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Post by rolando on Aug 27, 2015 16:09:08 GMT -5
Any thoughts on the new changes? I can't tell if the new proposed POS plan will be HUGHP only or will it have a Harvard Pilgrim option. Anyone know?
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Cautiously Optimistic
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Post by Cautiously Optimistic on Aug 28, 2015 5:14:30 GMT -5
While the details are yet to come, I do like what is being presented thus far. We'll see once the specifics such as providers and premiums are released. My fear is that the prior plan is made available (albeit with a higher co-pay) but at such a higher premium cost as to make it irrelevant. In any event, so far so good.
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Post by None on Aug 28, 2015 9:39:42 GMT -5
new POS option will be offered by both HUGHP and HPHC.
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Post by frankly on Aug 28, 2015 10:38:00 GMT -5
The details may end up being a lot less rosy than the presentation, I'm afraid. The new higher premium no-deductibles-nor-coinsurance plan option appears as though it will only be available as a POS plan, not as an HMO offering. The POS premiums are a lot higher than the HMO premiums -- about $950 per year for a family plan. So it looks like it might turn out that in order to take advantage of the new more predictable cost option (if you're currently in an HMO plan as most people are), you would have to BOTH sign up for the more expensive POS plan AND pay more for the no-deductible coverage -- I bet it will turn out to be a very costly choice.
Also, I don't get why they needed to increase office visit copays to $30 -- is that to "pay for" lab tests and x-rays not having deductibles? Talk about nickel and diming...
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Post by Information? on Aug 28, 2015 10:43:56 GMT -5
Where are you getting your information? Is this on Harvie? This seems very insider - I didn't see this published anywhere.
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Post by Beyond Harvie on Aug 28, 2015 12:25:50 GMT -5
The following information was shared with all exempt staff yesterday. It is not "inside"
Specifically, in 2016, we will:
• Offer a new Point of Service (POS) plan with a higher premium for those who seek more predictable out-of-pocket costs at the point of care. In addition to the POS plan offered for 2015, which will be offered again in 2016, this second POS plan has no deductibles or coinsurance for in-network care. Copayments will be $30 for office visits (primary care and specialists), and $100 for emergency room visits. As in the 2014 health plans, out-of-pocket maximums will be $2,000 per individual and $6,000 maximum per family for in-network care. Out-of-network care will be subject to the same deductibles, coinsurance, and out-of-pocket maximums as our other POS plan.
• Remove deductibles and coinsurance on outpatient diagnostic labs and x-rays and institute an increase – from $20 to $30 – in office visit co-pays. This change applies to the current HMO, POS, and PPO offerings from both HUGHP and Harvard Pilgrim Health Care. Outpatient diagnostic labs and X-rays will no longer be subject to a deductible or coinsurance. These changes are intended to make costs more predictable for participants.
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Post by Waiting to See on Sept 1, 2015 6:08:13 GMT -5
I sure hope that we get this right and avoid the demoralization, upset, and turmoil that accompanied the changes last year. I am hoping that the communications are clear, accurate, and as free of "spin"as possible. There were several instances last year where this did not seem to be the case. I am cautiously optimistic and thankful for whatever degree the committee and the provost truly heard and reacted to the concerns of the community. People could use a lift! Time will tell.
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Post by frankly on Sept 21, 2015 8:10:20 GMT -5
OK, I'm ready to weigh in on the 2016 changes to the 2015 health plans -- after looking at the additional details revealed last week.
- The removal of deductibles and coinsurance for lab tests and x-rays is a good thing -- except it is undone (or more than undone?) by the increase in the office visit copay from $20 to $30. There are some health conditions that require a lot of office visits and office visit copays: mental health, injuries requiring physical therapy, supervised blood pressure checks, etc. I think it's not entirely rare for some types of patients to have 10 or 25 office visits subject to copayments in a year...
- The new "no-deductibles-or-coinsurance" option ("POS Plus") is indeed available only as a POS plan. Too bad there's not an "HMO Plus" plan, and I don't really understand why not. If you're currently on an HMO plan and want to pay for the predictability of no deductibles nor coinsurance, you would now have to pay a charge for that predictability, and an additional charge for the out-of-network coverage in a POS plan, which you probably don't need or you would have been in the POS already. Looks like the combined effect will be about $1,400 per year MORE for family coverage (if you're switching from HMO to POS Plus). That's a steep price, especially for people at the lower end of the pay spectrum.
- The new reimbursement program levels do represent an improvement, although I wish it had gone further. $1,600 is still a lot of exposure for someone making $51,000 per year...
Overall, I'd say it's probably not much or any more generous that the 2015 plan -- just different in its effects on different people. What do others think?
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