More health benefits plan updates

Sacha Smith | The Southern Ute Drum


In our last update in the Drum we announced the upcoming major change to our Tribal Member Health Benefits Program in an effort to make sure all tribal members learned about the future changes that will be effective on September 1, 2016. Our last article focused on announcing the change to a new Third Party Administrator to manage the Tribal Member Health Benefits Program. We outlined several of the positive improvements including the change to a new Health Card representing the Anthem Blue Cross and Blue Shield Network of providers as the new network our tribal members will now have access to. The news of this positive improvement has been well received by many and there have also been some questions about what other changes the tribal members might be seeing as well.

First of all, there will be absolutely NO changes in the dental or vision program that covers our tribal members. We will continue using Delta Dental for all dental services and the VSP program for all vision services. There will be no changes in how these two services will be accessed or paid for nor any changes in the basic benefits. The pharmacy benefits program, as we indicated in our previous article, will however, see some positive changes.

The major change in the pharmacy benefits program will be the conversion to a new pharmacy benefits manager or PBM. The current PBM, Pequot Pharmacy Services, will change to Silverback Rx, which is a full service company that is focused on pharmacy benefit solutions for Tribal Nations.

The Silverback Rx company includes a nationwide network of over 67,000 pharmacies to choose from that will ensure our tribal members will have easy access to any local as well as most any out state major pharmacies. Should the tribal member encounter a pharmacy that is not in the network the Silverback Rx Company will seek to contract with that pharmacy to ensure easy access for the tribal member.

As for benefits, or what drugs are covered, there will be no change from the current plan; so all tribal members will be able to get their prescriptions filled in the same manner as with the current program manager Pequot. There will be one positive upgrade to the current plan, which requires the use of mail order after three refills.

Under the Silverback Rx company program all mail order prescription services will be totally voluntary for the tribal member. This issue has been a concern for some tribal members and the requirement for mail order has now been eliminated.

Should tribal members prefer to get their prescriptions filled via mail order the Silverback Rx Company will utilize the Walmart Home Delivery Pharmacy program. The use of this mail order service will require that the tribal member obtain a new prescription from their provider to be sent to the Walmart Home Delivery Pharmacy for filling.

Another upgrade to look forward to is the inclusion of the pharmacy benefits information on the tribal member’s new medical benefits card so that it will not be necessary to carry a second card for pharmacy benefits.

The staff in our Tribal Health Department are diligently working to get ready for the conversion to the new program and welcome any questions that you may have. Please contact any of our Benefit Coordinators; Cindy Gallegos (970-563-4813), Erika Atencio (970-563-4704), or Misha Weaver (970-563-4716) with any questions.

More information will be coming out soon to make sure you are all well informed about the upcoming changes including, coverage on the Tribe’s Facebook page and on the Southern Ute Tribal Website.

Also please note on your calendar that we plan to have an open meeting for tribal members on Thursday evening August 4 to meet and discuss any questions on the new plan. Representatives from Health Smart as well as our Tribal Member Health Benefits Team will be at this meeting to help address any questions. The meeting is scheduled to start at 5:30 p.m. and end at 7:30 p.m. at the Casino with light refreshments being served.


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