June 10, 2008

Attention MCSIG Non-Medicare Participants:

 The purpose of this letter and enclosures is to inform you about important changes to your medical and prescription benefit plans effective July 1, 2008.  Please read this material carefully.  If you have questions regarding this material please call our customer service line at 831-755-8055 or 800-287-1442.

Plan changes were necessary to hold our medical premium increase to 10% for FY09.   MCSIG understands how plan design changes can affect our members.  We made every effort to structure the plan design changes in a way that allows you to reduce your expenses depending on the choices you make.  

The plan design changes are summarized below.  More detailed information concerning the pharmacy and behavioral health program changes are enclosed.

PPO OPTION I - The non-network coinsurance for hospital and physician services and other benefits (home visits, well child care, maternity care, physical therapy, outpatient diagnostic x-rays and lab work, mammography and radiation, chemotherapy and hemodialysis) is now 60%.  You will only be affected by this change if you utilize a non-network provider (a provider not in the network).  To avoid any impact by this benefit change, utilize a network provider.  Our network has not changed.  You can view available network providers in our area by going to www.anthem.com or you can call MCSIG customer service.

 PPO OPTIONS II AND III AND CALCARE HMO - No plan design changes.

 BEHAVIORAL HEALTH PROGRAM  -  The behavioral health plan design is changing to a two-tier network and an out-of-network benefit is being added.  The current in-network tiered copays are changing to a flat $15 copay each visit for up to 45 combined visits annually.  See the enclosure entitled Understanding Your Employee Assistance Program (EAP) & Behavioral Health Benefits for more detailed information.

 PHARMACY PROGRAM

 A number of changes are being made to the pharmacy program plan design:

• A Drug Quantity Management program is being implemented

• MCSIG is adopting Express Scripts’ broader, more extensive formulary

• Co-pays are changing

• 60 day retail prescriptions will require two 30-day co-pays

• An exclusive mail order program is being implemented for maintenance drugs

These changes will help control our pharmacy costs and will more equitably distribute savings among all plan participants (through a lower medical premium increase). 

Express Scripts is in the process of identifying members that will be impacted directly as a result of the pharmacy changes.  During the months of June and July Express Scripts will be sending those members additional, detailed information concerning their options.  See the enclosure entitled MCSIG Pharmacy Benefit for more detailed information. 

Thank you.