Frequently Asked Questions

Transcription

1 Healthcare Plans Frequently Asked Questions

2 What medical plans pa will be made available aaabeo to professional staff under the District s contract proposal? Personal Choice 1 (PPO) Personal Choice 10/20/70 (PPO) Keystone Direct Point of Service C1 F1 01 (DPOS) Keystone Point of Service C2 F1 01 (POS) Aetna Open Access

3 What is the difference between a PPO, HMO, DPOS and POS type plan?

4 PPO Preferred Provider Organization A comprehensive medical plan which hallows direct access to medical care including specialists. There is no referral needed for a provider in the network. The plan allows great flexibility and freedom of choice since a member is not limited to in network providers and can receive partial reimbursement for out of network care.

5 HMO Health Maintenance Organization A comprehensive medical plan where medical care is coordinated through a pre selected network provider, the Primary Care Physician. A referral from the Primary care Physician is required for all other care. For certain services (x ray, lab, podiatry, and physical/occupational therapy), your primary care physician is contractually required to refer you to a designated network location. There is no reimbursement if you leave the HMO network.

6 POS Point of Service A comprehensive medical plan where medical care is coordinated through a pre selected network provider, the Primary Care Physician. A referral from the Primary care Physician is required for all in network medical care. For certain services (x ray, lab, podiatry, and physical/occupational therapy), your primary care physician is contractually required to refer you to a designated network location. This plan is more flexible and provides more freedom than an HMO plan because there is coverage/ reimbursement if you leave the HMO network.

7 DPOS Direct Point of Service A comprehensive medical plan which operates much like a Personal Choice plan. The member must pre select a Primary Care Physician but referrals are only needed for 4 designated services (x ray, podiatry, spinal manipulations and physical/occupational therapy). All other network specialists can be accessed directly allowing for more flexibility l and freedom of choice for the member. This plan is more flexible and provides more freedom than an HMO plan because there is coverage/reimbursement tif you leave the HMO network or if you do not receive a referral for services.

8 What are the specific coverage differences among the proposed PPO, DPOS, and POS plans? Detailed plan design information can be found on the HHSD website ( horsham.org). Side by side plan comparisons Summary documents for each plan Summary of the differences between the PC 10/20/70 plan and the DPOS C1 F1 01 plan Medical premium and employee cost comparisons

9 Will my current providers accept all of the proposed plans? All of the Independence d Blue Cross plans include 100% of the area hospitals. Providers are the same in the Keystone DPOS and POS plans. Approximately 29,000 physicians are in the Keystone plans and 27,000 physicians are in the Personal Choice Plan. There is a 93% crossover of providers between the Keystone and Personal Choice Plans. To determine if your provider(s) is in a specific plan, log onto

10 Why is offering alternative medical plans and increasing employee co pays on the current plan offerings necessary? Currently, the district i spends close to $10,000, on health care coverage for its employees. With medical cost increases trending at 12+% per year, the district will be faced with annual expenditure increases of over $1,000,000 per year. If no changes are made to the current plan offerings and co pays for professional, administrative and support staff, the cost increases that are confirmed for next year will be close to $1,000,000. Act 1 limits will make paying for health care and other expenditures extremely difficult.