As many of you already know, July 1 marks the effective date for new changes to the benefits offered in our healthcare plans on a roll-in basis. Several determining factors influenced these changes - including new or revised legislation, member feedback and/or appeals, and the competitive landscape. The changes to our core benefits simplify the plans, which will make it easier for customers to understand and easier for you to sell. The additional benefit flexibility and plan offerings will help to ensure you find the right solution for your clients.
FOR TRADITIONAL PLANS (Optima Vantage, POSA, and Plus)
In addition to the pharmacy benefit already included in their core health plan, we have added two standard pharmacy options (Low and High). Now groups will have choices in the Rx deductible amount their employees will pay and have opportunities to save on premiums. These options are being offered to all core health plans except Design and Equity. The pharmacy options do not apply to our Individual Products.
FOR ALL PLANS
Beginning July 1, our prescription drug formulary will officially operate as "open," with all drugs placed in one of the four tiers (we have effectively been running this way for years, so this is really a clarification). Standard pharmacy protocols still apply. In addition, since most medical services received from a state- or city-run health department are typically primary care-type services, those services will now be charged at the primary care physician (PCP) Copayment rate instead of a specialist Copayment rate.
For all fully insured small and large groups, we have removed the annual limits on early intervention services. Annual limits have been eliminated from orthopedic and prosthetic durable medical equipment (DME) and replaced with a 30 percent Coinsurance for all plans except Design and Equity Consumer-Directed Health Plans (CDHP). For artificial limbs a 30 percent Coinsurance will apply to all plans except CDHP plans.
FOR CONSUMER-DIRECTED HEALTH PLANS
Benefit Changes
For Equity and Design plans we are streamlining benefits so that all services are covered at the overriding Coinsurance level of the applicable plan (previously, coverage for reduction mammoplasty, vaccines and some injectables were at different levels). For Equity 80% and 90% plans, we are adding a four-tier pharmacy Copayment structure after the Deductible so that all Equity plans offer the same pharmacy benefit.
Product Offering Changes
In response to the quickly changing marketplace, we have made changes to our CDHP product offerings. These changes include the retirement of a few existing plans and the introduction of a variety of new plans and complementary programs.
With our Equity suite specifically, we are continuing to focus on fostering consumerism while managing risk and premium costs effectively. Consequently, we are sun-setting the lower-deductible 100 % plans on both the Vantage and Plus platforms. For July 1 effective dates, the Equity $2500/100% and $3000/100% plans will no longer be available to new groups or current clients that do not already have them in place. Groups that have them in place may maintain them.
On the Design suite, we have added 90% plans and eliminated Design 2000/80%. Keep on the lookout out for more information in the near future on additional new Design plans that will offer greater premium-saving opportunities.
Please click on the links below for additional details on these changes:
If you have any questions or need additional information, please don't hesitate to contact your account representative.