Reasons for Changes
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FREQUENTLY ASKED QUESTIONS
FOR THE CHANGE
are the concerns
and why is MPS making
these changes to its health insurance plans?
MPS seek to minimize the health
changes will be made
to the MPS health plan
vendors and design?
receive a new
identification card for my
health plan coverage and prescription drug coverage, and when can I
expect to receive them?
Will there be a special
open enrollment period in
2011 so that I can switch health plans from the PPO to the EPO?
concerns and why is MPS making these changes to its health insurance
plans? Back to top
There are several reasons for these changes:
did MPS seek to minimize the health plan changes? Back to top
MPS worked collaboratively with the unions to:
- Seek competitive bids from major health plan vendors to
obtain improved pricing without jeopardizing the quality of MPS health
plans and breadth of provider/hospital networks.
- Make design changes to address cost drivers and to achieve
deeper provider discounts and steerage to in-network providers.
- Establish employee premium contributions to:
- Share costs with employees.
- Encourage employee selection of the health plan that would
best meet employee needs.
will be made to the MPS health plan vendors and design? Back to top
- New third party administrators (TPA).
United HealthCare will
replace Aetna and take over the administration of the MPS PPO/Indemnity
Health Plan, which means the MPS PPO/Indemnity Health Plan is
continuing, but UnitedHealthcare will administer the claims and manage
the provider networks.
Medco will be the third party administrator for
the retail and mail order pharmacy benefits for all members currently
under the UnitedHealthcare EPO Plan.
- Improved PPO network and Pharmacy network discounts with
lower claims administration costs and more competitive vendor contracts
with service and price guarantees.
The MPS health plans are
self-insured and over 97% of the district’s health care expenses are in
payments to doctors, hospitals, and pharmacies for claims. About
3% of its costs go to the cost of paying TPAs to administer claims and
- The breadth of the (Preferred Provider) PPO provider network
for the MPS PPO/Indemnity Health Plan was maintained with minimal
disruptions; for example:
Based on claims for Wisconsin facilities
(i.e., hospitals) UHC matches Aetna at a rate of 98.5%:
98.5% Aetna 98.8%
Based on claims for Wisconsin
non-facilities (i.e., physicians) UHC matches Aetna at a rate of 84.5%:
UHC 84.5% Aetna 85%
- Breadth of pharmacy network was maintained with Medco
becoming the third party administrator (i.e. TPA/pharmacy benefit
manager) for the MPS EPO Health Plan.
- Medco network has all of the chain pharmacies and the
majority of small/local pharmacies that are in the current UHC pharmacy
- Medco is the claim processor for the UnitedHealthcare
pharmacy network so transition should be a smooth one.
Plan design changes for both MPS PPO and EPO health plans
that support obtaining deep provider network discounts and preserving
cost effectiveness of both plans. (For details refer to Q and A)
MPS PPO/Indemnity Health Plan design changes include:
- New separate annual deductibles for in-network and
- New annual coinsurance percentage paid by the plan for
- New separate annual coinsurance limits –
out of pocket limits.
- Conversion to a new pharmacy plan design – a three-tier
formulary with new co-pays.
MPS EPO Health Plan design changes include:
- New annual deductible.
- Conversion to a new pharmacy plan design – a three tier
formulary with new co-pays.
- Elimination of the NVA vision benefit for
(Note: This benefit is not provided to retirees under the PPO/Indemnity
Employee premium contributions for health benefits effective
no sooner than August 1, 2011.
Will I receive a
new identification card for my health plan coverage and prescription
drug coverage, and when can I expect to receive them? Back to top
Yes. You will receive a
welcome kit and a new card from UnitedHealthcare for medical claims and
a new card from Medco for prescription drug claims via U.S. mail a day
or two before the changeover to the new TPA, UnitedHealthcare.
Will there be a
special open enrollment period in 2011 so that I can switch health
plans from the PPO to the EPO? Back
No. Switching between plans
is permitted only during annual open enrollment. The next annual
open enrollment is in September 2011 with an effective date of November
1, 2011 for the change.