Printer friendly version

UC Lab employees will have several health-care plan choices in ‘04

University of California Laboratory employees and retirees will have some new choices in 2004 when United Healthcare begins providing health-care coverage of UC Lab employees and retirees on Jan. 1, 2004.

United Healthcare plans will replace Blue Cross/Blue Shield New Mexico’s point-of-service and HMO plans. UC Lab employees and retirees can choose from several United Healthcare plans at Open Enrollment from Nov. 1 to 30, said Sandra Haire of Benefits and Employment Services (HR-B).

United Healthcare will offer three different medical plans: an Exclusive Provider Organization (EPO) plan, a Preferred Provider Organization (PPO) plan and a consumer-driven health plan called iPlan. All three plans utilize United Healthcare’s provider networks; the UHC Web site has network updates, said Haire, adding that those networks are still being developed and additional updates are scheduled to be announced on Oct. 1. The plans are still being finalized, but brief descriptions of the plans and how the plans complement one another are provided below.

Open enrollment materials with plan details will be mailed out to UC Lab employees and retirees the week of Oct. 15.

Select EPO (exclusive provider organization)

For UC Lab employees and retirees currently in an HMO, the EPO "Select" plan operates much like the former HMO. It offers a national network as opposed to a network limited to New Mexico and, as a result, greater flexibility than the previous HMO.

With the EPO Select, UC Lab employees and retirees must use UHC’s EPO network doctors and hospitals. The Lab employee or retiree chooses a primary care physician from the UHC EPO network as their personal doctor. In addition, the Select EPO plan also allows the employee/retiree to self-refer to any network doctor or hospital nationwide. There are no claim forms or bills to worry about.

Here are two examples of how the EPO Select plan can work:

• An employee/retiree has a primary care physician that he or she uses to help coordinate overall care. Because the employee/retiree has a history of skin cancers, he or she also sees a dermatologist every six months. Both of these providers are in the UHC EPO network. The employee or retiree can self-refer to his or her dermatologist whenever it is time for a check-up; there’s no need to obtain a referral or authorization from a primary-care physician.
• A Laboratory employee/retiree’s son attends college in Boston. The son has severe allergies; because the employee is enrolled in the EPO plan, they must use only Select EPO-network doctors and hospitals. Using United Healthcare’s Web page, the employee can search for EPO doctors and locate several allergy specialists in Boston. The son can use any EPO doctor nationwide and be covered. If the son transfers to another university in a different part of the country, the UC Lab employee can again use the Web site to find an allergy specialist in the new location. If there are no EPO allergy specialists located in the new region of the country, the employee or son can call United Healthcare’s customer service line to obtain help in locating an EPO network provider. The son must use a Select EPO network provider to be covered, unless the situation or medical condition is an emergency, in which case they can obtain care at the nearest emergency room.

Some of the important benefits of the Select EPO include the following:

• the employee or retiree can choose a primary physician from the national United Healthcare network. A list of physicians in the network can be found at the Pathways to Change Web site.
• the employee or retiree has access to a national network of specialists, hospitals and other providers through their primary physician or through self-referral.
• Emergencies are covered anywhere in the world.

Using a non-EPO doctor or hospital for a non-emergency will result in no coverage from the EPO plan. So for example, if a UC employee or retiree chooses the Select EPO plan and doesn’t use a doctor in the Select EPO network, they are not covered under the plan if a medical condition arises.

Options PPO (preferred provider organization)

A preferred provider organization plan provides access to United Healthcare’s national network of physicians. Similar to the current point-of-service plan, users of this plan have the freedom to seek treatment from physicians both in and out of network, and see specialists without a referral.

With the Options PPO, UC Lab employees and retirees have access to United Healthcare’s largest network of physicians and can choose from the growing national network of more than 380,000 doctors and specialists, as well as from more than 4,000 hospitals nationwide. The PPO network of physicians is larger than the Select EPO network of physicians with some overlap between the two networks.

With such a large network, it’s easy to find medical care while traveling or for children away at school. An employee can even choose to see a specialist at any time, without a referral. An employee’s or retiree’s doctor may already be a part of UHC’s network. If not, employees can visit any out-of-network doctor and still enjoy benefits, with somewhat higher deductibles and copayments.

Here are two examples of how the Options PPO can work:

• An employee has been seeing the same urologist for 10 years. Because the employee has had some problems in the past, it’s very important that the employee continue seeing this particular provider. Unfortunately, the urologist is not in the UHC PPO network. The Lab employee can still see this provider, but will pay more out of pocket for deductibles and co-insurance than if he changed to a PPO provider. With the Options PPO, the employee has a choice.
• An employee’s son is awarded a Rhodes Scholarship and plans to attend Oxford in England. Because the son will be out of the country, the employee enrolls in the Options PPO plan during open enrollment so that the son will have coverage overseas. The employee will be able to access PPO providers close to home and is covered at the network level, while the son is covered at the out-of-network level overseas.

With the Options PPO, the majority of an employee’s health needs are covered with less expense when visiting a network doctor or facility. In addition, when an employee visits network doctors and hospitals, there are no claim forms or bills to worry about.

iPlan consumer model

Consumer-driven health plans are a new alternative to traditional insurance models. These plans promote member responsibility and freedom, while also providing resources to help people become more knowledgeable and thrifty consumers of health care.

UC Lab employees only are eligible to sign up for the iPlan. Retirees are not eligible for this plan. The iPlan gives UC Lab employees greater choice and control in managing their health-care expenses. With iPlan, they have greater responsibility for their health care spending. In return, they also gain the freedom to make the best decisions about how those health-care dollars are used, said Haire.

The iPlan includes the following components:

• United Healthcare’s PPO network
• United Healthcare’s Web site, which includes information and resources on care coordination, a treatment cost estimator, personalized benefits and account information, hospital comparisons and UHC customer service agents.
• A personal benefit account (PBA): the University of California Laboratory’s contributions to the employee’s health benefits are utilized to reimburse the employee for initial out-of-pocket health care expenses. These funds can be used toward deductible costs, coinsurance or other eligible expenses. Unused funds at the end of the year can be rolled over to be used in the future.

Here is one example of how the iPlan can work:

• A Lab employee believes in managing his or her own health care and doesn’t want any limitations on the choice or level of control. The employee is interested in health topics and researches everything on the Internet before seeing a doctor. The employee chooses the iPlan, knowing that he or she will have all of their preventive care covered at 100 percent. If other health-care services are needed, the iPlan pays for the first $750 of the employee’s $1,500 deductible through the personal benefit account. After that, the employee is responsible for the rest of the deductible and is then covered by a PPO-like benefit.

Haire said more information about the plan options will be available at the HealthCare: Pathways to Change and United Healthcare Web sites.

Other Headlines