October 6, 2003

Health plan changes announced for 2004

By Beth Grubb

As employers nationwide deal with skyrocketing health care and prescription drug costs, Human Resources (HR) enlisted the help of a group of knowledgeable and concerned Emory employees to improve the University’s health care plans for 2004.

The group—made up of faculty, staff and medical representatives from areas such as the Rollins School of Public Health, the Finance Division, Employee Council, the University Senate’s fringe benefits committee and Emory Healthcare—reviewed proposals submitted by major vendors and made recommendations for plan changes.

“We are pleased to announce that, despite a large increase in our health plan cost, we managed to keep employee premium increases at 5 percent or less,” said HR Vice President Alice Miller. “We have also added Blue Cross Blue Shield as our new vendor for EmoryCare and HealthChoice.

“Blue Cross Blue Shield offers extensive local and national networks and an excellent disease management program,” Miller said. “We will be continuously working with them to improve the health of our employees. Aetna will continue to be the vendor for Emory-Choice.”

Adult orthodontia now will be available through the traditional dental plan, and rate increases for all dental plans will be minimal. Employees who enroll in health care coverage are automatically eligible for behavioral health, vision, and prescription drug benefits.

Both EmoryCare and HealthChoice are preferred provider organizations (PPOs) that offer an enhanced three-tier network: The “core” network, which includes providers primarily affiliated with Emory Healthcare; the Blue Cross Blue Shield national network; and out-of-network options for access to any provider. By using the core network, participants get the highest quality of care at the lowest cost.

While EmoryCare and HealthChoice use the same network providers, Health-Choice offers a lower payroll deduction with some higher out-of-pocket costs.

EmoryChoice is a health maintenance organization (HMO) providing core network and Aetna national network options. The amounts of co-pays, coinsurance, deductibles, etc., will vary based on the network option. However, there is no coverage for services provided outside these two networks, and EmoryChoice members are required to select a primary care physician (PCP) who will coordinate all their care.

This year’s Open Enroll-ment Period, during which employees may change their health care plans, will be held Oct. 20–Nov. 7.

“Employees should review the health care plans carefully and base their decision on what is best for their needs, rather than on just the payroll deduction alone,” said Mary Smith, director of benefits for HR. “Once they choose a plan, they cannot change it until the next Open Enrollment Period.

“A great way to help pay for out-of-pocket health care expenses is with a flexible spending account (FSA),” Smith continued. “Employees can reduce their taxes by setting aside money on a pre-tax basis for medical, dental, prescription and vision expenses not covered by insurance. In 2004, FSAs can be used to pay for over-the-counter medicines such as pain relievers, antihistamines, contact lens solutions and cold remedies.”