The Christian Brothers Employee Benefit Trustn (EBT) Newsletter fourth edition for 2021. Keeping you informed and providing you with outstanding service.
Foreword from HBS Managing Director John Airola
2022 Plan Notices
Watch for new ID Cards
No Surprises Act/Balance Billing
Resources to set goals for healthy living
Supporting Mental Health
Managing the winter blues with Teladoc
Start Hearing—Online hearing test
Resources and Reminders
Annual Notices and Summary of Benefits & Coverages (SBCs)
We are in the middle of the holiday season and there are decorations to be hung, carols to be sung and probably a long list of things left undone. Yet, as we celebrate Advent, we are reminded it is not about getting weighed down by the hustle and bustle or the complexities of today’s world. This is a time of hope and reflection, and a season for sharing good tidings.
It’s a time to actually slow down and count your blessings in a year that continues to have its struggles. We want to take a moment to share our gratitude for the work of our members and their ministries, as you sustain us in so many ways. Our wish is to provide the care and attention to your health benefit needs so that you don’t have to, hopefully checking one of those items off your list.
We care about you and your wellbeing, and ensuring one’s mental health is just as important as physical health and cannot be emphasized enough. We hope this issue of reminders, tools and resources serve as a helpful guide.
It is an honor to serve you as we strive to provide the type of care and attention that is specific to your health benefit needs.
May your days be filled with peace, joy, health and happiness.
Merry Christmas,
John Airola
View Health Benefit Flyers
Effective Jan. 1, 2022, the CBEBT SaveOnSP program will be modified. Specialty medications provide unique treatments with remarkable results for complex, chronic diseases. We are happy to inform you that the number of specialty medications available at no cost to the participant continues to increase. The Plan now includes more than 350 medications in the SaveOnSP program. A list of these medications can be found here or call SaveOnSP at 1.800.683.1074. Beginning on January 1, 2022, the SaveOnSP program will move to a 30% coinsurance for all SaveOnSP medications. If a participant on an eligible medication enrolls in the SaveOnSP program, the participant incurs no cost. If, however, the participant chooses not to enroll, then the 30% coinsurance (instead of the previously listed dollar amount) will apply, up to the participant’s out-of-pocket maximum. As a reminder, some manufacturer copay assistance programs require participants to enroll in their program annually. SaveOnSP recently introduced a new online portal which allows participants an additional way to connect with SaveOnSP. This new portal will be available to select participants who are on medications requiring annual manufacturer copay assistance re-enrollment. SaveOnSP will make the portal available to additional participants and with expanded services throughout 2022. While many new medications have been added, a few manufacturers will no longer be offering copay assistance for certain medications in 2022. SaveOnSP manages all enrollments and will be in contact with those participants to support them through the transition process.
Quarterly, Express Scripts Inc. (ESI), the Trust’s Pharmacy Benefits Manager, announces changes to its formulary drug list. Each drug included on the formulary is approved by the Food and Drug Administration (FDA) and reviewed by an independent group of doctors and pharmacists for safety and efficacy. Some prescription drugs currently covered will be excluded from the formulary list, while other prescription drugs will move from a Preferred Brand status to a Non-Preferred Brand status.
Medications indicated on the formulary list are typically grouped into three tiers: Generic, Preferred Brand and Non-Preferred Brand. Formulary management enables participants to choose clinically appropriate and cost-effective drugs for specific conditions. Medications not on the formulary list are not covered by the Plan.
In the event a participant’s medication is removed from the formulary list, a notification will be sent well in advance, informing participants of other drugs available in the same therapeutic class.
For the most updated information, visit the Rx Formulary Management section of our website. Please note, the formulary list is not all-inclusive and does not guarantee coverage, as it is subject to change. In addition to using this list, you are encouraged to ask your doctor to prescribe generic drugs whenever appropriate.
Please note that while the Trust subscribes to Express Script's National Preferred Formulary, certain prescription drugs and/or preventative care inconsistent with the tenets of the Catholic Church may not apply or be covered. Please refer to your plan booklet for further details.
Christian Brothers Health Benefit Services has issued new enhanced ID cards to comply with legislation set by the Transparency in Coverage (TiC) and No Surprises Act (NSA) requirements of the Consolidated Appropriations Act, 2021. The NSA requirements include an end to surprise balance billing, a public notice of accurate pricing on in-and out- of-network procedures, and readily available contact information for providers, among other requirements, to be enforced throughout the next several years. One of the first implementations of the NSA will be the rollout of enhanced ID cards by January 1, 2022. Plan sponsors are expected to implement the ID card requirements using a good-faith, reasonable interpretation of the law. We expect all ID cards to be delivered by December 31, 2021. To provide clear and concise direction for contact information and pricing, ID cards will now include:
Please keep in mind: If you have any upcoming appointments, use your current card through December 31, 2021.
New cards should be given to all Medical providers to ensure the proper routing and payment of claims. You should use your new card beginning January 1, 2022.
Your ID card will reflect your specific copay, deductible, and out of pocket amounts.
You can view, print and request additional ID cards through our website www.mycbs.org/health. The 2022 ID Cards are now available and displayed on the portal.
Balance billing occurs when a provider charges an amount greater than what the patient’s insurance covers. Patients have to pay that difference or that “balance.” This is typically prevalent when a patient uses an out-of-network provider. Additionally, surprise balance billing comes into play when a patient chooses to use an in-network facility for care but inadvertently ends up being seen by one or more out-of-network medical providers or when patients receive emergency care and did not have a choice of where to go or who treats them.
The full requirements of the law will not roll out for some time, as additional guidance and review is now deemed necessary for healthcare providers to comply. However, an interim final rule on surprise billing was released in July, restricting it for patients in job-based and individual health plans who get emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.
Additional guidance was released in September, “Requirements Related to Surprise Billing; Part II,” which provides additional protections against surprise medical bills, including the establishment of an Independent Dispute Resolution (IDR) process to determine out-of-network payment amounts between providers (including air ambulance providers) or facilities and health plans; and also provides a way to appeal certain health plan decisions.
According to the Departments of Labor, this rule details how the total payment to an out-of-network provider or facility will be determined. When a payment dispute for services that fall under surprise billing protections occur, either a provider, facility, or air ambulance provider or plan/issuer may initiate a 30-day open negotiation period. If open negotiation fails, either party may initiate the federal IDR process. This rule details how this process initiates, what is eligible for this process, and how IDR entities should consider factors when determining a payment amount.
For the services described above that currently fall under the no balance bill protections, the patient should not receive a balance bill nor have to be involved in any dispute over payment determinations for these services. Please review, Your Rights and Protectections Against Surprise Medical Bills for more information, which will be included in all Explanation of Benefits (EOBs). Note: The law currently does not cover all out-of-network services, just those described above. If a patient knowingly seeks out-of-network care, those providers may balance bill for services beyond what is covered by insurance.
A healthy lifestyle is key to both diabetes and hypertension management and Livongo Health, CBEBT’s premiere partner, has the tools to help participants like you stay on track this holiday season, setting you up for a healthy new year. As a reminder, with Livongo, you have access to both the diabetes management program, including a connected glucose meter and real-time insights, unlimited test strips with no copays or out-of-pocket fees, shipped directly to you and 24/7 support from expert coaches, and the hypertension program, including a connected blood pressure monitor, personalized insights after each check, and one-on-one support from expert coaches. Livongo also offers a library of tools to help set goals for a healthier lifestyle including:
4 Steps to Build Your Best Support Network Motivational Walk Activity (Audio) How Can I Set Successful Weight-Loss Goals? 10 Key Steps to Get Back on Track Habit First, Effort Later
Setting SMART Goals
Check the Livongo Library for additional resources. Read this for details on your benefits with Livongo.
The Christian Brothers Employee Benefit Trust (CBEBT) recognizes the critical importance of mental health services and continues to support your needs, exceeding the requirements of the Mental Health Parity and Addiction Equity Act (MHPAEA) reemphasized by the Consolidated Appropriations Act, 2021. Mental health is an important component of overall health care and is treated as such in CBEBT health plans, affording opportunities for participants to receive counseling for conditions like depression, anxiety, marital or family issues. In July, the CBEBT added access to Teladoc Health's network of licensed psychiatrists, psychologists and therapists with expanded coverage for behavioral health at no additional cost. Set up your account or log in today. In addition, all participants have access to Animo, at no cost. Animo, which is based on the underlying principles of cognitive behavioral therapy (CBT), delivers a variety of personalized web and mobile platform tools that improve your emotional fitness and enhance your overall wellbeing—all in a safe and secure manner. Animo provides users with unlimited access to personalized care and evidence-based support to foster meaningful and lasting behavior change. The program uses a variety of tools, such as:
Furthermore, with self-guided resources plus personalized coaching through Textcoach®, you can address stress, depression, anxiety or simply boost their overall emotional wellbeing. Textcoach® from CuraLinc Healthcare is a convenient and stigma-free access point that also allows you to conveniently connect with a licensed counselor, also known as a 'Coach.' Participants who may not be receptive to face-to-face counseling may appreciate Textcoach® as a behavioral health resource on a mobile or desktop platform, using text-based dialogue, voicenotes, resource links and video lessons. All coaches are independently licensed clinicians who also have a special accreditation for providing technology-based care.
Learn how the Animo platform works by watching the short video on this page or linking to it here. Safe and secure, participants have access to personalized resources through the Animo app, portal, or web. Get Started.
As the days become shorter and darker, some people can become affected by seasonal affective disorder (SAD). In fact, millions of adults may suffer from SAD and not realize it. According to the National Institute of Mental Health (NIMH), SAD is not considered a separate disorder but is a type of depression characterized by its recurrent seasonal pattern, with symptoms lasting about four to five months per year. Some signs and symptoms of SAD include those associated with major depression and some are specific to winter-pattern SAD. NIMH lists the following symptoms, noting not every person with SAD will experience all these symptoms:
For winter-pattern SAD, additional specific symptoms may include:
While scientists do not fully understand what causes SAD, research indicates that people with SAD have reduced activity of the brain chemical serotonin, which helps stabilize one’s mood, feelings of wellbeing, and happiness. The NIMH research also suggests that sunlight controls the levels of molecules that help maintain normal serotonin levels, but in people with SAD, this regulation does not function properly, resulting in decreased serotonin levels in the winter. This, combined with low melatonin in people with SAD, makes for a change in one’s body daily rhythm. As a result, they can no longer adjust to the seasonal changes in day length, leading to sleep, mood and behavior changes.
Teladoc therapists can help The NIMH research indicates a variety of means to help treat SAD, including medication, light therapy or cognitive behavioral therapy. Teladoc mental health providers, to whom CBEBT participants have access at no additional charge, can help with strategies and treatments to manage SAD so you can enjoy the winter season. Therapists and psychiatrists are available to talk by phone or video, seven days a week. Sign up here today.
One in five people have hearing loss. Our partner, Start Hearing, (formerly known as American Hearing Benefits) is making it easier than ever to check if hearing health is suffering. Check out this free online hearing test.
As a member of the Christian Brothers Employee Benefit Trust, you can enjoy significant discounts on hearing technology through Start Hearing:
CBEBT participants and their families are eligible for free annual hearing consultations. For more information, call 888.529.0194 or visit www.starthearing.com/partners/CBS
SBCs for 2022 and other plan documents are now accessible at mycbs.org/health under My Coverage Summary. Please be sure to check for any changes to your medical and prescription benefit coverage.
Webinars on Demand Explore our growing digital collection of materials designed to provide an easy-to-use database of educational information. Check out all our past webinars on our website.
