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Issue: # 118
| <October 16, 2014 |
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Dear :
It seems every month we see more clients transition over to Deductible and tiered network plans. Especially over the last 6 months under the new Obamacare Rules, the traditional co-payment plans have been hit hard with renewal increases. The movement towards the smaller, or limited network plans has been slower, but now the health carriers, like Harvard Pilgrim have begun to aggressively price their limited network plan, Focus.
One of the biggest issues with deductible plans is that the providers do not do a good job letting subscribers know prices to enable them to shop out their services. This is finally starting to change.
Going forward, we will see more companies advertise their lower prices like MRI Shields does with Teddy Bruschi . In the end, consumers need to shop for healthcare services just like any other consumer product. This sounds great on paper, but try to educate your employees to ask questions and talk more openly to the physicians.
Insurance companies now have different networks, tiered networks, co-payment plans and deductible plans. Let us help you analyze your needs and find the best fit.
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Blue Cross and Harrington Hospital
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Blue Cross has a tiered network plan that has different payments for different hospitals. The hospitals are actually broken down into 3 categories/tiers. The more expensive the hospital is to Blue Cross, the more expensive the co-payment/deductible will be.
Blue Cross has an option called HCCS, which can be added to most plans. This option lowers the monthly premium but imposes a surcharge on select services at designated hospitals. Approximately 19% of the hospitals in Massachusetts are subject to the surcharge. this is a viable option you should check out.
In central Mass, UMASS and Harrington in Southbridge have always been in the most expensive tier for Blue Cross. Effective January 1st, Blue Cross has moved Harrington to the middle tier for their tiered plan and it will no longer be subject to the surcharge if you have the HCCS rider.
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Blue Cross Vision Plan
Even though health insurance renewals are always a challenge, employers still look at the total benefits package and try to maintain a competitive package to retain employees. The new Blue Cross vision plan provides a greatly needed benefit for not a lot of money. Keep in mind, premiums are eligible under the Section 125 Plan, thus creating an additional FICA payroll tax savings to the employer. Highlights include: 
- annual eye exams
- 130 cash allowances for frames annually (130 annually)
- 25 co-payment for lens annually
- 200 cash allowances for contacts
- discounts on other procedures
- click here for Blue Cross brochure
Employers may offer with or without an employer contribution. At companies, where we have implemented, the average participation has been 50%. If you would like a quote, send us an e-mail today.
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October 1st deadline, real cost transparency of costs
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In the end, the only way to truly control premiums is to control claims costs. How can you control costs, if the consumer is not sure of the costs? This has become even more critical as employers have shifted to deductible plans.
Each carrier must have a system in place by October 1st to provide real time cost transparency. Good story on this, click here. Each carrier has their own twist but it requires:
- Members log in and shop for health care procedure/service online using whatever system the underlying carrier has installed.
- Some carriers are even offering a rewards check if you choose a cost-effective facility.
This is all very new so we are leaning just like you and will keep you updated through this newsletter. We strongly encourage you to use whatever system your carrier has installed on their website to show the costs of your procedures. Not only do you 1) save money, but 2) may get a reward!!
Tufts press release for Empower Me.
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Fallon has two networks - Select
- Direct
Direct is a smaller network that comes in about 10% less then Select. In Central Mass, this meant that you would not be able to have direct access to UMASS or Heywood in Gardner. Effective July 1st, Henry Heywood is now in the Direct network.
Link to all the Fallon networks.
If you are along the Route 2 corridor and do not need direct access to the UMass facilities in Worcester, you should take a look at Fallon Direct network.
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