Changes to the Indemnity PPO options
|
PLAN |
Empire MEP HCPPO Out of Network |
Emoire MEP HCPPO In Network |
|
HOW DOCTORS & PATIENTS LIKE THIS PLAN |
A+ BEST for Adults Preventive Exams for children not covered |
Your Aetna Doctors should be sure they are in the Empire HCPPO |
|
Deductibles and co-pays |
$250/$625 Out Of Pocket max. increased to $700
|
same as in network co-pays are not counted to deductibles |
|
Well Child Care |
80% after deductible |
100% immunizations & office visits |
|
PRESCRIPTION PLAN CHANGES |
no assignment of benefits reimbursement only
|
% raised for co-pays out of pocket raised |
|
CAN I USE MY OUT OF NETWORK DOCTOR & HOSPITAL
|
All doctors are covered for 80% of office fee after deductible |
$15 co-pay $5 co-pay with Medicare |
|
ADVANTAGE OF USING IN NETWORK DOCTORS
|
Most doctors know this plan and accept it. |
Co-pays instead of % |
|
PHYSICAL THERAPY/ CHIROPRACTIC |
Same as Medical Coverage Out-of-Network In-Network agrees to managed care limits
|
80 % of contracted rate |
|
OUT PATIENT MENTAL HEALTH |
80% after deductible |
80% after deductible |
HMO Options for 2009
|
814.Empire BCBS NY HMO |
21.Aetna HCN NY |
847.Aetna HMO |
822.HIP NY |
838.HealthNet NY/CT |
|
Only doctors at participating hospitals will accept. Bare Bones Coverage |
Comprehensive Primary Care at a low cost. |
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
|
|
$150 Hospital co-pay per admission added |
NONE |
$150 Hospital co-pay per admission added $50 emergency room |
$100 Hospital co-pay per admission added |
$150 Hospital co-pay per admission added |
|
no change
|
no change
|
no change |
no change |
no change |
|
no change |
no change |
NONE |
NONE |
NONE |
|
NO |
70% covered after $250 deductible with limits on fees and procedures including hospital care |
NO |
NO |
NO |
|
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. |
|
$10 co-pay |
Limited number of visits both in and out of network b 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
|
|
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 |
Verizon Open Enrollment 2008
This information is what we have so far. I will post a comparison chart as soon as I see the one the company gives out. Please call the Local or the Health Line frist if you are considering making a change.
Open enrollment for active members is November 12, 2008 through November 25, 2008.
Open enrollment for members who retired after 1986 will be November 5, through November 18, 2008. All other retirees can make changes anytime effective the first of the month following a 30 day period.
There will be a Benefit Renewal Brochure mailed to our members on October 27, 2008. Those members who are in the MEP plan will receive a brochure which details the changes from the MEP to the new MEP HCPPO. Those who are participating in the MEP PPO will receive a brochure which details the changes from the MEP PPO to the new MEP HCPPO and lastly those who participate in the HCN or an HMO will receive the information about the new MEP HCPPO.
The new medical plan option, the MEP HCPPO will replace the current MEP and the MEP PPO. This plan will be the default plan. All new hires who do not select a plan will be placed into the MEP HCPPO.
Any member who currently participates in the MEP or the MEP PPO will automatically be enrolled in the new MEP HCPPO. These members only need to make a change during open enrollment if they want to choose a different plan.
Any member who currently participates in the HCN or an HMO will continue in those plans unless they make changes and enroll by November 25, 2008.
THE PREFERRED CARE (NEW YORK) OPTION 839 WILL NOT BE AN OPTION IN 2009.
Those members will need to select a new plan or they will default into the MEP HCPPO.
Any member that wants a copy of the Health Plan Comparison charts can visit www.verizon.com/benefits or they can call 1-877-4VZ-BENS beginning October 29, 2008.
It is important for our members to review their covered dependents during the benefit renewal process.
The new ” Anytime Enrollment Process” becomes effective January 1, 2009. Our members must be enrolled in the same plan for 12 months before he/she can make a medical plan change (other than a life event). Therefore, the first time anyone can make a change under the “Anytime Enrollment Process” is January 1, 2010.
“Anytime Enrollment” for members who retired after 1986 becomes effective January 1, 2009 and retirees can make a change anytime effective the first of the month following a thirty day period.
Triple Home Run
1. New name of plan administered only by Empire Blue Cross better reflects the plan design. In and out of network coverage based on 80/20 UCR (Now the Verizon PPO) and adds well baby coverage.
2. No Open Enrollment closed period. All members covered now by Aetna MEP/Indemnity will automatically be transfered into the new improved plan. Also, during the course of 2009, if you find that you have chosen the wrong plan, you can change one time to another plan. Please be aware that you should not call benefits to change from Aetna MEP/Indemnity to the new plan. This will be considered your one time change. Only call if you are changing from an HMO to the new plan or any other plan.
3. There is stronger protection language for members using FMLA.
You can Fight Against Cost Shifting and WIN!
In Unity Their Is Strength!
2009 Medical Plan Changes
Health Plan Changes
The bottom line is that members who took the Aetna MEP/Indemnity Plan so that they could go to their out of network doctors while still benefiting from well-baby coverage and in-network discounts, should change to the improved Empire Blue Cross MEP plan. This will allow you and your family to have the same kind of coverage that Aetna was offering, but without the administrative problems some of you experienced with Aetna.
HMO options remain the same and there is no need to change if you are happy with your plan.
You do not have to contribute to any plan premium, so make your decision based on how you prefer to access care. Please do not hesitate to call the Health Line with any questions about your coverage or help in choosing a plan. We are Your Patient Advocate. We are not affiliated with any insurance plan or doctors office.
CALL 718-612-2360 or visit GetHealthHelp.com
Paid Family Leave as of Summer 2008
Beth fell from a ladder while changing a light bulb in her home. She now requires three half hour physical therapy treatments a week for a pinched nerve. The therapist who accepts her health insurance only has office hours from 9-5. Beth tries to make her appointments during lunch hour, but sometimes it can be over two hours before she’s back at her desk.
Ann is a single working mom who lives with her two children. Last year her mother was diagnosed with Alzheimer’s. Ann has to get up at 4 am to get everyone ready and dropped off at their various day cares and schools. She still arrives late to her job a few times a month if her Mom has a doctor’s appointment or if she needs to wait for a sitter.
Patty is up for partner in a law firm. It’s taken her almost twenty years to get here and she worries that she will be too old to have a child if she waits much longer. No woman has stayed in the firm after childbirth, let alone be offered a promotion.
The Family Medical Leave Act (FMLA) was enacted in 1993 to help workers to take time off from their jobs without the fear of losing their seniority or being dismissed. Under FMLA, eligible employees may take up to 12 weeks unpaid time off, in continuous spans of time or through intermittent or reduced schedule leave. Workers may take time from work because of a serious health condition or to care for a spouse, child or parent who has a serious health condition or to care for a newborn or newly adopted or foster child.
In January 2008, Congress enacted the first significant changes to the law since its inception in 1993. Employees caring for members of the military—those who become ill or injured in the line of duty—are now eligible to take up to 26 weeks of unpaid leave.
Meanwhile, the FMLA is so confusing that a whole new industry has sprung up surrounding compliance and administration. Doctors have been known to charge up to $25 to fill out all the required paperwork. Besides the difficulty in understanding and enforcing the law, FMLA’s effectiveness is constrained by its limited coverage and because millions of workers cannot afford to take leave without pay.
While some Federal Legislators continue to propose bills that would eliminate FMLA coverage for short-term illness, legislation that will provide Federal Employees with four weeks of paid parental leave passed the U.S. House of Representatives on June 19, 2008. It is now in the US Senate but President Bush promises to veto the bill.
Proposals such as The Family Leave Insurance Act of 2007 (S. 1681) which would expand FMLA to include paid leave on a federal level have gone nowhere. Barack Obama proposes that as President he would expand the FMLA by providing help to the States for expanding the reasons for leave to include children’s academic activities or to address domestic violence and sexual assault. John McCain opposes any expansion of FMLA.
On May 2, 2008, New Jersey joined California and Washington to become the third state to enact a law allowing employees to take time off with limited pay for medical care or to care for a sick immediate relative. The New Jersey Time to Care Coalition led the advocacy efforts for S786/A873, which will extend the State’s existing temporary disability insurance system to provide workers with family leave benefits. Under the program, employees may receive two-thirds of their salary, up to $524 a week and will provide 6 weeks of benefits. The legislation is designed to run concurrently with the federal FMLA while it clarifies some areas that have caused problems in administration, such as definitions of who is eligible and reasons for taking leave. It also imposes fines and criminal penalties for employees who fraudulently claim paid leave benefits.
The law will go into effect in January 2009, and workers will be able to take paid leaves as of July 2009. The day that Governor Corzine signed the Paid Family Leave Act, the New Jersey Ledger’s blog was filled with posts by employees who objected to any new payroll deductions and employers who feared the burden of further overhead costs. Temporary Disability Insurance is currently jointly funded by employers and employees. The program would continue to be jointly funded, but the modest premium increase would be borne by covered employees alone. Employers fear that lost productivity from absent employees and greater administrative responsibilities will increase their costs.
An overview of the rights of employees under the New Jersey Family Leave Act can be found at http://state.nj.us/treasurypensions/epbam/additional/fmla-overview.htm.
The U.S. Department of Labor web site has a chart which explains the differences between the Federal vs. the New Jersey Family and Medical Leave laws at http://dol.gov/esA/programs/whd/state/fmla/nj.htm.
Now, more states are exploring ways to clarify and expand coverage. 11 states, California, Connecticut, Hawaii, Minnesota, New Jersey, Oregon, Rhode Island, Vermont, Washington, Wisconsin and the District of Columbia have enacted statutes that affect the employees and employer’s rights and responsibilities. A list of bills introduced in 2008 can be found at http://www.paidfamilyleave.org/otherstates.html
In New York State, although the Assembly passed the Working Families Time to Care Act (A9245) in 2007, the Senate did not act until 2008 when the entire 30-member Democratic Conference and four Republicans, signed a letter addressed to Senator Thomas Morahan (R-New City) in support of S.8428. June 2008 marks the second consecutive year Senate Democrats have called for the passage of Paid Family Leave legislation proposed by Morahan. The New York State Paid Family Leave proposal is similar to the New Jersey and California laws.
You can learn more about paid family leave in New York State and what you can do to help at the New York State Paid Family Leave Coalition web site, http://www.timetocareny.org/index.html
Happy Holiday
Open Enrollment Comments
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 |
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