Benefits Plans - Prescription Drug Plan: ID Cards and Claims

Page last updated: Wednesday, 06-Aug-2014 10:33:26 EDT

Enrollment

Once you enroll in any University of Michigan health plan, you are automatically enrolled in the U-M Prescription Drug Plan. For information on enrollment, call the SSC Contact Center at 734-615-2000 or 1-866-647-7657 (toll free).

New members receive a Welcome Kit in the mail, containing two (2) MedImpact prescription drug ID cards. The Member ID number on the front of the card will be the letter “U” followed by your U-M employee ID number. If you call MedImpact Member Service for assistance at 1-800-681-9578 you will be asked to provide your Member ID number to verify your participation in the U-M Prescription Drug Plan.

Show Your U-M Prescription Drug ID Card

Show your U-M prescription drug ID cardWhen your doctor writes a prescription for you, take it to a participating pharmacy and show the pharmacist your U-M prescription drug ID card. Showing your card saves you time and money. The pharmacist will confirm your enrollment in the U-M prescription drug plan and fill your prescription.

The amount you will be charged depends on the drug you and your doctor choose. For prescriptions covered under the plan you will pay only a co-pay or co-insurance amount. See Prescription Drug Plan Costs and Co-Pays for more information.

When you show your drug ID card to fill a prescription at a participating pharmacy, you do not need to file a claim form.

What if I show my card and the pharmacist indicates I am not and/or my dependents are not eligible for the prescription drug plan?

You need to call the university SSC Contact Center at 734-615-2000 or 1-866-647-7657 (toll free) between 8:00 a.m. and 5:00 p.m. Monday through Friday and speak to a representative. If applicable, the university representative may be able to update your enrollment and give you the information needed to get your prescription filled the same day at your plan co-pay.

Please review the Paper Claims reimbursement information provided below before paying cash retail price for your prescription.

Replacing an ID Card

If you are already enrolled and need a replacement card, please call MedImpact Member Service at 1-800-681-9578 (toll free) to request a new card.

Temporary ID Card

If you need to fill a prescription before receiving your MedImpact ID card, or if you have lost your ID card, you may print a temporary ID card to take to your pharmacist. Be sure to call MedImpact Member Service at 1-800-681-9578 (toll free) to request a new card or use the self-service website to print your own ID card at https://mp.medimpact.com/umh.

Your ID card can be used at a local, network retail pharmacy or at NoviXus, the university's mail service pharmacy. Mail Service is a convenient and cost-effective way to get 90-day supplies of maintenance medications.

ID Cards for Dependents

You can obtain additional MedImpact ID cards for your eligible dependent children by calling MedImpact Member Service at 1-800-681-9578 (toll free).

How does my child at an out-of-state school obtain prescription drugs?

MedImpact has a large nation-wide network of participating retail pharmacies that will be able to process the prescription. Call MedImpact Member Service at 1-800-681-9578 (toll free) to locate a participating pharmacy near where your child lives. You can also locate a pharmacy near your child by accessing the Pharmacy Locator on the MedImpact member website at: https://mp.medimpact.com/umh

NoviXus mail order services are also available to your eligible dependents.

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Paper Claims

Paper reimbursement claim forms are only needed for purchases at non-network pharmacies or purchases made without the drug ID card. You have 90 days from the date of the prescription fill to file a reimbursement claim. If you fail to submit receipts within the 90 day limit you risk not receiving reimbursement.

Download the claim form, or contact MedImpact Member Service at 1-800-681-9578 (toll free) to request a claim form.

Upon claim approval, you will be reimbursed based on the contracted price that a participating pharmacy would charge for the same drug, minus your co-pay or co-insurance amount. The participating pharmacy contracted price is almost always significantly lower than cash retail prices.

Mail your reimbursement claim form to:

MedImpact Healthcare Systems, Inc.
10680 Treena St, 5th Floor
San Diego, CA 92131

Fax: 858-549-1569

How long do I have to file a paper claim?

You must submit claims within 90 days of the drug purchase date to receive reimbursement.

Reimportation of Prescription Drugs

The practice of purchasing prescription drugs for personal use in foreign countries and transporting them back into the United States (reimportation) has increased over the past few years. Reimportation may involve emergency situations when visiting another country or where individuals are attempting to save out-of-pocket cost by purchasing drugs that have lower drug cost due to governmental price controls in other countries.

The University of Michigan is concerned that medications purchased abroad may present a health risk. Reimportation of prescription drugs is illegal in the United States. The University of Michigan Prescription Drug Plan does provide for claim reimbursement up to a 34-day supply when drugs are purchased outside the United States on an emergency basis. Regular purchasing of monthly supplies outside the U.S. is discouraged and may result in denial of claims being paid unless pre-approved by the drug plan (i.e., individuals who live outside the U.S.).

Medication standards and regulations vary from country to country. The U.S. Food and Drug Administration (FDA) is only responsible for drug products marketed and sold in the United States. The following are a few suggestions to assist in decreasing the risk of drug purchases in foreign countries:

  • Purchase drugs in a foreign country only from licensed retail pharmacies
  • If you have concerns about the quality of a foreign pharmacy seek advice from the U.S. Embassy in that country for a recommended pharmacy
  • The safety of medications purchased in Canada from licensed retail pharmacies can generally be considered to be safe as their drug supplies come mainly from U.S. manufacturers
  • Drugs purchased through Internet pharmacies outside the United States or purchased from outlets in the United States that mail prescription medications back into the United States pose risks to individuals. Beyond this practice being illegal, Internet pharmacies may use secondary suppliers rather than U.S. manufactured drugs, which increases the risk of obtaining counterfeit medications that could jeopardize your health.

Going on vacation? Leaving the country for an extended period of time?

  • Be informed on this topic by visiting the FDA website at: www.fda.gov
  • One extra month refill of your prescriptions for vacation can be requested by contacting MedImpact Member Service at 1-800-681-9578
  • A 90-day supply may be obtained with a 90-day prescription from your doctor

If quantities larger than 90 days are required, please contact the U-M Benefits Office at 734-515-200 or 866-647-7657 (toll free) at least a week prior to leaving the country.  Before calling, please make sure your pharmacy has a prescription with enough refills for the duration of the trip.

Prior Authorization

To see if your medication requires prior authorization, please refer to the online U-M Formulary.  Medications that require prior authorization will be designated with “PA” in the Requirements/Limitations column.

Using Non-Network Pharmacies

If you have your prescription filled at a pharmacy that does not participate in the MedImpact network, you will have to pay the full cost of the drug and file a claim with MedImpact for reimbursement. Claims must be filed within 90 days of fill. Older claims will not be reimbursed. Non-network reimbursement is limited to a 34-day supply. You will be reimbursed based on the contracted price that a participating pharmacy would charge for the same drug, minus your co-pay amount. The plan will not reimburse costs exceeding the contracted price. This reimbursement process also applies if you do not present your MedImpact ID card when you have your prescription filled at a participating pharmacy. Reimbursement claim forms are available from the Forms page. Or contact MedImpact Member Service to request a form.

If you are going outside of the United States, leave all of your medications in their original labeled containers. Take a copy of the original prescription written by your doctor for each medication you are taking. Check with the embassies of the countries you are visiting for any restrictions on entering the country with certain medications. A letter from your doctor listing your medications and related diagnoses can help when passing through customs and in replacing lost or stolen medications.

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Coordination of Benefits (COB) Secondary Claims

You may be covered by more than one health plan that includes prescription drug coverage. This is where coordination of benefits (COB) can work to your advantage. COB is a way to coordinate all of your benefits when dual coverage exists. When your plans are coordinated with one another, they work together to give you maximum benefits.

All prescription drug claims must be processed within 90 days of the date of service to receive payment, consistent with Medicare Part-D requirements. The University of Michigan drug plan will not adjudicate claims over 90 days old.

For those not Medicare eligible, primary prescription drug plan is the coverage you select through your own employer, while coverage under your spouse’s employer is generally your secondary carrier. When your U-M health plan is your primary prescription drug plan, it pays for all covered prescription drugs, less co-pays and deductibles, if applicable. Your secondary health plan may pay for drugs not covered by the U-M Prescription Drug Plan, and possibly part of the co-pays required under the U-M plan.

When a non-U-M prescription drug plan is primary, but does not cover the drugs you received, U-M Prescription Drug Plan pays for drugs which are covered under the U-M plan, less co-pays and deductibles.

If you are insured under more than one plan with drug coverage, it is your responsibility to notify the pharmacy you use at the time of purchase for coordination of your benefits. Failure to bill the University of Michigan prescription drug plan and other drug plan(s) appropriately could result in additional out-of-pocket expenses for you.

When a member has prescription drug coverage through another plan that does not contain a coordination of benefits provision, the benefits of that other plan shall, to the extent not prohibited by applicable law, be payable before U-M Prescription Drug Plan determines the extent, if any, to which any drugs provided to the member constitute covered drugs. Unless a Medicare Part D plan is primary, any benefits payable under the other plan shall not exceed the amount U-M Prescription Drug Plan would have paid if there was no other plan. If a person has a Medicare Advantage Plan that includes prescription drug coverage, the U-M plan will not pay any prescription drug benefits (nor medical benefits).

For members with coverage under another prescription drug plan with applicable coordination of benefits clauses, all benefits will be coordinated in accordance with applicable law and the terms and conditions of the U-M Prescription Drug Plan. When coverage under U-M Prescription Drug Plan and coverage under another plan applies, the order in which the various plans will pay drug benefits will be determined as follows using the first rule that applies:

a. A plan that covers a person other than as a dependent will be deemed to pay its benefits before a plan that covers the person as a dependent; except that if the person is also enrolled as a Medicare beneficiary Medicare is: (i) secondary to the plan covering the person as a dependent; and (ii) primary to the plan covering the person as other than a dependent. In this case, the benefits of a plan that covers the person as a dependent will be determined before the benefits of a plan that covers the person as other than a dependent and is secondary to Medicare.

b. The plan that covers the person as a dependent child of a person whose birthday comes first in a calendar year will be primary to the plan that covers the person as a dependent child of a person whose birthday comes later in that calendar year. If both parents have the same birthday, the benefits of a plan that covered one parent longer are determined before those of a plan that covered the other parent for a shorter period of time.

c. Claims for dependent minor children of separated or divorced spouses or children whose custody or guardianship is determined by a court will be processed in accordance with the following rules:

(i) Benefits for a minor child of divorced or separated parents will be determined first by the court decree and second by the plan covering the child as a dependent of the parent with legal custody prior to the plan of the parent without legal custody.

(ii) Benefits of the plan covering the minor child of a remarried parent with legal custody will be determined first by the plan of the parent with legal custody; second, by the plan of the spouse of the parent with legal custody; and finally, by the plan of the parent without legal custody.

(iii) In the event of joint legal custody, benefits for a minor dependent child of divorced or separated parents will be determined as provided in section “b” above.

(iv) If, however, a court decree otherwise establishes financial responsibility for medical, dental or other health care expenses for minor children, subsections (i) through (iii) will not apply. Benefits of the plan covering the minor child as a dependent of the parent with such responsibility will be determined prior to any other plan that covers the minor child as a dependent.

d. If subsections “a”, “b”, and “c” above do not establish an order of payment, the plan under which the person has been covered for the longest will pay its benefits first, subject to the following:

The plan that covers the person as a laid off or retired employee or his/her dependent shall be determined after the benefits of any other plan that covers the person as an employee who is not laid-off or retired or his/her dependent. If the other plan is lawfully issued in another state and does not have a provision regarding laid-off or retired employees; and, as a result, each plan determines its benefits after the other, then this paragraph will not apply.

e. The benefits of a plan that covers the person on whose expenses a claim is based under a right of continuation pursuant to federal or state law shall be determined after the benefits of any other plan that covers the person other than under such right of continuation. If the other plan does not have a provision regarding the right of continuation pursuant to applicable law; and, as a result, each plan determines its benefits after the other, then this paragraph will not apply.

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Limitations
The University of Michigan in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend or terminate them.