Health Insurance: Q & A

CONNECTICUT STATE EMPLOYEES/DISTRICT 1199 MEMBERS

Answers to common questions surrounding the recent July 2005 changes to the state employee health insurance plans:
Pharmacy/Prescriptions
Dental


PHARMACY/PRESCRIPTIONS
The 800 number for Pharmacare and prescription questions is 1-800-318-2572.

What should I do if my prescription is rejected or the co-pays charged are incorrect?
You should call the Pharmacare customer service at 1-800-318-2572 or have your pharmacist call at the point of sale. This should resolve the problem. If the co-pays are wrong, document the error and you will be reimbursed for any additional out-of-pocket costs.

My pharmacist says I have to pay more if I decline the generic version?
Typically, your doctor must indicate on the prescription that you are to receive the brand-name version in order to get it at the normal $6 co-pay. Otherwise, you get the generic version (this help keeps everyone's costs down.)

But because of the current data problems (see below), Pharmacare is currently allowing state employees to receive either the brand-name or generic version at the $6 co-pay.

If your request for the brand-name version was rejected on or before July 7, return to your pharmacy to reprocess your prescription.

Pharmacare doesn't have my current information?
State Comptroller says this should corrected in the next week (mid-July). In the meantime, if you urgently need a prescription filled, contact your Payroll Clerk/Officer. He/She should fax the correct information to Pharmacare and provide you with an official letter so your pharmacist can process the prescription (they can access these materials on the Core-CT website.)



DENTAL
The 800 customer service number for United Dental Basic and Enhanced plans is 1-800-896-4834.

 I heard that if I chose the Basic dental plan, I might be “balance billed” by my dentist?

Just as under the prior Basic plan from Anthem, any state employee may be “balanced billed” for the difference between the cost of the service and the reimbursement rate from the insurance company. However, it is likely that the “balance billing” will not take place in any greater frequency than before.

If your dentist has not “balanced billed” you in the past and starts now, you should ask why now and tell 1199 (call 860-251-6030) about it. The balance billing issue is something we are watching closely and working hard to make sure the experience under United is not substantially different than under Anthem.

Under the Basic plan, can I go to my dentist even if he has not signed up with UnitedHealthcare?

Yes. Your dentist will simply submit a reimbursement request to United and he/she will be paid according to the benefits of the plan and United’s reimbursement rates (which are the same or better that those under the old Anthem plan.)

I signed up for the Enhanced dental plan, but I just got an insurance card in the mail that says I'm in the Basic plan? What gives?

You'll should receive a new Enhanced plan dental card in the mail in July. Because of the initial data problems, UnitedHealthcare decided to send all state employees with dental insurance a Basic card so they'd have something to show the dentist. When you receive the correct Enhanced plan card, be sure to discard the Basic card.

I believe I chose the wrong dental plan (Basic vs. Enhanced) — what do I do?

If you feel you chose the wrong plan and need to switch, call the 1199 office at 860-251-6030 by August 15, 2005. We will compile all requests and work to coordinate switch-overs with the Comptroller’s Office.