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Healthy TraditionsBoard of Directors: |
Program Manager: |
Wellness Coordinator: |
| Mark Gagnon : Chairman Kelle Little : Vice- Chairman Cal Mukumoto: Secretary/Treasurer Joan Metcalf: Tribal Council Member |
Rod Cook Direct : 541-751-0940 ( x 1 ) Toll Free : 866-436-4785 ( x 1 ) Cell : 541-297-0531 Fax : 541-756-4714 Email : rodcook@coquilletribe.org Mail : PO Box 921, North Bend OR 97459 |
Denise Stuntzner Direct : 541-751-0940 ( x 2 ) Toll Free : 866-436-4785 ( x 2 ) Cell : 541-297-8334 Fax : 541-756-4714 Email : wellness@coquilletribe.org Mail : PO Box 921, North Bend OR 97459 |
1. Background
Prior to May 1, 1998 : Tribal Member’s living outside of the Tribe's 5-county service area (Coos, Curry, Douglas, Lane, and Jackson), had no group health care coverage available to them through the Coquille Indian Tribe (CIT). In 1998, a vehicle was created which allowed the CIT to provide Group Health Care Protection to the Tribal member’s living outside the 5-county service area - that vehicle was named the “Nasomah Health Group”.
2. Origination
The Origination of the word “Nasomah”, comes from the Miluk language of the Lower Coquille Band of Tribal Indians, and means “People of the Great Water”. Coquille Tribal member Jennifer Mecum designed the Nasomah Logo, which incorporates four animals (a salmon, eagle, whale, and a wolf).
3. Established
May 1, 1998 for the benefit of the eligible participants and their eligible dependents.
4. Purpose
To provide comprehensive health care protection to the eligible employee’s of the Coquille Indian Tribe, as well as CIT Tribal member’s living outside of CIT's the 5-county service area .
5. Offers
A. Medical Plans
Effective for Plan Year begining on/after 5-1-11. Open to all eligible employee’s (and dependents) of the tribe.
EPO plan amendment #16 - Adding TC Members, effective 11-01-11:
EPO plan amendment #17 - Adding KoKwow Language, effective 5-01-12:
EPO plan amendment #18 - Adding Waiting Period Language, effective 5-01-12:
EPO plan amendment #19 - Adding Diabetic Office Visit Language, effective 11-01-12: Memo - Diabetes Office Visits
Effective for Plan Year begining 5-1-11. Open to all eligible employee’s (and dependents) of the tribe.
PPO plan amendment #17 - Adding TC Members, effective 11-01-11:
PPO plan amendment #18 - Adding KoKwow Language, effective 5-01-12:
PPO plan amendment #19 - Adding Waiting Period Language, effective 5-01-12:
PPO plan amendment #20 - Adding Diabetic Office Visit Language, effective 11-01-12: Memo - Diabetes Office Visits
Effective for Plan Year begining 5-1-11. Open to all enrolled CIT Tribal member’s (and dependents), living outside the Tribes' 5-county service areas (i.e.: Coos, Curry, Lane, Douglas and Jackson Counties of Oregon).
OSA plan amendment #15 - Adding Waiting Period Language, effective 5-01-12:
OSA plan amendment #16 - Adding Diabetic Office Visit Language, effective 11-01-12: Memo - Diabetes Office Visits
B. Dental Plan
All three Nasomah Plans (EPO, PPO and OSA) will pay up to $1,500 per plan year, towards each members' respective dental claims. See the Summary Plan Documents listed above to learn more about what services are included within each of the 3-classes of dental benefits; and how much the plan will pay towards respective services incurred within each class. Additionally, members' may choose any dental provider they prefer to have work on them - we do not have a dental Preferred Provider Network that you must choose providers from.
C. Vision Plan
All three Nasomah Plans (EPO, PPO and OSA) will pay up to $300 per plan year, towards each members' respective vision claims. See the Summary Plan Documents listed above to learn more about what services are included within the vision benefits. Additionally, members' may choose any vision provider they prefer - we do not have a Preferred Provider Vision Network that you must choose providers from.
D. Pharmaceutical Plan
30-Day Quantities : With in-town and mail order options. All three Nasomah Plans (EPO, PPO and OSA) require you to pay up to $8 for Generic 30-day pharmaceutical purchases; $25 for Preferred Brand 30-day purchases products; and 50% for Non-Preferred Brand products.
90-Day Quantities : Members can receive significant savings if they purchase 90-day supplies from either their local pharmacies; or, through our chosen Mail Order vendor. If you need to take a medication for more than a year or perhaps the rest of your life; then, you will want to consider filling those prescriptions every 90-days, rather than every 30-days. Members only have to pay a 2-month copay amount towards their 3-month supply. For generics they would pay $16, saving $8 every 3-months; and for Preferred Brands $50, saving $25 every 3-months.
Formulary : To help members and their prescribing clinicians understand what we consider as a Generic, Preferred and Non-Preferred pharmaceutical product, our pharmaceutical vendor has prepared the attached alphabetical listing, to help guide members and prescribers in choosing the best, cost-effective option for the member. 2012 Formulary
Client Benefit Design : To help in identifying what prescriptions are covered and/or excluded, members and physicians can use the attached pharmaceutical benefit design to help understand what pharmaceutical purchases may require Prior Authorizations; and or, which ones have imposed restrictions. CBD
Pharmacy Benefit Manager Website : For additional information, members can log on to our pharmacetical benefit managers website at : www.walgreenshealth.com
Precription Reimbursement Form : Use this form to request reimbursement on a prescription which perhaps did not process electronically for you at the point of service. Member Prescription Claim reimbursement Form
Coordination of Benefits Form : If you have 2-pharmaceutical plans; then, you can request reimbursement on the out-of-pocket amount you paid after your first (other) prescription plan paid, by using this form. Coordination of Benefits Reimbursement Form
6. Premium Costs
If you are interested in knowing how much it costs to enroll in one of our 3-Health Plans; then, please review the attached rate sheets :
A. Mill Casino Employer Group :
Employees who elect the EPO Plan:
Employees who elect the PPO Plan:
B. CIT Employer Group :
Employees who elect the EPO Plan:
Employees who elect the PPO Plan:
C. CIT Tribal Members (living Outside of the Tribes' 5-County Service Area) Group :Non-Medicare Enrolled, CIT Tribal Members who elect the OSA Plan:
Medicare Enrolled, CIT Tribal Members who elect the OSA Plan:
7. Enrollment Forms
EPO Plan: Enrollment Form; Declination Form; Other Insurance Form
EPO Plan Referral Policy: All members of the Nasomah EPO Plan are required to acquire written referrals for all medical services outside of the CIT's Tribal Health Clinic (CITCHC). There are certain exceptions to this general rule; so, please read the attached to learn more about your rights and responsibilities - when choosing this plan.the same.
PPO Plan: Enrollment Form; Declination Form; Other Insurance Form
OSA Plan: Enrollment Form; Declination Form; Other Insurance Form
Please contact the Nasomah Program Manager (see above) with any questions about these forms.
Please mail all completed forms to the Nasomah Program Manager, at his address - as indicate at the top of this web page.
8. Third Party Administrator
HealthComp Administrators:
PO Box 45018, Fresno CA 93718
Call : 800-442-7247 to verify eligibility and benefits
Call : 800-755-7247 to discuss medical precertificationsFax: 559-499-2464 to send claims in to be adjudicated
For more information, contact their website address : http://www.healthcomptpa.com
Looking Up Claims : If you are interested in reviewing your claim status on-line; then, you will want to log on to HealthComp's website. Once you log-in, you can view your claims history; order new ID cards, verify that your address is correct in their system; see that all of your dependents have been identifed as coverable dependents on your chosen Plan; etc.
Please reveiw the attached document to see how to log on to HelathComp's website : How To Look Up Claims
9. Preferred Provider Organization Networks
Members in our PPO and OSA plans receive reduced out of pocket costs when using providers listed in either of these two PPO networks:
1. HCDirect: www.fchn.com ; For Providers in OR and WA: Instructions on how to navigate the First Choice Health Network (FCHN) webpage - to locate a Preferred Provider: FCHN -Network Instruction Sheet
2. MultiPlan (PHCS): www.multiplan.com ; For Providers Outside of OR and WA: Instructions on how to navigate the MultiPlan (PHCS) webpage - to locate a Preferred Provider: Multiplan (PHCS) - Network Instruction Sheet
10. Summary Annual Reports
Nasomah is required by its Articles of Incorporation to make available to its Plan Members as well as the Coquille Tribal Members, these Summary Annual reports:
Plan Year: May 2011 - 2012 . . . . . . SAR (PY 11-12)
Plan Year: May 2010 - 2011 . . . . . . SAR (PY 10-11)
Plan Year: May 2009 - 2010 . . . . . . SAR (PY 09-10)
This is a copy of Nasomah's 15-Year, Historical Income/Expense Summary:
Plan Years: 1998 - 2012 . . . . . . Nasomah Financial History (PY 98-'12)
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