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Benefit Improvement for Diabetics

During the changeover from Cigna to ProAct, it came to the Fund’s attention that Cigna had been charging covered individuals inconsistently for insulin, oral diabetic medications and diabetic supplies. Following review of our plan design, we have adopted a consistent policy that will result in greater cost savings for more of our participants/dependents.

Effective back to January 1, copays will be charged on all prescriptions for insulin and oral diabetic medications, but not on any of the diabetic supplies typically used by diabetics: insulin pens and cartridges, insulin syringes, needles, pen needles, lancets, alcohol swabs, blood glucose and test strips.

The above approach was applied to all claims received on or after April 2nd of this year. If you and/or your dependent were required to make a copay for any diabetic supplies from January 1 to April 1st, a refund from ProAct’s claims processing entity, Optum Rx, will be issued and mailed out within the next 7 to 14 business days.  In the event more than one copay was made during that period, one combined refund payment from Optum Rx will be issued.

Under the new approach, participants/dependents will be charged copays only for insulin products and oral diabetic medications, but never for diabetic supplies, no matter what a pharmacy lists first on a particular claim, and no matter whether items are bundled into one claim or filled separately.

We apologize for the overcharge that some participants/dependents may have experienced during the transition from Cigna to ProAct.