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Healthcare Plan Information

NALC Health Benefit Plan

The NALC Health Benefit Plan offers clinical and educational services that focus on treatment outcomes to improve overall health and support patient safety. The companies we work with, Cigna, CVS Caremark and OptumHealth Behavioral Solutions, incorporate programs into their networks to evaluate and improve the quality and safety of patient care. Each program is proactive, patient focused and outcome oriented with safety and care as its primary goal. In addition, these programs include member education which is a key component in helping members become active participants in their own well being.

Our Programs:

Drug Utilization Reviews for your protection

As our pharmaceutical benefit manager, CVS/Caremark ensures the safety and control of drug therapy. All pharmacy claims data is integrated in a single, company-wide, real-time technology platform. This allows Caremark to review each flagged prescription to see the full picture of a member's drug utilization and potential inappropriate or harmful therapy patterns. The Plan and CVS/Caremark also evaluates long-term drug history, retrospective analysis, to identify risk for drug interactions of drug-induced diseases. The analysis identifies opportunities to reduce unnecessary prescriptions or to simplify member's therapy. A safety letter is sent to the prescribing physician along with the member's 12-month prescription profile to alert the doctor to evaluate his treatment program. This information not only provides the doctor with the most appropriate clinical alternative available, but it is also educational.

Disease Management

These programs offer a considerable amount of personalized attention from clinicians and program educators who are available to discuss lifestyle changes, therapeutic outcomes, and other health related matters to assist patients in dealing with their experiences. Support is available for patients with chronic heart failure, coronary artery disease, chronic obstructive pulmonary disease, diabetes, and asthma. Call Alere™ Health Management at 1-866-270-2202 for more information.

Managed Behavioral Health

The OptumHealth Care Advocacy program is designed to support the Plan’s goal of ensuring that all our members receive necessary, appropriate and high quality behavioral health services. They ensure early, easy access to high quality, goal-focused care. Care management programs, such as identifying individuals whose medical conditions are co morbid with behavioral health needs. This type of Care Advocacy program recognizes mental health disabilities as issues affecting the member’s overall health status and brings tools and clinical interventions to make a difference thereby improving the lives of members.

Hospital Utilization/Transplant Programs/Case Management

The NALC Health Benefit Plan uses Cigna’s CareAllies to provide services such as inpatient acute facility pre-admission certification, case management, and specialty case management, and specialty case management services for oncology and transplant services. These CareAllies programs are designed to enhance the quality care and quality of life for individuals with severe and complex conditions. Case managers are experienced nurses who work with the individuals, family members and treating physicians to help coordinate care and benefits, explore care alternatives, monitor progress, coordinate discharge planning and follow-up, and help ensure that benefits are used effectively.

How do you know we only settle for the best?

There are many industry standard gauges built into our medical and mental practitioners networks as well as into our nationwide pharmacy network to ensure high standards for quality of service. Besides a rigid credentialing process of organizations such as Joint Commission, URAC and NCQA in which the companies we work with are accredited, quality of care is also monitored through client and patient complaints and media reports. Provider education may be warranted to improve performance levels.

You can expect quality and safety measures built into NALC Plan programs.

To maintain the quality services, the companies we work with conduct periodic audits and surveys to provide excellent treatment outcomes.

We utilize the Cigna HealthCare Shared Administration OAP Network. Cigna uses their own national credentialing standards, which are based on NCQA and state-specific requirements, to screen providers. They collect and verify each provider's credentials during initial credentialing and again at re-credentialing. During the initial credentialing process with primary care physicians, and OB/GYNs, the network representative may conduct an on-site office assessment based on NCQA standards. In addition, providers can participate in Cigna’s orientation program, continued education courses, and online communications to assist them in improving patient outcomes.

OptumHealth has created a diverse network of licensed and certified professionals nationwide for our membership to utilize their mental health and substance abuse benefits. Network provider’s performance is tracked and the online provider locator tool indicates which providers have achieved excellent ratings. OptumHealth provides feedback to clinicians as part of the recredentialing process, which occurs every three years.

Our Prescription drug benefit manager is CVS Caremark. They feature a comprehensive pharmacy audit program based on both concurrent and retrospective auditing. CVS Caremark's pharmacy audit department is one of the most experienced in the industry, with over 40 dedicated audit staff that includes on-site auditors, investigative auditors, and departmental claims analysts performing daily reviews of prescription drug claims.

Want to Know More?

To connect with our members through the internet, the NALC Health Benefit Plan offers valuable information on our "Health Center" through our website at www.nalc.org/depart/hbp. Here members can link to safety, medical and educational information as well as to our business partner's website to view:

OptumHealth Behavioral Solutions Resources including the "Live and Work Well" site which offers useful information on emotional well-being.

CVS/Caremark's website gives access to the latest information about chronic diseases, medicines and health conditions. The site includes “Ask-a-Pharmacist” section where patients can get confidential reliable answers to their questions.

Cigna's "mycareallies.com" provides information and tools to help participants improve and maintain their health, provides access to health and medical information and offers interactive tools that allow participants to get immediate feedback on their health status. Some of the features on this site are Health Assessment Tool, Health & Fitness Tools, Lifestyle Assessment Tools, Healthy Rewards, Healthwise Knowledge Library, and WebMD Personal Health Manager.

Our members can connect daily with our 24-hour help lines to access in-person support for a wide range of mental health and substance abuse concerns, including depression, eating disorders, coping with grief and loss, to name a few. Call 1-877-784-8797 to speak with professionals who can help you. In addition, we offer a 24-hour nurse line that gives members access to a registered nurse 24 hours a day, 7 days a week. Members can discuss health concerns and treatment options with qualified medical nursing specialists in the privacy of their home and at a time of their own choosing. Call 1-877-2020-NALC (6252)

These activities available through the internet, telephone and in writing can have an impressive impact on consumer's health and safety. To learn more about the NALC Plan and our special features, contact our Customer Service Department at 1-888-636-6252. Call us today and discover why NALC Plan members continue to rate the NALC Health Benefit Plan as one of the top plans in the FEHB Program.

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