Christian Brothers Employee Benefit Trust
Plan Change Notice for the
Archdiocese of Seattle
Download full Plan Change Letter
The following Plan changes will be effective Jan. 1, 2020*:
*Unless otherwise noted
Coverage for Video and Virtual Visits
Video and On-Line visits, also known as Virtual Visits, will be covered under your plan if offered by the physician. Under the plan, you will be subject to the office visit copay or plan of benefits that would normally apply.
Essential Health Benefits Habilitative Coverage
CBEBT has always included rehabilitative services when deemed medically necessary. These services are defined as the treatment of disease, injury, developmental delay, or other cause by physical agents and methods to assist in the rehabilitation of normal physical bodily function, that is goal-oriented and where the person has the potential for physical improvement and ability to progress.
Until now, CBEBT did not cover Habilitative services, which are defined as health care services that help a person maintain, learn, or improve skills and functioning for daily living. Such services may include physical therapy, occupational therapy, speech-language pathology and other services.
Beginning January 1, 2020, CBEBT will offer you Habilitative benefits limited to 20 visits, when medical necessity is shown, not to be combined with any service provided under Rehabilitative benefits. CBEBT will continue to provide Rehabilitative services as it has in the past provided medical necessity has been met.
Expansion of Livongo—Hypertension (high blood pressure)
Beginning January 1, 2020, CBEBT participants with hypertension (high blood pressure) can enroll in the Livongo for Hypertension program at no cost. The Livongo for Hypertension program offers real-time recommendations tailored to each person’s unique health experience. When you enroll in the program, you will receive a connected high blood pressure monitor and access to the Livongo App through which you send your blood pressure readings. After each reading, a specialist provides you with personalized content based on the current reading and your past trends. You also receive feedback if your blood pressure is elevated and you can schedule a session with Livongo’s trained coaches. If you have hypertension and are also currently enrolled in the Livongo for Diabetes program, you can now manage both conditions with one easy point of contact.
Know Your Prescription Drug Plan
Smart90 Prescriptions—90-day prescription fills at Walgreens Retail Network Pharmacies
Nearly all Rx plans offered by CBEBT have a Retail Refill Allowance that allows you to have an initial fill and two subsequent refills at a retail pharmacy before you are asked to utilize the mail-order pharmacy. You may continue to fill at the retail pharmacy after the two refills but you will pay the corresponding mail order copay and be limited to a 30-day supply of medication.
Smart90 Prescriptions gives you the option to either fill a 90-day prescription at a Walgreens (or its affiliates). This option applies to no other retail pharmacies for the 90-day fill option. The program provides you with flexibility if you prefer not to have your 90 days of medication delivered to your home.
2020 Prescription Formulary Changes
Periodically Express Scripts, the Trust’s Pharmacy Benefits Manager, announces changes to their formulary drug list. Some prescription drugs currently covered will be excluded from coverage while other prescription drugs will move from a Preferred Brand status to a Non-Preferred Brand status.
The formulary is a list of drugs—generic and brand name—that offer the greatest overall value to Plan participants. Formulary management enables you and your physicians to choose clinically appropriate and cost-effective drugs for specific conditions.
The exclusion list is for medications not covered on the Express Scripts drug list. For each one of those excluded drugs, there are clinically equivalent, lower-cost options available. The Formulary Exclusion List includes preferred alternatives for those medications that are not covered.
Express Scripts also has made available a list of name-brand drugs that will be classified as Non-Preferred effective January 1, 2020, and the Preferred Alternatives for each drug.
*Participants who may be affected will be notified in advance.