The major Employee/Non Medicare Health Plan changes effective July 1, 2015 include:
- Harvard Pilgrim Independence Plan and Tufts Health Plan Navigator will become POS plans. Members must designate their PCP with the plan and get referrals to specialists for the highest benefit level.
- Prescription drug copays will increase to $10/$30/$65 retail up to 30-day supply and $25/$75/$165 mail order up to 90-day supply.
- The calendar year deductible will change to $300 (individual) /$600 (two person) /$900 (family)
- All health plans will tier specialists and the copays will increase to $30/$60/$90
- Inpatient hospital copays for the wide network plans will increase to $275/$500/$1,500
- Outpatient surgery copays for most plans will increase to $250
There are a few benefit enhancements:
- The calendar year deductible will transition from a calendar year to a fiscal year. For 2015, it will be a calendar year, for January – June, 2016 a half calendar year, and July, 1, 2016-June 30, 2017 will begin the fiscal year calendar year deductible. This will eliminate the deductible barrier for switching plans at next year’s Annual Enrollment.
- Other ancillary benefits will also transition to the fiscal year (for example, physical and occupational therapy)
- The Flexible Spending Account program for state employees will also move to a fiscal year and follow this same transition schedule.
- For the Dental/Vision plan, new coverage for composite fillings on posterior teeth – covered at 80%
For Medicare Members
- Prescription drug copays will increase to $10/$30/$65 retail up to 30-day supply and $25/$75/$165 mail order up to 90-day supply.
Additional details will be in the GIC Benefit Decision Guides. These will be shipped to agencies, municipalities and retiree/survivor homes beginning April 3. The MBTA health fair is Wednesday April 15th make sure you attend so you can have all your questions answered.
