About this analysis
I have done this type of analysis every year since 1995. Copies will be available at the Local and in the Health Line Doctors offices.
I hope it makes it clear that 50A.Empire MEP Indemnity is the best plan for single adults and families with children over 16. The 185.AetnaMEP PPO/Indemnity is best for families with young children. Most problems occur when members have chosen the HMO options.
I just started getting complaint calls from people who have the 838.HealthNet NY/CT coverage. They can’t find doctors who are familiar with the plan. I’ve met the reps from that company and they are usually offering their Medicare plan. I see that they also cover the NYC workers, so from what I can tell this is a scaled down model of the old GHI.
This year’s choices and the way that Hewitt presented their comparison, leads me to the conclusion that they are preparing for a national plan that offers Consumer Directed Health Coverage. The CWA National web site has a great explanation of how Consumer Directed Health Plans will affect the members.
2008 Verizon Health Plan Comparative Analysis
2008 VERIZON HEALTH PLANS COMPARATIVE ANALYSIS
This analysis is to help you choose the right plan for your needs. The analysis is based on comments from Doctors and Patients made to GetHealthHelp.com. The plan details were taken from the 2007 & 2008 Benefits Renewal Worksheets, delivered by Hewitt. It is not meant as an endorsement or complaint about any plan.
Go online BEFORE October 30, 2007 to http://resources.hewitt.com/verizon or call 1-877-275-8947 ONLY if you want to change your plan selection from last year.
|
PLAN |
50A.Empire MEP Indemnity |
185. AetnaMEP PPO/Indemnity |
814.Empire BCBS NY |
21.Aetna HCN NY |
847.Aetna HMO |
822.HIP NY |
838.HealthNet NY/CT |
|
HOW DOCTORS & PATIENTS LIKE THIS PLAN |
A+ BEST for Adults Preventive Exams for children not covered |
BEST, Some Problems Proving Medical Necessity Well Baby In Network Only
|
Only doctors at participating hospitals will accept. Bare Bones Coverage |
Network Providers are good in this plan. |
Only doctors at participating hospitals will accept. Bare Bones Coverage |
VERY GOOD for Preventive Services for children and women’s care. |
Doctors compare this coverage to Medicare HMO’s. Small Network
|
|
CHANGES FROM LAST YEAR (2007) |
Deductible raised from $200/500 to $250/625 Out Of Pocket max. increased to $700
|
Deductible raised from $200/500 to $250/625 Out of Pocket max. increased to $700 |
$150 Hospital co-pay per admission added |
NONE |
Replaces 803A. Aetna $150 Hospital co-pay per admission added $50 emergency room |
$100 Hospital co-pay per admission added |
$150 Hospital co-pay per admission added |
|
IN NETWORK PRESCRIPTION PLAN |
Annual Out of Pocket max. raised to $300 70-85% covered with limits on co-pay
|
Annual Out of Pocket max. raised to $300 70-85% covered with limits on co-pay
|
In-Network Only limited co-pays |
70-85% covered with co-pay maximums |
$5 co-pay 34 day supply $10 mail order 90 days |
Small co-pays for network and mail order generic & approved drugs. No Coverage for some drugs. |
Small co-pays for network and mail order generic & approved drugs. No Coverage for some drugs |
|
OUT OF NETWORK PRESCRIPTION PLAN |
70-85% covered with same co-pay max as in-network except has a $50. deductible
|
70-85% covered with same co-pay max as in-network except has a $50. deductible and patient pays then gets reimbursed
|
NONE |
70-85% covered with same co-pay max as in-network except has a $50. deductible and patient pays then gets reimbursed
|
NONE |
NONE |
NONE |
2008 Verizon Health Plan Choices Analysis
|
CAN I USE MY OUT OF NETWORK DOCTOR & HOSPITAL
|
All doctors are covered for 80% of office fee after deductible |
All doctors are covered for 80% of office fee after deductible with some limits on fees
|
NO |
70% covered after $250 deductible with limits on fees and procedures including hospital care |
NO |
NO |
NO |
|
ADVANTAGE OF USING IN NETWORK DOCTORS
|
Doctors agree to a fee schedule which may lower your out of pocket cost |
Pay only a $15 co-pay for office visits |
Requires PCP Selection Limits out of pocket cost |
No out of Pocket for In Network doctors visits $15 co-pay for specialists |
Requires PCP Selection Pay only a $10 co-pay for office visits |
Pay only a $10 co-pay for office visits. |
Pay only a $10 co-pay for office visits. |
|
CHIROPRACTIC COVERAGE |
Same as Medical Coverage Out-of-Network In-Network agrees to managed care limits
|
80% covered fees after deductible for both In and Out of Network with medical necessity and fees subject to limits
|
$10 co-pay |
Limited number of visits both in and out of network Preauthorization and $1500 Annual Max. |
Only limited in-network coverage with managed care limits |
Limited number of visits in-network $10 co-pay |
Limited number of visits in-network $10 co-pay
|
|
OUT PATIENT MENTAL HEALTH |
Good Plan Most Providers Accept In- Out Network |
Good Plan Most Providers Accept In-Out Network |
Approved Services in-network $10 co-pay |
Authorization Required $15 in network 50% out |
Approved Services in-network $10 co-pay |
60 visits limit in-network $10 co-pay |
Approved Services in-network $10 co-pay |
© Caryn Isaacs, Health Care Policy Analyst October 2007 š PatientAdvocate@GetHealthHelp.com É 718-612-2360 7 GetHealthHelp.com
About this analysis
This analysis is to help you choose the right plan for your needs. The analysis is based on comments from Doctors and Patients made to GetHealthHelp.com. The plan details were taken from the 2007 & 2008 Benefits Renewal Worksheets, delivered by Hewitt.
It is not meant as an endorsement or complaint about any plan.
Go online BEFORE October 30, 2007 to http://resources.hewitt.com/verizon or call 1-877-275-8947 ONLY if you want to change your plan selection from last year.
If you have further questions or comments; call GetHealthHelp.com at 718-612-2360
Caryn Isaacs, Health Care Policy Analyst
110 Wall St., 11th Floor
New York, NY 10005
Plan Analysis Continued
|
ADVANTAGE OF USING IN NETWORK DOCTORS
|
Doctors agree to a fee schedule which may lower your out of pocket cost |
Pay only a $15 co-pay for office visits |
Requires PCP Selection Limits out of pocket cost |
No out of Pocket for In Network doctors visits $15 co-pay for specialists |
Requires PCP Selection Pay only a $10 co-pay for office visits |
Pay only a $10 co-pay for office visits. |
Pay only a $10 co-pay for office visits. |
|
CHIROPRACTIC COVERAGE |
Same as Medical Coverage Out-of-Network In-Network agrees to managed care limits
|
80% covered fees after deductible for both In and Out of Network with medical necessity and fees subject to limits
|
$10 co-pay |
Limited number of visits both in and out of network Preauthorization and $1500 Annual Max. |
Only limited in-network coverage with managed care limits |
Limited number of visits in-network $10 co-pay |
Limited number of visits in-network $10 co-pay
|
|
OUT PATIENT MENTAL HEALTH |
Good Plan Most Providers Accept In- Out Network |
Good Plan Most Providers Accept In-Out Network |
Approved Services in-network $10 co-pay |
Authorization Required $15 in network 50% out |
Approved Services in-network $10 co-pay |
60 visits limit in-network $10 co-pay |
Approved Services in-network $10 co-pay |
Open Enrollment is Oct.17-30, 2007
|
PLAN |
50A.Empire MEP Indemnity |
185. AetnaMEP PPO/Indemnity |
814.Empire BCBS NY |
21.Aetna HCN NY |
847.Aetna HMO |
822.HIP NY |
838.HealthNet NY/CT |
|
HOW DOCTORS & PATIENTS LIKE THIS PLAN |
A+ BEST for Adults Preventive Exams for children not covered |
BEST, Some Problems Proving Medical Necessity Well Baby In Network Only
|
Only doctors at participating hospitals will accept. Bare Bones Coverage |
Network Providers are good in this plan. |
Only doctors at participating hospitals will accept. Bare Bones Coverage |
VERY GOOD for Preventive Services for children and women’s care. |
Doctors compare this coverage to Medicare HMO’s. Small Network
|
|
CHANGES FROM LAST YEAR (2007) |
Deductible raised from $200/500 to $250/625 Out Of Pocket max. increased to $700
|
Deductible raised from $200/500 to $250/625 Out of Pocket max. increased to $700 |
$150 Hospital co-pay per admission added |
NONE |
Replaces 803A. Aetna $150 Hospital co-pay per admission added $50 emergency room |
$100 Hospital co-pay per admission added |
$150 Hospital co-pay per admission added |
|
IN NETWORK PRESCRIPTION PLAN |
Annual Out of Pocket max. raised to $300 70-85% covered with limits on co-pay
|
Annual Out of Pocket max. raised to $300 70-85% covered with limits on co-pay
|
In-Network Only limited co-pays |
70-85% covered with co-pay maximums |
$5 co-pay 34 day supply $10 mail order 90 days |
Small co-pays for network and mail order generic & approved drugs. No Coverage for some drugs. |
Small co-pays for network and mail order generic & approved drugs. No Coverage for some drugs |
|
OUT OF NETWORK PRESCRIPTION PLAN |
70-85% covered with same co-pay max as in-network except has a $50. deductible
|
70-85% covered with same co-pay max as in-network except has a $50. deductible and patient pays then gets reimbursed
|
NONE |
70-85% covered with same co-pay max as in-network except has a $50. deductible and patient pays then gets reimbursed
|
NONE |
NONE |
NONE |
AGINGICON.COM
Have you lived a life of accomplishment, doing what fulfills
you? Have you reached an age where things are harder to do?
Are you a leader and you know that you cannot do it alone?
Then, you are an Aging Icon.
My name is Caryn Isaacs.
Having been at the helm of developing hundreds of healthcare
businesses and running several multi-million-dollar companies,
my journey includes pioneering a physician-owned HMO and
active engagement in Healthcare Reform.
As a Patient Advocate, my company, GetHealthHelp, LLC,
specializes in crafting solutions that enable Aging Icons to
continue pursuing their passions.
An example is a 98-year-old author, playwriter and poet who is
suffering from fibromyalgia and thought that all her work
would be forgotten. I found a way for her legacy to continue by
publishing them as books and now working on having them
made into films.
If this sounds like something of interest, let’s meet to talk
further.
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