Welcome to UPHealth.com

You must be logged in to view personalized information.

 
UPREHS Alerts
 
 
DepotDrug

Frequently Asked Questions


Eligibility and Dues

HOW DO I KNOW I AM ELIGIBLE FOR BENEFITS?

  • Eligibility for benefits for most active employees is based on the fact that he/she has worked 7 compensated days in the previous month to be eligible for medical and prescription benefits in the current month. Premium payment by the employer for the current month is often not available until mid-month. A dues/premium waiver may apply when the employee is on approved Leave of Absence for illness, injury or some other circumstances.
  • Eligibility for retired members requires an accepted application for the plan in which they enroll, and timely payment of dues/premiums. Dues/premiums are due on the first day of each quarter. Retirees may pay dues on a monthly basis through automatic transfer from their bank or credit union account.

HOW MUCH ARE MY PREMIUMS/DUES?

  • Monthly dues are determined by your plan, and your current eligibility. The rates below are general information about individual plans and do not necessarily apply to you:
    • Active employees: Payroll deductions may vary depending on your Union contract. Payroll deductions for UPREHS are included in the National Health and Welfare Plan deduction.
    • Optional Family Supplemental Coverage: $90.00 -$130.00 per month, depending on which plan your dependents have as the primary insurance.
    • Active members on an approved Leave of Absence or COBRA: Please contact our Membership Department at 800-547-0421 or through help@uphealth.com for your specific circumstances.
    • Pensioner Under 65, or members on RRB Disability Annuity: $500.00 per month.
    • ERMMB (Early Retirement Major Medical Benefit: is a nationally subsidized retiree plan: $0 cost
    • 60/30 Plus plan: $200.00 per month for members age 60 or over, and who have 30 or more years of qualified rail service.
    • Medicare Members and Medicare Spouses: $240 per month per individual. This plan includes Part A and B secondary coverage and the Medicare Part D Prescription Drug Plan. We welcome spouses to join our Medicare Secondary plan when they become eligible for Medicare. Please contact our Membership Department for an application. We offer spouses the same individual coverage as our railroad retirees.
    • Dependents (with the exception of Medicare Spouses) are not currently eligible for coverage with UPREHS. Please contact your assigned National Health and Welfare Carrier for premium costs.

I AM THINKING OF RETIRING:
WHAT SHOULD I DO TO KEEP HEALTH COVERAGE?

  • Contact UPREHS Membership Department at least 60 days prior to your last day of work to receive the correct application and plan information.
  • UPREHS; P O Box 161020; Salt Lake City, UT 84116
    800-547-0421 or help@uphealth.com
  • Choose a plan: If you are 60 or more years of age, with 30 or more years of rail service, you may choose from one of 2 plans:
    1. ERMMB (Early Retirement Major Medical Benefit): Benefits are limited, but there is no monthly cost to you.
    2. 60/30 Plus Plan: This plan provides a higher level of coverage and higher lifetime maximum benefits. Cost is $155.00 per month.
  • If you are retiring because of disability due to illness or injury before you have 30 years of service; if you are quitting your railroad job, or have been terminated or dismissed, please contact the UPREHS Membership Department as soon as possible to maintain your health insurance.
  • UPREHS; P O Box 161020; Salt Lake City, UT 84116
    800-547-0421 or help@uphealth.com



Doctors’ Referrals

CAN I SEE ANY DOCTOR? DO I NEED A REFERRAL?

  • UPREHS does not require members to have a referral to see another doctor or to see a specialist. Medical providers are either in or out of our network and referrals are not recognized as authorization to see an out-of-network provider. For the best benefits, members should go to a participating health care professional. A covered service by an out-of-network provider will be reduced to 40% of the plan allowable. Medical providers are either participating in our network, or are considered out-of-network.
  • You can find a participating doctor, hospital, laboratory, surgery center, or radiology facility by going to FIND A DOCTOR/FACILITY. Provider listings are frequently updated. If you need a specialist, or you are being sent for surgery or testing, please make sure you check the directory listing on this web site to make sure the provider is in-network.



Prior Approval

DO I NEED PRECERTIFICATION OR PRIOR AUTHORIZATIONS?

  • Medicare patients do NOT require medical prior authorizations from UPREHS.
  • For other members, prior authorization is required for all in-patient stays, Intensive out-patient substance abuse treatment, extended physical therapy, and some goods and services as designated in the plans. Sleep studies, CPAP, BiPAP, and TENS equipment require prior authorization. Payments will be reduced if there is no prior authorization on file.
    • For medical in-patient authorizations call 866-776-4793.
    • For mental health or substance abuse admissions, call 866-776-4793.
    • For extended physical therapy and some goods and services call 800-547-0421 for a Care Coordinator.
    • For medications requiring prior authorizations call 800-880-1188 or 866-443-1095 for Medicare Rx prior authorization.
  • Click HERE for a list of services requiring prior authorization



Claim Submission and Payment

WHAT IS “THE PLAN ALLOWABLE”?

  • Reimbursement for each specific procedure is based in the UREPHS Plan allowable amount. Plan allowable amounts are not quoted over the phone. Payment is determined when the claim is presented.

HOW DO I SUBMIT A CLAIM?

  • Claims Submission: Timely filing limit for claims is one year from the date of service. Electronic filing is required and will result in faster payments. Providers may submit claims with Payer ID# 87042. Paper claims, black and white claims, and faxes, will not be accepted.
  • Claims Payments: UPREHS’ payment of claims is determined when the claim is presented, not when eligibility is verified. Only services that are a benefit of the member’s plan will be paid. We employ industry standardized edits which may reduce or deny specific charges based on the information submitted on the claim. Claims to in-network providers will be based on the network agreement and plan benefits. Claim payments for out-of-network providers will be reduced to 40% of the UPREHS plan allowable amount.
  • Claim Payment Reductions: Payments may be reduced for failure to comply with required prior authorization for all In-Patient services, and certain Out-patient procedures.
  • Appeal of Claims Payment or Denials The member, member representative or a provider may appeal, in writing within 180 days following the initial notice of payment or denial, if they believe a claim was incorrectly denied or payment was incorrectly reduced.



UPREHS Medicare Secondary Plan

IS UPREHS AN HMO OR A MEDICARE REPLACEMENT PLAN?

  • No, UPREHS is a Medicare SECONDARY Plan.
  • Our Medicare members retain Original Part A and B Medicare.
  • The Center for Medicare and Medicaid Services (CMS) has authorized UPREHS to make Medicare Part B primary payments only to participating physicians.



Prescription Services

HOW DO I ORDER PRESCRIPTIONS AND
DO I HAVE TO USE THE MAIL ORDER PHARMACY?

  • All maintenance prescriptions will need to go through the Depot Drug Mail Order Pharmacy. Maintenance drugs are medications you take for more than one month.
  • We accept new prescriptions by mail, fax and e-prescribe.
  • We accept prescription faxes ONLY from the physician.

    Depot Drug does not accept prescriptions by telephone, nor do we solicit refills from providers.

  • It is our members’ responsibility to contact their doctors for prescriptions to be renewed.
  • Orders are shipped in tamper-proof packaging for your protection. Once the outer security packaging is open, medications, by law, cannot be returned.

HOW TO ORDER REFILLS ONCE THE PRESCRIPTION IS ON FILE:

    depotdrug
  • On-Line: At depotdrug.com.
  • Telephone (automated): Use the automated phone system at any time: Call 800-547-0421. Press ‘2’ for pharmacy services.
  • Telephone (live person): During business hours, call Depot Drug at 800-331-6353 for a representative’s help.
  • By mail: Refill slips and address labels are included with each prescription shipment.

HOW TO PAY FOR YOUR PRESCRIPTIONS:

  • Copayments may be made by Visa or MasterCard.
  • Copayments may be also be made by check or money order when ordering refills by mail.

CHECK ON YOUR PRESCRIPTIONS:

  • From their secure web account, members can see the status of an order they have placed and see an order in process
  • Members can verify when an order was filled, and when it was shipped. An email verifying the shipment of your prescription order will be sent to members registered on the web site
  • Our mailing address for prescriptions:

      Depot Drug
      P.O. Box 165090
      Salt Lake City, UT 84116-5090

      Telephone: 800-331-6353
      Pharmacy fax number: 801-595-4440 or 801-595-2000

      Physicians may e-prescribe to Depot Drug
      NCPDP Number 4602745

IS IT OK TO TAKE GENERIC PRESCRIPTION DRUGS?

  • Generic drugs have to meet the FDA’s rigorous approval process to be considered equivalent to a brand drug. Generic drugs must legally contain exactly the same active ingredients, in the same amounts, the same quality and performance as the more expensive brand-name drugs. Most people will not notice any difference. UPREHS will fill your prescription with an FDA approved generic, when possible. Generic drugs will work the same way brand-name drugs work, and are just as strong. You should always follow your doctor’s instructions. Because generic drugs cost less, your copayments are lower. The lower our costs, the longer we can maintain your same excellent benefits without a plan dues/premium increase to you.

CAN UPREHS HELP ME IF I HAVE SLEEP APNEA OR
OBSTRUCTIVE PULMONARY DISEASE?

  • UPREHS has our own Complete Sleep Program. We can help you by supplying you with testing and respiratory equipment that is right for you.
  • If your physician feels you are at risk for sleep apnea they may recommend a sleep test. Depot Drug has made these tests easy and affordable. With your doctor’s prescription an at-home sleep test will be sent to you. All sleep studies MUST have PRIOR-AUTHORIZATION. Once the sleep study test data is collected, a diagnosis and recommended treatment plan will be sent to your doctor by a pulmonary specialist. UPREHS will supply you with equipment that may be ordered: a CPAP, BIPAP, AUTO CPAP, Humidifier, or a CPAP mask and supplies. You must have a valid prescription from your physician for this equipment, which includes the pressure levels to be pre-set on the machines.
    Benefits of the at-home sleep test:
    • Easy and Convenient – done in your own home on your own time
    • No need to take time off work
    • FDA Approved
    • Sleep technician available for counseling and to answer your questions
    • No need to travel to a sleep center and spend the night away from home
    • Affordable
  • The member or physician may fax the doctor’s prescription for testing or equipment to: 801-595-2051.
  • All sleep tests and equipment must be Pre-Authorized through UPREHS. If no preapproval is obtained your claim will be denied. To preapprove your test or equipment, please have your physician call us at: 800-877-0618.

Member FAQ's


members at a glance
About UPREHS
Contact Us
Frequently Asked Questions
Member Login
Forgot Password
Website Feedback
Legal Disclaimers
HIPAA
Privacy Policy
Disaster Policy

Connect with us

 Like us on Facebook
 Follow us on Twitter
 See us on Instagram
© Copyright 2003, 2018. Union Pacific Railroad Employes Health Systems, All rights reserved.