Christian Brothers Health Benefit Services
Plan Change Notice for the
Diocese of Raleigh

Medical & Prescription Drug Out-Of-Pockets Combined

Medical and Prescription Drug Out-of-Pockets for all Plans will be combined on January, 1, 2020. Check your Summary of Benefits & Coverage (SBC) to see your combined Out-of-Pocket levels.

Coverage for Video and E-Visits

Video and On-Line visits, also known as E-Visits, will be covered under your plan if offered by the physician. Under the plan, you will be subject to the office visit copay or plan of benefits that would normally apply.

Know Your Prescription Drug Plan

Smart90 Prescriptions—90-day prescription fills at Walgreens Retail Network Pharmacies

Nearly all Rx plans offered by CBEBT have a Retail Refill Allowance that allows you to have an initial fill and two subsequent refills at a retail pharmacy before you are asked to utilize the mail-order pharmacy. You may continue to fill at the retail pharmacy after the two refills but you will pay the corresponding mail order copay and be limited to a 30-day supply of medication.

Smart90 Prescriptions gives you the option to either fill a 90-day prescription at a Walgreens (or its affiliates). This option applies to no other retail pharmacies for the 90-day fill option. The program provides you with flexibility if you prefer not to have your 90 days of medication delivered to your home.

If you’re wanting to switch from Express Scripts’ home delivery to the Walgreens Smart90 program simply bring your current prescription bottle(s) to the Walgreens of your choice and they will be able to transfer your 90-day prescription to that pharmacy. 

Essential Health Benefits Habilitative Coverage

CBEBT has always included rehabilitative services when deemed medically necessary. These services are defined as the treatment of disease, injury, developmental delay, or other cause by physical agents and methods to assist in the rehabilitation of normal physical bodily function, that is goal-oriented and where the person has the potential for physical improvement and ability to progress.

Until now, CBEBT did not cover Habilitative services, which are defined as health care services that help a person maintain, learn, or improve skills and functioning for daily living. Such services may include physical therapy, occupational therapy, speech-language pathology and other services.

Beginning January 1, 2020, CBEBT will offer you Habilitative benefits limited to 20 visits, when medical necessity is shown, not to be combined with any service provided under Rehabilitative benefits. CBEBT will continue to provide Rehabilitative services as it has in the past provided medical necessity has been met.

Expansion of Livongo—Hypertension (high blood pressure)

Beginning January 1, 2020, CBEBT participants with hypertension (high blood pressure) can enroll in the Livongo for Hypertension program at no cost. The Livongo for Hypertension program offers real-time recommendations tailored to each person’s unique health experience. When you enroll in the program, you will receive a connected high blood pressure monitor and access to the Livongo App through which you send your blood pressure readings. After each reading, a specialist provides you with personalized content based on the current reading and your past trends. You also receive feedback if your blood pressure is elevated and you can schedule a session with Livongo’s trained coaches. If you have hypertension and are also currently enrolled in the Livongo for Diabetes program, you can now manage both conditions with one easy point of contact.

2020 Prescription Formulary Changes

Periodically Express Scripts, the Trust’s Pharmacy Benefits Manager, announces changes to their formulary drug list. Some prescription drugs currently covered will be excluded from coverage while other prescription drugs will move from a Preferred Brand status to a Non-Preferred Brand status.

The formulary is a list of drugs—generic and brand name—that offer the greatest overall value to Plan participants. Formulary management enables you and your physicians to choose clinically appropriate and cost-effective drugs for specific conditions.

The exclusion list is for medications not covered on the Express Scripts drug list. For each one of those excluded drugs, there are clinically equivalent, lower-cost options available. The Formulary Exclusion List includes preferred alternatives for those medications that are not covered.

Express Scripts also has made available a list of name-brand drugs that will be classified as Non-Preferred effective January 1, 2020, and the Preferred Alternatives for each drug.

*Participants who may be affected will be notified in advance.

On behalf of Christian Brothers Services, thank you for your continued participation in the Trust and the privilege to serve you and your family.