Vol. IX, Issue 19
August 1, 2012
- Medco and Express Scripts Merger—Update
- MLR Notification by U.S. Behavioral Health Plan Under HealthFlex
Medco and Express Scripts Merger—Update
As announced in the April 4 HealthFlex Express, Medco Health Solutions and Express Scripts have merged as one company under the Express Scripts name and logo.
Beginning September 1, 2012, the “Express Scripts” name and logo will appear on most Medco participant communications, including the Medco website (www.medco.com), print communications, Explanation of Benefits (EOBs) and the Member Services (customer service) telephone line. This is a step toward fully integrating Medco and Express Scripts by January 2014.
The merger is being implemented in stages to minimize disruption to Medco members, including HealthFlex participants. In general, how HealthFlex participants order prescriptions, call Member Services or access member websites will not change under the Express Scripts name. Specifically, the following will not change as of September 1, 2012 (but may change in the future):
- Member ID cards—Medco members will continue using their ID cards to fill prescriptions.
- Medco website URL—Members may continue accessing the website at www.medco.com and through a link from the HealthFlex/WebMD website.
- Medco Pharmacy—Mail-order prescription refills will continue using the Medco Pharmacy name.
- Medco’s toll-free telephone numbers—Medco’s existing phone numbers can still be used to order prescriptions and to reach Member Services.
- Retail pharmacy network—Medco members can continue using participating retail pharmacies, including Walgreens.
- Medco refill order forms.
- Medco prescription numbers.
More details about the Medco/Express Scripts merger are available in these Frequently Asked Questions or by calling Medco’s Member Services at 1-800-841-2806.
MLR Notification by U.S. Behavioral Health Plan under HealthFlex
Participants in the General Board of Pension and Health Benefits’ HealthFlex plan may have received a letter recently from U.S. Behavioral Health Plan, California (also called United Behavioral Health or UBH) about the Medical Loss Ratio (MLR) rule under the Patient Protection and Affordable Care Act (PPACA)—also referred to as the Affordable Care Act (ACA) or the federal health care reform law. Participants do not need to take any action in response to this letter.
The letter refers to UBH and UnitedHealthcare (UHC), and may be confusing to some participants who are covered under HealthFlex by Blue Cross and Blue Shield of Illinois (BCBSIL) as claims administrator. Please note that UBH is owned by UHC. Because UBH is the behavioral health insurer for all active plan HealthFlex participants—regardless of their medical claims administrator—participants with BCBSIL coverage received the UBH letter referring to UnitedHealthcare. The letter appears to have been sent to all participants who were covered in 2011 by a HealthFlex active plan.
The MLR is a new rule under the PPACA that requires insurance companies to spend at least 80% of premiums on claims (meaning no more than 20% may be spent on administration costs and marketing). If an insurance company does not meet the MLR limits, it must refund premiums to covered insured persons and provide notification.
As the insurer of HealthFlex mental/behavioral health benefits, UBH is subject to the MLR and therefore distributed this letter to HealthFlex active plan participants. The letter informs the participant that the group through which he or she was covered in 2011, i.e., UBH, satisfied the 80% MLR rule.
The MLR does not affect the other benefits provided through the other claims administrators (BCBSIL and UHC) under HealthFlex because the plan is a self-funded church health plan for these benefits. Nevertheless, even though the self-insured benefits provided under HealthFlex are not subject to the MLR rule, the plan’s administrative costs generally do not exceed 9-10% of total premiums/contributions received annually—meaning 90% or more of plan contributions are spent on claims.
Participants do not need to take action at this time. The letter is for informational purposes as required by the ACA.
Copyright © General Board of Pension and Health Benefits
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