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Preventive Drug Coverage Enhancement with ProAct

The Trustees of the Equity-League Health Fund recently learned that, with the switchover to ProAct on January 1, 2018, an unintended reduction in benefits occurred – the application of copays to certain preventive prescriptions, such as birth control pills. These drugs have a long history of being dispensed with a copay, in conformity with the Health Fund’s Summary Plan Description (SPD), which defines the Plan’s health benefits. But several years ago, without our knowledge, Cigna began to administer some of those benefits without a copay.

Given the long-standing nature of Cigna’s practice, and the desirability of encouraging certain preventive treatments, the Trustees have decided to cover, without a copay, the preventive drugs that Cigna had been administering without a copay. This change is retroactive to January 1, 2018. A complete list of the categories of affected drugs appears below.

Those of you who were subjected to copays for the listed drugs beginning on January 1 of this year will be automatically reimbursed by ProAct. However, it will take several weeks for ProAct to modify their claims system to reflect the new benefits, so claims will continue to be processed with copays until then, and refunds will be made following that system change. It should be noted that ProAct had no fault in this incident. They were administering the benefit as described in the SPD.

It should also be noted that there are some differences between the list of drugs covered by Cigna and ProAct. If you were affected by differences in covered drugs, you should have already received a letter from ProAct informing you of the change(s) and offering advice on how to work with ProAct (and your physician as needed) to find a substitute.

We recognize that prescriptions in the preventive drug categories listed below provide an important benefit for many of you and we apologize for any inconvenience that resulted from the inadvertent reduction in benefits that occurred. We will soon be adjusting our Summary Plan Description to reflect these changes, as well as our website and other communications.

NEW PRESCRIPTION CATEGORIES WITH NO COPAY

Aspirin Products

Breast Cancer Prevention Drugs

Hormonal Contraception, Barrier Contraceptive Devices and Emergency Contraception

Bowel Prep Products for Colorectal Cancer Screenings

Fall Prevention/Vitamin D Supplementation

Folic Acid Supplementation

Pediatric Multivitamins, Iron Containing Products and Fluoride Supplementation

Smoking Cessation

If you have any questions regarding these changes, please don’t hesitate to contact the Fund Office, at 212.869.9380, or ProAct, at 833.636.1400.