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The Bulletin Board |
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Beginning January 1st, DBMS Health Services will perform Medical Management services for Wabash including pre-certification of hospital admissions, MRI, PET and CT scans, and outpatient mental health and substance abuse services. DBMS health care professionals will evaluate requests for medical services and facilities according to national benchmarks, guidelines and criteria under the provisions of your Wabash benefit plan. DBMS will determine the appropriateness, medical need and efficiency of requested services and direct providers and members toward the most cost-effective quality treatment available while continuing to monitor your care to assure quality and appropriateness of your overall treatment plan. |
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Case Management Consultants is a company in St. Louis, Missouri, which employs Registered Nurses (RNs) with training and experience to coordinate medical services required when you are experiencing a medical problem, injury or illness. These RNs, who are called Case Managers, work directly with members, their family, physician and health care providers. Services coordinated / provided are:
The Case Manager is available to assist you and your family in navigating the health care delivery system to assure that you understand your illness and are receiving the most appropriate and cost-effective care. |
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New Prescription Drug Benefit Program - Effective 1/1/2010 Effective January 1, 2010, LDI Integrated Pharmacy Services will administer the Prescription Drug Benefit Program for Wabash. LDI's skilled pharmacy health care team consists of Clinical Pharmacists, Pharmacy Technicians and Customer Care Representatives all committed to providing the safest, most cost-effective and reliable pharmacy benefits and services to our members. Contact LDI directly to discuss your prescription benefits by calling the Customer Care Call Center at (866) 516-3121. LDI Customer Care Representatives are available 24 hours a day, seven days a week to provide the best possible service to Wabash members. Participating Pharmacies: LDI has over 63,000 pharmacies in their network. You may contact LDI directly or refer to their website at www.LDIRx.com to determine if an independent pharmacy participates in the network. You will be required to present your ID card to the pharmacist to update your record. Contact Wabash if you need a new or replacement ID card. Mail Order Prescriptions: LDI offers a convenient mail order program delivering medications safely to your door in confidential, secure packaging. Prescriptions are filled directly from LDI's own on-site pharmacy within 24 hours of prescription receipt. LDI's mail order program is ideal for medication you take on a regular basis. You can order your prescriptions through the Mail Order Service by phone, mail or online. Additional information on the LDI mail order program is available at www.LDIRx.com. Specialty Medications: Working with your healthcare provider, LDI administers a comprehensive, patient-centered specialty medication pharmacy program that focuses on early intervention, medication compliance and prevention of complications, improving quality of care while managing health care costs. Specialty medications are high-cost oral, injected, infused or inhaled medications that are either self-administered or administered by a healthcare provider and used or obtained in either an outpatient or home setting. Specialty medication and high cost injectables require pre-authorization. If you are currently receiving specialty medications and have not been contacted by LDI, please have your provider call LDI Pharmacy Services at 1-877-705-0111 to ensure there is no lapse in your medication.
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Imported Mail Order Drug Program - Effective 1/1/2010 Wabash offers an imported mail order drug program for brand name drugs without a generic equivalent available in the United States. Effective January 1, 2010, CanTrust Rx Midtown Pharmacy in Winnipeg, Manitoba will fill your prescriptions and ship them right to your door. CanTrust Rx is a Canadian licensed retail, mail and internet pharmacy with over 30 years of pharmaceutical experience. Click on Pharmacy Form.PDF. (To view and print out this form you need to have Adobe Acrobat Reader installed on your computer. It is a free download and you may download it by following this link.) Complete the Pharmacy Form and submit it with your valid prescription (or a copy) signed by a licensed physician by either:
These documents will be reviewed by pharmacists and a physician. They will either approve your prescription or request more information. You or your physician may be contacted to provide additional information. Once approved, your medication will be shipped to you. A maximum of a 90-day supply of prescription medication may be shipped at one time. Please allow up to 21 days from the day of ordering for the shipment to reach you. the shipment may arrive in as little as 7-10 days but we recommend ordering early to make sure that you don't run out of your medication. Members will be required to pay a co-payment on international prescriptions of $30, or 20% of cost, whichever is greater. Shipping charges are $12.00 USD per shipment. Two or more customers living in the same household may request that their orders be shipped together. Indicate your preferred method of payment and provide CanTrustRx with the billing information. Choose either: MasterCard, VISA or American Express or include a Certified Check or Money Order made out to "CanTrustRx". Personal checks or postal money orders are not acceptable. You may call and cancel your order at any time up until the day it is shipped. After the order has been shipped, it cannot be cancelled. It is illegal for CanTrustRx to take back and redispense medication that has been shipped. You may order a refill of your medication(s) by phone or by fax/mail using the prescription Reorder request Form. Once the refills on your prescription have run out, you will need to submit a new prescription to CanTrustRx. The goal of CanTrustRx is to get your medications processed within 14 business days, plus 7-21 business days for shipping. This process will be delayed if: a. Your doctor or pharmacy has to be contacted to get a copy of the prescription b. Your billing information is inaccurate or incomplete. Always ensure that you copy down your credit card information accurately, and ensure that all the fields are completed when filling in our on-line forms c. Your credit card company denies the purchase because it is from a foreign company. Sometimes as a security measure, credit card companies will deny purchases that are made in a foreign country if they can tell that you haven't traveled there recently. It helps if you are able to speak to your credit card company to let them know that a purchase from Canada or CanTrustRx in Canada will be going through on your credit card, so that they will know to permit this purchase. The initial prescription orders may take several extra days for CanTrustRx to process. We suggest that those members who currently have prescriptions filled through Expedite Canadian pharmacy may want to reorder prior to the end of calendar year 2009 to ensure they have adequate quantities available for the month of January 2010. For more information see www.cantrustrx.com.
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Friends Of Wabash Discount Drug Program The Friends of Wabash discount drug program will continue. Call the Wabash Membership Office at (217) 429-5246 to request a card to begin or continue participating as a friend. |
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Active Member Benefit Comparison |
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Member Handbook - Active Member Handbook - Medicare Handbook Medicare Mem Printer Version.pdf Member Handbook Changes Member Handbook Changes For Web.PDF
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Summary Annual Report For Welfare Plans For Wabash Memorial Hospital Association Health and Welfare Plan This is a summary of the annual report of the Wabash Memorial Hospital Association, 37-0806462 for the Health and Welfare Plan for the year ended December 31, 2008. The annual report has been filed with the Employee Benefits Security Administration as required under the Employee Retirement Income Security Act of 1974 (ERISA). Wabash Memorial Hospital Association has committed itself to pay certain hospital, surgical and dental claims incurred under the terms of the plan. BASIC FINANCIAL STATEMENT The value of plan assets, after subtracting liabilities of the plan, was $4,641,552 as of December 31, 2008, compared to $5,168,873 as of January 1, 2008. During the plan year, the plan experienced a decrease in its net assets of $527,321. This decrease includes unrealized appreciation or depreciation in the value of plan assets; that is, the difference between the value of the plan's assets at the end of the year and the value of the assets at the beginning of the year or the cost of assets acquired during the year. During the plan year, the plan had total income of $14,329,105. This included employee contributions of $5,828,843, employer contributions of $8,575,068, reimbursement payments of $974,654, income from investments of $243,230, and unrealized gains on investments of $1,292,690. Plan expenses were $14,856,426. These expenses included $974,451 in administrative expenses, $582,595 in clinic operations, $12,468,518 in benefits paid to participants and beneficiaries, and $830,862 for fees paid to preferred provider organizations. YOUR RIGHTS TO ADDITIONAL INFORMATION You have the right to receive a copy of the full annual report, or any part thereof, on request. The items listed below are included in that report: 1. An accountant's report 2. Assets held for investment To obtain a copy of the full annual report, or any part thereof, write or call the office of Wabash Memorial Hospital Association, c/o Ms. Tamara Bivins, who is the plan administrator, located at 1501 North Water Street, Decatur, Illinois 62526, 217-429-5246. A nominal fee to cover copying costs may be charged. You also have the right to receive from the plan administrator, on request and at no charge, a statement of the assets and liabilities of the plan and accompanying notes, or a statement of income and expenses of the plan and accompanying notes, or both. If you request a copy of the full annual report from the plan administrator, these two statements and accompanying notes will be included as part of that report. The charge to cover copying costs given above does not include a charge for the copying of these portions of the report because these portions are furnished without charge. You also have the legally protected right to examine the annual report at the main office of the plan, 1501 North Water Street, Decatur, Illinois 62526 and at the U.S. Department of Labor in Washington, DC or to obtain a copy from the U.S. Department of Labor upon payment of copying costs. Requests to the Department should be addressed to: Public Disclosure Room, Room N-1513, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, DC 20210. |
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Wal-Mart $4 Generic Program To view a list of the $4 generic drugs available at Wal-Mart pharmacies, go to www.walmart.com/medicare and view the printable list of all the $4 generic drugs available by clicking on "$4 generic drug program".
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Benefit Check Wabash benefits do not pay for elective asbestos testing or heart screening that is being shown in television commercials. Wabash is only authorized to pay for medically necessary testing that is ordered by a physician or other legitimate medical professional. |
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How To Contact Any questions or problems regarding claims or the Illinois Blue Cross Network may be directed to your personal claim representative at (888-800-9161). Last names beginning with: A-F ask for Denise, G-M ask for Ruthie and N-Z ask for Nona. |
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Tax Deductible Contributions Tax Deductible Contributions to our Foundation provide a great way for you to say thanks and be remembered by your friends and colleagues after you're gone. For as little as $250.00 a year (depending on your age and health), you can leave as much as $50,000 to the Foundation through an insurance policy. We want you to make the Wabash Memorial Hospital Foundation your favorite charity. Please consider an annual gift to Wabash as you write checks to your other charities. Your railroad brothers and sisters will appreciate your generosity. |
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Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. (HIPAA,45 CFR 164.520(1)(I), FEDERALLY REQUIRED NOTIFICATION The Wabash Memorial Hospital Association (WMHA) has adopted this Notice of Privacy Practices to comply with Federal Guidelines as outlined in the Health Insurance Portability and Accountability Act (HIPAA). It is also our policy to advise each member of their rights and expectations with respect to the privacy of certain Protected Health Information (PHI). Protected health information is defined as: any 'individually identifiable health information' whether maintained or transmitted on paper, in electronic format or orally. It may include demographic information collected from an individual that is created or received by a health care provider, health plan, health care clearinghouse, or employer, that relates to an individual's past, present or future physical or mental health or condition, or payment for that individual's health care, and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual. WMHA acknowledges that during routine business transactions it is necessary to collect, receive and make use of certain personal or family medical information that is considered PHI. This information may come from hospitals, clinics and physician providers or other insurance entities. Without such data, we would be unable to properly process and pay medical claims on your behalf. Since we provide either Primary or Secondary coverage for all WMHA members, we maintain Business Partner Agreements with other Providers who may be directly or indirectly involved in your healthcare. In those instances where we also serve as a 'Provider', that data must be shared with other insurance entities to receive proper reimbursement for your treatment. Our intent and ongoing practice is to resolutely and diligently protect the privacy of all the health information of all our members that we may be expose to in any form, from any source. The development of this policy focuses on the following acknowledgments and assumptions.
Protected Information: PHI may be received from many sources via U.S. Mail, telephone, in writing or over a computer line. Information may be oral or recorded in any medium, that relates to an individual's past, present or future physical or mental health or condition, or provision of or payment for healt6h care to an individual or: Created or received by health care provider, health plans, public health authority, employer, insurers, schools or clearinghouses. Identifiable Information: Includes demographic data collected from an individual, created or received by a health care provider, health plan, employer or clearinghouse that may directly or inadvertently permit identification or an individual, e.g., name address, SSN, phone number. Allowable use of data: Generally, WMHA may use or disclose PHI to 1) carry out patient treatment, 2) facilitate payment for such treatment, and 3) to carry out our own health care operations such as assisting in the settlement of member's FELA claims. As a provider, as well as insurer, WMHA will only share a minimum level of information on behalf of a member in order to determine eligibility and covered benefits, assist with precertification or preauthorization, utilization review, billing claims management etc. Example: Your doctor may share medical information about you with another health care provider. For example, if you are referred to another doctor, that doctor will need to know if you are allergic to any medications. Similarly, your doctor may share PHI about you when calling in a prescription. WMHA WILL NOT SHARE MEMBER INFORMATION FOR MARKETING MAILING LISTS OR FUND RAISING PURPOSES EXCEPT AS MAY BE DIRECTLY AFFILIATED WITH WMHA SUCH AS THE WABASH HOSPITAL ASSOCIATION FOUNDATION. Worksite Health / Safety and Law Enforcement / Public Interest as well as certain areas of medical research are issues that allow the exchange of PHI without specific consent. This data will normally be collective; group data/statistics unless if demanded by a court of law, specific member information related to child abuse, adult abuse, neglect, domestic violence or national security, may be demanded. Permission: Consent, Authorization and Oral Permission: Consent from the patient must be granted to Direct Treating Providers giving them permission to use PHI for treatment, payment, or healthcare operations. This can permit a One Time Event or good until revoked. Consents must be signed and dated and may be revoked at any time. Exceptions noted are for treatments required by law, certain emergency situations, when language barriers exist, treatment to inmates and some health plans and clearinghouses. Oral Permission is adequate for the sharing of some PHI such as notification of family members or friends involved in one's care or care payment and/or certain directory information. Religion information may be disclosed to clergy. Oral permission is adequate also for the ordering of prescription medications, x-rays and medical supplies. Authorization is required for the release of PHI in situations not requiring consent: i.e. to persons/entities not directly involved in the patient's care such as Workman's Compensation claims, third party payers, life insurance inquiries, transfer of certain medical/pharmacy records, etc. WMHA will have available upon request by a member information about who is requesting information, what, when and how that information is disclosed and by whom. We will always satisfy the Privacy Rules by only providing the Minimum Necessary to satisfy the request. WMHA will inform members of this Privacy Notice. WMHA acknowledges that certain member rights exist, such as:
WMHA is required to:
We reserve the right to change our practices and to make the new provisions effectively for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you've supplied us. For More Information Or To Report A Problem: Should you have further questions or wish to make a change in the protected health information, please contact Ms. Tamara Bivins, WMHA Administrator at (217) 429-5246. If you believe your privacy right has been violated, you can file a complaint with Ms. Tamara Bivins, WMHA Administrator, PO Box 1340 Decatur, Illinois 62525 or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. THE EFFECTIVE DATE OF THIS PRIVACY NOTICE SHALL BE APRIL 1, 2003
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