SPOTLIGHT ON BENEFITS April 2018
The Office of Employee Benefits and Risk Management is pleased to provide monthly messaging about the many benefit options and features within the BPS employee benefits program, as well as important reminders. This effort is to help inform/remind plan participants of what’s available and how to get the “biggest bang for their benefit buck.”
The BPS Health Plan is Self-Insured: What Does That Mean?
Rather than pay premiums to “some giant insurance company” to cover our claims (medical + Rx), BPS’s health plan claims are actually paid by enrolled employees, retirees, and the School Board. You see, each of these groups contributes to a pool of funds (called the Trust Fund) and it’s from this Fund that health plan claims are paid. Therefore, our “insurer” is really us and we use a Third Party Administrator (TPA) that gives us access to a nationwide network of health care providers (with negotiated pricing), and processes all our claims. Currently, our TPA is CIGNA.
Because the BPS Trust Fund (our money) pays the claims for thousands of health plan members, it’s important that each member:
is a wise consumer of health care services and thinks about spending health care dollars as if they were their own – because, really, they are.
strives to achieve and maintain good health. The bottom line is that every dollar saved on health care spending is a dollar that can be spent elsewhere in the district, such as in classrooms or for salary increases or additional benefits.
How to Be a Wise Consumer of Health Care Services
Your doctor has just written you a prescription for a colonoscopy and recommended you use the local hospital for the procedure; your neighbor endorsed his cousin, Dr. I. Dunno, to do it. But are either the best choice? How would you know? Where do you go for answers? Don’t worry! All the information you’d need to make an informed decision can be found either by calling Cigna – 800-244-6224 – or by going to www.mycigna.com. On their website, Cigna offers all kinds of information and tools to help you shop for providers with the best pricing and outcomes for your needed procedure. Now, about that colonoscopy, here’s an example: For zip code 32955, mycigna.com includes the following:
5 providers with a cost of $722;
7 providers with a cost around $1,350
2 providers showing a $1,554 cost
In addition to looking at the providers’ locations and costs, you’ll also want to check their credentials and what quality ratings and/or recognitions they’ve earned. Those with the Cigna Care Designation symbol are providers who have met Cigna’s high-quality and cost-efficient standards. Also, don’t forget that using IN-network providers is the best way to save yourself, and the BPS plan, money. That’s because Cigna negotiates discounts on what their network providers charge AND, if applicable, the coinsurance amount you pay for IN-network providers is 20%. If you use nonnetwork providers, the coinsurance amount you’d pay is 40%.
REMINDER: Nov. 15, 2018 is the deadline for enrolled employees and covered spouses to complete a biometric screening AND a Health Assessment in order to earn a reduced In-network plan deductible for the 2019 plan year.