COMMON INSURANCE QUESTIONS AND ANSWERS!

Q. Are there generic alternatives available for Lipitor?

A.  Yes-- and you could save money, too. Experts estimate that up to 80 percent of patients on a brand-name statin like Lipitor could be effectively treated by a generic alternative. We encourage you to talk to your doctor about switching to a generic, if appropriate, so you can benefit from the savings as soon as possible. If your doctor determines that a generic alternative from the Medical Formulary works for you, you may be able to save $40 every time you refill your prescription.

If your doctor believes that you need a more potent brand-name drug, Crestor and Vytorin are on Medica's Formulary as preferred alternatives. Your benefit plan does provide coverage for non-formulary drugs, such as Lipitor, however, you are responsible for the highest copayment amount in your coverage.

Medica's formulary includes five statins:

    Formulary Generic Statins:  simvastatin (Zocor); prevastatin (Pravachol); and lovastatin (Mevacor)

    Formulary Brand-name Statins:  Vytorin and Crestor.

Q. Do I need a referral to go to Mayo Clinic?

A. Referrals are required for care received at Mayo Clinic. If you are seeing a provider at one of the Mayo Health System Clinics-- Luther Midelfort in Eau Claire or Red Cedar Medical Center in Menomonie, your physician may refer you to Mayo Clinic-- Rochester if it is determined to be medically necessary. The referral process is driven by your physician at Luther Midelfort or Red Cedar Medical Center. The referral must occur prior to you receiving services as Mayo Clinic. These physicians are familiar with the process and have the necessary referral forms.

Q. I was seeing a Dr. at Mayo Clinic-Rochester prior to July 1, 2007. Do I need a referral now to continue seeking care at Mayo Clinic?

A. Yes, you should speak to your referring physician at Luther Midelfort in Eau Claire or Red Cedar Medical Center in Menomonie. These physicians are familiar with the process and have the necessary referral forms.

Q. How is insulin covered?

A. Beginning on October 10, 2007, Medica began processing insulin claims at 100% coverage for both formulary and non-formulary prescriptions. Insulin claims were previously paid at the 3-tier pharmacy benefit. This change was made to align with the previous benefit offered through the prior medical plan.

Q. I would like to quit smoking. What resources do I have?

A. the Medica Tobacco Cessation Program offers you a free coaching service which is designed to help tobacco users quit. This confidential service connects tobacco users with a trained coach who will help guide and support you through the process of becoming tobacco free. If medically appropriate, an 8-week supply of nicotine replacement therapy (gum, patches or lozenges) is mailed to your home in two shipments at no cost to you. The American Cancer Society has scheduled the Great American Smokeout (GASO) for November 15, 2007, to encourage smokers to quit for a day in the hope they may quit for good.

Q. Do I have access to a fitness discount program?

A. Yes, Fit Choices by Medica. The Fit Choices by Medica program provides a $20 credit toward your monthly dues when you work out at least eight days per month at any participating fitness center-- a great incentive to work out regularly. You may obtain a listing of participating health clubs on medica.com.

Q. Do I have access to an on-line health and wellness website?

A. Yes, My Health Manager from Medica. My Health Manager is a website that is all about you-- your well-being, your interests and your time. It is packed full of information, interactive tools and trackers, and is available 24/7. You can earn up to $100 per year in quarterly gift cards for your participation.

Medica Customer Service is available to answer your questions from 7:00 AM to 6:00 PM CST at 1-800-228-1403. You may also choose to log into mymedica.com for information regarding your Medica benefits.

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Note:  Medica has joined with Target and Walmart in offering over 300 generic drugs through their pharmacy for as low as $4. Based on Walmart practices, treatment of women employees and many other issues, we are recommending that people go to the Target site (people are free to go wherever they choose). Please direct people to the following sites for further information:

For the basic Target pharmacy site:

http://sites.target.com/site/en/health/page.jsp?contentld=PRD03-004319

For a specific listing of medications covered, go to

http://sites.target.com/images/pharmacy/4DollarAlpha100207F.pdf?ref=sc_iw_r_1_0_1Alpha

Many prescriptions have an ansterisk * which indicates "Pricing on these drugs is higher than $4. in CA, CO, LA, MN, MT, PA, RI, TN, WI and WY due to state law. Please ask your Target pharmacist for specific pricing in these states."