PPO / Indemnity Health Plan - FAQ
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FREQUENTLY ASKED QUESTIONS
PPO
/ INDEMNITY HEALTH PLAN
UnitedHealthcare Choice Plus
What
are the new
calendar year deductibles and
coinsurance limits for the PPO/Indemnity Health Plan?
How do
health plan
deductibles and coinsurance
features work in- and out-of-network?
Will I
receive a new
identification card for my
health plan coverage and prescription drug coverage, and when can I
expect to receive them?
Can I use
the in-network
deductible and in-network
coinsurance that I pay to satisfy my out-of-network deductibles and
coinsurance respectively?
Will I
receive “credit” for
what I have already paid
on claims processed by Aetna towards my “new” deductible and
coinsurance limit for calendar year 2011 and will this carry over to
the new administrator, UnitedHealthcare?
Where can I
go for more
information on the design
changes made to the MPS PPO/Indemnity Health Plan?
How can I
find out if my
doctor, hospital, or
therapist is in the UnitedHealthcare Choice Plus Network?
Will there be
a special open
enrollment period in 2011
so I can switch health plans from the PPO to the EPO or from the EPO to
the PPO?
How long
will Aetna continue
to process the claims I
incurred before the switch to UnitedHealthcare, and will
UnitedHealthcare process these “runoff” claims?
What if
I am in treatment
with a doctor who is in
the Aetna network and I find out that the doctor is not in the
UnitedHealthcare Choice Plus Network? What transition benefits
are available to me, and what do I need to do to obtain them? If
there are forms, where may I obtain them and what is the timeline for
completion?
What are
the new monthly
premium rates for the PPO?
What are the
new calendar year deductibles and coinsurance limits for the
PPO/Indemnity Health Plan? Back to top
|
PPO/INDEMNITY HEALTH PLAN
|
ANNUAL DEDUCTIBLE
IN-NETWORK
|
ANNUAL DEDUCTIBLE
OUT-OF-NETWORK
|
|
Single
|
NEW:
$75
|
NEW:
$326
|
|
Current:
$100
|
Current:
$100
|
|
Family – Two Persons
|
NEW:
$150
|
NEW:
$500
|
|
Current:
$200
|
Current:
$200
|
|
Family – Three or More Persons
|
NEW:
$225
|
NEW:
$500
|
|
Current:
$300
|
Current:
$300
|
|
Note: Deductibles are calendar year and will no
longer be combined in- and out-of-network.
|
|
PPO/INDEMNITY HEALTH PLAN
|
COINSURANCE
|
COINSURANCE
|
|
Coinsurance - Amount Paid by Plan
|
NEW:
90%
|
NEW:
70%
|
|
Current:
90%
|
Current:
80%
|
|
PPO/INDEMNITY HEALTH PLAN
|
ANNUAL
COINSURANCE LIMIT
IN-NETWORK
|
ANNUAL
COINSURANCE LIMIT
OUT-OF-NETWORK
|
|
Single
|
NEW:
$200
|
NEW:
$1,100
|
|
Current:
$200
|
Current:
$500
|
|
Family – Two Persons
|
NEW:
$400
|
NEW:
$2,200
|
|
Current:
$400
|
Current: $1,000
|
|
Family – Three or More Persons
|
NEW:
$600
|
NEW:
$2,800
|
|
Current:
$600
|
Current: $1,500
|
|
Note: Coinsurance limits are calendar year and do not
include your deductible or co-pay (i.e., $10 per visit).
Co-insurance limits will no longer be combined in- and
out-of-network.
|
How do
health plan deductibles and coinsurance features work in- and
out-of-network? Back to top
In general, first you pay the annual calendar year deductible before
the plan pays. Then, any service that is subject to coinsurance,
the plan pays the stated coinsurance percentage (90% in-network or 70%
out-of-network) and the employee/retiree pays their coinsurance
percentage (10% in-network or 30% out-of-network) until the
employee/retiree calendar year coinsurance limit is met for the
calendar year. Thereafter, the plan pays for 100% of covered
services for the remainder of the calendar year. The exception to
this would be covered services subject to co-pays (i.e. fixed dollar
office visit co-pays, urgent care co-pays, prescription drug co-pays,
emergency room co-pays, etc.) which the employee/retiree must pay in
addition to the deductible and coinsurance limit.
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 in the mail a day or two before the changeover
to the new TPA, UnitedHealthcare.
Can I use the
in-network deductible and in-network coinsurance that I pay to satisfy
my out-of-network deductibles and coinsurance respectively? Back to top
No. In-network and out-of-network deductibles and coinsurance are
no longer combined.
Will I receive
“credit” for what I have already paid on claims processed by Aetna
towards my “new” deductible and coinsurance limit for calendar year
2011 and will this carry over to the new administrator,
UnitedHealthcare? Back to top
Yes. We will transfer your claim payment history from Aetna to
UnitedHealthcare twice; once during the first week after the conversion
to UnitedHealthcare and then again in 60 to 90 days to catch and record
any subsequent claim payments. You will not receive any refund
reflecting the new, lower in-network deductibles that will commence
with the conversion to UnitedHealthcare.
Where can I go
to get more information on the design changes made to the MPS
PPO/Indemnity Health Plan? Back to top
How can I find
out if my doctor, hospital, or therapist is in the UnitedHealthcare
Choice Plus Network? Back to top
Will there be a
special open enrollment period in 2011 so I can switch health plans
from the PPO to the EPO or from the EPO to the PPO? Back to top
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.
How long will
Aetna continue to process the claims I incurred before the switch to
UnitedHealthcare, and will UnitedHealthcare process these “runoff”
claims? Back to top
No, UnitedHealthcare will not
process claims for services you received prior to the effective date of
the switch to UnitedHealthcare. This process is referred to as
the processing of runoff claims (those claims for services you received
before the effective date of the switch to UnitedHealthcare). The
exact date that Aetna will stop processing runoff claims is still under
discussion. However, you can plan on Aetna processing your runoff
claims at least until October 1, 2011. Remember, your Aetna
in-network providers are responsible for filing your claims with Aetna;
therefore, you may want to call them and advise them that they should
not delay the processing of your claims. You are responsible for filing
out-of-network claims with Aetna and you are encouraged to file them
with Aetna as soon as possible. UnitedHealthcare will not process
Aetna runoff claims.
What if I
am in treatment with a doctor who is in the Aetna network and I find
out that the doctor is not in the UnitedHealthcare Choice Plus
Network? What transition benefits are available to me, and what
do I need to do to obtain them? If there are forms, where may I
obtain them and what is the timeline for completion?
This is referred to as “Transition
of Care Benefits” and under certain circumstances you may be eligible
to receive time-limited continuation of care from a non-network
provider at the in-network coverage level. If you have determined
that your Aetna in-network provider is not in the UnitedHealthcare
Choice Plus network and you, or your covered dependent, are being
treated for a serious medical condition; such as, non-surgical cancer
treatment – chemotherapy or radiation therapy; severe or end-stage
renal disease; symptomatic AIDS; undergone a recent bone marrow or
organ transplant, or are on the waiting list to obtain an organ; or
pregnancy in the second or last trimester or moderate/high-risk
pregnancy, you may contact UnitedHealthcare Customer Service at
1-877-440-5982 to obtain an Application for Transition of Care
benefits. For consideration of mental health/substance abuse
services you may also contact UnitedHealthcare Customer Service.
You must apply within 30 days of
the change to UnitedHealthcare in
order to be considered for Transition of Care Benefits.
You can
contact UnitedHealthcare to request an application prior to April 1,
2011, particularly since you may need your provider’s assistance to
fully complete the application; however, you cannot mail it to
UnitedHealthcare for processing until April 1, 2011. Because the
application must be filed within 30-days of the change to
UnitedHealthcare, it is suggested that you begin the application
process so that you are already prepared to mail it to UnitedHealthcare
on April 1 or shortly thereafter so that you do not miss the 30-day
filing period. Mail the completed application to the address
shown on the application. You will receive a coverage decision
from UnitedHealthcare by mail.
What are the new
monthly premium rates for the PPO Health Plan? Back to top
|
|
Current
|
New
|
Current
|
New
|
|
HEALTH PLAN
|
Aetna
PPO/Indemnity
Effective
July 1, 2010
Thru
June 30, 2011
|
UnitedHealthcare
PPO/Indemnity
Effective
April 1,
2011
Thru
June 30,
2011
|
UnitedHealthcare
EPO Plan
Effective
July 1, 2010
Thru
June 30, 2011
|
UnitedHealthcare
EPO Plan
Effective
April 1,
2011
Thru
June 30,
2011
|
|
ACTIVE EMPLOYEES
INCLUDING VISION
|
|
Single
|
$ 1,012.15
|
$
882.38
|
$ 560.69
|
$
527.47
|
|
Family
|
$ 2,237.21
|
$
1,950.48
|
$ 1,471.73
|
$
1,384.50
|
|
RETIREES (Does not
Include Vision)
|
|
Single
|
$ 1,008.02
|
$
878.25
|
$ 560.69
|
$
523.34
|
|
Family
|
$ 2,227.19
|
$
1,940.46
|
$ 1,471.73
|
$
1,374.48
|
|
Single, w/Medicare
|
$ 383.44
|
$
343.37
|
$ 415.15
|
$
362.26
|
|
Couple, one w/Medicare
|
$ 1,391.47
|
$
1,221.62
|
$ 977.60
|
$
885.61
|
|
Couple, two w/Medicare
|
$ 766.89
|
$
686.73
|
$ 832.70
|
$
724.52
|
|
Family, one w/Medicare
|
$ 1,602.61
|
$
1,405.58
|
$ 1,326.20
|
$
1,213.40
|
|
Family, two w/Medicare
|
$ 978.03
|
$
870.69
|
$ 1,180.66
|
$
1,052.32
|
|
Family, three w/Medicare
|
$ 1,150.33
|
$
1,030.10
|
$ 1,243.09
|
$
1,086.79
|
|
Note:
Retiree’s Employee
Contribution varies by the amount of the premium in effect as of the
date of retirement.
Retirees who are not
entitled to Board-paid coverage pay the entire premium.
|
