If you have questions about any aspect of your health insurance coverage, please check the Q & A on this page. If you have a question that is not answered here, please submit your question to Jessie Moulton at email@example.com
Q. Why is the consortium changing carriers?
A. As a result of rising health care costs, the Consortium, in an effort to ensure that it is making the most effective use of its limited resources, sought to analyze alternative insurance carriers through a Request for Proposal (RFP) process. With the assistance of the Consortium’s Consultants, Segal Consulting, projected costs and services were analyzed for the incumbent, Excellus, and three other carriers that submitted proposals. Based on projected claim costs, member services and a more favorable prescription drug arrangement, the Consortium’s Board of Directors, with input from members of the Advisory Committee, made the decision to end the relationship with Excellus and to begin working with Empire Blue Cross effective January 1, 2020.
Q. Who was involved in the decision to change?
A. Consensus was reached by members of a combined committee of the members of the Board of Directors and all current and active members of the Advisory Committee after interviewing Excellus and Empire and analyzing information provided by both the carriers and Segal Consulting.
Q. Are there any changes being made to the Plans?
A. Aside from changes made effective July 1, 2019 ($100 ER copay, Telemedicine w/o coinsurance) to Platinum 2, the plans remain as they were under Excellus.
Q. Are all covered benefits of the plans going to be exactly the same as they were under Excellus?
A. No two insurance companies operate exactly the same. Most differences between Excellus and Empire exist behind the scenes, like network management and case management. There are others, like the list of covered prescription drugs, that may impact a small number of members. Empire will work directly with members and their physicians to minimize the impact and to ensure continued quality care going forward.
Q. Who is going to notify retirees of the website address?
A. Local retiree groups will be provided with the link. Retirees who are not members of these groups are encouraged to contact their active locals for the information. The link will be provided to each District in the CEWW BOCES region and they will be asked to add it to their website.
Q. Does the Consortium have stop-gap insurance?
A. No. Analysis has shown that there would have been little to no financial advantage to having this coverage for the Consortium’s plans over the past two years.
Q. What is the basis for pharmaceutical rebates?
A. These are negotiated between pharmaceutical companies and pharmacy benefit managers and then a portion is shared with the insurance provider. Rebates are marketing tools and are generally offered on high-cost drugs that are competing against other drugs that treat similar conditions.
Q.Is telemedicine available for Plan 1?
A. Yes. It is subject to the 20% co-insurance. For Plan 2, the co-insurance is waived.