EHA News

EHA News

NEW!! Over-the-counter COVID-19 testing

Test kits that do not require a doctor’s order or a lab to read the results are considered over-the-counter (OTC). Beginning Jan. 15, 2022, there will be a $0 cost share for up to eight individual OTC COVID-19 tests per member per 30 days. This applies to all fully-insured and self-funded groups that utilize BCBSNE’s pharmacy benefits manager, Prime Therapeutics, as well as individual health plan members. This does not apply to Medicare Advantage, Medicare Supplement or Medicare Part D members.

The current list of eligible OTC COVID-19 tests is below. Only these tests are eligible for reimbursement. Tests purchased prior to Jan. 15, 2022, are not eligible for reimbursement.

Blue Cross Blue Sheild Flier:  Over-the-counter (OTC) COVID-19 Testing

Eligible OTC COVID-19 Tests:

 NDC/UPC    Brand Name
 Tests/ Pack
 56964000000     ELLUME COVID-19 HOME TEST                            1
 11877001140     BINAXNOW COVID-19 AG CARD HOME TEST      2
 50021086001     ELLUME COVID-19 HOME TEST                            1
 08337000158     INTELISWAB COVID-19 RAPID TEST                     2
 14613033968     QUICKVUE AT-HOME COVID-19 TEST                   5
 14613033972     QUICKVUE AT-HOME COVID-19 TEST                   2
 60006019166     ON/GO COVID-19 ANTIGEN SELF-TEST                2
 82607066026     FLOWFLEX KIT HOM TEST                                     1

Our pharmacy benefits manager, Prime Therapeutics, has established a preferred network of pharmacies to support members in obtaining at home tests without member cost share. This network includes approximately 65,000 pharmacies nationwide. These preferred pharmacies can bill OTC COVID-19 tests directly to your insurance, resulting in no cost to you.

Click On Below Link:
**View The List OF Participating Nebraska Pharmacies

Tests purchased from a non-preferred pharmacy, online retailer or retail store can be submitted for reimbursement through the pharmacy paper claims process for OTC COVID-19 tests. These claims will be reimbursed at a maximum of $12 per individual OTC COVID-19 test. For example, a box that includes two tests would be reimbursed at a maximum of $24. Shipping and tax are not reimbursable.

Click on CovidTest.gov Link:

Beginning Jan. 19, 2022, free tests will also be available to order at CovidTests.gov

COVID-19 testing for public surveillance or employment purposes is not covered. This includes testing for work, school, travel and other public surveillance reasons, unless reimbursement becomes required by law.

Update: Over-the-Counter COVID-19 Testing

 

 

Blue Cross and Blue Shield of Nebraska is actively working toward implementation of the over-the-counter (OTC) COVID-19 testing guidance in partnership with our pharmacy benefits manager, Prime Therapeutics.

Beginning Jan. 15, 2022, there will be a $0 cost share for up to eight individual OTC COVID-19 tests per member per 30 days through the member’s pharmacy benefits. 

Prime Therapeutics has established a preferred network of pharmacies to support members in obtaining at home tests without member cost share. This network includes approximately 65,000 pharmacies nationwide. 

Members will be able to obtain OTC COVID-19 tests at no cost through any of these preferred pharmacies. A list of the preferred pharmacies will be available on the Blue Cross Blue Shield  website on Jan. 15, 2022. You can also find these links below.

Tests purchased from a non-preferred pharmacy, online retailer or retail store can be submitted for reimbursement through the existing pharmacy paper claims process. These claims will be reimbursed at a maximum of $12 per individual OTC COVID-19 test.

Please click on the below link for more information from Blue Cross Blue Shield of Nebraska:

**BCBS Covid News Link**

Pleas click on the below link to find pharmacies in Nebraska:

**Nebraska Pharmacies Link**

First quarter 2022 prescription drug lists now available

Blue Cross and Blue Shield of Nebraska’s Prescription Drug Lists (PDLs) are updated on a quarterly basis by the Prime Therapeutics National Pharmacy and Therapeutics Committee. This committee develops clinically appropriate PDLs that meet the needs of our members by focusing on prescription drug safety, effectiveness, unique qualities, and cost. Members may view our PDLs at NebraskaBlue.com/DrugList.

2022-23 Rates & Benefits Released

Mental Health Benefit Change Beginning September 1st, 2021

Starting Sept. 1, 2021, in-network behavioral health office services will be covered at 100% of BCBSNE’s allowable amount, whether in-person or by using the telehealth benefit. (Out-of-network telehealth visits will continue to be non-covered.) HSA-eligible High Deductible Health Plans are still subject to deductible and coinsurance for in-person and telehealth behavioral health office visits. Per IRS regulations, except for preventive health benefits, insurance carriers cannot pay first dollar coverage on HSA-eligible HDHP plans. First dollar coverage means insurance pays expenses beginning with the first dollar charged for health care, without copayments or deductibles having to be paid.  The current definition of preventive health benefits does not include behavioral health treatment.

 

Blue Cross Blue Shield Settlement Notice

We were just made aware of an email notice that was sent to our members regarding a Class Action Settlement with the Blue Cross Blue Shield Association. The email came from the Blue Cross Blue Shield Claims Administrator at this email address: Notice@BCBSsettlement.com.

There is a summary at this link:  April 6, 2021 H&W Compliance Quarterly.

The notice provides additional resources with more details and contact information:

 

Coverage for COVID-19 Related Treatment

Working in conjunction with Blue Cross Blue Shield of Nebraska, EHA’s medical plans have followed the guidance of local and federal health officials regarding coverage for coronavirus testing and treatment.  Last week, in their continued effort to invest in the health of their members, the EHA Executive Committee voted to further extend 100% coverage of COVID-19 related testing and  treatments through March 31st, 2021. Any extension beyond this date will be based on an evaluation of the situation by the full EHA Board in February.

This means members with medical coverage who present with symptoms or have been exposed to others who have tested positive for COVID-19 will pay nothing for medically appropriate, in-network testing and treatment related services in a telehealth session, doctor’s office, urgent care facility or emergency room.

If members have questions about their claims or coverage, please have them call the Member Services Department at the number on the back of their BCBSNE ID card.

Educators Health Alliance Approves 2.96% Increase in Rates

There will be an overall increase of 2.96 percent in premiums next year for the medical and dental insurance plans used by nearly every Nebraska school district, following action by the Educators Health Alliance (EHA), a consortium of three statewide public school groups that manages the plan.  Medical insurance rates for active employees will increase 3.06 percent. Medical insurance rates for retirees will increase by 4.95 percent as, for the first time, special services fees will be included in the premium rates for retirees.  Dental rates for all employees and retirees will remain unchanged from the 2020-21 rate level.

When the 2021-2022 plan year begins next Sept. 1, it will mark the 19th consecutive rate increase of less than 10 percent.  The average annual increase over the past ten years has been 4.1 percent. 

“The COVID pandemic has resulted in significant disruption for our members,” said Sheri Jablonski, EHA Board Chair.  “It has also made it difficult to set rates for the 2021-22 plan year. Nevertheless, we are pleased we’ve been able to maintain our streak of nearly 20 years without a double digit increase in rates and, especially, to average just over 4 percent for the last decade.”

The only benefit change for the 2021-22 contract year is an enhancement for the non-HSA PPO plans.  Member cost sharing for visits to counselors and psychiatrists will be eliminated. 

“We believe it is important, particularly in these stressful times, to encourage our members to seek counseling if they feel anxious or overwhelmed and we did not want the benefit plan to discourage office visits by having the deductible applied first,” said Maddie Fennell, executive director of Nebraska State Education Association.  “We are also encouraging all school districts and EHA members to follow CDC guidelines related to COVID in order to continue to mitigate claims and keep future rate increases low.”

An alternate network product offering will be expanded in the 2021-22 plan year to all districts in areas of the state where network competition is possible.

Jablonski indicated the single digit increase in premium rates is made possible due to several factors, including:

  • The impact of the EHA’s state-wide wellness and health promotion program;
  • A program designed to assist in the management of chronic diseases and emerging diseases;
  • Holding the line on health and administrative cost increases; and
  • Continued prudent management in the design and choices of benefit plans.

“The EHA Wellness program has been instrumental in improving the health and wellness of EHA covered employees,” said Beth Kernes Krause, EHA Vice Chair and Auburn Public Schools Board of Education member. “The wellness plan continues to expand, such as the recent addition of the Headspace program, and includes options for individuals and school groups to earn financial incentives for achieving goals set by the program.”

“The EHA Board understands the financial concerns of our members as well as the fiscal constraints facing school districts,” said John Spatz, executive director of the Nebraska Association of School Boards. “It is an important responsibility of the EHA Board to balance the health insurance premium increase and the benefit adjustments for both districts and individual employees and their families.”

“The EHA Board takes its responsibility for plan oversight very seriously and we believe the rate increase and benefit enhancement decisions reached by the Board for the 2021-22 plan year have been well thought out and discussed,” said Mike Dulaney, executive director of the Nebraska Council of School Administrators.  “We are confident these changes will allow us to continue to provide a quality, affordable health insurance plan well into the future.”

The Educators Health Alliance is a non-profit corporation that was created to procure quality, affordable health care insurance for Nebraska educational employees. The rates set by the EHA Board are for the Blue Cross and Blue Shield of Nebraska (BCBSNE) health care plan used by more than 400 public school district and affiliate groups in the state. The plan is governed by a 12-member board representing the Nebraska Association of School Boards, the Nebraska Council of School Administrators and the Nebraska State Education Association. More than 80,000 Nebraskans are covered by the plan, making it the largest health plan in the state.

For more information, contact Sheri Jablonski, EHA Chair, 402-475-7611, sheri.jablonski@nsea.org

2020-2021 Certificates of Coverage released

2020 Back to School Message

Dear Nebraska Educator,

The Educators Health Alliance would like to sincerely thank you for the work you are doing as we launch into the 2020-21 school year in these unprecedented times. We’d like to pass on a few reminders as the health of our members is the reason we exist.

First, we urge you to take advantage of the EHA benefits that are available to you. It is critically important that you schedule your normal preventive physician visits for annual exams, mammograms, colonoscopies, etc. Continue to take your prescription medications and if you aren’t already, consider refilling your maintenance prescriptions with 90-day supplies to reduce the number of visits to your pharmacy. If you need to talk with someone about any stress or anxiety you are experiencing, EHA providers are available for in-person visits or remote telemedicine visits.

Second, please continue to take care of yourself by continuing to exercise regularly, maintain a healthy diet and use stress reduction techniques such as meditation, deep breathing exercises, stretch breaks, etc. It may be difficult for you to think of yourself when you are concerned with those around you, but it is important to make sure you take care of your physical and mental wellbeing in these unusual and challenging times. The EHA Wellness Program has several challenges and programs to help you take care of yourself and is always available for you. Please see the enclosed card for more information on how you can get involved. If you have questions or aren’t familiar with EHA Wellness, email contact@ehawellness.org today.

Finally, we wanted to remind you to continue to follow the CDC recommended guidelines to reduce the spread of COVID-19:

  • Wear a mask when in the presence of others;
  • Maintain social distance of 6 feet whenever possible;
  • Frequently and thoroughly wash your hands with soap and water; and
  • Use hand sanitizer when unable to access soap and water for handwashing.

We thank you for everything you continue to do to serve children and youth in Nebraska. We encourage you to take care of yourself and to access all the EHA has to offer you as we work together to enter the new school year in a safe and healthy manner.

Sincerely,

Maddie Fennell, NBCT  
NE State Education Association  

Mike Dulaney, Ph.D.
NE Council of School Administrators

John Spatz, J.D.
NE Association of School Boards

Pages