Health Insurance
|
The College will continue to offer a choice of health plans administered by Anthem Blue Cross Blue Shield of Maine (BCBS) for 2009: HMO Maine and Comp-Care (an indemnity plan). Your current health election (HMO, Comp-Care, or Opt-out) will automatically continue for the 2009 Plan Year, unless you change your election by November 21. Election changes will require completion of a change form. Health Maintenance Organization (HMO) HMO Maine is a health-maintenance organization (HMO) owned by Anthem Blue Cross Blue Shield. HMOs generally emphasize a comprehensive approach to patient health and use a primary care physician to coordinate care. The HMO offers a network of physicians (including more than 50 primary care physicians in the Waterville area) to provide primary care and specialty care to its members. Click here for a HMO Maine Provider's Directory of physicians. The HMO requires that each employee and family member select a primary care physician (PCP). All medical care - routine, specialty, and hospital - must be authorized by the PCP and the plan to be covered by the HMO. By working through the PCP, participants generally receive 100 percent coverage for eligible expenses, less a $20 office visit co-payment. Medical services provided without PCP authorization will not be covered. All inpatient and outpatient services for mental illness or substance abuse also require pre-certification from Behavioral HealthCare. While some physicians will contact Behavioral HealthCare on your behalf, it is your responsibility to obtain authorization from Behavioral HealthCare before services are obtained. To contact HMO Maine, call 1-800-527-7706. Comp Care Comp-Care is a more traditional indemnity plan offered by BCBS. Benefits are provided for eligible medical expenses, subject to annual deductibles and co-insurance payments. Employees and their dependents seek medical services from physicians and other providers of their choice - hospital stays and surgical procedures are, however, subject to utilization review. Comp-Care has a deductible of $250 per person. Once the deductible has been satisfied, the participant is responsible for 20 percent of the next $5,000 in eligible expenses - the co-insurance amount - and BCBS is responsible for 80 percent. BCBS pays 100 percent of eligible expenses over $5,250. The combination of the deductible and co-insurance is the maximum annual out-of-pocket expense ($250 + $1000 = $1,250). The family deductible is $250 per person up to a maximum of $500 per year. The family out-of-pocket maximum is $1,250 per person, up to $2,500 per year. Most medical providers in Maine have participation contracts with BCBS. The providers agree to submit claim forms directly to BCBS and to accept BCBS allowances as the basis for the maximum payment. Participants receiving services from non-BCBS providers will be responsible for charges over the BCBS allowances and will receive benefit payments reduced by 20 percent. One fully-completed claim form is required per illness per physician each year. NOTE: The address to send your claim forms to is: Anthem Blue Cross and Blue Shield Separate benefit amounts and pre-authorization procedures may apply for home health care, hospice care, chiropractic care, substance abuse, and treatment of mental and nervous illness. Opt-Out of Coverage Employees with other coverage may elect to opt out of the health insurance plan and receive a one-time payment of $300 each January, subject to evidence of other coverage. The opt-out payment is subject to payroll taxes. Initial opt-out may be prorated for partial year, if applicable. |