand formulary considerations.
Contact CVS Caremark at (888) 202-1654 with questions regarding the Formulary Drug Exclusion Program.
Retirement Benefits Summary
This information is designed to provide an overview of the benefits available to retirees of the University of Nebraska. Every effort has been made to provide an accurate summary of the university’s benefits program. However, if there is a conflict between this material and the documents and contracts, the documents and contracts will govern. While the university hopes to offer these programs indefinitely, it has the right to amend or terminate any benefit plan.
Eligibility for University of Nebraska retirement benefits includes the following:
Social Security Benefits
Social Security retirement benefits may be commenced as early as age 62 although monthly benefit payments will be reduced. Social Security benefits may also be delayed until age 70 which will increase the monthly benefit payment amount.
Illustrations depicting estimated Social Security income at age 65 are available upon request to the Social Security Administration.
To apply for Social Security benefits, individuals should contact the local Social Security Administration office at (800) 772-1213 at least three months prior to the retirement date.
Medicare Insurance consists of two parts: Hospital Insurance (Part A) and Medical Insurance (Part B). Medicare is effective the first day of the month the retiree or their spouse attains age 65. If the retiree is already receiving Social Security benefits, enrollment in Medicare Parts A and B is automatic and beneficiaries will be notified and receive their Medicare Identification card approximately three months prior to their 65th birthday. In most cases, there is no premium for Medicare Part A. Enrollment in Medicare Part B, however, requires a monthly premium that is automatically deducted from the Social Security benefit check.
Employees who continue to work after age 65 while participating in the university’s group medical insurance plan (as an active employee) should delay enrollment in Medicare Part B during active employment. As an active employee, group medical insurance coverage will be the primary insurer of medical benefits, thus Medicare Part B is not required. Once Medicare Part B has been delayed due to participation in the university’s group medical insurance plan (as an active employee), Medicare Part B enrollment should be requested 8 months prior to retirement.
Benefits Available at RetirementMedical Insurance
Employees who are enrolled for group medical insurance at retirement may continue coverage for themselves and dependents after retirement. Only those dependents that are enrolled for coverage at retirement are eligible to continue medical insurance. In addition, coverage is limited to the same medical benefit option the retiree was enrolled for prior to retirement. The medical benefit option may be changed, however, at any annual NUFlex benefits enrollment.
If an employee does not continue the university’s medical insurance as a retiree, coverage may not be added at a later date. In addition, retirees who cancel their university medical insurance coverage during retirement may not reenroll for coverage. Once coverage is cancelled, elections are irrevocable and cannot be reinstated.
The university’s retiree group medical insurance plan coordinates with both Medicare Part A and Part B. For retirees and spouses (if applicable) age 65 or older, Medicare becomes the primary insurance while the university’s group medical insurance plan becomes secondary. As a result, all medical insurance claims should be initially submitted to Medicare for reimbursement. The Campus Benefits Office should be notified when a retiree or covered spouse becomes Medicare eligible so that a premium adjustment can be made.
As an alternative to the university’s retiree medical insurance, retirees may continue group medical insurance coverage through COBRA. Although the COBRA premium may seem favorable to the retiree premium, COBRA coverage is limited to a maximum of 18 months. More details may be found on the COBRA Information page.Premiums
Retirees must pay the full cost of the medical insurance coverage.
Group medical insurance premiums are based on the retiree’s Medicare Part A and Part B enrollment. Retirees and/or dependents not enrolled in Medicare Part A and Part B are required to pay the “non-Medicare” premium. Retirees and/or dependents enrolled in Medicare Part A and Part B are eligible for the “supplemented by Medicare” premium. This lower premium is made possible due to the university’s retiree insurance plan coordinating benefits with Medicare. To be eligible for and receive the “supplemented by Medicare” premium, retirees must provide the Campus Benefits Office a copy of their Medicare insurance card. Medicare insurance cards must indicate both Medicare Part A and Part B to receive the “supplemented by Medicare” premium.
Payment of group medical insurance premiums will be electronically withdrawn (ACH) from the retiree’s bank account (retiree may choose the account) on the fifth day of each month. The first monthly premium payment should be made, however, by personal check or money order to allow sufficient time to process and set up the retirement status. Thereafter, premiums will be withdrawn electronically.
Comparison of University’s Retiree Group Medical Insurance Plan versus a Private Medicare Supplemental Insurance Policy
Private Medicare Supplemental (Medigap) Policy
Policies are designed to help cover the excess costs of medical services that Medicare insurance does not pay. For example:
Employees who are enrolled for group dental insurance at retirement may continue coverage for themselves and dependents after retirement. Only those dependents that are enrolled for coverage at retirement are eligible to continue dental insurance.
If an employee does not continue the university’s dental insurance as a retiree, coverage may not be added at a later date. In addition, retirees who cancel their university dental insurance coverage during retirement may not reenroll for coverage. Once coverage is cancelled, elections are irrevocable and cannot be reinstated.
Retirees must pay the full cost of the dental insurance coverage. Premium information may be viewed on the retiree premium summary
Payment of group dental insurance premiums will be electronically withdrawn (ACH) from the retiree’s bank account (retiree may choose the account) on the fifth day of each month. The first monthly premium payment should be made, however, by personal check or money order to allow sufficient time to process and set up the retirement status. Thereafter, premiums will be withdrawn electronically.
Retirees may continue term life insurance coverage subject to the following limitations:
Life insurance premiums will be billed by Assurity Life Insurance. Premium payments should be sent directly to Assurity Life Insurance.
Dependent Life Insurance
Employees enrolled for dependent life insurance coverage at time of retirement may continue coverage for a spouse and/or dependent child subject to the following limitations:
Coverage for a Spouse
Life insurance premiums for a spouse will be billed by Assurity Life Insurance. Premium payments should be sent directly to Assurity Life Insurance.
Coverage for a Dependent Child
Life insurance premiums for dependent child will be billed by Assurity Life Insurance. Premium payments should be sent directly to Assurity Life Insurance.
Long Term Care Insurance
Employees who are enrolled in the long term care insurance program may continue coverage after retirement. Premium payments should be sent directly to CNA. For more information or details regarding premium payment options, CNA should be contacted (877) 895-6759.
Other University Benefits
Other university benefits including long term disability, vision care*, accidental death & dismemberment insurance, Health Care Reimbursement Account*, and Dependent Care Reimbursement Account may not be continued after retirement.
*Vision care and Health Care Reimbursement Account participation may be continued through COBRA.
Tuition Scholarship Program
Retirees and their eligible dependents may participate in the Tuition Scholarship Program.
Retirement Plan Information
TIAA-CREF retirement income illustrations can be requested by calling TIAA-CREF directly at (800) 842-2776. This information is available online at www.tiaa-cref.org.
Fidelity Investments has a distribution packet that can be requested by calling Fidelity directly at (800) 343-0860. This information is available online at www.Fidelity.com/atwork.Updated: March 10, 2014
NUFlex 2013 Communication