Highlights of Changes in 2005 Benefit Plans

The New TSB Card Option

TSB health care reimbursement account participants were given a new option for reimbursements this year: a debit-type MasterCard that allows them to pay for services from their TSB health care reimbursement account. Of 6,220 TSB participants, approximately 1,800 requested the card.

The card is voluntary and issued upon request. Presently, only newly hired employees can request the card. Employees interested in this option next year can request it in December/January after electing TSB during Open Enrollment 2006. Detailed information is at www.indiana.edu/~uhrs/benefits/tsb.html.

Current TSB debit card users will want to remember the following tips:

• The card is only to be used for qualified health care expenses.
• If purchases are not substantiated within 30 days, the card will be deactivated until receipts are submitted.
• If the card is inadvertently used to purchase ineligible items, the participant must repay his or her account. (The participant will be notified by Nyhart if ineligible expenses are detected from the receipts.)
• Just like a credit card, lost or stolen cards must be promptly reported and deactivated.

State Prescription Purchasing Program

The 2004 Indiana state law mandating a state prescription drug purchasing program—Indiana Aggregate Prescription Purchasing Program (IAPPP)­—has resulted in a number of changes in the pharmacy program for employees enrolled in the following IU-sponsored medical care plans:

• IU PPO $900 Deductible
• IU PPO-Plus
• Blue Preferred Primary POS

The most significant change is that the new prescription plan administrators incorporate more managed care features into their processes. Managed care is intended to contain health care costs. Examples of managed care requirements that may need to be met before certain drugs are covered under a plan are as follows:

Prior authorization is the process of verifying medical necessity before a request for prescription benefits is approved.

Step therapy means the patient may need to use one or more medications before benefits for the use of another medication can be covered.

Quantity limits are the amounts of a medication for which a patient can obtain benefits during a specific period of time (typically monthly).

Dose optimization normally involves the conversion from a twice-daily dosing schedule to a once-daily dosing schedule based upon the manufacturer’s recommended use.

Additional information about how the IAPPP impacts each medical care plan is at www.indiana.edu/~uhrs/benefits/prescription05-main.htm.

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