For New Customers Only

Optima Health has a new Group Medication Transition of Care. 

Please read the Frequently Asked Questions (FAQ) below regarding our process change. 

Note: This applies only to initial enrollment and must accompany an enrollment application.

When will this go into effect?

This went into effect for new groups during their first enrollment period effective July 1, 2007.

How will members get the form?

The form will be provided in the new groups fulfillment packages or  at open enrollment meetings.

When is the form to be completed?

The form must be completed prior to the group’s enrollment date.

Why was the decision made to grandfather forever as opposed to giving timeframe (i.e., 90 or 120 days) to convert to the lower cost alternatives?

Goal is to capture these members through the same initiatives to move members to lower cost alternatives through direct mail, newsletters, etc.

Will new employees of an existing group have this transition of care?

No. This transition is only for employees of new groups coming on Optima Health during the group’s first enrollment period.

What about new employees who express dissatisfaction or have pharmacy issues coming on the plan?

These members will be handled on an as needed basis. New members still have the ability to appeal at an individual level.

Is there a BOI issue with discrimination?

No. This was reviewed and approved through our Legal council.

Has anyone evaluated the cost impact?

Yes and the impact is minimal.

Is the web Pharmacy Tool tied to the group or the individual member?

The pricing tool is tied to the individual, so members with authorizations in the system will have their copay displayed correctly.

How often will the list of drugs on the Medication Transition of Care form be updated?

Quarterly. In conjunction with quarterly pharmacy changes.

Process

• Forms will be made available to new groups through the fulfillment process and/or through Account Executives at open enrollment meetings.
• One form should be completed per individual and submitted along with the enrollment application.
• The forms will be collected in a box in the Enrollment Department.
• The Enrollment Department will note the Member ID number and group name on the form and place back in the box for pickup.
• Pharmacy will pick up the forms daily, enter the necessary authorizations in Argus, and place a note on the member’s Problem Log.
• The forms will then be returned to the Enrollment Department for future scanning into Macess.

Questions? Contact your Account Executive.