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Two new medical plans available for 2011

To help employees with the rising cost of health care premiums, UC Human Resources has developed two new health plans for 2011.

UC faculty and staff will be able to choose among eight high quality health plans during the Open Enrollment period that runs from October 25 to November 23; the new plans give them additional lower-cost choices.

“All of our plans provide a high level of comprehensive coverage-medical, prescriptions and behavioral health,” said Dwaine B. Duckett, vice president of human resources.

UC Human Resources worked with insurance carriers to develop the two new value-priced options as a strategy to offset double-digit increases in premiums for most medical plans amid UC’s continuing budget challenges.

UC employees will experience increases, but how much of the increase employees will pay has not yet been determined. Many employees are likely to see significant cost increases if they do not closely examine lower-cost alternatives that may fit their needs.

“Given the continuing increases in premiums and the university’s budget issues, last year we set out to chart a new course, redesign programs and innovate with regard to health care coverage,” Duckett said. “Failing to adapt to market realities would jeopardize our ability to provide quality health care to our employees into the future.”

UC has addressed these issues by working with insurance providers to create two new value-priced plans: a Health Net plan that features a customized network of doctors and hospitals and an Anthem plan that combines a preferred provider organization (PPO) with a health reimbursement account (HRA).

“In the new Health Net Blue & Gold plan, the benefit features – copayments, covered benefits, and so on-match those of our current Health Net plan, which we will continue to offer,” said Duckett. The only difference is that enrollees must use the hospitals and doctor groups in the custom network.

About 60 percent of current Health Net subscribers use doctors and other providers included in the Health Net Blue & Gold network. All of UC’s medical centers are among the providers in the new plan. At this time, the full list of network providers is being finalized and will be available on the Health Net website around October 20.

Those whose doctors are not in the Blue & Gold network can continue to see their doctor in the regular Health Net plan, choose a different plan that includes their doctor, or find a new doctor if they prefer to enroll in a lower-cost plan option.

“The Health Net Blue & Gold plan basically gives a cost advantage to faculty and staff who use the custom network providers,” said Duckett. “Those who want the option to use providers outside the defined network will have to pay more.”

The Anthem Lumenos PPO with HRA combines a traditional PPO plan with a UC-provided health reimbursement account. It is similar to the CIGNA Choice Fund plan, which it replaces, but at a significantly lower monthly premium.

Enrollees can choose any medical provider they want, though in-network providers cost less. Medical expenses are paid automatically from the HRA first. Once all the funds in the HRA are used, members pay all costs until they reach the deductible. On any services after that, members pay 20 percent coinsurance for in-network services and 40 percent for out-of-network services.

The Lumenos plan requires enrollees to take greater control of their health care spending since they pay the full allowable cost -not a copay or coinsurance cost-until they use up the HRA and meet the deductible. Anthem provides online tools to help manage health decisions and health care spending.

“This plan may not be for everyone, but it provides a good, low-cost option for those willing to more actively manage their health care,” Duckett said.

With two new health plans and additional changes as a result of health care reform, all faculty and staff need to actively engage in their health care choices this Open Enrollment period. If they don’t, Duckett said, they could wind up spending more than they really need to for coverage that is basically the same.

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