IMPORTANT NOTICE – July 2012
To All Active and Retired Plan Participants and their Spouses and other Eligible Dependents:
The Board of Trustees of the Connecticut Carpenters Health Fund wants to inform you about recent changes that may impact your prescription drug and other coverage and encourage you to access the benefits to which you are entitled. Please be advised of the following:
1. Specialty Pharmacy. Prescription Solutions by OptumRx manages the pharmacy benefit plan for the Connecticut Carpenters Health Fund. Certain medications, called “specialty medications,” require special handling, administration, or monitoring, and are usually used to treat complex, chronic conditions. Specialty medications are important to helping many people live healthier lives, but they are also some of the most costly medications available today. We want to make them accessible and affordable for both you and the Health Fund. Effective April 15, 2012, Prescription Solutions® by OptumRx™ Specialty Pharmacy became the Fund’s specialty pharmacy provider. This is an exclusive relationship, meaning that the only specialty medications the Health Fund will consider for coverage are those obtained through that Specialty Pharmacy. A list of specialty medications is available to you on the Connecticut Carpenters Health Fund’s website at www.ctcarpentersfunds.org or by calling the Fund at 1-800-922-6026.
If you were filling prescriptions for one or more specialty medications in the first quarter of 2012, you received a special letter with details about working with OptumRx to transition your specialty medications to the Specialty Pharmacy. If you did not receive that letter and want to fill or refill a prescription for a specialty medication, you should contact the Specialty Pharmacy at the toll-free number in the last paragraph of this section of this notice to learn how to order medications and answer your questions. Whether your specialty medication is oral or injectable, and regardless of who administers it, Prescription Solutions by OptumRx can deliver your order to your home or physician’s office, and shipping is at no charge to you.
Prescription Solutions by OptumRx makes it easy to reorder your specialty medications and can improve the accuracy of your orders. The Specialty Pharmacy also provides necessary supplies, such as syringes, alcohol swabs and Sharps containers, at no additional charge. Plus, you can receive educational materials about your specialty medications and specific health conditions through our advanced care programs.
The Specialty Pharmacy’s clinical pharmacists, who specialize in specialty therapies, are also available 24/7 to answer your questions about specialty medications, although all questions about your care should be directed to your prescribing physician. If you have any questions, call the specialty team at 1-866-218-5445 or visit www.PrescriptionSolutions.com.
2. Monthly Retiree Costs Stay the Same. Retiree monthly contribution rates, subsidized by the Fund, are currently $330 for each Medicare-eligible retiree and spouse, and $675 for retirees not yet eligible for Medicare or if one spouse is Medicare-eligible and the other is not. In the past, the Trustees have reviewed these rates in July, with the help of the Fund’s actuarial consultant. The current rates have been in effect since July 1, 2006 and the Trustees decided not to change them for the year that began July 2012.
3. Women’s Health and Cancer Rights Act of 1998. Under federal law, group health plans that provide medical and surgical benefits covering mastectomy must provide benefits for certain related reconstructive breast surgery. This applies to reconstruction of the breast on which the mastectomy was performed, surgery or reconstruction on the other breast to produce a symmetrical appearance, prostheses and physical complications of all stages of mastectomy, including lymphedemas (swelling). Coverage is subject to all of the Plan’s normal rules, including co-payments, annual deductibles and coinsurance provisions.
4. Member Assistance Program. PLEASE remember in these difficult times that the Health Fund contracts with an independent Member Assistance Plan (MAP) that offers counselors available 24 hours a day. The MAP can help you with family problems, anxiety and stress, drugs and alcohol, depression, gambling problems, job conflicts and marital problems. You may be entitled to get up to 6 visits for free. The MAP can be reached at 1-888-373-5073. All consultations are confidential between you and the MAP.
This Notice is intended to be a brief description of the topics described. In any situation involving Fund benefits, the documents governing the Fund will control. It constitutes a Summary of Material Modifications to the Fund, and we are furnishing it to you in accordance with U.S. Department of Labor regulation §2520.104b-3. Please keep this Notice with your Summary Plan Description for future reference and contact the Benefit Office with any questions. All benefits are subject to amendment and/or termination as the Trustees may determine to be in the best interests of the Fund's participants and beneficiaries.
For the Health Fund Board of Trustees,
Deborah L. Palmieri, Health Fund Administrator