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4J Classified Benefits Update

2005-06 Issue No. 3

Patrick Munyon, Classified Benefits Coordinator phone: 687-3248 email: munyon@4j.lane.edu

In this issue:

 

$ave Money on Medical Expenses!
Pay Fewer Taxes!
It’s the Flexible Spending Plan! (back to top)
Would you like to save 30% or more on your out-of-pocket medical costs for next year?
This translates to saving about 30 dollars on every hundred dollars you put in your Flexible Spending Account towards medical expenses next calendar year.

The Flexible Spending Plan is administered under contract with Manley Administrative Services. See the schedule of enrollment meetings below, and mark your calendar.

By putting a monthly payroll deduction into your Flexible Spending Account, you can pay for eligible expenses with pre-tax dollars.

A few items to remember:
  • You decide how much of a monthly deduction you want for next calendar year.
  • Your payroll deduction will be put into the account before you are taxed on that money. That’s where the savings come from!
  • You decide when to be reimbursed out of your account within the calendar year. If needed for eligible expenses, you can have access to your total year’s payroll deductions as early as February!
  • Be conservative in the estimate of your expenses. Any money left in your account at the end of the year is lost. However, you can spend your account money on a wide variety of eligible expenses.
  • If you have double coverage for insurance, or have no out-of-pocket medical costs, you may be one of the few people who would not want to participate in the Flexible Spending Plan.

Examples of eligible expenses:

  • Doctor visit copays
  • Prescription drug copays
  • Many “over the counter” drugs
  • Prescription eyeglasses
  • Contact lenses and solution
  • Dental, orthodontia deductibles/copays
  • Chiropractor visits
  • Acupuncture visits
  • Massage therapy (for treatment of illness or injury)
  • Diabetic supplies
  • Psychiatrist/Psychologist copays
  • More!! Attend a meeting for details!

The meeting schedule:
Wed. 11/16, 4:00 pm Sheldon Library
Thur. 11/17 4:30 pm Holt Elementary (during OSEA Chapter mtg.)
Tues. 11/22, 4:00pm SEHS Library
Thur. 11/1, 4:00 pm NEHS Library
Wed. 12/7, 4:00 pm Churchill Library
Tues. 12/13, 7:00 pm Ed Center Auditorium
Thur. 12/15, 3:30 pm Ed Center Auditorium
The enrollment deadline is December 15!

 

Boniva is a Non-Preferred Drug (back to top)
There is an error on some of the Preferred Drug Lists that employees received with their enrollment packets.
Boniva, a drug for the treatment of Osteoporosis, was erroneously listed on some of the lists as preferred. Boniva is a non-preferred drug. If you have questions about this, contact ODS Pharmacy Services at 1-888-361-1610.

 

Our Prescription Drug Benefit (back to top)
What remains the same?
The format of the plan remains the same:

  • $15 minimum for coverage, then 50% member co-payment, up to set maximum limit.
  • Local pharmacies: One co-payment for a 34-day supply.
  • Mail order pharmacy: One co-payment for a 90-day supply.

Important: What’s changed?
The maximum limit for member co-payment will vary, depending on the drug that is prescribed. The new three-tier plan is based upon the following system:

  • Generic drugs: 50% member co-payment, up to maximum of $35.
  • Preferred brand drugs: 50% member co-payment, up to maximum of $50.
  • Non-preferred brand drugs: 50% member co-payment, up to maximum of $75.

As you can see, the choice of drug will affect how much your co-payment will be. This is an effort to control the upward spiral of prescription drug costs.

The Preferred Drug list is in the back pocket of your red Classified Benefits Overview book, or on the ODS website at www.odscompanies.com

If you see a drug you’re taking in the “non-preferred” category: Review the list with your health care provider to see if some lower cost alternatives might be appropriate for you.

Any drugs that aren’t listed are paid as generic or preferred brand.

The three tiers, with their location on the drug list in parentheses:

Generic (marked with a $ in the left “G” column): A drug, determined by physicians and pharmacists to be therapeutically equivalent to the brand name version. Generic drugs must contain the same active ingredients as their brand-name counterpart and be identical in strength, dosage form and route of administration. Generic drugs are usually the lowest in cost to the patient, and lowest in cost to the plan.
Preferred brand (marked by a $$ in the middle “P” column): These are brand-name drugs that have been reviewed by ODS and found to be clinically effective at favorable costs. Preferred brand drugs are usually lower cost to the patient, and lower cost to the plan than the non-preferred.

Non-preferred brand (marked by a $$$$ in the right “NP”column): These are brand-name drugs that have been reviewed by ODS and found not to have a significant advantage over preferred brands, but usually cost more. Drugs that have alternative treatment options are also considered high cost (non-preferred) drugs. The non-preferred brand drugs are usually highest cost to the patient, and highest cost to the plan.

New: Coverage for several “over the counter” (OTC) medications:
Several low-cost OTC alternatives to the expensive “non-preferred brand” drugs are now covered under our plan, with the lower generic co-payment. A prescription is required, and the prescription are dispensed by the pharmacy. The drugs that are covered:

Claritin (all OTC brands), diphenhydramine, and chlorpheniramine for allergy treatment
Prilosec (all OTC brands), famotidine, and nizatidine, for stomach ulcer and GERD (acid reflux) treatment

 

Wellness Clinic (back to top)
The 4J Wellness Clinic can prescribe a free 30 day sample of the above listed drugs, as well as some other low-cost generic drug alternatives.

For an appointment, call 686-1427

Remember, there’s never a cost to you, or your benefits-eligible dependents, for Wellness Clinic office visits.
(You must call to cancel any scheduled Clinic visit to avoid a $20 “no show” fee)

The information in this newsletter has been summarized. It is presented as information --not advice or counsel. In all instances, the benefits, conditions, and limitations as outlined in the 4J Master Contracts prevail over this representation. Please refer to your Benefits booklet or the master contracts available at the District offices for additional information regarding your benefit plans.

 

Please send comments or questions to the 4J Web Team.
Last updated: February 10, 2006 by Lutz  Eugene School District 4J Eugene School District 4J