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Editor's note: As the Laboratory continues planning for open enrollment in November and a new health-care plan provider beginning in January 2004, the Daily Newsbulletin will publish news stories about the various new plans being offered. The Preferred Provider Organization, or PPO plan, is one of the new plans being offered by United Healthcare. Thursday's Daily Newsbulletin will discuss in detail a third plan option, which will be available to active Laboratory employees only. Blue Cross Blue Shield New Mexico will continue as the Lab's health-care provider through Dec. 31.

Options PPO similar to point of service plan

The new Preferred Provider Organization, or PPO plan through United Healthcare, the Lab's new health-care provider in 2004, is similar to the Point of Service Plan (POS) now available through Blue Cross Blue Shield New Mexico.

Both active University of California Lab employees and retirees are eligible to sign up for the Options PPO plan, said Sandy Haire of Benefits and Employment Services (HR-B).

The Options PPO plan design is similar to the POS plan, but is now split into two parts with separate rate structures. The Options PPO New Mexico is for employees who live in New Mexico and want more choice in providers than United Healthcare's EPO plan provides.

Options PPO National/Out of Area is for employees who live outside of New Mexico or in areas outside of the United Healthcare service area or abroad. The Options PPO plans offer 90 percent, 10 percent co-insurance if employees/retirees select an in-network provider and 60/40 co-insurance if they select a doctor/provider who is not in the PPO network.

The Options PPO in-network coverage has a $250 deductible per individual and $750 deductible per family. Out of pocket limits are $3,000 per individual and $9,000 per family. After an employee/retiree reaches the out of pocket limit, the plan will cover procedures at 100 percent. The Options PPO out-of-network coverage has an individual out of pocket limit of $6,000 and a family deductible of $18,000.

All plan deductibles, out of pocket limits and co-payments are the same as Blue Cross Blue Shield New Mexico's Point of Service plan, Haire said. Since the United Healthcare PPO network and EPO networks in New Mexico are very similar, the only real difference between the EPO and PPO for New Mexico residents is the option to go to physicians who are not in the United Healthcare network, she explained. For Lab employees who live outside the United Healthcare service area or abroad, this is the only plan available unless you live in Nevada or the Washington D.C. tri-city area. Those employees will continue to have other plans such as PacifiCare of Nevada and Kaiser Permanente Mid-Atlantic for Washington, D.C. employees and retirees, along with the new Select EPO plan.

Haire said in-network doctor's visits have a $20 co-payment with additional charges for such procedures as x-rays, blood tests, MRI's and other lab work paid at 90 percent /10 percent co-insurance once the deductible is met. Well baby care is covered at 100 percent up to age 2 years. This includes all immunizations required.

Additional benefits available to Lab employees include hearing aids, which are covered at 50 percent or a maximum of $2,000 per ear in a period of 36 months; surgery for the morbidly obese; 20 visits each for physical therapy, occupational therapy and speech therapy; and coverage for Christian Science practitioners. Chiropractors and acupuncturists are covered as they have been previously. Chiropractors have to be members of the American Chiropractic network and acupuncturists must be licensed, Haire added.

Prescription drugs

The new provider for prescription drugs is Medco.

Retail prescription drugs - One co-payment for up to a 31-day supply during each one-month period. Note: The present prescription plan provides a 30-day supply.

• Generic $15 co-payment
• Preferred brand $30 co-payment
• Non-preferred brand $45 co-payment.

Mail-order prescription drugs - One co-payment for up to a 31-day supply. Two co-payments for a 32-90-day supply. Note: The present prescription plan provides a 30-day supply.

• Generic two co-payments or $30
• Preferred Brand two co-payments or $60
• Non Preferred Brand two co-payments or $90.

If a member or doctor requests a brand-name drug when a generic equivalent is available, members pay generic co-payment plus cost difference between the brand name and generic. The member pays the cost difference between selecting a brand-name drug over an available generic drug.

More information about plan options for 2004 is available at the HealthCare: Pathways to Change Web site. The Pathways Web site also has a link to United Healthcare's Los Alamos Web page.

-- Steve Sandoval

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