Frequently Asked Questions For Medical Plan Changes
Q. Will there be an increase in my benefit premiums for 2016?
A. Yes. There will be an increase to lay employee premiums, clergy blended rate and the amount of clergy payroll deduction in 2016.The benefit plan continues to provide a comprehensive, quality medical insurance plan for participants and their families without disruption of network providers.
Q. The Choice Plus plan mentions co-insurance. What is the difference between co-insurance and co-payment?
A. Co-insurance is the percentage of covered medical expenses you must pay in conjunction with the percentage paid by United Health Care. These amounts together are called co-insurance because you (the member) and United Health Care (the insurance company) share the cost. A co-payment is the charge you are required to pay for certain services - Usually a set dollar amount. However, in 2016 the plan will only have a co-insurance after satisfying the deductible.
Q. Do I have to meet a deductible before the plan pays any benefits?
A. Yes. In 2016 you must meet your deductible before the plan begins to pay any benefits. For those enrolled in the family plan, the deductible is cumulative. One person can satisfy the family deductible or a combination of family members may satisfy the family deductible. Under the family plan, there will no longer be an individual deductible or individual maximum out-of-pocket. Therefore, the $3,000 family deductible must be satisfied before the plan begins to pay at the 80% co-insurance.
Q. Do I have to meet a deductible for prescription drugs in 2016?
A. Yes. The prescription drugs are also subject to the same $1,500 individual deductible or the $3,000 family deductible before the plan begins to pay at the 80% co-insurance.
Q. Will I have the option of the mail order for prescription drugs in 2016?
A. Yes. We will continue to have a mail order option with the new plan. The member will be responsible for the full contracted rate for their medications until they satisfy their deductible; then the plan will pay the 80% co-insurance. There will no longer be a co-payment for pharmacy. You will still be able to obtain a 90-day fill on medications but you will pay for all 3 months. You will no longer receive the third month free of charge.