State Employee's

nezwee · February 2012

Did you see the proposed changes to our health benefits?

Good stuff, guess we can figure out where the COLA will come from.

linzee · February 2012

I'm so confused with the new benefits. We have the PPO. Please explain it to me. I know copay is increasing but what about this 90% thing

nezwee · February 2012

You know how pregnancy is covered 100% except for the first copay? Well now we'd have to pay 10% of the hospital bill.

Here is a link we were given that explains it in terms of surgery. http://dbm.maryland.gov/benefits/Documents/BenefitPlanChanges2012.pdf

weezie825 · February 2012

I am not a state employee, but it sounds like your plan will now have co-insurance. Basically it means that you'll have to pay your co-pay plus a certain percentage of the billed charges.

tspring82 · February 2012

weezie825:
I am not a state employee, but it sounds like your plan will now have co-insurance. Basically it means that you'll have to pay your co-pay plus a certain percentage of the billed charges.

Exactly...ppo and pos will have 10% coins but that's for your major services. You'll still be able to go to the doc and just pay your copay for your PCP/Specialists. But if you have to have any services done that are nonroutine, you'll pay 10% of the bill. Once you pay 1000 bucks out of pocket though, the plan will pay at 100% for the rest of the plan year. We will still have $15 PCP copays but now $30 for specialists. The cost of ee share for ER care will increase too. If you guys have PPO and have never ever gone out of network (OON) in PPO, consider the EPO plan. They use the identical doc network as PPO but you just don't have OON coverage. I love it because it's a national network and I don't have to worry about paying out of pocket if I get sick on vacation because I know I'll always be able to find a provider. Plus cost wise it's way cheaper. Aetna and UHF require you to designate a PCP but no referrals are needed. Carefirst doesn't require a PCP or referrals. I am a little ticked that they approved Express Scripts next year. I know the bid occurred before the whole Walgreens fiasco but it's incredibly annoying that we're not going to be able to use Walgreens...especially since they are literally building a new one across the street from where we live.

Stef611 · February 2012

So we have BCBS as my hubby is teacher and we were told this would no longer be available next year ??

Do any of you have CIGNA - do you like it - all our docs are in it but just wanted to get opinions as we will have to change

Thanks

tspring82 · February 2012

Stef611:

So we have BCBS as my hubby is teacher and we were told this would no longer be available next year ??

Do any of you have CIGNA - do you like it - all our docs are in it but just wanted to get opinions as we will have to change

Thanks

The Cities and Counties maintain their own insurance plans...they don't fall under the State so I don't think your DH will fall under the changes above. What area does he teach in?

mdharris29 · February 2012

I work for BCPS and it has nothig to do with this. BCBS is being phased out. I switched to Cingna in January and love it. I pay less per paycheck, less in co-pays, and it has no co-insurance, unlike BCBS. All of my doctors have been in the plan and I have had great customer service.

MereFM99 · February 2012

I haven't received any information about changes, so thanks for the heads up. Besides the powerpoint, is there a list somewhere of all of the changes that are being made, or does the powerpoint cover everything?

nezwee · February 2012

I wasn't aware of the change over to express scripts like Trish talked about above, but these are the only changes we've been notified of. I'm sure we'll get an increase in what we pay.

summer08bride · February 2012

nezwee:
I wasn't aware of the change over to express scripts like Trish talked about above, but these are the only changes we've been notified of. I'm sure we'll get an increase in what we pay.

I haven't heard anything about this. I have BCBS and I love them. Guess I need to go do some research.

linzee · February 2012

Is the EPO like an HMO?

I hate insurance.

tspring82 · February 2012

Your OE Guide will probably be mailed out in early April. The dates for OE are April 17th-May1st with a correction period May 9-16th.

EPO's replaced HMOs 3 years ago. They're way better in the sense that they give you a national network of providers and you don't have to get referrals. So with the national network, you have the same providers as the PPO plans because they use the idential network. In otherwords, if your current doc accepts the PPO insurance, then your doc automatically accepts the EPO.

linzee · February 2012

Hmm. I've always had the PPO because I hate referrals and i am an expert self diagnoser. The EPO is so much cheaper too.

I may be making a switch.

I don't anticipate many procedures and the family cap is fairly low so at the most we would pay $2000 per year for co-insurance.

I'll need to up the amount i put in my flexible spending account for sure.

nezwee · February 2012

tspring82:
Your OE Guide will probably be mailed out in early April. The dates for OE are April 17th-May1st with a correction period May 9-16th.

EPO's replaced HMOs 3 years ago. They're way better in the sense that they give you a national network of providers and you don't have to get referrals. So with the national network, you have the same providers as the PPO plans because they use the idential network. In otherwords, if your current doc accepts the PPO insurance, then your doc automatically accepts the EPO.

Are you sure about this? I was going to switch to the EPO last year but didn't cause my PCP didn't come up in the EPO listing, but came up in the PPO listing.

So many acronyms, you'd think we were the feds!

tspring82 · February 2012

Is s/he in a practice? Sometimes when they are the practice bills under another docs name if your doc isn't listed as accepting the insurance. When we went through training when the EPOs came out, that's what the vendors told us...that any PPO doc will take the EPO insurance because it's the same network.

nezwee · February 2012

Not to my knowledge. He owns the practice. Guess I'll have to make some phone calls once the OE paperwork comes out.

MereFM99 · February 2012

I have the CareFirst EPO and they (CF) told me that when I'm looking for a participating provider, I should use the PPO network on their website because both plans use the same providers. So if you generally stay in network with the PPO, it would save a lot of $ to switch to the EPO. I love it!

Stef611 · February 2012

tspring82:
Stef611:

So we have BCBS as my hubby is teacher and we were told this would no longer be available next year ??

Do any of you have CIGNA - do you like it - all our docs are in it but just wanted to get opinions as we will have to change

Thanks

The Cities and Counties maintain their own insurance plans...they don't fall under the State so I don't think your DH will fall under the changes above. What area does he teach in?

He is in baltimore county - thanks I just realized this from your post !

Stef611 · February 2012

mdharris29:
I work for BCPS and it has nothig to do with this. BCBS is being phased out. I switched to Cingna in January and love it. I pay less per paycheck, less in co-pays, and it has no co-insurance, unlike BCBS. All of my doctors have been in the plan and I have had great customer service.

Thanks so much for the info- we actually signed up for BCBS this year but now he told me we have 30 days to switch since they didnt explain enough about the new BCBS copays , etc . Oy this insurance stuff never ends

mdharris29 · February 2012

Yea and there is some drama with doctors no longer being apart of the plan. I did not want to switch, but everyone that already had were talking about how great it was. I have been very happy with the switch. I will have 100% of my pregnancy covered where my last child I had to pay $500. It is does cover a lot.

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