New Plan Year Awareness Month
- ICUBA
- Apr 1
- 3 min read
The New Plan Year is Here!
April 1st marks the start of the new benefit plan year for ICUBA. This is the time of year when your annual deductible and out-of-pocket maximum limits reset. Any changes made to the plan during annual enrollment also become effective April 1st.
This year, some important changes to keep in mind include;
*Behavioral Health Services are now part of the Florida Blue network, members will use one ID card for medical, behavioral health, and prescription pharmacy benefits.
Out-of-Pocket Maximums are increasing by $1,000 for individuals & $2,000 for families.
Prescription Costs are changing for brand preferred, brand non-preferred, and specialty medication.
GLP-1 medications for weight loss require participation in Virta’s Sustainable Weight Loss Program (smart phone is required for participation).
*It is important to know that providers may no longer be in-network due to the transition from Aetna to Florida Blue. Eligible members can apply for Transition of Care coverage by completing the online form and sending it to BCBS. You can search for in-network behavioral health providers using the providers search tool in My Health Toolkit or by using the Provider Search Tool.
Behavioral Health Transition of Care Form
Aetna was the behavioral health coverage carrier for ICUBA members until March 31, 2025. Starting April 1, 2025, BCBS has replaced Aetna as the behavioral health coverage provider. If you were seeing an Aetna provider who is not in-network with BCBS, you must submit a Transition of Care form in order for claims to be paid to that provider.
Once a transition or continuation of care decision is made, the determination will be entered into the transitional care management system, and you'll be notified of the decision in writing.
If the treatment or condition under consideration is approved, claims will be paid as in-network benefits for the duration of the approval. All other claims will be paid according to plan benefits.
If the treatment or condition under consideration is denied, claims will be paid according to plan benefits for services received from an out-of-network provider.
If an approved provider is out-of-network, the member may be required to pay any amount charged at or above the allowable rate (commonly referred to as balance billing).
Access the form online: Transition of Care Request Form
Fax: (803) 264-0259
Mail: Columbia Service Center
Attn: Transition of Care AX-F21PO Box 10028
Columbia, SC 29202
Tips for Completing the Form
Submit one form per condition/treatment.
Include your current provider’s name, specialty, and contact information.
Describe the condition and expected duration of care.
Sign the authorization section at the bottom of the form.
A parent or legal guardian must sign for patients under 18.
TIP OF THE MONTH
It's important to review your Employee Benefits Guide to better understand the changes taking effect on April 1, 2025. Reviewing the guide ensures you’re aware of how these changes affect your healthcare costs and coverage, especially if you use brand-name medications, specialty drugs, or GLP-1 prescriptions for weight management. Taking a few moments to explore the guide now can help you avoid unexpected costs later and take full advantage of your available benefits.
GLP-1 for Weight Loss now exclusively through Virta
Virta is ICUBA’s Brand Partner for members with Type 2 Diabetes.
Beginning April 1, 2025, they’ll also be providing services for weight loss & pre-diabetes!
If you’re currently taking a GLP-1 medication for weight loss, there will be some changes to how you can receive that medication. GLP-1 prescriptions exclusively for weight loss will require your enrollment and participation in Virta’s Sustainable Weight Loss Program (in partnership with OptumRx). If you’re currently taking medications such as Wegovy, Zepbound, or Ozempic for weight loss, you must apply to the Virta program to continue receiving medication.
Details on how to apply for the Virta program have already been sent to current GLP-1 users by mail, but if you have questions you can call an ICUBAcares Pharmacist at (877) 286-3967, Monday to Friday, 9 PM to 5 PM.
PLEASE NOTE A MOBILE DEVICE IS REQUIRED FOR VIRTA PARTICIPATION.
GLP-1 medication prescribed for Type 2 diabetes are NOT affected by this change and will remain covered through your regular pharmacy benefit.
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