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Human Resources
Human Resources

2019 Benefits Changes & FAQs

We understand how important benefits, especially healthcare coverage, are to our campus community. Because of that, we look critically at what we offer and work to improve when possible. After careful consideration, we will be making a healthcare administrator change. Starting January 1, 2019, Butler will no longer be using Anthem’s insurance program.

In consultation with Butler’s Healthcare Advisory Committee, we looked for an innovative solution to our unique healthcare needs. We decided that Apta Health was the best solution moving forward.

Meet Apta Health! (click for video)

Apta Health is a healthcare plan coordinator. They work on Butler’s behalf to manage and coordinate all the different parts of our health plan. This patient-focused model gives the University much more flexibility when it comes to tailoring our new healthcare plan to meet employees’ needs. Instead of being tied to one company and relying on them for all aspects of our plan, we now have a coordinator finding the best in class services for each part of our plan (pharmacy manager, healthcare plan, for example), in an effort to provide our community with optimal coverage.

Apta Health Educational Forums

In order to make this transition as smooth as possible, we offered several information forums so you could learn more about Apta Health.  If you were unable to attend a link to the presentation is posted in the Quick Links section of this website and a list of Frequently Asked Questions from the meetings is listed below.

 

2019 Open Enrollment

Open Enrollment for 2019 benefits begins on October 22 and ends on November 2, 2018.  Plan costs will be communicated prior to the open enrollment period in October. 

We will host several 2019 Open Enrollment forums and provide further information. Please watch your email and The Butler Connection or RSVP for the dates, times, and locations of the Open Enrollment information forums. As 2019 Open Enrollment information is released you will find links to plans and rates and the information forum presentation on the  2019 Benefits Open Enrollment webpage.  Please send your questions to askHR@butler.edu

 

Key Benefits of the Butler Healthcare plan with Apta Health

  1. Apta Health will use United Healthcare’s Choice Plus network of doctors and specialists.
    United Healthcare and Anthem are both big, broad networks. A disruption analysis comparing Anthem’s network and United’s network was completed. The study revealed that there was a less than one percent difference between the in-network doctors of both providers. As a result, we anticipate minimal disruption for our campus community.
     
  2. Apta Health uses MagellanRx as the pharmacy benefit manager.
    A prescription disruption analysis comparing MagellanRx and Express Scripts was completed. Out of about 20,000 prescriptions, roughly 400 will no longer be covered. However, of those 400, there are alternative medications that will be covered that address the same issues.
     
  3. Apta Health’s model focuses directly on customer advocacy, care, and engagement.
    Members of Butler’s health plan will work directly with a small team of Apta Care Coordinators when they have a question about benefit coverage or in-network participation. 

How did the University chose Apta?

The change to Apta Health stems from both a desire for quality, patient-focused, customer service, and the University’s strategy for creating a culture of care and employee well-being. After careful consideration and deliberation with Butler’s Health Care Advisory Committee, University leadership began looking for innovative solutions to Butler’s unique healthcare needs by asking for Request for Proposals from various healthcare providers. During this search, one company in particular—Apta Health—stood out. 

What network does Apta Health use?

With Apta Health we will use providers in the United Healthcare Choice Plus network.

Prior to January 1, 2019, you can click on the "Search For A Healthcare Provider" link and find a primary care doctor who is in the United Healthcare Choice Plus network.

After December 17, 2018, you can call your Apta Care Coordinator (1-877-610-8817; M–F;  8:30 AM – 10:00 PM ET)  for assistance determining if your current provider is in the UHC Choice Plus network or for help finding new in-network providers.

After January 1, 2019, You'll first need to register online at butler.myaptahealth.com.     

Once logged in:

  • Click "Find In-Network Providers" 
  • Search for a doctor
  • Click "Add/Modify Primary Doctor" to make your designation.

Don't forget to contact the physician first to ensure that he or she is accepting new patients. If you need help or have questions, call your Apta Care Coordinators.

Will I have to change doctors?

Apta Health will use United Healthcare’s Choice Plus network of doctors and specialists. 

United Healthcare and Anthem are both big, broad networks. A disruption analysis comparing Anthem’s network and United’s network was completed. The study revealed that there was a less than one percent (<1%) difference between the in-network doctors of both providers. As a result, we anticipate minimal disruption for our campus community.

Who are the Apta Care Coordinators?

Apta Care Coordinators are a team of nurses, patient services representatives, and benefits experts who are ready to help you before, during, and after any health event. Think of the Apta Care Coordinators as your healthcare champions. They fight hard to help you save money and make sure you get quality care.

What can Apta Care Coordinators help with?

Apta Care Coordinators can help you with anything related to your healthcare and health benefits. Whether you have a question about your claims or bills, need help knowing what's covered under your plan, want to prepare for an upcoming doctor visit, or just need a new ID card—the Apta Care Coordinators are here for you. No question is too big or too small.

How do I get in touch with my Apta Care Coordinator?

Benefits through Apta Health do not begin until January 1, 2019, but your Care Coordinators are available for questions and assistance beginning December 17, 2018You can call your Care Coordinators at 1-877-610-8817.

After January 1, 2019, You can call your Care Coordinator, visit butler.myaptahealth.com, or download the mobile app here. 

Do I need to inform my doctors about the Apta Care Coordinators?

Yes.  Once you receive your new insurance card or during any doctor or healthcare provider visit after January 1 2019, be sure to show them your ID card and ask that they review it carefully. It has all the information the office needs to have your claims processed and contact your Apta Care Coordinators.

You will also want to point out that your provider network will change from Anthem to United Healthcare Choice Plus. Verify that your provider is in-network and help make sure that your claims after 1/1/2019 are sent to the right place.

What is a Primary Care Physician (PCP)?

A Primary Care Physician (PCP) can be a family doctor, a general practitioner, a doctor of internal medicine, or a pediatrician (for children). A PCP is sometimes called a Family Doctor or a Primary Care Doctor. During pregnancy, your OB/GYN may serve as your PCP for the purpose of giving referrals.

Am I required to designate a Primary Care Physician for myself and each family member?

While not required, we strongly encourage you to designate a Primary Care Physician.

Think of your PCP as the physician whose job it is to get to know you and your health over time. When you begin all healthcare events with your Primary Care Physician, you're building a relationship that will help him or her be ready for you when you need care. Whether it's treating you when you get sick, providing a referral to a specialist, or administering a preventative screening such as an annual physical, your PCP will make sure you get the best care throughout your life.

What if I don't currently have a Primary Care Physician?

You should choose one! Click on the "Search For A Healthcare Provider" link and find a PCP who is in the United Healthcare Choice Plus network.

You can call your Apta Care Coordinator (1-877-610-8817; M–F;  8:30 AM – 10:00 PM ET)  for assistance determining if your current provider is in the UHC Choice Plus network or for help finding new in-network providers.

You'll need to register online at butler.myaptahealth.com.  Once logged in:

  1. Click "Find In-Network Providers" 
  2. Search for a doctor
  3. Click "Add/Modify Primary Doctor" to make your designation.

Contact the physician first to ensure that he or she is accepting new patients. If you need help or have questions, call your Apta Care Coordinators.

Don't forget to take your Annual Wellness Exam Incentive form when you visit your PCP for your checkup! Return the completed form to the HR Benefits Office (JH 052) and you will receive a $100 wellness incentive. Incentives will be processed monthly upon receipt and verification of the form.

 

Why should I get a referral from my Primary Care Doctor before seeing a specialist? Is it required?

While not required, we strongly encourage you to get a referral from your Primary Care Physician before seeing a specialist. You'll receive a discount on your copay for office visits with specialists when a referral is in place. In addition to helping you avoid visits to the wrong specialist, your PCP will tell your Apta Care Coordinators about your referral.

If you are being referred to an out-of-network doctor (which happens often) or if the referral is for healthcare services that are not fully covered, the Apta Care Coordinators will call to alert you ahead of time, helping you avoid higher costs. Many times, a referral will help you see a specialist even faster, and some specialists require a referral before they will see you.

Do I have to make an office visit to my Primary Care Physician each time I need a referral?

Your PCP decides if an office visit is necessary in order to give a referral. Usually, the decision is made based on your symptoms and how often you visit. Each referral obtained is valid for 12 months. 

If I have to see a specialist several times in the course of treatment, do I need a referral for each visit?

No, only one referral is needed for each course of care. To give the specialist enough time to evaluate and treat your condition, your Primary Care Physician will likely include several visits in your referral. However, if your specialist recommends surgery or another procedure, the specialist's office will obtain pre-certification and will work with your Apta Care Coordinators behind the scenes on your behalf.

What if I have an emergency? Do I need to have a referral first?

No. In the event of a true emergency, always go to the nearest hospital or other medical facility.

If you are treated at an emergency room or urgent care center, your benefits will be paid according to your health plan benefit level even if you do not have a referral. If you need continuing care with a specialist after being treated for an emergency injury or illness, let your Primary Care Physician know so that they can issue a referral. If you have difficulty reaching your PCP, call your Apta Care Coordinators.

What is a pre-certification? Is it required?

Before you receive certain medical services or procedures, your health plan requires a doctor to confirm that these requested services are considered medically necessary under your plan. This verification process is called "pre-certification." Even if some services or therapies are performed in your doctor's office, you may still need a pre-certification.

Services requiring a pre-certification include:

  • Inpatient hospitalizations
  • Out-patient surgeries (includes Colonoscopies)
  • Transplants—Organ and Bone Marrow
  • Durable medical equipment (DME) over $500
  • Skilled nursing facility admissions
  • Oncology care and services (chemotherapy, radiation therapy, etc.)
  • Dialysis
  • MRI's, MRA's, and PET scans
  • Home health care and services
  • Hospice care
  • Occupational therapy
  • Physical therapy
  • Speech therapy

For your convenience, services that require pre-certification are listed on your ID card as well. 

What if I already have an appointment to visit a specialist scheduled in January 2019?

You’ll need to have your PCP provide a new referral to the Apta Care Coordinators. You can do this as early as December 17, 2018 even though your benefits will not begin until January 1, 2019.

Remember a referral is not required but if you visit a specialist without a referral you will pay a higher copay for your visit.
 

There is a 60 day grace period starting January 1, 2019 to get a referral for your early 2019 appointments. If you have questions about this process or need assistance obtaining a referral, we encourage you to begin working with the Apta Care Coordinators. 

What if I don’t obtain a pre-certification?

If your procedure or service requires pre-certification and a pre-certification is not obtained, you will pay a $500 penalty.  

During the transition to Apta Health, you will have a 30 day grace period starting January 1, 2019 (ending January 30, 2019) to obtain a pre-certification for any services you already had scheduled. 

Will my premiums go up for 2019?

Pricing—premium rate changes based on healthcare costs and claims history (just as with Anthem)— will be announced during open enrollment in October 2018.

What about my dental coverage? Will it remain the same? Who do I call?

Dental coverage will remain with Delta Dental of Indiana and there will be no plan or pricing changes for 2019.

Your Apta Care Coordinator will be able to provide general assistance regarding our dental and they can provide the correct Delta Dental or HR contact if they are unable to assist.

I hear our vision coverage is changing. What's up with that?

Vision coverage for 2019 will be provided through EyeMed.  General questions and issues can be addressed to your Apta Care Coordinator.  They can also provide contact information or direct you to HR if they are unable to provide assistance with your issue.

2019 Vision coverage rates and plan details will be found HERE  as soon as they are released for open enrollment.

 

Are Urgent Care facilities impacted by the change to Apta Health?

Urgent Care facilities, like hospitals and physicians, are either in or out of network.  Check the Search for my Medical Provider link to see if your urgent care facility or your urgent care physician are in the United Health Care Choice Plus network. If you need assistance you can contact your Apta Health Care Coordinator beginning December 17, 2018 or reach out to askHR@butler.edu.

If I have already been seeing a specialist do I need a referral in January 2019?

While not required, we strongly encourage you to get a referral from your Primary Care Physician before seeing a specialist. You'll receive a discount on your copay for office visits with specialists when a referral is in place. In addition to helping you avoid visits to the wrong specialist, your PCP will tell your Apta Care Coordinators about your referral.

If you are being referred to an out-of-network doctor (which happens often) or if the referral is for healthcare services that are not fully covered, the Apta Care Coordinators will call to alert you ahead of time, helping you avoid higher costs. Many times, a referral will help you see a specialist even faster, and some specialists require a referral before they will see you.

All these new names! Who do we call, Magellan, UMR, UHC or Apta?

The Apta Care Coordinators can help you with anything related to your healthcare and health benefits. Whether you have a question about your claims or bills, need help knowing what's covered under your plan, want to prepare for an upcoming doctor visit, need a new ID card, have questions about your medications, setting up home delivery, referrals, pre-certifications—the Apta Care Coordinators are here for you. No question is too big or too small.

Is an Endocrinologist considered a PCP?

An Endocrinologist is a specialist and you will need a referral from your PCP in order to receive the discounted specialist copay when you visit an endocrinologist.

What do I do if I no longer need to take a maintenance medication that is on the mail order program or if the dosage changes?

Your healthcare provider will issue a new prescription when the dosage of your medication changes.  The provider's office can submit the new presctiption directly to MagellanRx.  You can contact your Apta Health Care Coordinator and they can work with you to cancel prescription deliveries from MagellanRx.

Is my physical therapist considered a specialist? Do I need a referral?

A Physical Therapist is a specialist.

While not required, we strongly encourage you to get a referral from your Primary Care Physician before seeing a specialist. You'll receive a discount on your copay for office visits with specialists when a referral is in place. In addition to helping you avoid visits to the wrong specialist, your PCP will tell your Apta Care Coordinators about your referral.

If you are being referred to an out-of-network doctor (which happens often) or if the referral is for healthcare services that are not fully covered, the Apta Care Coordinators will call to alert you ahead of time, helping you avoid higher costs. Many times, a referral will help you see a specialist even faster, and some specialists require a referral before they will see you.

Physical therapy services require pre-certification.  If your procedure or service requires pre-certification and a pre-certification is not obtained, you will pay a $500 penalty.  

During the transition to Apta Health, you will have a 30 day grace period starting January 1, 2019 (ending January 30, 2019) to obtain a pre-certification for any services you already had scheduled. 

If I am having surgery or being treated in the hospital are all the healthcare providers in-network?

If the hospital is in the United Health Care Choice Plus network the physicians treating you and the ancillary services (laboratory, radiology, anesthesiology, etc.) will be treated with umbrellaed, in-network coverage.  You can contact your Apta Health Care Coordinator to ensure your choice of Hospital is in-network.

Note:

Prior to moving to the new care coordination model with Apta Health please use the "Search for My Health Care Provider"  link to search the United Healthcare Choice Plus physicians network and see if your current physicians and service providers will remain in-network.

We are also providing a MagellanRx Formulary list and a "Search for my Rx" link in the "Quick Links" section, through which you can search for your current prescription medications and see how they are covered by the Apta Health plan in 2019.