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OU Health Plan

ORANGE ULSTER HEALTH PLAN MEMBERS
View/download Important Benefit Information For All Active And Pre-65 Retirees

Welcome to Luminare Health!

Luminare Health is the new benefit administrator for the OU Health Plan.  We process your claims, answer your questions and manage other aspects of your health benefits.  We want to take this opportunity to welcome you!

With change comes questions and we want to provide you with some helpful information.

Network

You can continue to access the Blue Cross/Blue Shield Association’s Blue Card Program as you do today.

ID Cards

Your ID card has been mailed to your home address.  We are aware that our ID Card vendor experienced a delay in mailing your ID cards.  We apologize for any inconvenience.  If your ID card does not arrive, you can still access care!

  • You can access a digital copy of your ID card online, anytime, via our member portal, www.myluminareHealth.com
  • You can access a digital copy of your ID card online, anytime, via our mobile app myLuminareHealth, available on Apple’s App Store or Google Play.

Prescriptions

EmpiRx will also be able to identify you with the information you have on file currently with your pharmacy until your new ID card arrives.

Customer Service

Please feel free to reach out to Luminare Health customer service with any questions at 1-855-656-3261.  We look forward to assisting you!

Benefits at a Glance

View/download Benefits at a Glance document

Summary of Benefits

View/download Summary of Benefits document

 

Medicare Primary Retirees

Luminare Health is the new benefit administrator for the OU Health Plan.  We process your claims, answer your questions and manage other aspects of your health benefits.  We want to take this opportunity to welcome you!

With change comes questions and we want to provide you with some helpful information.

Network

You can continue to access the Blue Cross/Blue Shield Association’s Blue Card Program as you do today.

ID Cards

Your ID card has been mailed to your home address.  We are aware that our ID Card vendor experienced a delay in mailing your ID cards.  We apologize for any inconvenience.  If your ID card does not arrive, you can still access care!

  • You can access a digital copy of your ID card online, anytime, via our member portal, www.myluminareHealth.com
  • You can access a digital copy of your ID card online, anytime, via our mobile app, myLuminareHealth available on Apple’s App Store or Google Play.

Prescriptions

EmpiRx will also be able to identify you with the information you have on file currently with your pharmacy until your new ID card arrives.

Customer Service

Please feel free to reach out to Luminare Health customer service with any questions at 1-855-656-3261.  We look forward to assisting you!

Benefits at a Glance

View/download Benefits at a Glance document

About OU Health

OU Health is happy to be your healthcare plan provider. We are committed to ensuring that you are assisted at any and every point in the healthcare process. In addition, you will experience our commitment to excellent customer service whenever you interact with our employees.

You can count on OU Health to provide professional and personalized services at all times. We will answer any questions you have about claims, benefits, and more in a timely and friendly manner. It is important to us that you are a satisfied consumer.

Listed below is just some of the information we have for Members on our website:

or give our offices a call at 845-781-4890 and we will direct you to the appropriate department.

OU Health offers zero co-pay season flu vaccine

The OU Health Plan has arranged with EmpiRx to offer a Zero Co-Pay Seasonal Flu Vaccine to members of the Plan.

As long as the OU Health Plan is primary for you and your dependents then you are eligible to receive the Flu Vaccine at zero cost.

To receive your Free Flu Vaccine simply go to any pharmacy that participates with EmpiRx and present your OU Health member ID card.

Medicare Primary Retirees

To receive your Free Flu Vaccine simply go to any participating pharmacy and provide your red, white, and blue Medicare ID card. Your pharmacy will bill Medicare directly for the flu shot.

This year, more than ever please consider obtaining the flu shot as medical experts have advised that having both Covid and the Flu together definitely could be more injurious to the lungs and cause more respiratory failure.

US Government Official website for ordering Free At-Home COVID Tests

https://www.covidtests.gov

MEDICARE MEMBERS: IMPORTANT INFORMATION REGARDING YOUR NAVITUS MEDICARERX PRESCRIPTION DRUG PLAN

The OU Health Plan and our Board of Trustees have approved enhancements to your Navitus MedicareRx Prescription Drug Plan to assist in limiting/lowering your out-of-pocket expenses. The enhancements are:

  • The 90-Day Tier 1 copay will be reduced from $10 to $5 at your pharmacy and Costco mail order
  • The prescription drug copay structure will be:
    • Tier 1 – Generic:  $5 for 30 days,  $5 for 90 days
    • Tier 2 – Preferred Brand: $35 for 30 days,  $70 for 90 days
    • Tier 3 – Non-Preferred Brand: $60 for 30 days,  $120 for 90 days

Lowering costs for members and the health plan:

The OU Plan conducted a cost analysis that demonstrated that the health plan pays more for Tier 1 Generic drugs when members filled those prescriptions at CVS/Target, Walgreens, Rite Aid and Duane Reade pharmacies compared to other local or grocery store pharmacies.

The analysis indicated the plan saves between $10-$30, for each 90-day, tier 1, generic script, when prescriptions are filled at local and grocery store pharmacies rather than the pharmacies noted above.

Still have questions? Contact Ann Draughan or Matt Bourgeois at the Plan Office at 845-781-4890

IMPORTANT UPDATE: COVID-19 Weekly Testing for Return to Work NOT Covered by the Plan effective January 1, 2022

On September 2, 2021, pursuant to 10 NYCRR 2.62, NYS teachers and staff who are not fully vaccinated are required to have testing performed for COVID-19 at least once per week to return to work.

Effective January 1, 2022, weekly testing, required as a condition of employment to return to work, will NOT be covered by the Orange Ulster Health Plan.

Claims for COVID-19 testing can range between $125 – $300 per test or more, depending on the type of COVID test and provider.  Plan members who utilize health plan coverage on or after January 1, 2022, to fulfill weekly COVID-19 testing requirements for return-to-work mandates under 10 NYCRR 2.62, will be responsible for 100% of the costs for any COVID-19 test, as well as any associated office visit costs.

All medical claims are subject to audit by the Plan.  Any claims for COVID-19 testing and associated office visits related to weekly COVID testing requirements, will be solely the member’s responsibility.

The Plan will ONLY cover COVID-19 tests when an individual is symptomatic or has come into contact with an individual who has tested positive.  For these situations, the member will have zero out-of-pocket and the Plan will pay 100% of the testing costs.

COVID-19 vaccines and flu vaccines are covered 100% by the Plan. Members can schedule vaccinations at any participating pharmacy or at their local healthcare provider.

Please call the OU Health Plan office with any questions you may have.

Free COVID-19 Testing is available for members with symptoms or in contact with someone who tested positive

In an effort to identify free COVID-19 testing options for employees, please
refer to the links provided below to locate a free testing site and
availability:

Rite Aid – https://www.riteaid.com/pharmacy/services/covid-19-testing
Walgreens – https://www.walgreens.com/findcare/covid19/testing
Local Independent Pharmacies – https://doineedacovid19test.com/

You can also research free COVID-19 testing sites for other states by going
to:  https://www.hhs.gov/coronavirus/community-based-testing-
sites/index.html