A state of emergency has been declared related to the outbreak of novel coronavirus (COVID-19). If you are impacted and need assistance in obtaining medical service or prescription drugs, please contact Customer Service at 1-866-597-9560. If you are experiencing a medical emergency, please call 911.

Essence Healthcare is waiving all member related costs associated with the testing and treatment of confirmed or suspected COVID-19 cases from March 6th forward. This includes any applicable co-pays, co-insurance, or deductibles that our members would have normally been responsible for. This waiver will be in effect until May 31,2020, at which time we will reevaluate based on the status and containment of the COVID-19 virus.

Your over-the-counter (OTC) benefit is managed by Convey Health Solutions. Unfortunately, due to the COVID-19 pandemic, Convey is experiencing shortages of certain OTC items. Please visit the Convey website at www.essencehealthcareOTC.com for latest availability. You may also call Convey to place an order and if a specific item is not available, they can help you find an alternative solution. Their number is 1-877-494-2806. Please be assured that Convey is working diligently to refill their inventory. We apologize for any inconvenience this may cause and thank you for your patience.

Here's more information on managing stress during this time.

 

Understanding your Part D Explanation of Benefits (EOB)

The Explanation of Benefits (EOB) is a document you will get for each month if:

  • you had activity in your Part D benefit in the prior month or
  • we need to notify you of a change in coverage for a drug you are currently taking.

The EOB will show your “Total Drug Costs to Date” also known as “Total Drug Spend” which is what both you and Essence have paid for your Part D drugs. This Total Drug Costs to Date is what counts towards your initial coverage limit of $4,020 for Essence Advantage HMO & Essence Advantage Plus HMO. The EOB also provides your year to date True Out of Pocket (TrOOP) Costs to Date, and that amount is only what you have paid out of pocket and counts towards you reaching the Catastrophic Phase ($6,350).

Your Explanation of Benefits will contain the following information:

  • How much you have paid so far this year for your prescriptions
  • Your recent claims for prescriptions
  • Updates to our drug list (formulary)

If you have a question about any information contained in your EOB, we encourage you to contact us.

Please Note: Items/services appear on the EOB when a claim is processed, not necessarily for the month in which you received the item or service.

Y0027_20-322 - Last updated 01/30/2020