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Administered by Allegiance Benefit Plan Management, Inc. providing the Cigna Open Access Network and CVS CareMark Pharmacy Services Williamson County Diabetes Care Plan Member Guide

Williamson County Diabetes Care Plan - · PDF fileWilliamson County . Diabetes Care Plan . Member Guide . Williamson County Diabetes Care Plan (DCP) Williamson County understands that

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Page 1: Williamson County Diabetes Care Plan - · PDF fileWilliamson County . Diabetes Care Plan . Member Guide . Williamson County Diabetes Care Plan (DCP) Williamson County understands that

Administered by Allegiance Benefit Plan Management, Inc. providing the Cigna Open Access Network

and CVS CareMark Pharmacy Services

Williamson County

Diabetes Care Plan Member Guide

Page 2: Williamson County Diabetes Care Plan - · PDF fileWilliamson County . Diabetes Care Plan . Member Guide . Williamson County Diabetes Care Plan (DCP) Williamson County understands that

Williamson County Diabetes Care Plan (DCP)

Williamson County understands that diabetes is a major health problem and if not managed

properly, can lead to serious health complications. Williamson County offers additional

resources, support, and enhanced medical and prescription drug benefits through a Diabetes

Care Plan. Enrolling in the DCP is the first step to better health. Please use this guide to learn

more about the many services and benefits available to enrollees of the DCP.

Diabetes Care Plan benefits include: Three free diabetes-related doctor visits Select free diabetes-related prescription drugs and supplies Wellness education to help you understand your condition Free dilated retinal eye exam Reminders for essential screenings and exams Case Management

Value you can appreciate

The DCP offers superior value with enhanced medical and prescription drug benefits to

provide support to participants. When you enroll, you’ll receive up to three diabetes-related

doctor visits, as well as select prescription drugs and supplies at no cost—a potential savings

of hundreds of dollars each plan year.

Welcome

Page 3: Williamson County Diabetes Care Plan - · PDF fileWilliamson County . Diabetes Care Plan . Member Guide . Williamson County Diabetes Care Plan (DCP) Williamson County understands that

Eligible participants (age 18 or older) must be enrolled in one of the Williamson

County Medical Plans and diagnosed with diabetes or pre-diabetes.

Enroll in the DCP by completing and submitting the DCP enrollment form.

Enrollment in the DCP can occur anytime during the plan year and you will be

able to use your existing ID card to start receiving the enhanced benefits.

Complete all required Health Actions by October 31st of each plan year in order

to remain enrolled in the DCP. Claims history may be reviewed to ensure you have

met the requirements. In some circumstances you may be asked to submit

documentation to report completion of required health actions.

Fill your diabetes-related prescription drugs and supplies at any retail or mail

order pharmacy contracted with the CVS CareMark Network. Included in this

packet is a list of the prescription drugs that are available to you at no cost. Your

pharmacy plan will be updated so you can use your existing ID card.

Visit your Cigna Open Access Network doctor for three free diabetes-related

visits. Your medical plan will be updated so you can use your existing ID card to

receive enhanced coverage.

Remember to always use a Cigna Open Access Network doctor.

Take advantage of the opportunity to talk with your StarPoint Case Manager. Your

personal case manager will be providing educational material by mail and

reaching out to you by phone to review outstanding required Health Actions and

discuss any questions or concerns you may have about the program.

Always take great care to manage your health and improve your education!

Important Program Information How the DCP works

Page 4: Williamson County Diabetes Care Plan - · PDF fileWilliamson County . Diabetes Care Plan . Member Guide . Williamson County Diabetes Care Plan (DCP) Williamson County understands that

Health Action Requirements Listed below are the minimum care requirements to stay enrolled in the DCP.

If your required Health Actions have not been completed by October 31st , you will

automatically be removed from the DCP. For Example, if you do not complete the required

Health Actions during November 1, 2012– October 31, 2013, you will be ineligible for the

DCP effective November 1, 2013. If you complete a Health Action requirement that the

claims administrator does not have record of, you will need to complete a Health Actions

notification form and submit documentation of the completed Health Action(s). Doctor visits, screenings and frequencies required for enrollment in the DCP may be different from the

care plan designed by you and your doctor. The DCP Health Plan actions should not replace the care plan

designed by you and your doctor.

Health Actions must be completed between 11/1 through 10/31 of each Plan Year

Page 5: Williamson County Diabetes Care Plan - · PDF fileWilliamson County . Diabetes Care Plan . Member Guide . Williamson County Diabetes Care Plan (DCP) Williamson County understands that

Medical and Pharmacy Benefits Being diligent about taking your diabetes prescriptions and monitoring your blood sugar

can be critical to maintaining your health. That’s why Williamson County is making many

diabetes-related prescription drugs and supplies, as well as doctor visits, available at no cost

to you when you enroll in the DCP and follow the required Health Actions.

To see the current list of the prescription drugs and supplies visit www.askallegiance.com/

wilco and review the DCP prescription drug list contained under the Pharmacy Icon. For

your convenience, a list is included at the end of this brochure, but please note this may be

subject to change throughout the year and you should review the website for current

information.

The list includes insulin (oral and injectable) blood glucose testing supplies and certain

prescription drugs that treat cholesterol, high blood pressure and depression. If your

medication is not listed, you may want to discuss other options with your doctor so you can

benefit from this program.

The Cigna Open Access Network will be your source for

contracted medical providers. Click the ”Find a Doctor“ link on

your dedicated website at www.askallegiance.com/wilco.

You can fill your prescriptions at any retail or mail order

pharmacy contracted with the CVS CareMark Network.

For more information on the Pharmacy network, visit

www.caremark.com.

Diabetes Care Plan

Primary Care or Specialist

Doctor Visits No cost to you for three diabetes-related visits per year

Pharmacy Retail

(31-day Supply) No cost to you for select prescriptions and supplies

Pharmacy Mail Order

(90-day Supply) No cost to you for select prescriptions and supplies

Note: The above table reflects your in-network costs for diabetes-related care. Be sure to fill

your prescriptions at any CVS CareMark Network pharmacy. Standard benefits apply for all

other non diabetes-related care except those listed on the DCP prescription drug list.

Page 6: Williamson County Diabetes Care Plan - · PDF fileWilliamson County . Diabetes Care Plan . Member Guide . Williamson County Diabetes Care Plan (DCP) Williamson County understands that

CVS CareMark Diabetic Meter Program

Regular blood glucose testing is essential for people with diabetes. The CVS CareMark

Diabetic Meter Program can provide you with a free Meter and test strips to monitor your

blood glucose levels .

DCP members can call the CVS CareMark Diabetic Meter Team toll-free on weekdays

between 8 am to 6 pm for assistance with their free meter kit. A Customer Care

representative can help you choose one of five available meters. For added convenience, a

representative can contact your physician to request and process prescriptions.

Meter kits will be shipped directly from the manufacturer to members within 7 to 10 days of

the order. Test strips and lancets can be shipped from CVS CareMark within 10 to 14 days.

Members may receive no more than one meter kit as part of their pharmacy benefits every

plan year. Meters are provided by Roche (ACCU-CHEK) and LifeScan (OneTouch).

ACCU-CHEK® or OneTouch® blood glucose meter kit, which includes a starter supply of test

strips and lancets, at no cost, is part of CVS CareMark Mail Service Pharmacy benefits.

Vision Care

Managing diabetes and pre-diabetes also involves protecting your eyes. Diabetes can

damage the blood vessels in the retina. This damage is called diabetic retinopathy, which can

lead to blindness and other eye problems. Finding and treating retinopathy early may

prevent vision loss.

Retinopathy often does not cause symptoms that you can notice in the early stage so,

regular eye exams are important. The DCP addresses this concern by providing you with a

benefit to see an ophthalmologist or optometrist (eye doctor) who cares for people with

diabetes.

Protect your Eyes Have a dilated eye exam at least once a year with the provider of

your choice. Call your eye doctor right away if you have any

vision changes.

Call Toll-Free 1-800-588-4456 for assistance with ordering your free meter

Page 7: Williamson County Diabetes Care Plan - · PDF fileWilliamson County . Diabetes Care Plan . Member Guide . Williamson County Diabetes Care Plan (DCP) Williamson County understands that

How to Enroll

If you, or any of your dependents who are over 18 years old, have received a diagnosis of

diabetes or pre-diabetes, complete the DCP enrollment form and submit to the Human

Resources Department. You can be enrolled in the DCP anytime throughout the benefit year.

The DCP benefits will be effective upon completing and submitting an enrollment form. You will

retain your current medical plan election in addition to receiving the DCP enhancements. A

new ID card will not be required.

Support you can count on–

Case Management

Williamson County Human Resources Department

301 S/E Inner Loop, Suite 108

Georgetown, Texas 78626

Phone 512-943-1533

Email [email protected]

Perhaps the most valuable resource available to

you under the DCP is access to, and outreach

from, a Case Manager who will be assigned to

you through StarPoint Medical Group. Your Case

Manager will reach out to you upon your

enrollment and will be available to discuss the

benefits and requirements of the DCP, as well as

assist with questions you may have regarding

your condition.

Your Case Manager will initiate follow up calls to

remind you of outstanding required Health

Actions and keep you up-to-date with diabetes-

related news and information through quarterly

mailings. Your Case Manager will provide you

with their contact information so you can get in

touch anytime you have questions or concerns.

StarPoint : 1-877-792-7827

Page 8: Williamson County Diabetes Care Plan - · PDF fileWilliamson County . Diabetes Care Plan . Member Guide . Williamson County Diabetes Care Plan (DCP) Williamson County understands that

How will I receive my free diabetes-related prescription drugs and supplies? You can fill your free prescriptions at any retail pharmacy that contracts with CVS CareMark or use CVS

CareMark mail order pharmacy. Your pharmacy plan will be updated automatically so you can use your

existing ID card to receive the enhanced pharmacy coverage. For more information on the CVS

CareMark network pharmacies visit www.caremark.com.

How will I receive three no cost diabetes-related visits to my doctor? As part of the DCP, you will automatically have three free diabetes-related visits if your claim is coded

as related to diabetes or pre-diabetes. Simply present your ID card at your doctor visit and feel free to

let them know you have three no cost diabetes-related visits as part of your DCP.

Which medications are free under the DCP? You will have the benefit of free select prescription drugs used to treat diabetes, pre-diabetes, and

other related conditions. This includes insulin's (oral and injectable), blood glucose testing supplies

and certain medications that treat cholesterol, high blood pressure and depression. All other

medications will be covered at the standard benefit level for retail and mail order. A list has been

included in this brochure which may be subject to change. Please review the current information on

the www.askallegiance.com/wilco website by selecting the pharmacy icon.

How are the DCP required Health Actions determined? Health actions are based on recommendations by the American Diabetes Association for treating

diabetes and pre-diabetes. They are also based on guidelines from the American Cancer Society.

How are my required Health Actions tracked?

The Claims Administrator will review claims history to track your required Health Actions. The Case

Manager assigned to you will review this information and reach out to discuss your progress. In some

instances, such as with screenings that may not be required yearly, you will need to complete a Health

Actions notification form and submit documentation of the completed Health Action(s).

How do I reach a Case Manager?

After your initial diagnosis of diabetes or pre-diabetes, or enrollment in the DCP, a Case Manager will

call you twice by telephone and if they can not reach you, they will send you a letter at your home

address with their contact information. The Case Manager serves as a valuable resource for

information and will help you benchmark your progress with the Health Action requirements.

What happens if I don’t complete my Health Actions in the compliance period?

Not completing your required Health Actions during the benefit period which starts on November 1st

and ends the following October 31st will make you ineligible for continued participation in the DCP for

future years.

Frequently Asked Questions

Page 9: Williamson County Diabetes Care Plan - · PDF fileWilliamson County . Diabetes Care Plan . Member Guide . Williamson County Diabetes Care Plan (DCP) Williamson County understands that

Enrollment

Benefit questions

Williamson County Human Resources

301 S/E Inner Loop, Suite 108

Georgetown, Texas 78626

Phone: 512-943-1533

8am to 5pm, Monday through Friday

Email [email protected]

Allegiance Benefit Plan Management, Inc.

1-855-333-1009

7am to 7pm, Monday through Friday

Website: www.askallegiance.com/wilco

Contact Information

For more information on the Diabetes Care Plan, please contact the following resources:

Page 10: Williamson County Diabetes Care Plan - · PDF fileWilliamson County . Diabetes Care Plan . Member Guide . Williamson County Diabetes Care Plan (DCP) Williamson County understands that

DCP Prescription Drug List

Free diabetes related prescription drugs and supplies list is subject to change

Page 11: Williamson County Diabetes Care Plan - · PDF fileWilliamson County . Diabetes Care Plan . Member Guide . Williamson County Diabetes Care Plan (DCP) Williamson County understands that

Diabetes Care Plan (DCP) Enrollment Form

SECTION I :

Employee ID Number:

Employee First Name: Employee Last Name:

Employee Address:

City: State: Zip Code:

Employee Phone Number: Employee Email:

SECTION II :

I am the Employee (Skip to Section III & IV) I am a dependent, age 18 or older (Complete Section II, III, & IV)

DCP Enrollee Social Security Number:

DCP Enrollee Date of Birth: DCP Enrollee Gender: Female Male

DCP Enrollee First Name: DCP Enrollee Last Name:

DCP Enrollee Address:

City: State: Zip Code:

DCP Enrollee Phone Number: DCP Enrollee Email:

SECTION III :

Eligible participants (age 18 or older) must be enrolled in one of the Williamson County Medical Plans and

diagnosed with diabetes or pre-diabetes.

I certify I meet the eligibility requirements for DCP Enrollment and understand I must complete all required

Health Actions by October 31st of each plan year in order to remain enrolled in the DCP.

I am enrolled in one of the Williamson County Medical Plans OR

I understand my DCP enrollment is contingent upon enrolling one of the Williamson County Medical Plans

SECTION IV:

Employee Signature: Date:

DCP Enrollee Signature: Date:

Submit your DCP enrollment form to the Human Resources Department:

Email: [email protected] • Fax: (512) 943-1535

301 S/E Inner Loop, Suite 108 • Georgetown, TX 78626