Beginning January 1, 2021, you’ll notice a few benefit enhancements and changes to coverage and cost-sharing between you and the plan. The enhancements and changes described below apply for the new single SAG-AFTRA Health Plan, and for Plans I and II (for participants running out their current coverage in 2021).
Be sure to use network providers when you need care — get contact information
- BlueCard PPO (doctors, hospitals, facilities)
- Industry Health Network providers (Los Angeles-area doctors, hospitals, facilities)
- LiveHealth Online (medical telehealth)
- Beacon Health Options provider (telehealth for mental health needs)
- MDLIVE (telehealth for mental health needs)
+ Benefits for virtual medical and mental health office visits continue
When you need medical care
During the COVID-19 crisis, our plan began covering virtual office visits with doctors online and by phone. We’ll continue this benefit into 2021. The new Plan deductible and regular cost-sharing for an office visit will apply.
You also have access to virtual visits through our LiveHealth Online benefit. This includes:
- An in-person visit with a board-certified medical professional through your phone, tablet, or desktop .
- Help with nonemergency medical problems, like a cold, flu, ear / sinus infection, and allergies
- Short-term prescriptions, if needed
These services are completely confidential.
For your mental health and emotional well-being
The Plan covers virtual visits (phone and online / video) with a Beacon Health Options network counselor, therapist, or psychiatrist. Contact Beacon Health Options at (866) 277-5383 for a referral to an in-network behavioral health provider or to find immediate help if you’re in crisis.
You can also take advantage of virtual visits through Beacon’s MDLIVE resource (available through mobile app, website, and by phone). Register at mdlive.com/counseling, or download the app to your mobile device (App Store and Google Play).
The Plan deductible and regular cost-sharing for an office visit apply.
These services are completely confidential.
+ Rx Savings Solutions
Prescription drug use makes up a big share of our plan’s expenses, and your prescriptions may take up a big part of your own healthcare budget.
To help manage our collective costs, we’re introducing a new resource called Rx Savings Solutions. You can use Rx Savings Solutions through your phone or computer, and see actionable ways to save on your medications — for example, by switching to a generic version of your brand-name drug or getting a better price at a local pharmacy.
Using Rx Savings Solutions is free and completely confidential.
+ New prescription drug network provider — CVS
Currently, Express Scripts serves as the plan’s prescription drug provider. Effective January 1, 2021, we’ll change to CVS Caremark as our drug provider. You’ll receive more information about this change later in 2020.
With CVS Caremark, you can use any pharmacy in their broad network but if you choose a CVS pharmacy, you’ll receive a seamless customer experience. You’ll be able to pick up specialty medications and speak with a pharmacist, choose whether to receive your maintenance medications via mail or pick up at the store and have the option to receive your maintenance medications in pre-sorted prescription packs.
No action is required now. Watch for more information in October and November.
+ Medical and hospital services deductible accumulate together
Quick reminder: Your deductible is the amount you pay for healthcare services before the plan’s cost-sharing kicks in. Effective January 1, 2021, we’ll combine our Plan’s in-network medical and hospital deductibles.
- The combined in-network deductible will be $500 for individuals and $1,000 for families.
- There is a higher combined deductible for Plan II (for participants running out their current coverage in 2021) of $1,000 for an individual and $2,000 for families.
- Also, the current Industry Health Network deductible will continue to apply ($150 for individuals and $300 for families).
Also remember: Our plan covers many in-network preventive care services at no cost to you — with no deductible requirement. Be sure to understand what care is appropriate for your age and gender, and make your appointment(s).
+ Elimination of out-of-pocket maximum for out-of-network services
You and the Plan will typically pay much less when you receive care through a network provider, because network providers agree to accept a pre-approved, discounted amount for their services. When you go out-of-network, providers may charge much more than the contracted rates. This costs both you and our plan much more money as we pay benefits. So, we strongly encourage you to use network providers whenever possible.
With this in mind, effective January 1, 2021, we’re eliminating the Plan’s out-of-pocket maximum benefit for out-of-network services. We’ll pay our share of coinsurance (based on the Plan’s Allowance), and you’ll be responsible for any balance due.
Finding a network provider
Our plan contracts with Anthem’s BlueCard PPO network, giving you access to one of the nation’s largest networks of doctors, hospitals, and other healthcare facilities.
Participants in California can use Industry Health Network providers, as well.