Board learns about medical plan change

A change in medical plans was discussed at the Ector County ISD Board of Trustees meeting Thursday.

Benefits Coordinator Eric Smith, an independent contractor, and Yolanda Gordon, director of benefits and risk management with the district, made the presentation, which included a switch from Blue Cross Blue Shield to AETNA and included a clinic that would be located nearby.

Smith said the move should generate about $750,000 in plan savings.

“AETNA is putting a full time customer service/claims advocate on site at ECISD,” Smith said.

The presentation showed that ECISD will have a dedicated customer service team and dedicated toll-free number.

AETNA is building an ECISD dedicated website to assist employees with provider searchers, general plan information and more, the presentation showed.

Members will have access to CVS health HUBS at no cost for after hours and weekend acute care visits.

A move from Express Scripts to PCA Rx was recommended. The move will generate about $1 million in plan savings, the presentation showed.

Employees will now have access to both CVS and Walgreens pharmacies. Currently, they only have access to CVS.

They will have Texas-based customer service and lower co-pays are expected for all members.

The presentation showed that the clinic is expected to open in the middle of January to provide all employees and dependents on the health plan direct access to care.

The initial/first-year costs will be approximately $1.4 million, the presentation showed.

The savings generated and costs will be offset by doctors claim costs; decreased emergency room visits; decreased urgent care visits; disease management savings, the presentation showed.

The clinic will be staffed with a doctor, nurse practitioner and four medical assistants. It will be open 40 hours a week and hours are to be determined.

All services will be provided at no cost to employees on the health plan (visits lab work, shots, etc.) Exceptions to this are those on the health savings account plan who will have a $25 co-pay.

Open enrollment will be from Nov. 1-Dec. 3 and there will be no increase in premiums this year.

The plan is designed to provide little disruption to employees. Help will be available from First Financial on every campus to help with enrollment.

Employees will receive new medical and pharmacy id cards.

The presentation said they will work with the outgoing pharmacy vendors to get mail-order prescription and prior authorizations transferred over.

If this does not happen, members may have to get a new prescription from their provider and they will grandfather prior authorizations for 90 days to ease the transition.

They are looking for a site currently.

There will be an onsite AETNA person. Smith said he has told AETNA that person has to be bilingual.

Chief Financial Officer Deborah Ottmers said they already have a First Financial person locally.