Thu Jul 7th, 2016
Categories: Top Stories
Tags: Anthem Blue Cross Blue Shield, Benefit Coordinators, Capitol Administrators, First Health PPO, HealthSmart, Pequot Pharmaceutical Network, Silverback Pharmacy, Third Party Administrator, TPA, Tribal Employee Plan, Tribal First, Tribal Health Department, Tribal Member Health Benefits Plan, www.healthsmart.com
On October 1, 2013, Tribal Council implemented the first ever-formal Tribal Member Health Benefits Plan that provided expanded access to healthcare coverage both at the local level as well for all out of area tribal members. This formalized plan, while self-funded by the tribe, was designed to provide tribal members with an insurance like coverage card that would enable not only improved access to care but participation in a nationwide network of providers that would also serve to reduce the historic cost increases the Tribe faced each year when covering tribal members for their healthcare services. Because of the complexities in today’s healthcare environment, tribal members were often faced with being turned down for care because they didn’t have an insurance card or were faced with having to pay out-of-pocket for many health services.
The implementation of this new plan, which has been administered by Capitol Administrators, a Third Party Administrator (TPA), using the First Health PPO network was a bold decision made by Tribal Council. When it began three years ago, it met many of the original objectives. However, after nearly three years of functioning under the new plan many things were identified as needing improvement. Among some of the early issues identified were timely payment of claims by the TPA; needed improvement in communications and overall service from the TPA; need for a larger network of providers; and improved discounts for the ever increasing costs of healthcare.
Armed with almost three years of experience with the plan, and coupled with lots of tribal member feedback and staff input, Tribal Council made the decision to solicit proposals from other TPA companies and networks in its attempt to create improvements in the overall program serving the members. To that end, and after many months of review and consideration, a recent decision was made to cancel existing agreements covering the medical services and pharmacy services program with Capitol Administrators and the Pequot Pharmaceutical Network and enter into a program with Tribal First, an organization specializing in working with Native American Tribes. The Tribal First program will utilize HealthSmart as the TPA and the Anthem Blue Cross Blue Shield provider network for the medical services portion of the plan, and Silverback Pharmacy services to deliver the pharmacy services portion of the plan.
The projected date of conversion to the Tribal First program through HealthSmart and Silverback will be September 1, 2016. The Tribal Health Department will be providing updates and ongoing communications to all tribal members that will outline all the planned changes and enhancements that will improve the plan. Several of the key improvements in the plan will be the use of the Anthem Blue Cross Blue Shield network, similar to the Anthem Blue Cross Blue Shield network presently used by the Tribal Employee Plan, and the ability to merge the pharmacy benefits program under this same card so tribal members will only need one health benefits card instead of the current two. In addition to written communications, there will be open meetings set up for tribal members to attend and have their questions addressed.
Once implementation is complete, tribal members will be able to carry the nationally recognized Anthem Blue Cross Blue Shield network card that will provide a much more expanded network of providers both locally and nationally as well as an expanded network of pharmacy benefit providers through Silverback. The Tribal First and its exclusive TPA partner HealthSmart have a very fine reputation of working with Tribal organizations, which will improve communications and claims processing on behalf of the tribal members. For those who wish to do a little research on HealthSmart, their website is: www.healthsmart.com. Once the plan becomes effective we will provide a different address, and mobile application for your reference, as well as other important plan information.
The Tribal Health Department is looking forward to bringing these new changes to the Tribal Members Health Benefits Plan and are excited about the improvements in service and coverages that will benefit all tribal members. The staff of the Tribal Health Department working on implementing the new plan include Benefit Coordinators, Cindy Gallegos (970-563-4813), Erika Atencio (970-563-4704), and Misha Weaver (970-563-4716), who can be contacted with any questions.