HomeMy WebLinkAboutC98-312 Rocky Mountain HMOOCKY MOUNTAIN HMO
September 22, 1998 ���' �
Dear Sue Eaton:
In November, 1997, we notified you of an opportunity to change benefit plans effective January 1, 1998. If
you elected not to implement the changes January 1, 1998, they would be implemented at renewal. This letter
is to confirm those benefit changes will take place at your renewal date of January 1, 1999. Most changes are
wording changes, clarifications that reflect new regulatory requirements. Two of the changes are being
implemented by Rocky Mountain HMO to help control medical costs and provide benefits similar to current
market trends.
First, Rocky Mountain HMO will introduce a new prescription drug benefit structure effective January 1,
1998. Prescription drugs are one of the fastest rising components of health care costs. To deal with these
increased costs, many healthcare organizations are instituting closed drug formularies, covering only a limited
list of medications. We do not want to put this type of rigid restriction on our members, so we have designed
a plan which addresses the increase in pharmaceutical costs but also leaves the purchasing decision and
corresponding costs in the hands of the member.
The new benefit structure is based on a three-tier program. All pharmaceuticals will be classified under one of
three specific categories: generic, preferred brand, or nonpreferred brand. You will continue to have a choice
between a deductible plan and a copayment plan for your employees, but the new plans give your employees
some additional choices in the purchase of their prescription drugs.
The tiers will provide the same base copayment level you currently have. For example, if you have a $5
copayment drug option, the three -tiered level will be $5/$10/$25. The $7 copay option will convert to a
$7/$12/$25 and the $10 copay option will be $10/$15/$25. The deductible drug option will have a coverage
percentage of 80% for generic drugs, 70% coverage for preferred brand name drugs and 50% coverage for
non -preferred brand name drugs.
Second, infertility drugs will be excluded in 1998. Rocky Mountain HMO will provide coverage for four
artificial insemination procedures per pregnancy attempt. This benefit change meets federal and state
requirements for coverage of treatment for infertility and aligns us with current market trends.
Attached to this letter is the 1998 Health Benefits Contract Summary of Benefit Changes for your review.
Please sign below to confirm your acknowledgement of the above changes to your Rocky Mountain HMO
benefits. Converting tothese benefit changes now will help to reduce.the increases in pharmaceutical and
medical expenses and any resulting rating impacts.
Sincerely,
Patty Clark
Accou anager
98 plawchanges ferny employer group, Eagle County Government, as described above
krO,as-de,scribed in the enclosed summary of benefits will be implemented January 1, 1999.
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Providing quality healthcare to our members
50891 Highway 6, Suite 02. Glenwood Spdngs, Colorado 81601-2537 • (970) 945-3070 • Fax (970) 945-0611
2775 Crossroads Blvd., F.O. Box 10600. Grand Junction, Colorado 81502.5600 • (970) 244-7760 • Toll Free: 1-800-643-0719 • Fax: (970) 244-7880
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