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Marketplace Coverage Notice



Dental Plan Changes Effective June 1, 2018

Family Coverage

 As of June 1, 2018, Rochester Public Schools is mailing EOB's directly to enrolled dependents who are age 13+, at their home address or other address of record.

Subscribers, through whom any dependents are enrolled in dental coverage, will no longer receive their dependents’ EOBs via mail and will no longer have access to them through PreferredOne’s website. The subscriber can request permission from the dependent(s) to receive and view the dependent’s EOBs and other dental information.

 PreferredOne continues to enhance the website functionality, in particular the process for the distribution of explanation of benefits (EOB's) for enrolled dependents age 13 and older. With these improvements, EOB's and other dental coverage information, is available directly to dependents age 13+ by registering for access to the PreferredOne site. The subscriber needs to click the arrow following Important June 2018 Consent/EOB Change… at the top of the member web page.

Contact Insurance Services with any questions.

Phone: 507-328-4280
Fax: 507-328-4213
Email:
insurance@rochester.k12.mn.us

Rochester Public Schools Medicare Carve-Out Co-Pay Plan

Who is eligible?

  • Employees, dependents and/or retirees who meet the qualification to be eligible for Medicare. You must enroll in both Medicare parts A & B and the District policyholder must be enrolled in the Co-Pay health plan.
  • As an active employee, if you are Medicare eligible, the District remains the primary payer until you separate service from the District. You must notify Medicare that you are still actively employed in a benefits-eligible position.
  • As a dependent of an active employee, if you are Medicare eligible, the District remains the primary payer until the employee separates service, however you must be enrolled with Medicare and inform them that your spouse is still an active employee.While actively employed, the dependent premium remains in place. Upon separation of service, you are responsible for notifying Medicare timely of the separation of service, as the District will then become the secondary payer for you as you are then only eligible to continue District benefits under the Medicare Supplemental Plan.

Benefits under the Medicare Supplemental Health Plan

  • Benefits for a Medicare eligible participant under the Medicare Supplemental Plan are paid as a Medicare carve-out.
    • The District’s secondary payment is determined by considering the difference between the Medicare allowed amount and paid amount, and then applying applicable plan benefits. This carve out method will leave the member liable for their deductible, and once met, a portion of the Medicare member liability will be paid until the full OOP has been met. At which time, plan benefit payment is applied.At no time will payment be made that exceeds the allowed amount.
  • The District co-pay plan will remain the primary payer for Prescription Drugs, therefore it is not necessary for you to purchase a Medicare Part D plan. The District’s Prescription plan is creditable coverage, meaning it pays equal or greater than Medicare for prescription drugs purchased thru the pharmacy.

Who pays first if there is other health coverage in addition to Medicare?

What is the cost of the Medicare Supplemental Plan?

  • The current monthly cost for the copay supplemental Medicare carve-out plan is $376 per person.This premium is applicable upon the policyholder separating service from the District and electing to continue coverage. Prior to separation, the dependent premium is applicable, as the District is still the primary payer.


Health Plan Changes Effective 2018
We have partnered with Blue Cross Blue Shield as we continue to remotely process our health plan claims.

Your new card will have the following information:
1. BCBS logo
2. New Group #
3. Individual Identification Number that starts with ZRS


Show the new card to all your health plan providers, pharmacies and fitness centers.


This does NOT include your Dental Plan!
Your dental card starts with 801 or 802

  • Your coverage is still provided to you thru Rochester Public School District-the Self Insured Health Plan!
  • Your provider network is staying the same or being expanded.
  • Your claims, benefits, and member service support will stay the same-you will continue to contact the Insurance Services Office at the Edison Building for service.
  • The plus is you now also have the benefit of using some of the services that Blue Cross Blue Shield of Minnesota (BCBSMN) can offer you.

    • You will be able to call 1.800.810.2583 when you are traveling in or outside the country to find a participating provider.  Using this network provider will provide you with in network benefit coverage which can save you $$$.
    • You will have access to a new website: www.bluecrossmnonline.com
    • Please take time to visit the website and create an account.  This account puts all your personalized medical administration information, like your network, your claims and benefits all at your fingertips.

             In addition, you will be able to:

     

    • Search tools to find a doctor in your network.
    • Access WebMD tools to check symptoms, complete with a wellness profile and a personal Health Record.
    • Learn about healthy living, conditions and treatment options with a large library of resources.
    • Print, email, fax or reorder your member ID card.

                                          

                                      Member Portal Reference

     

     

     


 

 


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