Announcements

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December 15, 2022

Express Scripts Pharmacy Network Change 

Starting January 1, 2023, Harris Teeter pharmacies will no longer be part of the Express Scripts pharmacy network. If you fill prescriptions at a Harris Teeter pharmacy, they will not be covered by the FAES pharmacy plan, and you may pay a higher cost for your medications. If you have recently or previously filled a prescription at a Harris Teeter pharmacy, you will receive a letter from Express Scripts informing you of participating pharmacies in your area. To avoid any interruption in your treatment, transfer your prescription to a participating pharmacy before January 1, 2023.  

It’s easy to move your prescription. Here are 3 ways to make the switch:

1. Take your prescription bottle to your new pharmacy and they’ll contact your current pharmacy to transfer your prescription.
2. Call your new pharmacy and ask them to transfer your prescription.
3. Ask your doctor to contact your new pharmacy with your prescription information.

Visit express-scripts.com/findapharmacy for a full list of in-network pharmacies near you.

Holiday Season Reminders 

Urgent Care vs. Emergency Care
Holiday closures and travel can affect your options to receive medical care. Your best choice for non-urgent situations is always a scheduled appointment with your doctor, however when that is not possible, you have choices.

Urgent Care: Many situations require immediate care that you might not be able to receive in your doctor’s office, yet these situations might not be serious enough to require the services of a hospital emergency room. In these situations, a walk-in clinic or urgent care center may be an appropriate choice. Remember, care received in an urgent care facility is costly, yet much less expensive than an emergency room. Below are some guidelines to determine when an urgent care center is appropriate.

• You have telephoned your doctor or nurse practitioner and he or she recommends that you go to an urgent care center.
• Your symptoms or injury have occurred outside of your physician’s regular office hours and are too severe to wait until the next regular office hours, yet not severe enough to warrant a visit to the emergency room.
• You do not have a regular doctor or primary care physician.
• You are out of town.
• You are unable to reach your doctor or nurse practitioner by phone.

Emergency Room Care: A visit to the hospital emergency room is the most expensive type of outpatient care. Emergency rooms should only be used for true emergencies, as they are staffed, equipped, and best suited for medical emergencies. Going to an emergency room for non-emergency care is a poor use of your health benefits and can be very costly. Some situations where emergency room care is appropriate include:

• A major injury, such as a broken bone
• A wound that continues to bleed vigorously despite application of pressure
• Decreased mental activity or awareness, or disorientation
• Shortness of breath
• A cold sweat accompanied by chest pain, abdominal pain or lightheadedness
• Severe pain

When faced with deciding where to go to receive medical care, be sure to evaluate all your options and choose the setting that best suits your illness or injury. Of course, in a true emergency, seek the appropriate care without delay. Choosing the most cost-effective options will go a long way toward ensuring that your employer can continue to provide you and your family with the quality, affordable health benefits you rely on.

Talkspace Support
The holiday season is a joyous and festive time, but it can also be very busy and stressful. FAES plan participants have access to Talkspace therapy and psychiatry services at no additional cost. Please view the Registration Guide on how to get started.

Flu Season
Flu season is here. Don’t forget to get a Flu Shot to protect you, your family, and your community. Visit Vaccines.gov to find a flu shot near you. 

Covid-19 Bivalent Booster and At-Home Test Kits

Covid-19 Bivalent Boosters are now widely available in our community. If it has been two months since you completed your primary vaccination series or received a booster, you are eligible for the Moderna and the Pfizer-BioNTech COVID-19 bivalent vaccine boosters.  Visit Vaccines.gov to find a COVID-19 vaccine near you. 

At-Home COVID-19 Test Kits: FAES plan participants can get free at-home COVID-19 tests in two ways:

1. Express Scripts (ESI) Pharmacy: Order up to 8 at-home COVID-19 tests every 30 days from Express Scripts Pharmacy. Log in or register to place your order on express-scripts.com.
2. Retail pharmacy: You can pick up tests from your local ESI-participating pharmacy. Purchase tests at the pharmacy counter and offer your benefit information for a $0 copay.

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August 29, 2022

FAES Open Enrollment: September 12-23, 2022 for Medical/Prescription, Dental and Vision Plans for the 2022-2023 Plan Year  

Since 1959 the Foundation for Advanced Education in the Sciences (FAES) has been working to support the professional and educational mission of the National Institutes of Health. This support includes a health insurance program for select members of the NIH community. Over the years FAES has made many changes to ensure a robust and sustainable insurance plan for members. 

FAES will continue to offer the Trustmark/Aetna Signature Administrators PPO Medical/Prescription plan and the MetLife Dental/Vision plan for the 2022-2023 plan year. We are pleased to announce that no coverage changes were made to the medical plan for the new plan year. The Prescription Plan will have one minor plan change to limit the prescription fill quantity on certain categories of medications to align with clinical dosing guidelines.

An updated benefit guide and insurance plan video will be posted on the FAES website before the start of our Open Enrollment period. 

Open Enrollment September 12-23, 2022

Open Enrollment is a time when you can make changes to your insurance election. Changes can include switching from individual coverage to family coverage (or vice versa), dropping coverage all together, or enrolling if you previously waived coverage. If you wish to make changes, please contact the FAES Insurance department by phone or email. Changes will take effect with the start of our new plan year on November 1, 2022. 

If you are currently enrolled and choose to remain on the plan for the new plan year, you will automatically be reenrolled in Medical/Prescription, and Dental/Vision plans effective November 1, 2022. You do not need to fill out new paperwork.

FAES Insurance will host Open Enrollment Information Sessions via Zoom at 3:00pm EDT daily (Monday-Friday) September 13-23, 2022. 

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June 30, 2022

Machine Readable Files Available  

FAES medical in-network rates and out-of-network allowed amounts are available as machine readable files via a new link on the FAES Insurance webpage. To access machine readable files with information specific to participants in the FAES Insurance Plan, please open the Healthcare Bluebook window and click on the link for Aetna Signature Administrators. 

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May 23, 2022

New Wallet Card and Provider Information Sheet

Trustmark will mail a new wallet card and provider information sheet to plan participants this spring. Plan participants can share the card and information sheet with providers when seeking care to assist the providers with verifying coverage and submitting claims to Trustmark. The documents also outline the relationship between Trustmark and the Aetna Signature Administrators PPO network. The wallet card can be carried along with your insurance card. An electronic version of both documents is available on the Trustmark portal and the FAES Insurance website.  

At-Home COVID-19 Test Kits

FAES plan participants can get free at-home COVID-19 tests in three ways: 

1. Express Scripts (ESI) Pharmacy: Order up to 8 at-home COVID-19 tests every 30 days from Express Scripts Pharmacy. Log in or register to place your order on express-scripts.com. 
2. Retail pharmacy: You can pick up tests from your local ESI-participating pharmacy. Purchase tests at the pharmacy counter and offer your benefit information for a $0 copay. If you pay for the tests out-of-pocket, ask for a pharmacy receipt. Log in to your account on express-scripts.com for instructions on how to submit a reimbursement claim.
3. Federal government: With the help of the United States Postal Service (USPS), households can request tests to be delivered for free. Learn more and order at-home tests at www.covidtests.gov. 

May is Mental Health Awareness Month

Mental health impacts every area of our lives. Our mental health affects everything we do, think, or say. Maintaining positive mental health, and seeking treatment for any mental health condition, is crucial to stabilizing constructive behaviors, emotions, and thoughts. Focusing on mental health care can increase productivity, enhance self-image, and improve relationships.

Nurturing mental health doesn’t just improve daily functioning, it can also help control — or better cope with — some physical health problems that are directly linked to mental health conditions. Other benefits of taking care of your mental health can include:

• Improving your mood
• Reducing your anxiety
• Creating an enhanced sense of inner peace
• Thinking more clearly
• Improving your relationships
• Increasing your self-esteem

Available Mental Health Resources

FAES plan participants have access to mental health resources and providers through the FAES medical plan and Talkspace. The medical plan allows plan participants to seek mental health care from in- or out-of-network providers with office visits at the same $15 copay. Coverage is the same for mental health office visits to in-network providers and out-of-network providers. There are no restrictions when selecting your mental health provider; you can go to any provider using the FAES medical plan. Talkspace is a digital mental health service that connects members to thousands of dedicated providers through a secure, HIPAA-compliant platform. With Talkspace, you can interact with your therapist via text, voice, or video messages—anytime, anywhere—including from the comfort of your home. Talkspace also has a network of licensed prescribers specializing in mental health care and prescription management.

Please see the registration guide on how on FAES plan participants can access Talkspace services at no-cost.

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March 30, 2022

FAES Health Insurance ID Card Redesign

All FAES plan participants will be issued a new health insurance ID card by mail in spring 2022. Each plan participant, including spouse and dependent children, will receive their own ID card with their name listed. 

• Member IDs and group numbers have not changed.
• The top right quadrant of the card is now titled “Medical Provider Network.” 
• In accordance with the “No Surprises Act,” the card will now list copayment amounts due for office and specialist visits, in- and out-of-network deductibles, and out-of-pocket maximum amounts.
• The “Medical Claims Submission” quadrant will now include additional information for providers.
• The new information “Claim Status Inquiry: Payer ID CRSMD” allows providers to check the status of submitted claims.

If you have an upcoming appointment and have not yet received your redeisgned health insurance ID card in the mail, you can still use your existing card. You can also access the most current health insurance ID card by registering for or logging into your mytrustmarkbenefits.com account.

The FAES Insurance Department is here to assist you with any questions you may have. Please do not hesitate to reach out to us for assistance. We are here to support you. 

301-496-8063 | faesinsurance@mail.nih.gov

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March 15, 2022

Clarification Regarding At-Home COVID-19 Test Kits Coverage 

FAES would like to provide clarification on how at-home COVID-19 test kits are covered by the prescription plan with our pharmacy benefit manager, Express Scripts (ESI). When purchasing an at-home COVID-19 test kit, members will either:

• Purchase the at-home COVID-19 tests directly from an in-network pharmacy
  
  • Purchase test kits at an in-network pharmacy counter. To find a retail pharmacy in the Express Scripts network please visit express-scripts.com and click “Find a Pharmacy.” You can also use the Express Scripts mobile app. Present your Trustmark/ESI member ID card and have the pharmacist process it thru your pharmacy benefit manager, ESI.  If the pharmacy processes the at-home COVID-19 test kit thru ESI, you will have no copay.  Please note:  The pharmacy is not obligated to process your at-home COVID-19 test kit thru the ESI pharmacy program. If the pharmacy will not process the claim through your ESI prescription coverage, please see the scenario below.
• Purchase the at-home COVID-19 tests from another retailer or provider
  
  • You purchase an at-home COVID-19 test kit and pay out-of-pocket.  For example, you may order it online, purchase it along with your other grocery items or purchase them at a store that does not have a pharmacy.  If this is the case, you will need to save your receipt and complete an ESI claim form for reimbursement.  Please note:  Your at-home COVID-19 test kit claim reimbursement will be the lesser of (1) the agreed upon contract rate with the provider per kit or (2) no more than $12 per kit.

Reminder: Each plan participant is allowed to purchase up to 8 at-home COVID-19 test kits every 30 days.

Please view this flyer for additional information.

Thank you.

FAES Insurance
301-496-8063
faesinsurance@mail.nih.gov

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February 3, 2022

At-Home COVID-19 Test Kits Now Covered 

As of January 15, 2022, the FAES pharmacy plan through Express Scripts will cover over-the-counter at-home COVID-19 test kits at no-cost for plan participants. Plan participants are eligible for up to 8 at-home COVID-19 test kit(s), per covered participant on the plan, from an in-network pharmacy every 30 days. You may go to any retail pharmacy in the Express Scripts network and obtain COVID-19 test kit(s) at the pharmacy counter. To find a retail pharmacy in the Express Scripts network please visit express-scripts.com and click “Find a Pharmacy.” You can also use the Express Scripts mobile app. If you are not able to obtain at-home COVID-19 test kit(s) at an in-network pharmacy, you can submit your receipt for reimbursement for up to $12 per test. Plan participants can register or login to their Express Scripts account to access a reimbursement form. This flyer has additional information.  

Another method to order at-home COVID-19 test kit(s) is through the Express Scripts Pharmacy delivery service. Plan participants can register or login to their Express Scripts account to place their order.

In addition, the Federal government, with assistance from the United States Postal Service (USPS), is providing households a total of 4 tests to be delivered free of charge by request. You can learn more and order at-home COVID-19 test kit(s) by visiting www.covidtests.gov

Benefit Plan Highlight: Mental Health Resources

FAES is committed to supporting the mental health and overall well-being of our plan participants. FAES offers access to Talkspace online therapy and psychiatry, as well as Lasting (relationship support) from Talkspace at no-cost to plan participants.

Therapy can benefit everyone. It isn’t solely beneficial after experiencing a traumatic event, ongoing anxiety, or a major life change; it can help in everyday life too! A therapist may provide new techniques for problem solving, help challenge irrational habits and incorrect assumptions, reframe long-held views, or help you grow and change. A therapist can also assist you overcome mental health conditions like depression and anxiety.

Primarily a therapist can help you:

• Understand your feelings- Learn what emotions are common for a condition or circumstances.
• Get immediate support- While deep-seated issues can be addressed down the line, counseling can benefit you in situations where you need help urgently.
• Plan your future-Therapists can assist to create a game plan and set goals for the future in a safe environment and keep you accountable.
• Relieve the pressure with a therapeutic relationship- Often, simply getting things “off your chest" in a safe space can be healing. If serious problems arise again, the on-going therapeutic relationship will keep you strong.

The most important thing is that a therapist is always there for you. They’re an impartial ally who will support you without judgment.

Talkspace therapy includes 4 live video sessions per month. Talkspace psychiatry includes 13 live sessions. FAES plan participants also have access to Lasting from Talkspace (relationship support). Please view the Registration Guide on how to get started.

The Talkspace program is a supplement to the comprehensive mental health benefits offered through the current FAES medical plan. The medical plan allows plan participants to seek mental health care from both in and out-of-network providers for office visits at the same $15 copayment. Plan participants will have the same coverage for mental health office visits when going in or out of the network. There are no restrictions when selecting your mental health provider since you can go to any provider nationwide using the FAES medical plan.

Insurance Claims and Verification Info Sheet

FAES compiled an info sheet about claims processing and insurance verification. We 'hope this will be a useful tool in navigating your health insurance.

The FAES Insurance Department is here to assist you with any questions you may have. Please visit our FAQ section for common questions. If you have questions or need additional assistance, please do not hesitate to reach out to us. We are here to support you.

Thank you.

FAES Insurance
301-496-8063
faesinsurance@mail.nih.gov

2021 Archived Insurance Announcements

2020 Archived Insurance Announcements