Oxford - Important New Procedures:
A.) Groups requesting Self Termination will no longer be required to provide notice of 30 days before the requested date. A request received up to the last day of the month prior to the requested date will now have their termination date granted. Groups MUST have proof that Oxford received the termination prior to the termination date. ( We suggest all terminations be sent by certified mail; return receipt requested in a timely manner.)
B.) Oxford will only accept BUSINESS checks or a start up check accompanied by a letter from the bank stating that they are a new business account and checks are being printed. Oxford will then expect all future premiums to be paid with a business check. Money orders, personal checks, or certified checks are unacceptable and new cases received with these will be returned.
C.) Groups renewing with Oxford that are wishing to make changes to their plan, will now be able to do so up to the 15th of the month Prior to their renewal date.

CIGNA: Effective 5/1/00 Cigna requires all enrolling in a POS plan to complete a “Preexisting Condition Inquiry Form”. Failure to complete this form at the time of enrollment may result in the delay or denial of claim payments.

United Healthcare:
United has created new guidelines for multi-site groups with a minimum of 10 enrolled members in the tri state area as follows:
A.) If you have between 11 and 25 enrolled employees, you may have up to 3 other contract sites outside the tri state area.
B.) If you have between 26 and 50 enrolled employees, you may have up to 6 other contract sites outside the tri state area.

Aetna US Healthcare:
Beginning with effective dates of May 1, 2000 and later, Aetna US Healthcare will require all New York employers to submit an NYS-45 Form with the group application. This change had been made to ensure compliance with New York State’s community rating laws.

ABG program / Aetna US Healthcare:
As of June 1, 2000 the ABG program will be closed to all NEW groups of ANY size. Current policyholders in the ABG program are NOT affected by this change. We are currently working on two new plans through the ABG program that should be available in the Third Quarter – we will keep you informed as information becomes available.

Basic Medical Plan:
FILCO has reviewed the available Medical Plans for the second quarter 2000 and for those clients that need basic medical coverage we recommend the following:

United Healthcare’s POS Plan P with a $20 Co-pay, the single rate is only $239.12 for this plan with an excellent network and telephonic referrals which are good for one year on the same diagnosis. Includes a $10/15/25 Rx card.

Horizon Healthcare’s PPO Plan with s $30 Co-pay, the single rate is only $228.50. Since this is a PPO plan, no referrals are necessary. Includes a $10/25/50 Rx card.

CIGNA HMO Plan #3 with a $20 Co-pay, the single rate is only $209.27 and includes a $10/20/40 Rx card.

Please note the following change in the GHI Prescription Drug Benefits effective July 1, 2000 for the following GHI Plans:

Choice
Choice Plus
Premier
Optima

Retail Pharmacy Service will now be a 3 tier Rx card for Generic / Brand / Brand Non-formulary at $10/$20/$30 for up to a 30 day supply.

Mail Pharmacy Service will now be a 3 tier Rx card for Generic / Brand / Brand Non-formulary at $20/$40/$60 for up to a 90 day supply.

The Rx card will also become a mandatory generic card. This means if a generic medication is available and the physician requests a brand or brand non-formulary the cost to the insured will be the difference between the cost of the brand / brand non-formulary and the generic medication along with the generic co-pay.

Please note the Rx changes are only for the Choice, Choice Plus, Premier and Optima plans. It does NOT affect the Flex-Select plans.

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