FURA Board Report, June 2023

By Barbara Mendes

FURA members, please forgive our delay in getting information to you. We have had more board meetings than normal. FUSD informed us of the upcoming change to Aetna Medicare Ad­ vantage, and we began to study the information and forming questions. Our Healthcare Liaison, Joanna Smith, called FUSD and/or Aetna to find out the answers. We have had many discus­sions regarding the answers.

Our most recent questions came after the drug formulary was released. While we found most of the answers seemed satisfactory, the biggest problems have been, and will probably continue to be, with what tier each of our prescriptions is on. Please be patient, and we will try to answer your concerns.

All of us on the board are of an age, and suffer from some health problems. Getting information to you is where we failed. Someone suggested we have a meeting like we have in the past. I must admit that is too huge a project for us to tackle. AND the Retired Teachers' Education Building has been sold, and is not available to us.

As you can see from this newsletter, we are trying to open up the avenues of communication. Please be patient. We apologize for the lack of info up to now.

Hold on to any information you receive from Aetna, the district, or the JHMB board. We appreciate your patience,

The FURA board, & Barbara Mendes, chair

www.FURAProtects.org

Notes from Healthcare Liaison

By Joanna Smith, LCSW, MPH, June 2023

By now FURA members have received multiple mailings from FUSD about coming changes in your health plan: the move to Aetna for both medical care and prescriptions will be effective July 1, 2023. We have been in contact with Delta Administrators and JHMB during this process and wanted to give you some tips as we head toward July 15¹•

Questions We Are Receiving:

1.     I heard about the change but want to know what I can do now:  There are important steps to take NOW before the change to Aetna begins on July I^st.

•        Get any refills you can on your current prescriptions in June. We hope there won't be glitches as the shift is made to the Aetna formulary, but we suggest you have medications on hand just in case.

•       Check the Aetna formulary to see if your drug is covered. You can check online by doing this: Go to www.AetnaRetireePlans.com and make the following selections: find doctors and prescription drugs; prescription drugs; check our drug list; then, formularies. Select "MAPD" and "2023 GRP Comprehensive Plus (5 Tier) Formulary - MAPD. If your drug is not listed, talk with your doctor about changing drugs, if appropriate, or fil­ing an appeal.

•       Sign up for the JHMB Newsletter: Information is often posted there first. Go to

www.JHMBHealthConnect.com to sign up.

•       Call Aetna with Questions: 800-307-4830, 5 a.m. to 6 p.m. pacific time. Or call FUSD Benefits: 559-457-3520,

8 a.m.-5 p.m. pacific time

2.   My Doctor Told Me they wouldn't accept the Aetna Plan. What Can I do?

One member has already had this happen. They reached out to JHMB and the District Benefits office who then contacted Aetna to clarify. With the Aetna plan, you can see any provider as long as the provider accepts Medicare and agrees to accept the Aetna plan. Aetna clarified that this provider involved does not accept any Medicare Advantage plans at all. In these situa­tions, you may be able to talk directly with your provider to see if they will make an exception for you. Otherwise, you would need to switch providers.

3.  What Hospitals will the Aetna plan accept?

A retiree may go to any in-network hospital or any out-of-network facility that accepts Medicare and is willing to accept the MA PPO plan. The following local hospital systems are either in-network or out of network and accept MA PPO: St. Agnes Medical Center, Clovis Community Hospital, Community Medical Center, Fresenius Medical Care, Stanford and UCSF. e Mayo Clinic in AZ does not accept MA PPO plans, regardless of health insurance carrier, except in the case of an emergency.

4.  Are there any specialists’ services that would require a referral from a Primary Care Physician? 

No referrals are needed: FURA members can see any specialist when they want to without a referral. Yes, this is correct; there are no referrals needed for our MA PPO plans.

 What Can I expect next?

There will continue to be mailings from the District as we ap­proach July 1st.

• Please be sure to read them carefully. If individual members want help with the switch to the new plan, you can call Aetna or the District Benefits office. Please sign up for the FURA News emails! This is the easiest and fastest way for us to communicate with you. Go to  www.FURAProtects.org, click "contact us" and send us an email with your name, address and a message to please add you to the email list.  Please encourage your fellow FURA retirees to sign up also!

VSP-vision

By Walter Franzell

FURA has been offering access to VSP since December 2011. This insurance is available to Fresno Unified CalSTRS & CalPERS retirees and their families. Our VSP Choice plan covers yearly examinations and purchase of eyewear. Premiums are very competitive with premiums remaining the same since 2011.

Using your benefit is easy. Find the VSP network doctor who's right for you, either on their website (vsp.com) or by phone (800-877-7195). At your appointment, just tell them you have VSP.

For additional information and application forms, contact:

Retiree Benefits Associates, LLC

% Walter Franzell PO Box 2326

Clovis, CA 93613

559-298-4606l

January 2023 Bulletin: Where Is My Aetna card?

This is the question we are asked most frequently right now! The cards were supposed to be in the mail by December 15th and I have put in a query to Delta about the status of the cards. They have confirmed with me that the cards are in the mail to FURA members.  IN THE MEANTIME, please try these two tactics: 

1.     Go online to www.deltahealthsystems.com and your card may be available for download directly from the site.

2.     Call Delta Health Systems at 800-807-0820 and talk with their customer service reps and see if they can give you your member ID and group number to show to your healthcare providers until your card comes in the mail.

I know this is incredibly stressful at a time when no one needs more stress. Please check back for updates on this website: as soon as I know more, I will post it.  Joanna Smith, Healthcare Liaison

November Update

I hope this season finds you well. It has been a most difficult year for so many people and with vaccines in place, I hope this winter will be an easier one for everyone. There are some changes that have been announced by FUSD for the health plans for 2022, and this newsletter is about those changes.

It is November, and that means it is time to look at your medical coverage through FUSD! By now all of you should have received the packet describing the option for 2022.

The enrollment deadlines if you are going to change your plan are important to note:

Deadline for switches between Plan Option A and Plan Option B is November 30, 2021

If you have questions about your benefits, please call the FUSD main switchboard at 559-457-3000 and ask for Benefits. Please do not contact FURA about benefits questions!

What are the changes in your health care coverage for 2022? There is a major change in the physicians’ network that can provide you with in-network (less expensive) coverage for Plan options A and B.

For many years JHMB has contracted with Anthem Blue Cross for retirees’ coverage. That meant that the in-network provider list you chose from was the one for Anthem Blue Cross. This is completely changing, effective January 1, 2022.



Elixir will still continue to provide prescription drug services for the PPO plans).

Effective 1/1/2022, your provider must be contracted with Aetna (rather than Anthem) for you to receive in-network rates for the PPO plans. Here are some common questions you may be asking: 

How will I know if my provider is in-network with Aetna? This is an important question, and now is the time to sort this out before the new year starts! This will help you avoid surprises after January 1st.

The best way to figure out if your provider contracts as an in-network provider with Aetna is to do what I call a “cross-check” of each provider you see. There are two steps:

1.  Now:  Talk with your provider’s office manager or business office to see if they are an in-network provider for Aetna for 2022. Aetna has a large national provider network, so many of your current physicians may be in Aetna’s network. But contracts change yearly, so it is important to check for 2022. 
2. In December:  Cross-check to see if your provider shows up on Aetna’s own list of in-network providers. You will receive a new Member ID card in December; once you have that card, use the link provided by FUSD to access the provider listings and see if your provider is listed. That link will come with the Membership ID card.

Cross-checking is the best way to know if your provider is truly in-network with Aetna. 

Now, about the plans, Option A and B:  what changes?

In Plan A, the co-insurance rate that you pay has decreased with Aetna from 10% to 5%. With Plan B, the co-insurance rate has decreased from 30% to 25%. This is a 5% savings for members in each plan provided you use in-network providers! That’s why it’s so important to do the “cross-check” listed above. 

I want to change to Kaiser:  what do I need to do? You should fill out the Kaiser enrollment form in the packet you received from the district and submit no later than November 19, 2021. Some people like the idea of everything “all under one roof,” including prescriptions. If you would prefer that to a PPO, Kaiser can be an option under the FUSD district plan. 

Delta Health Systems will continue to handle member services questions and claims matters.

Another big change, effective January 1, 2022:  Currently Plush Care provides telehealth services to FURA members.  As of January 1, 2022, Teledoc will provide telehealth services for the PPO Plan Options A & B. That means you could have a “visit” with a Board-certified physician using either your phone or the internet.

What kind of help can I get from Teledoc? If you would prefer to talk with someone without going out of your home AND if your condition involves something that is not an emergency (colds, flu, allergies, and sore throat are some good examples) then Teledoc may be a good option. It does NOT replace having a primary care physician that manages all of your care, one you see face-to-face for chronic/complex conditions. Teledoc is $5 per appointment and there is no co-pay. You may be able to have a Teledoc appointment more quickly than a face-to-face appointment with your regular doctor.

What’s new with the Elixir drug plan?  The short answer is, it is too soon to know.  The District has not yet released the specifics on the Medicare Drug plan through Elixir for 2022. Please watch this space for updates. I expect they will come in late November. 

Again, please note:  if you have questions about your benefits, please call the FUSD main switchboard at

559-457-3000 and ask for Benefits. Please do not contact FURA about benefits questions.

Be well everyone and best wishes for a holiday season filled with family and friends!