Schedule I3 Non-Medicare Prescription Drug Summary of Benefits.pdf
PDF 6 MB Posted
- Attached to
- HMO Services for MPSERS
- Solicitation number
- RFP - 171 - 230000003226
- Issued by
- Ingham County, Lansing City, Michigan
About this file
This document is a Summary of Benefits for the Non-Medicare Prescription Drug coverage under RFP No. 230000003226 issued by the Michigan Public School Employees' Retirement System (MPSERS), administered by the Michigan Office of Retirement Services (ORS). The RFP is for HMO health coverage, including medical and prescription drug services, for MPSERS Medicare-Eligible and non-Medicare Eligible Members, including Retirees, beneficiaries, COBRA participants, and Dependents. Key changes to the prescription drug benefits effective 1/1/2024 include the elimination of the 10% additional coinsurance for 31-day retail supplies of maintenance medications, the addition of 90-day retail pharmacy coverage, and the removal of specialty medication exclusivity with Optum Specialty. The resulting contract will have a one-year term with four one-year renewal options.
The RFP requires fully-insured HMO offerings only. Bidder proposals must include both non-Medicare and Medicare products with prescription drug coverage. The geographic scope includes Ingham County and the City of Lansing. Pricing terms, set-asides, and funding details are not provided in this document, but can be found in the full RFP files.
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Other files
| File | Type | Posted |
|---|---|---|
| Schedule H HMO Benefits Summary and Claims Paid Data.xlsx | XLSX spreadsheet | |
| Schedule I2 PPO Medicare Summary of Benefits.pdf | ||
| Schedule B Pricing.xlsx | XLSX spreadsheet | |
| 230000003226 Questions Answers.pdf | ||
| Schedule I4 Medicare Prescription Drug Summary of Benefits.pdf | ||
| Schedule K 834 Use Case and Example.docx | DOCX document | |
| Schedule F Definitions.docx | DOCX document | |
| Schedule Q RFI Report Template.xlsx | XLSX spreadsheet | |
| Schedule L Benefit Comparison and Actuarial Attestation.xlsx | XLSX spreadsheet | |
| Schedule N Section 2 Solutions Table.xlsx | XLSX spreadsheet | |
| Schedule J Dependent Coverage.pdf | ||
| Schedule M HMO Census Data REVISED.xlsx | XLSX spreadsheet | |
| 230000003226 HMO Services RFP.docx | DOCX document | |
| Schedule G - Contractor Performance Evaluation Survey.doc | DOC document | |
| Schedule R Payment Discrepancy Report Template.xlsx | XLSX spreadsheet | |
| Schedule I1 PPO Non Medicare Summary of Benefits.pdf | ||
| Schedule P TRR Report Template.xlsx | XLSX spreadsheet |
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Text version
SCHEDULE I3 - NON- MEDICARE PRESCRIPTION DRUG SUMMARY OF BENEFITS
RFP NO. 230000003226
Bidders please note the following changes that go into effect 1/1/2024:
Non-Medicare Changes:
-The 10% additional coinsurance will no longer apply when purchasing a 31-day supply of a maintenance medication at a retail pharmacy.
-90-day supplies will be covered at a retail pharmacy.* -Specialty medication coverage will no longer be exclusive to Optum Specialty. 40% coinsurance with a $50 minimum/no maximum will apply to specialty medications purchased at a non-preferred pharmacy.* -A specialty copay card solution will be implemented for coupon cards used for specialty medications. To reflect true out-of-pocket costs more accurately, members receive credit towards their out-of-pocket maximum for a drug cost they pay out-of-pocket.
-Members will have an opportunity to utilize divvyDOSE pharmacy. divvyDOSE is a full-service pharmacy that pre-sorts your prescription medications, vitamins and/or supplements by day, date, and time.
* Coverage already applies to Medicare members. Coverage has been added to non-Medicare to create alignment between Medicare and non-Medicare coverage levels.
File details come from the government source that posted it. Updated .