Silver Script

Enrollment CIF

Client Name State-Wide Schools Cooperative (SWSCHP)
Enrollment Go Live Date
  • 10/12/2016
Post Enrollment Go Live Date
  • 01/01/2017
Client Type
  • EGWP + Wrap
CARRIER(S)
  • Primary: X9533
  • Wrap: X3369
URL
Number of Lives
  • 5,000
Pre/Post Enrollment TFN
  • 866-768-4253
 

Plan Offered

  • 1 Plan Offered
Formulary Tier Generic/
Preferred Generic
Brand/
Preferred Brand
Non-Preferred Brand/
High Cost
Retail 1-30 Day supply $7.50 $30 $50
Retail 31-60 Day supply $15 $60 $100
Retail 61-90 Day supply $22.50 $90 $150
Mail 1-30 day Supply $7.50 $30 $50
Mail 31-90 Day Supply $15 $60 $100

 

Copay Details – Specialty Drugs 2017
Formulary Tier Generic/ Preferred Generic Brand/ Preferred Brand Non-Preferred Brand
Retail 1-30 Day Supply $50 $50 $50
Retail 31-60 Day Supply $100 $100 $100
Retail 61-90 Day Supply $150 $150 $150
CVS Specialty/Mail 1-30 Day Supply $16.67 $16.67 $16.67
CVS Specialty/Mail 31-60 Day Supply $33.34 $33.34 $33.34
CVS Specialty/Mail 61-90 Day Supply $50 $50 $50

 

Phone Enrollment Allowed?
  • No, enrollments are submitted via batch file from client.
  • After completing the Med D- Real Time Resolution of Eligibility process and determining that the member is not found in PeopleSafe, RxClaim, Facets, or with a pending enrollment Fazal, the member can be referred to:
Disenrollment Allowed?
  • If a member calls to disenroll from the plan the member can referred to:

 

Opt In/Opt Out
  • Opt Out
  • If a member calls to Opt Out of the plan (prior to being received by SilverScript) the member can be referred to:

 

Opt Out Cut Off Date
  • Members can Opt Out at any time prior to being received by SilverScript on the enrollment file.
  • Members can cancel their enrollment between being received on the enrollment file and their effective date.
  • If it is after their effective date, please reference the Disenrollment Section.

 

Opt Back In Allowed After Opt Out?
  • If member calls to opt back in before or after the original effective date the member can be referred to:

 

Age In Process
  • Age-In Enrollments will be sent via Batch File at least 45 days prior to the effective date
Wrap Coverage?

**Coverage Detail

  • Yes

 

Secondary Coverage?

**Coverage Detail

  • Yes, via wrap
DAW Penalty
  • No DAW penalty.
ICE (Incomplete Enrollments) Due Date for Additional Information is Missed
  • If the member does not respond to the RFI (Request for Information) letter within 30 days, and the enrollment is denied (verify in Fazal), the can be referred to:
Secondary Formulary
  • There is not a secondary formulary booklet
  • Members will receive an abridged formulary for the Primary plan with their welcome kit.

This can also be obtained from the website: www.SWSCHP.SilverScript.com

 

Batch PO Box Attestation?

(Client sends PO Box address as permanent address for member and attests to US Residency.)

  • Yes, the client will attest to US residency on behalf of all members.

FAQs

General/Plan Design

Why are we moving to this plan?

The Affordable Care Act allows employer group plans like State-Wide Schools Cooperative (SWSCHP) to work with Medicare Part D (prescription drug plan) to provide drug coverage for retirees and dependents enrolled in Medicare A and B. This partnership allows the plan’s retiree program to save money on the cost of prescription benefits because Medicare Part D will now cover some of the expense for retiree’s prescription drug plan.

 

What do I need to do to enroll in coverage?

State-Wide Schools Cooperative (SWSCHP) will automatically enroll eligible retirees and dependents into the SilverScript Employer Group plan. You do not need to take any action to enroll, other than look for your new prescription ID card to replace your current prescription ID card. SilverScript will mail your new card by late November. Show your new prescription ID card to your pharmacy starting January 1, 2017.

CCR Process Note: If a member receives a letter stating that they need to call to confirm their enrollment, reference the ICE (Incomplete Enrollments) Due Date for Additional Information is Missed section for instructions on completing the missing information on their enrollment in Fazal.


How are SilverScript and CVS Caremark affiliated?

SilverScript is a subsidiary of CVS Caremark.

 

How does the Employer Group Waiver Plan with SilverScript work?

SilverScript is a Medicare approved prescription drug plan that partners with your employer plan to provide prescription benefits. Both SilverScript and your employer will provide coverage on your prescriptions to ensure that your coverage remains consistent with your current non-Medicare coverage.

 

What prescription drug coverage will be available for non-Medicare-eligible dependents with a Medicare eligible family member?

Non-Medicare-eligible participants will continue to be enrolled in their current CVS Caremark coverage. There no changes to the provisions for non-Medicare eligible beneficiaries.

 

Will the new plan with SilverScript be the same as the current retiree plan?
Will the current co-pay structure remain the same in the new year?

The cost share for your drugs will not change with the new plan. Your co-pays and any applicable deductibles and out-of-pocket maximums will still apply and will continue to work the same way as they have previously.

 

How will the deductible/MOOP for the new benefit work?

Deductible: None
MOOP: $3,600

I’ve heard about a Coverage Gap or Doughnut Hole with Medicare Part D plans. Now that we’re on SilverScript, will that apply to me?

No, because you have enhanced benefits through your employer plan, you will not experience a Coverage Gap or Doughnut Hole.

 

Will claims for specialty medications be processed or handled differently with the new plan?

Coverage for specialty medications will remain the same. Members can utilize the CVS Caremark Specialty Pharmacy.

 

How will Medicare Part-B ONLY medications be covered going forward?

Drugs typically covered by Part B (such as diabetic testing supplies) should be submitted to SWSCHP Aetna Medicare Advantage Plan.

 Exception: Needles, Syringes and Insulin injection devices will remain covered under the SilverScript plan.

 

How will Part D vs. Part B medications be covered going forward?

Part D drugs will be covered by the SilverSript Med D primary and wrap plan. Part B drugs should be processed through SWSCHP Aetna Medicare Advantage Plan.

 

Enrollment

Can I opt out of coverage with the new SilverScript plan and remain covered under current plan?

No, Medicare eligible members cannot remain in their current plan unless they reside outside the United States. If you choose to opt out of the SilverScript coverage you, your spouse and dependents, will no longer have employer sponsored prescription coverage.

 

If I decide to opt out of the SilverScript plan, can I retain medical coverage?

Yes, you can opt out of SilverScript and still retain your SWSCHP Aetna Medicare Advantage Plan.

 

I have a PO Box, but not a street address; can I use my PO Box address?

Yes, a PO Box is acceptable as a Permanent Address as long as beneficiary attests to residing within the coverage area/United States.

CCR Process Note: Update the member’s address in Facets. If the member’s enrollment is held due to a PO Box for the physical address, route the address update to Enroll Spec for processing.

 

Can I reenroll in the plan after opting out of the SilverScript plan?

To request re-enrollment before your original effective date members may refered to: Benefits Representative at their district. The contact information can be found on the website www.swschp.org by reviewing the latest Retiree Guide > Get To Know Your Plan (tab)> Plan Documents> Retiree Guide> search Contact Information. If it is after the enrollment date – members must wait for the next OE period or qualify for SEP.

 

Formulary

Where can I find the formulary for the SilverScript plan?

An abridged (containing commonly dispensed medications) formulary will be mailed to you by late November. You can also access a copy of the formulary at www.SWSCHP.SilverScript.com

 

Premium Billing / LEP / IRMAA

Will I receive a premium invoice from SilverScript?

No, SilverScript will not invoice you for a premium amount associated with this plan.

 

If I am assessed an LEP, will State-Wide Schools Cooperative (SWSCHP) reimburse me or pay the penalty on my behalf?

If you are assessed a Late Enrollment Penalty, State-Wide Schools Cooperative (SWSCHP) will pay for that penalty on your behalf.

 

What is the Income Related Monthly Adjustment Amount (IRMAA)? Will I be billed for this?

Due to the Patient Protection and Affordable Care Act, beneficiaries whose adjusted gross income is greater than $85K for individuals or $170K for married couples will be charged a monthly amount in addition to other premiums for coverage.

If you are subject to paying IRMAA, Social Security will send you a letter to notify you. The letter will explain how SSA determined the amount you must pay and the will include the amount to be charged.

For questions about Part D-IRMAA withholdings from your benefit check, visit http://www.socialsecurity.gov/pgm/mediinfo.htm, call 1-800-772-1213, or visit your local Social Security office.

CCR Process Note: Visit the IRMAA Work Instruction for additional speaking points and information: MED D SilverScript – Income Related Monthly Adjustment Amount (D-IRMAA).

Will State-Wide Schools Cooperative (SWSCHP) reimburse for IRMAA premiums?

If you are assessed an IRMAA premium, the State-Wide Schools Cooperative (SWSCHP) may reimburse you for that amount. Refer to www.SWSCHP.org for further details.

 

Mail Order

Will my current mail order prescriptions transfer to my new plan?

Yes, most mail order prescriptions (with available refills) will be transferred to your new SilverScript account. Controlled substance medications cannot be transferred. CII prescriptions must be received via HARD COPY. CIII and lower can be faxed in to Caremark mail order. These will require new prescriptions.

 

Can I continue to obtain my current prescriptions at the retail pharmacy?

Retirees can continue to obtain their current prescriptions at a retail pharmacy, provided that refills available and haven’t expired at the time of fill. They must present their new SilverScript ID card to their pharmacy on and after January 1st.

 

Prior Authorizations

Will my prior authorization transfer to the new SilverScript plan?

No, existing prior authorizations will not transfer to the new plan. A prior authorization for the 2017 plan year can be requested starting 1/1/2017.

 

Communication Mailing Timeframes

When will I receive more information or materials for the SilverScript plan?

Mail Dates:

Contact a Care Navigator

Monday through Thursday: 8:00am - 8:00pm ET

Friday: 8:00am - 6:00pm ET

Saturday: 9:00am - 2:00pm ET

1-888 P-SWSCHP1-888 779-7247