Spring 2019 Issue of Spotlight on Benefits Available Now

The Spring 2019 issue of the Pension and Health Plans’ newsletter, Spotlight on Benefits, is now available.

In this issue:

Read about important Health Plan changes:

Previously, diabetic supplies like needles, syringes and test strips needed to be “bundled” with an insulin prescription to avoid paying a separate co-payment. Effective immediately, you may order your insulin and diabetic supplies separately but without an increase in your total co-payment, as the co-payment for diabetic supplies ordered separately from an insulin prescription has been reduced to $0.
Effective immediately, the Health Plan will not participate in Express Scripts’ Medicare Part B program, as previously reported in the Special R_X Edition of the Spotlight on Benefits. The program would have coordinated payment of claims for Medicare Part B-eligible supplies between the Health Plan and Medicare, which may cause confusion and would restrict your ability to continue to obtain certain supplies via mail order.
The Preventive Care section of the March 2015 Health Plan Summary Plan Description has been amended to update outdated website references and language in reference to current Health Plan policies. These changes are reflected in the March 2015 Health Plan Summary Plan Description Updates document on dgaplans.org/forms/health.

Learn more about your benefits and how the Health Plan determines medical necessity:

Nasal Surgery and Predetermination: A predetermination is a written analysis, provided by the Health Plan upon request, which evaluates the medical necessity of a particular treatment of procedure before you receive it. When it comes to complicated procedures like nasal surgery, requesting a voluntary predetermination beforehand can help you better anticipate your out-of-pocket financial responsibility by indicating which procedure codes might be deemed to be not medically necessary and therefore not covered by the Health Plan.
Mental Health Benefits: Individual therapy, like most medical services, is a covered benefit under the Health Plan when it is medically necessary. On the other hand, family therapy, relationship counseling, and the like—where more than one person is present—are not covered by the Health Plan.

Also included:

An explanation of what opioids are, how the opioid epidemic started in the United States, and how Health Plan benefits can be helpful in treating opioid addiction. The Health Plan covers both inpatient and outpatient chemical dependency treatment when medically necessary.
A description of the requirements that must be met in order for the Health Plan to consider a procedure or treatment medically necessary.
The UCLA/EIMG Jack H. Skirball Center, formerly located in Woodland Hills, California, has moved to a new location in Calabasas, California and been renamed the UCLA/EIMG Calabasas Health Center. The new location offers the same doctors, services and hours of operation as the Woodland Hills location.
The 2018 Basic Plan Annual Funding Notice is a required notice to all Pension Plans’ participants, contributing employers, and Producer Trustees about the state of the Basic Plan and its readiness to pay promised benefits.