| Issue: # 8 |
January 9, 2008 |
Greetings!
Keeping you informed of the latest developments in the employee benefit marketplace.
If you have any questions, e-mail Bill or Vanessa. To learn more about Advantage Benefits, click here. Many of our clients have found these newsletters to be quite helpful and we have now set up a link to hold all the archived newsletters on-line that can be accessed at anytime.
If you know anyone, who may find this information of interest, please forward them this newsletter (there is a link on the bottom), and they can subscribe themselves.
Sincerely,
Bill Randell & Vanessa Costa
Advantage Benefits |
| Minimum Credible Coverage
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Another requirement under the Commnwealth of Massachusetts Health Reform laws is that Employers must provide Minimum Credible Coverage (MCC) to employees by January 1st, 2009. It sounds worse then it actually is. No need for concern,as we are not aware of any clients that do not meet MCC. Basically, MCC ensures that minimum criteria for benefits are met.
Please note carriers will notify their clients at renewal during 2008, if they do not provide Minimum Credible Coverage. We only mention it here, since you will will surely hear MCC mentioned often this year as we approach the January 1st, 2009 deadline. |
| Deductible Versus Co-Payment
There is a difference |
We are seeing options that incorporate a deductible, before coverage begins. The hope is that employees facing a deductible will be more selective when seeking medical care, which then leads to lower utilization (claims) and hopefully lower premiums.
You may see two plans with varying premiums, where the only difference in benefits is that one states a $500 hospitalization co-payment, while the other states $500 deductible. Deductible plans typically only cover routine procedures during office visits and anything deemed not routine will be subject to the $500 deductible. When switching to deductible plans, it is crucial to communicate the difference to employees.
There is nothing wrong with deductible plans, but you need to understand the differences versus the standard co-payment plan design. Fallon has a great link that shows what is subject to a deductible and what is not. |
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Health Insurance Plans
Health Maintenance Organization (HMO)
HMO's have a network of doctors and hospitals you can choose from. There is a gate-keeper, your primary care doctor, that must give you a referral in order to see other doctors in the network. You are limited to the network and have no coverage outside the network, unless there is an emergency.
Point of Service (POS)
Hybrid plan. You can stay-in-network and it acts like an HMO with a primary care doctor and referrals. It allows the subscriber, however, to go outside the network for higher out-of-pocket costs; for example, the HMO Blue Choice Value Plus has $500 deductible per person out of network followed by 80% co-insurance with a maximum out-of-pocket of $1,000/ individual and $2,000/family. The POS has been the least popular of available plans.
PPO (Preferred Provider Organizattion)
There is a national network of providers, and you can seek coverage in or out of network. It is not necessary, however, to name a PCP or obtain a referral. This is the most flexible of all plan designs but comes with a cost, typically 22% higher then your standard HMO.
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Optometrist versus Opthalmologist
Primary Care Versus Specialist |
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An optometrist is a Doctor of Optometry, an O.D. (not to be confused with a Doctor of Medicine, an M.D.). To become an optometrist, one must complete pre-professional undergraduate college education followed by 4 years of professional education in a college of optometry. Some optometrists also do a residency.
An Ophthalmologist is an eye M.D., a medical doctor who is specialized in eye and vision care. Ophthalmologists are trained to provide the full spectrum of eye care, from prescribing glasses and contact lenses to complex and delicate eye surgery. They may also be involved in eye research.
HMO's allow an insured to see an Optometrist once every two years without a referral by paying the routine office co-payment. On the other hand, an Opthalmologist must be refferred by your primary care physician and is subject to the specialist co-payment
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