Consider
quality, cost, access to care
What will you choose: Empire Plan or HMO?
If you are a state PS&T employee, you have a chance
to reconsider your choice of health plan. The annual
option transfer period began November 1. As soon as the
health plan premium rates are approved, a flyer
indicating the biweekly employee-premium costs for each
health plan, as well as the important dates for benefit
choices, will be sent to your home.
You have 30 days from the date the rates are delivered to
the agencies to change your health-plan option for the
year 2001.
“This is the time,” said Lorraine Simpkins,
PEF’s health-benefits specialist, “to seriously
consider whether you are satisfied with your health-care
plan, evaluate the health plans available to you, and
decide if you want to change.
“While it’s important to know how much you are
paying for your health benefits, it’s equally
important to know what you are getting in return,”
Simpkins added. “You should consider quality,
coverage and access to your choice of provider in
addition to cost.”
For help selecting which health plan option is best for
you, check these sources of additional information:
• Your Personnel Office — “Choices,”
this year’s option-transfer booklet explains the
health-plan options available to you and provides a
benefit summary for each plan.
If you are interested in the Empire Plan, ask for
“The Empire Plan At A Glance 2000.” An Empire
Plan Participating Provider Directory should also be
available for reference purposes.
• NYS Department of Civil Service — Go to the
DCS web site at www.cs.state.ny.us and click on “Employee Benefits and
Services.” This site includes a link to the Empire
Plan Participating Provider Directory.
• NYS Department of Insurance — “The New
York Consumer Guide to Health Insurers” has
information about the quality of care that the HMOs and
health insurers are providing.
Call 1-800-342-3736 or go to the State Insurance
Department web site at www.ins.state.ny.us and click on “Consumers” and then
on “Health.”
• National Committee on Quality Assurance —
NCQA sets standards for the quality of care and service
that health plans provide to their members and accredits
the plans that meet these standards. To use NCQA’s
health-plan report card online to evaluate your options,
go to www.ncqa.org/pages/hprc/index.asp. Or, call 1-888-275-7585 to get
the accreditation status of an HMO.
• Consumer Reports — The August 1999 issue
rated 54 health plans and suggested strategies for
choosing a health-care plan and avoiding potential traps.
The report is available online at www.consumerreports.org. Scroll down the left sidebar and
click on “Consumer Interest” where you will
find the article, “HMOs 8/99” under the heading
“Insurance.”
Some
HMOs changing service areas for 2001
After reviewing proposals from HMOs that want to
participate in the NYS Health Insurance Program in 2001,
the NYS Joint Labor-Management Committees on Health
Benefits have announced changes to the list of HMOs and
service areas.
Independent Health — Hudson Valley withdrew its
proposal to participate because it’s ending HMO
coverage in the Hudson Valley, effective February 28,
2001. If you are enrolled in this option for 2000, you
were notified last August about the plan to end that
service and you must choose another plan now, during the
annual option-transfer period, for 2001.
All of the other HMOs that have been participating in
NYSHIP will continue to be available in the year 2001.
Those expanding their service areas are:
• Empire BCBS BlueChoice HMO — Schoharie,
Delaware, Sullivan, Ulster, Dutchess, Orange, Putnam,
Rockland, Westchester, 5 boroughs of New York City,
Nassau, and Suffolk counties;
• CDPHP — Broome, Chenango, Delaware, Essex,
Hamilton, Herkimer, Madison, Oneida, Orange, Otsego,
Tioga, and Ulster counties;
• MVP — Greene, Orange and Putnam counties; and
• United Healthcare — Herkimer and Oneida
counties.
Each HMO has sent its members a side-by-side comparison
of any benefit changes for 2001. You should review
carefully this information, as well as the
rates-and-deadlines flyer, when you receive it.
— Lorraine Simpkins
Changes
effective January 1
Empire Plan deductibles; co-pays increase in 2001
If you’re in the
state’s Empire Plan, look for these benefit changes,
authorized in the 1999-2003 PS&T contract, to start
January 1.
These include:
- Copayments for participating-provider services will
increase from $8 to $10 for:
• Physical therapy performed in a hospital
outpatient department;
• Office visits, surgical procedures, radiology
services, and diagnostic/laboratory services performed by
a participating provider;
• Cardiac-rehabilitation-center visits and
urgent-care-center visits;
• Physical-medicine services, including physical
therapy and chiropractic care, performed by an MPN
network provider; and
• Outpatient rehabilitation for alcohol and/or drug
abuse performed by a GHI/ValueOptions network provider.
The copay for mental-health services performed by a
network provider remains $15.
- Home Care Advocacy Program (HCAP) non-network benefits
will decrease.
HCAP covers durable medical equipment, diabetic and
ostomy supplies, private-duty nursing and home-care
services.
Currently, services/items received from non-network
providers are paid at 80 percent up to the
“reasonable and customary” (R&C) allowance,
subject to the basic medical deductible and out-of-pocket
maximum.
Effective January 1, however, non-network services/items
will be paid at 50 percent of the allowance used to
reimburse network providers, and coinsurance amounts will
not count toward the out-of-pocket maximum.
If you’re enrolled and receiving services from a
non-network provider, you will receive a letter from HCAP
about the benefit change. (See box below for an example
of the decreased benefit.)
- Hearing-aid reimbursement will increase from $800 to
$1,000.
- The Basic Medical annual deductible and the coinsurance
out-of-pocket maximum will increase.
Your annual deductible is rising from $249 to $259 each
for you, your spouse or partner, and your dependent
children.
Your maximum annual, coinsurance out-of-pocket expense
will go from $1,198 to $1,247 for you and for each
covered dependent.
The changes to the deductible and maximum out-of-pocket
expense reflect the 4.1 percent increase in the medical
component of the Consumer Price Index for Workers (CPI-W)
for the period July 1, 1999 through June 30, 2000.
For more information regarding these changes, see the
December 2000 issue of The Empire Plan Report.
How
HCAP changes will affect you:
Under your current non-network benefit, after meeting
your deductible:
If a non-network provider charges you $100
And if the HCAP R&C allowance for the service is $80
Then the plan pays 80 percent of the R+C allowance $64
You pay the difference $36
After January 1 —
If a non-network provider charges you $100
And the allowance for a network provider (NP) would be
$60
Then the plan pays 50 percent of the NP allowance $30
Maximum
dental benefit up $600
IThe annual maximum benefit under the GHI Preferred
Dental Plan is increasing from $1,200 to $1,800,
effective January 1.
GHI will pay a maximum of $1,800 in benefits per person,
per calendar year, for covered dental services, including
orthodontia.
The maximum lifetime orthodontic benefit remains $1,998
for each covered dependent.