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Also In This Issue
Copay and Coverage Review Changes
Ways to Save on Your Heartburn Medications
Third-Party Recovery
Monthly Premium Payments
 
It is vitally important for all agencies and school systems to pay their premiums as promptly as possible.  Premiums are due to BCBSNC by the 5th of each month regardless of the due date on the bill.  As a reminder, BCBSNC will hold claims payments to providers for that agency or school system until the premium is paid.
 
Resources are available to help you with reconciliation of your monthly billing statement.  In addition to the paper bill, electronic bills are available.  If you would like to receive an electronic bill, please call Membership Services at 1-800-245-7319
Important Flu Shot Information

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The State Health Plan is pleased to promote good health by making free flu shots available to our members. The flu shot program will run from October 1 through December 31, 2008.
 
Click here to learn more.
Why Are Immunizations Important? 

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August is recognized as National Immunization Awareness Month (NIAM). The goal of NIAM is to increase awareness about immunizations across the life span, from infants to the elderly.

Vaccines offer safe and effective protection from infectious diseases. By staying up-to-date on the recommended vaccines, individuals can protect themselves, their families and friends and their communities from serious, life-threatening infections.
 
August is the perfect time to remind family, friends and co-workers to catch up on their vaccinations. 
Quick Links...
Member Update from Jack W. Walker, Executive Administrator, 8/20/08
 
Following up on my July 24 Member Update and commitment to providing you with monthly financial information, I invite you to visit the News section of our Web site to review reports from our August 18th Board of Trustees teleconference meeting.  At that time, I provided the Board with a financial and operational update. 
 
After many weeks of reviewing and analyzing the State Health Plan's financial performance, I can now confirm the actual budget shortfall for Fiscal Year 2008.  After being adjusted for two delayed claims payments, the shortfall was $137.6 million -- rather than the $115 million reported earlier and referenced in a number of articles.  More...
Pharmacy Copay and Coverage Review Changes 
For Lexapro®, Aciphex® and Nexium®

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Starting October 1, 2008, the State Health Plan is making changes to the copay for brand name prescription medications Lexapro®, Aciphex® and Nexium®.  These medications will now require a $50 copay for a 34-day supply.  This change is being made because there are many generic alternatives available to these expensive brand name drugs.
 
Also begining on October 1, 2008, a formulary coverage review will now be required for all Aciphex® users and for all new users of Lexapro® and Luvox CR®.
 
For more information on these pharmacy changes, click here.

Ways to Save on Your Heartburn Medications

We at the State Health Plan want to help you better understand your pharmacy benefit so that you can make the best choices for your health, while saving money and getting the most from your health plan.
 
Because heartburn is such a common condition, there are many medications available for heartburn relief, in both prescription and over-the-counter options. Using OTC or generic heartburn alternatives to expensive brand name prescriptions is the best way to save money on your heartburn medications. 
 
Click here for a chart comparing the costs of alternative heartburn medications, as well as the annual savings you could realize by choosing a generic or OTC option.  As always, talk to your provider about whether a lower-cost heartburn medication may be right for you.

Third-Party Recovery
 
Third-party recovery and coordinating benefits are two ways in which the State Health Plan keeps costs down.  Unlike most other health insurance companies, the State Health Plan is allowed to recover medical expenses paid by the Plan when a third party, such as an auto insurance company, is liable for the payment. Recovering these funds helps reduce claim payments and allows the Plan to continue providing cost-efficient health care coverage to all of its members.  
 
The State Health Plan also coordinates benefits with other health insurance companies and with Medicare. When other insurance carriers provide primary coverage, they must pay for health care services first. The State Health Plan then provides secondary coverage.  This reduces the amount the Plan has to pay.
 
For example, if a member is in an automobile accident and needs medical care, the auto insurance carrier responsible for paying medical expenses must pay first.  The State Health Plan then provides secondary coverage.  If the State Health Plan has already paid for the medical expenses, the State Health Plan is entitled to collect the money from the auto insurer, or from the member if the auto insurer has paid the member directly.
 
The State Health Plan has contracted with Health Management Systems (HMS) to recover medical and pharmacy expenses from liable third-party insurance providers, such as auto insurance companies. This process is known as "subrogation."  If you or one of your employees are involved in an accident and received medical care or prescription drugs paid for by the State Health Plan, or if you or one of your employees have questions about who is responsible for paying medical claims, please contact Health Management Systems, Inc. (HMS) at 1-800-294-2757. In addition, through the process of reviewing claims, HMS may send you or your employee a letter asking if you were involved in an accident.  The State Health Plan appreciates your timely and thorough responses to HMS inquiries.

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State Health Plan for Teachers and State Employees | 4901 Glenwood Avenue, Suite 150 | Raleigh | NC | 27612