Oxford Changes and Updates
Preventive health guidelines
Oxford Source4Women Online Seminars (updated 1/6/12)
Seminars include audio and video, as well as time for questions with expert speakers. All seminars are recorded and available for viewing anytime at source4women.com.
These webinars are available to all of TC Community, regardless of
Re: Dependent Age Change effective 1/1/11
Due to a change in regulations, dependent children through age 26 can remain covered under a group health plan starting January 1, 2011 as long as he/she does not have access to an employer sponsored group plan. Any dependent children, regardless of student or marital status, financial dependency or residency, may remain covered through the end of the year of his or her 26th birthday.
If your dependent child’s coverage ended or was dropped from coverage during Open Enrollment based on the previous dependent age limit, you have a 30-day window to enroll him or her in
Westchester Medical Center participation in the Oxford network, effective May 22, 2009
As you may have heard, this past weekend, the United States declared a public health emergency in response to the recent reports of swine flu. We wanted to update you on swine flu, offer you and your employees resources for additional information, and let you know what is being done to address the situation.
Swine influenza, or “swine flu”, is a highly contagious acute respiratory disease generally found in pigs, caused by one of several swine influenza A viruses. Although humans do not normally get the disease, the current strain of the virus is contagious, and human infections can occur, according to the World Health Organization (WHO).
Why has a public health emergency been declared?
What are the symptoms of swine flu?
Swine flu symptoms are very similar to seasonal influenza and generally include fever, fatigue, lack of appetite, and coughing; although some people also develop a runny nose, sore throat, vomiting, or diarrhea, according to the Centers for Disease Control and Prevention (CDC). Individuals should use reasonable precautions if they suspect they may have been in contact with swine flu and contact their primary physician for specific advice.
What is being done to address the situation?
The company is tracking and responding to developments surrounding this situation. We have strong partnerships in the public and private sector, including the CDC, local and state health agencies. The company is prepared to fully leverage all available resources to address this situation, as needed. We want to assure you and your employees that we will judiciously consider all information and are fully prepared to meet your service needs if this situation escalates.
Quick Reference FAQs
In response to the numerous reports on swine flu, we are providing a quick-reference frequently asked questions (FAQs) document. It includes preventive tips, symptoms of swine flu and more, and can be shared with your employees. We have also posted the FAQs on our member, employer and broker home pages at www.oxfordhealth.com. The information is based on the latest CDC information. Please be aware, however, that this situation is evolving and members should visit the CDC Web site for the most up-to-date information.
For the most up-to-date information, frequently asked questions and more, please refer to the CDC or WHO Web sites:
www.oxfordhealth.com will be updated as new information is made available.
Prescription Drug Changes for May 1, 2009
Effective May 1, 2009, there will be tier changes to both the Advantage (Tier 1, Tier 2, Tier 3) and Traditional (Tier1, Tier 2) Prescription Drug Lists (PDL):
The PDL Management Committee makes tier placement decisions based on clinical, economic, and pharmaceutical cost factors. These evidence-based decisions ensure medications with the best overall value are available in the lowest tier.
Tier Change Timing
- Up-tiering changes are made on an annual basis for the Traditional PDL on January 1 with the exception of up-tiering associated with the launch of new generic medications.
- Up-tiering changes may be made to the Advantage PDL up to six times per year.
- Up-tiering due to the launch of a generic drug will take place anytime during the year for both the Advantage and Traditional PDLs to coincide with the introduction of the generic drug.
- Down-tiering changes to the PDL or implementation of drug exclusions may occur throughout the year for both PDLs.
- The following medications will move from Tier 2 to Tier 3 on the Advantage PDL effective May 1, 2009.
- Metrogel 1% Gel
- The following down-tiering changes will take place on May 1, 2009.
Medication Advantage PDL Traditional PDL Current Tier Placement New Tier Placement Current Tier Placement New Tier Placement Bystolic Tier 3 Tier 2 Tier 3 Tier 2 Calomist Tier 3 Tier 2 Tier 3 Tier 2 divalproex sodium Tier 2 Tier 1 N/A N/A Exjade Tier 3 Tier 2 Tier 3 Tier 2 glyburide/metformin Tier 2 Tier 1 N/A N/A Noxafil Tier 3 Tier 2 Tier 3 Tier 2 ramipril Tier 2 Tier 1 N/A N/A Sanctura XL Tier 3 Tier 2 Tier 3 Tier 2
- Precertification/Prior authorization will be required for the following drugs effective May 1, 2009:
- Soma 250
- Venlafaxine ER
Supply Limits Transition
- Effective June 1, 2009, certain medication supply limits per copayment (formerly quantity limits) will be changed to supply limits per month (formerly quantity duration).
- This revision will result in revised or new supply limits for certain drugs as listed on the Oxford Benefit website- Effective 05/01/09 and 06/01/09 for the Advantage and Traditional PDLs.
OrthoNet - OptumHealth Transition
OptumHealth is a leading physical medicine company that has significant experience in promoting best practices and evidence-based health care, while working with physical and occupational therapists as well as other providers of therapy services and their patients.
As part of this new arrangement, please be aware that your provider will need to collect some basic information from you regarding your current condition, for submission to OptumHealth. Please be prepared to provide this information at your next visit. If this information is not requested, remind the provider’s office of the new physical and occupational therapy benefits administrator for UnitedHealth Oxford plans. This information is helpful to both your provider and OptumHealth in understanding the current status of your condition. Also, failure to provide this information to OptumHealth may result in a denial of services, and delay the claims process.
Oxford Member ID Card Transition
Beginning November 3, 2008, the new ID card will be issued to new Oxford members, any member who requests a replacement ID card and members renewing with changes to their Oxford plan. Member's medical benefits are not affected by this change. Click here for the informational brochure.
Medco Mail Interchange Pilot Program
Effective May 1, 2008, Oxford has implemented the Mail Interchange program for a small group of antihypertensive and antidepressants medications filled through Medco by Mail. Members who submit new or refillable prescriptions for these medications will be contacted by specially trained Medco representative and informed of any lower cost alternatives available to them. This is a voluntary program for members. If a member is interested in changing to the alternative, the pharmacist will contact the prescribing physician for authorization. If the physician authorizes the change, the new medication will be dispensed.
After two attempts, if the member can not be reached or has not responded to messages informing him or her of the possibility of medication interchange, the Medco pharmacist will contact the prescribing physician to request authorization for interchange. If the physician authorizes the change, the new medication will be dispensed and the member will receive an automated phone message and a letter informing him or her that his or her physician approved the interchange. The message and letter also provide instructions for stopping the interchange if the member prefers the original medication. If the physician does not authorize the change, the original prescription will be dispensed.
To find out the specific medications, you can contact Oxford at 800.444.6222 or visit www.oxhp.com.
Oxford Premium Designation Program
The UnitedHealthcare Premium Designation program is now live for
The UnitedHealth Premium® designation program is a physician performance assessment initiative that uses evidence and expert-based physician consensus standards to evaluate cardiac facilities and physicians in certain specialties for quality and efficiency of clinical care.
Two stars = Quality and efficiency of care
The primary source of data for performance assessment in the UnitedHealth Premium designation program is claim and other administrative data and is based on externally-developed standards.
- Physicians who have successfully met the quality criteria or the quality and efficiency of care criteria will receive the designations and will be identified to consumers online and in our directories.
- Effective immediately, designation status can be viewed using the Oxford Provider Search tool.
Please note these designations are also live on the United Healthcare website and you may already be familiar with the designations.
On January 31, 2008,
- If you have received services from this facility (previously named Bayonne Medical Center) recently or reside in a county neighboring Bayonne Medical Center, it will be necessary for you to select another hospital—one that is participating in the appropriate network—in order to meet your health care needs on an in-network basis. If you have an elective procedure already scheduled at
, you must contact your physician for assistance in selecting another participating facility. For help selecting a participating hospital, you should call the Customer Service number on the back of your member ID card. Additionally Bayonne Hospital Center Oxfordmembers can use the online provider and physician directories available on the appropriate member web site – myuhc.com for UnitedHealthcare members and Oxfordhealth.com for members. Oxford
- If you are presently receiving hospital services through
or are admitted to the hospital on an emergency basis, medically necessary services will continue to be covered on an in-network basis. However, transfer to a participating hospital will be coordinated by your attending physician. Should you decide not to be transferred, additional services will be covered on an out-of-network basis. Bayonne Hospital Center
As is our standard policy, care for an emergency illness, injury or condition will be treated as in-network care at any hospital. A primary care physician (PCP) or specialist should not refer employees to
Brookdale University Hospitaland Medical Center and Jamaica Hospital Medical Center Flushing Hospital Medical Center
Effective May 1, 2008, any care that employees receive from the above listed facilities, other than emergency or transitional care, will be on an out-of-network basis.
As is standard policy, care for an emergency illness, injury or condition will be treated as in-network care at any hospital. A primary care physician or specialist should not refer employees to a Medisys Health Network facility for routine treatment or tests. Instead, they should refer employees to one of the major neighboring hospitals in our network including:
- Kingsbrook Jewish
Medical Center University Hospitalof Brooklyn New York Methodist Center Queens Hospital Center New York Hospital Medical Centerof Queens
- Mary Immaculate Hospital
To minimize the disruption that this may cause you and provide you with sufficient time to find another
Effective May 1, 2008, any care that you receive from
As is our standard policy, care for an emergency illness, injury or condition, will be treated as in-network care at any hospital. A primary care physician or specialist should not refer you to a
Questions about changes and updates, please contact