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SWSCHP Alert June 2008

Thanks to everyone who worked with their doctor's and medical care providers to invite them to join the POMCO network, and to those who let us know the names of providers they needed to have invited to join, we have added many new participants. Click on the Participating Providers section to view the list of who's been added

TO ALL SWSCHP/POMCO MEMBERS THE SWSCHP/POMCO TOLL FREE NUMBER IS NOW OPERATIONAL CALL TO FIND OUT IF YOUR PRESENT PROVIDER PARTICIPATES WITH THE POMCO NETWORKS TOLL FREE: 1-888-P-SWSCHP

POMCO TO REPLACE BLUE CROSS BLUE SHIELD JANAUARY 1, 2008 Effective January 1, 2008, SWSCHP will change its Hospital and Medical claims administrator from Empire Blue Cross Blue Shield to POMCO. Members will receive new ID cards from POMCO prior to January 2008. We expect service and responsiveness to improve. Our SWSCHP Hospital, Medical and Prescription Drug Benefits Plan will not change as a result of our move to POMCO. 90 to 95% of the providers used by our members also participate with the POMCO/Multiplan/PHCS Allied Networks. EMPIRE will continue to process all hospital and medical claims for dates of service incurred before January 1, 2008. Empire Blue Cross Blue Shield PO Box 1407-Church Street Station New York, N.Y. 10008-1407 1-800-6-SWSCHP 1-800-679-7247 Effective January 1, 2008, POMCO will process all hospital and medical claims for dates of service incurred after December 31, 2007. POMCO PO Box 6329 Syracuse, New York 13217 1-888-P-SWSCHP 1-888-779-7247 (Telephone # Operational Monday, December 3, 2007) MEDCO continues to be the pharmaceutical benefits manager for SWSCHP to provide prescription drug services to our members. Medco’s participating pharmacies fill prescriptions for all approved medications at the retail pharmacy, at its mail order pharmacy or, in regard to certain Specialty Drugs, through the Accredo Specialty Pharmacy. SWSCHP encourages our members to use the mail order pharmacy for all maintenance drugs. To see if your doctor/provider participates, click here. Then click on POMCO/Multiplan Allied. Remember, providers’ network memberships can change; it is always a good idea to verify with your doctor/provider directly. If you are unable to find your provider on the POMCO website, please click here. Go to, "search on-line" and follow the directions. (This is a provider search engine only). If you don’t see your provider/s listed at either site, you will want them to become participants. To do this easily, click here and click on "Recruit a Provider".

CO-PAY CHANGES EFFECTIVE JULY 1, 2007 Medical: $20 Co-Pay for Participating Provider Services Hospital, In-Patient: $100 Co-Pay Per In-Patient Admission Hospital, Out-Patient: $25 Co-Pay for the Following Out-Patient Procedures: Surgery Diagnostic Labs Diagnostic Radiology (MRI, CT Scans, Pet Scans, etc.) Mammography Administration of Deferral for Treatment of Cooley’s Anemia

PRESCRIPTION DRUG CHANGES EFFECTIVE JULY 1, 2007 Generic Drug Deductible Waiver The purchase of generic drugs either at the retail pharmacy or at the mail order pharmacy will not be subject to the $85 individual or $170 family deductibles. This deductible waiver provides additional savings to members and dependents when using generic drugs. Specialty Pharmacy There are many high cost injectable drugs for certain disease states (Growth Hormones, Hepatitis C, Multiple Sclerosis and others). Effective July 1, 2007, there will be a new program in place to have these drugs delivered to your home for your convenience. If you are presently taking one of these drugs you will be contacted by mail and phone. Please be aware that there will be a $50 co-payment that will apply for all specialty medications. These drugs will no longer be available at the retail pharmacy. Co-Pay Changes   Retail Pharmacy 30 Day Supply Mail Order Pharmacy 90 Day Supply Generic $5.00 After 1st Refill - $10.00 $10.00 Brand $20 After 1st Refill - $40.00 $40.00 Non Formulary $40 After 1st Refill - $80.00 $80.00 Specialty Pharmacy Drugs Not Available at Retail Pharmacy 30 Day Supply - $16.67 60 Day Supply - $33.33 90 Day Supply - $50.00

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SPECIAL PAYMENT ARRANGEMENT FOR SWSCHP MEMBERS Westchester Anesthesiologists Westchester Anesthesiologists has entered into a special financial arrangement for anesthesia services to SWSCHP members at White Plains Hospital, Lawrence Hospital and Phelps Hospital. In order for SWSCHP members to be eligible for this special arrangement the following must occur. 1. Westchester Anesthesiologists will bill Empire directly. SWSCHP members will also receive a billing statement with instructions for payment. 2. Empire will make payments to members. 3. * Within 10 days after receipt of Empire’s check and Explanation of Benefits members are to send the following to Westchester Anesthesiologists: * Empire’s check or your personal check for the same amount made payable to Westchester Anesthesiologists. * Empire’s Explanation of Benefits. * Your check for a $15 co-pay. * CHECKS, CO PAYS OR EXPLANATION OF BENEFITS sent to Westchester Anesthesiologists after 10 days of receipt from Empire will receive no consideration on their balance. Payments should be mailed to: Westchester Anesthesiologists 800 Westchester Avenue Suite S614 Rye Brook, NY 10573 If you have any questions or concerns contact Westchester Anesthesiologists at 914 428-5454 Or Herb Friedman at 1 800 814 6265 Note: Please be advised that members who are primary to other insurance plans or who are Medicare Primary are not eligible for this special arrangement.

SWSCHP/DISABILITY/MEDICARE If you, your spouse or your covered dependents become disabled at any age you must inform your school district immediately and enroll in Medicare Part A and Part B. Failure to do so will expose you to serious financial losses. If you are disabled, Medicare becomes the Primary payor and SWSCHP becomes the secondary payor for the disabled person. If you have any questions, contact your school district Health Benefit Representative or Herb Friedman at 800-814-6265.