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benefitsInfo > Oxford Changes and Updates

Oxford Changes and Updates

2014 Prescription Drug List -  PDF Mobile - PDF

Oxford Preventive Health Care Online Tool:
Preventive health guidelines

Oxford Source4Women Online Seminars (updated 1/6/12)
Source4Women provides tools and resources focused on keeping our UnitedHealthcare and Oxford members and their families healthy. As part of their commitment to helping people live healthier lives, UnitedHealthcare offers an online seminar on an important health topic every month.

Seminars include audio and video, as well as time for questions with expert speakers. All seminars are recorded and available for viewing anytime at

1/1/12 12:30 ET - Diet and Lifestyle Changes that Go the Distance

2011 Calendar of Webinars
To register for an upcoming Source4Women online seminar, visit and click on ‘online seminars.All seminars are recorded and archived for viewing after the live seminar date.

These webinars are available to all of TC Community, regardless of Oxford membership or gender.

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 Oxford. Please complete an Oxford Addition/Change Form along with a Benefit Election Form and submit them to HR by January 10, 2011. Enrollment will be effective retroactively to January 1, 2011.

Westchester Medical Center participation in the Oxford network, effective May 22, 2009
Oxford has reached a new multi-year agreement with Westchester Medical Center.
Effective May 22, 2009, Westchester Medical Center will once again be an Oxford participating hospital. Please be assured that as of May 22, you can use Westchester Medical Center on an in-network basis.
Please also note that Westchester Medical Center was a non-participating hospital from March 17, 2009 through May 21, 2009 and, as such, any covered services provided during that time will be reimbursed at the out-of-network rate for those members with out-of-network benefits. Any covered services provided on or after May 22, 2009 will be reimbursed at the in-network rate.

Addresses Swine Flu Concerns
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.

What is swine flu?
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?
The United States public health emergency declaration allows the federal government to free up additional resources to help address this situation, much like it recently did during the public health emergency declarations for the recent flooding in Minnesota and North Dakota.

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 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.

More information
For the most up-to-date information, frequently asked questions and more, please refer to the CDC or WHO Web sites: will be updated as new information is made available.

Prescription Drug Changes for May 1, 2009

Effective May 1, 2009there 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.


Up-tiering Changes
  • The following medications will move from Tier 2 to Tier 3 on the Advantage PDL effective May 1, 2009.


    • Metrogel 1% Gel
    • Nascobal
    • Zylet


Down-tiering Changes
  • 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

Effective April 1, 2009, ACN Group, Inc. (OptumHealth) will begin administering the physical and occupational therapy benefit for UnitedHealthcare Oxford plans.

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

Oxford Premium Designation Program

The UnitedHealthcare Premium Designation program is now live for Oxford branded accounts!  The provider search tool has been upgraded to display and search by Premium Designation status on our web site This value-added program provides Members with another way to help them make informed healthcare decisions. 
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.
                                One star =  Quality designation only
                                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. 

Bayonne Medical Center
On January 31, 2008, Bayonne Medical Center was sold to a third-party and renamed as Bayonne Hospital Center. The new entity, Bayonne Hospital Center, has decided not to assume the hospital agreement that Bayonne Medical Center had with UnitedHealthcare. Therefore, Bayonne Hospital Center is considered a non-participating facility and all services other than emergency care will be considered to be out-of-network for UnitedHealthcare as of 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 Bayonne Hospital Center, 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 Oxford members can use the online provider and physician directories available on the appropriate member web site – for UnitedHealthcare members and for Oxford members.  
  •  If you are presently receiving hospital services through Bayonne Hospital Center 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.


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 Bayonne Hospital Center for any treatment or tests. Instead, they should refer employees to one of the major neighboring hospitals in our network, including: Jersey City Medical Center, Meadowlands Hospital Medical Center, Greenville Hospital, Christ Hospital, Hoboken University Medical Center, and Palisades General Hospital.

Medisys Hospital System in NY
The Oxford agreement with Medisys Health Network will terminate on May 1, 2008. Medisys Health Network consists of:

  • Brookdale University Hospital and Medical Center
  • Jamaica Hospital Medical Center and
  • 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 Hospital of Brooklyn
  • New York Methodist Center
  • Queens Hospital Center
  • New York Hospital Medical Center of Queens
  • Mary Immaculate Hospital

Peconic Bay Medical Center
The Oxford agreement with Peconic Bay Medical Center terminated on March 1, 2008.   

To minimize the disruption that this may cause you and provide you with sufficient time to find another Oxford participating hospital, care received at Peconic Bay Medical Center will be considered in-network through April 30, 2008.

Effective May 1, 2008, any care that you receive from Peconic Bay Medical Center, other than emergency or transitional care, will be on an out-of-network basis.  

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 Peconic Bay Medical Center for any treatment or tests. Instead, they should refer you to one of the major neighboring hospitals in our network, including: Southhampton Hospital, Good Samaritan Hospital or Huntington Hospital.


Questions about changes and updates, please contact Oxford at 800.444.6222 or Human Resources at x3175.