New health care plans for 2008
Closer look at the new plans
The University’s new employee health care plans are Preferred Provider Organizations (PPOs), an approach in which enrollees have more responsibility for and more control over their health care expenses. In addition, it provides coverage for both innetwork and out-of-network providers. (“Networks” include all providers contracted with Aetna or Excellus to care for enrollees.) In fact, it’s based on principles much like your auto insurance. Here’s how it will work with the new PPOs:
How the new health plans differ from current plans
1. Employees pay a premium to enroll in a plan. In general, the University pays more than 80% of the full cost of the premium while the employee picks up the rest through pre-tax payroll deduction. The program is structured so that full-time employees making less than $40,000 per year pay a lower portion of the premium, and those making over $100,000 pay a higher portion.
2. Once enrolled in a plan, the employee is responsible for health care expenses (except for free , in-network preventive care) until a deductible is met. The amount of the deductible varies with each plan and whether you have single or family coverage, but plans with lower premium costs come with higher deductibles.
3. If the employee’s out-of-pocket expenses exceed the deductible, the health care plan begins to bear the majority of the costs. This is called “coinsurance,” and the actual percentage of health care costs borne by the insurance plan (in-network: 80% or 90%) versus the employee varies with each plan. Again, plans with higher premiums have lower deductibles and better coinsurance.
4. The employee’s costs are capped at a predetermined amount, called an “out-of-pocket maximum.” The out-of-pocket maximum includes deductibles and coinsurance, but does not include costs for prescription drugs for the High and Low Deductible plans and the Copay plan. Once the employee reaches this out-of-pocket maximum, the insurance plan picks up 100% of the cost. While most enrollees won’t reach this spending cap, knowing the outof- pocket maximum is important in understanding your full risk.
5. Like our current health care plans, employees can continue to use a flexible spending account (FSA) to pay health care costs with pre-tax dollars. Using a Health Savings Account is only an option for the PPO- HSA eligible plan, and this option is best suited to those able to handle a high out-of-pocket maximum ($2,200 for a single/$4,400 for a family contract).
Compare new plans
Printable fact sheets allow you to compare copays, out-of-pocket maximums, and other features of each of the new plans.
PPO High Deductible Plan (print fact sheet)
The PPO High Deductible Plan provides a higher deductible and out-of-pocket maximum,
which requires the member to potentially pay higher overall costs for services incurred under
the plan. However, there are lower payroll deductions associated with enrollment.
PPO Low Deductible Plan (print fact sheet)
The PPO Low Deductible Plan provides a lower deductible and out-of-pocket maximum,
which means lower overall costs for services incurred under the plan. However, there are
higher payroll deductions associated with enrollment.
PPO HSA-Eligible Plan (print fact sheet)
The PPO HSA-Eligible plan combines the highest deductible and out-of-pocket maximum
with the lowest monthly payroll deductions. Individuals enrolled in this plan must be
prepared, in the event of a catastrophic illness or injury, to pay up to the out-of-pocket
maximum outlined on the fact sheet. An HSA plan, similar to an FSA plan, to which employees
contribute pre-tax dollars, is available.
PPO Copay Plan (print fact sheet)
The PPO Copay plan is most similar to the Exclusive Provider Organization (EPO) plans offered
today. These plans require the highest monthly payroll deductions, but provide the lowest
cost for services incurred under the plan, in most cases.
