Conference 7.286::digital

    I live in Leominster, and the package I got states my individual cost
    per week would be $7.72 and Family cost per week would be $28.43 for
    the HCHP.  I am currently in CMHC, and probably won't change, but would
    be interested to know how the Leominster HCHP rates fit with other
    communities...what do Clinton & Northboro rates look like?
    
    Mark
    

    Clinton is $7.72 for HCHP and Northboro is $2.43 for the same plan.

    Are those the individual or family rates?   I'm curious about this too,
    since the cost to me (living in Gardner) of all the HMOs is greater
    than the DEC Plan 2.   Gardner isn't in Healthnet area yet.  Could
    others who have Tufts please post their charges where you live?
    It seems to me the HMO's are a premium out there.
    
    Here's the costs in Gardner:
    
    Plan			Individual		Family
    Tufts			9.25			31.69
    CMHC			8.77			25.82
    Montachusett (Blue Cross)	7.33			22.76
    DEC #1			-0-			 8.50
    DEC #2			4.50			20.50

   If you continue your dialogue with Mr. Brady, you might also want to ask
    him what would happen if you voluntarily moved from Clinton to Nor'b'ro
    during the year.  Would your costs go down?  If you moved the other way,
    would your costs go up?  Would you have an opportunity to re-enroll at
    the time you voluntarily moved?

    I asked this in one of the meetings (sales presentations?), and was not
    given an answer.  Something to the effect of "we have a memo in to
    Corporate to find out about that..."

    Who is this guy, Corporate, anyway?

    Broader question:  Why didn't "Corporate" think through these details
    before implementing the program?  Surely it should have occurred to
    _someone_ that people do move, even when they're not part of a Digital
    relocation...

    
    
    	It was my understanding from the meeting I was in that Digital 
    	is not running this Healthnet thing rather the HMOs have targetted
    	specific areas to test it before implementing it on wider
    	scale.
    
    	So the HMOs *not* Digital planned and implemented this whole thing.
    	
    	We were told to send mail to our personnel reps who would then forward 
    	it to the different digital liasons and their respective HMOs inorder 
    	to get the inequities resolved.
    
    	Otherwise it'll be at least a year before everyone is offerred the
    	healthnet/reduced basic-HMO package.
    
    
    						Mike
    						----

Here is the response I got from "Corporate Benefits" via my PSA.
I had asked about the seeming geographic descrimination between
inside and outside the Colorado Digital HealthNet area.

---------------------------------------------------------------------

1.  The employee's understanding of the rates for the Digital 
Medical Plans being different for employees living in or out of a 
HealthNet area is correct.  They are different.  

The costs for indemnity plan coverage are skyrocketing for both 
employees and the company.  The addition of HealthNet gives 
employees an alternative opportunity to receive quality medical 
care for an affordable price.  In areas where we have been able 
to offer HealthNet, we have based the cost sharing on managed 
care, and the rates reflect that basis.  Without this additional 
choice, everyone choosing the indemity plans would have very high 
payroll deductions with no alternative.  In non-HealthNet areas, 
it would not be fair to use the same basis of cost sharing, since 
those employees do not have the alternative choice.  This is in 
no way discriminatory to either HealthNet or non-HealthNet 
employees, since the choices are different for them. 

If your employee feels it is appropriate to seek legal action, he 
is free to do so.  

2.  No one likes to see payroll deductions go up, but the reality 
is that as costs continue to rise rapidly, employees will see 
their deductions rise as well.

Insurance costs for a group are determined by the usage of the 
group, not by one individual.  Your employee and his family might 
have had small medical expenses this year, but they may have huge 
expenses next year.  If you think of the parallel of car 
insurance or home owner's insurance, it might be easier to 
explain.  I have to pay auto insurance every year, and I have 
never had a claim.  That doesn't mean that my own premium won't 
increase if the cost for providing auto insurance goes up.  

Digital has determined that HMO's are able to control costs by 
managing a patient's care appropriately.  We are supporting the 
managed care concept for the long-term future, not just as a 
short-term fix.  The HMO's chosen to be included in HealthNet 
were carefully chosen as quality providers.

----------------------------------------------------------------------

I feel that the above statements reflect a complete lack of understanding
and disregard of the concerns of myself and other employees.

I haven't decided yet whether to take up the gauntlet of legal action
thrown down by the above anonymous spokesman from "Corporate Benefits".

					Dick

    Marlboro:
    Choice              Individual       Family
    ===========================================
    HEALTHNET/HCHP         3.43           19.02
    HEALTHNET/Fallon       1.00            9.05
    Lahey/Blue Cross       1.71            8.36
    Tufts                  3.72           17.28
    Pilgrim                2.96           10.75
    Bay State              3.88           14.79
    Harvard CHP            2.43           14.02
    Fallon CHP             0.00            4.05
    DMP1                   5.50           21.75     (Ouch!
    DMP2                  10.25           34.00            Ouch! Ouch!)
    
Any errros were unintentional and author is not liable for it.

    Leominster:
    
    Provider                Individual         Family
    ==================================================
    Central Mass (CMHC)       $8.77             $25.82
    Harvard (HCHP)            $7.72             $28.43
    Tufts (TAHP)              $9.25             $31.69
    Montachusett (MHP)        $7.33             $22.76
    Digital (DMP1)            $0.00             $ 8.50
    Digital (DMP2)            $4.50             $20.50
    
    Mark
    

    And for at least this upcoming year could once control how much
    they pay for insurance by quickly changing their mailing address
    so their mailing address is in a cheaper area?  I believe one is
    entitled to have a mailing address anywhere they desire.  For the
    person in Clinton what would happen if they got a PO Box in Northboro?
    If one could juggle their rates like this then the system is broken.
    
    

>                  <<< Note 1308.5 by OOES::ULTRA::SEKURSKI >>>
>                     -< HMOs not Digital running this. >-
>    	It was my understanding from the meeting I was in that Digital 
>    	is not running this Healthnet thing rather the HMOs have targetted
>    	specific areas to test it before implementing it on wider
>    	scale.
>    
>    	So the HMOs *not* Digital planned and implemented this whole thing.
    
    
	Digital identified which towns Healthnet would be offered in
    according to the Fallon rep who visited our site.   

Don't know why mine differs so much at points with .7:
    
Marlboro:

	Provider    	            	Individual         Family
	==========================================================
	HealthNet - Harvard (HCHP)	2.43		14.02
	HealthNet - Fallon		1.00		9.05
	Fallon				0.00		4.05
	Tufts (TAHP)            	3.72		17.28  
	Central Mass (CMHC)     	7.06		24.42
	Bay State	       		3.88		14.79
	Pilgrim 	       		2.69		10.75
	Harvard (HCHP)         		2.43		14.02
	Digital (DMP1)         	 	5.50		21.75
	Digital (DMP2)         	 	10.25		34.00


Steve                                                            

Ashby, MA
Ashby is not a HEALTHNET area. The choices are limited in my opinion.


	Provider    	            	Individual         Family
	==========================================================
	Central Mass (CMHC)     	8.77		25.82
	Bay State	       		9.17		29.20
	Tufts				9.25		31.69
	Montachusett			7.33		22.76
	Digital (DMP1)         	 	ZERO		 8.50
	Digital (DMP2)         	 	4.50		20.50


Rick                                                            

    >
    > Fallon                          0.00            4.05
    >
    
    This is way cheaper than what I was quoted in my open enrollment
    booklet ($3.05 individual, $14.06 family). I live in either Shirley
    or Lancaster, depending on whether you are speaking to my mailman
    or tax collector. Could somebody living in Shirley/Lancaster please
    post their Fallon rates so that I know I am not being socked for
    putting down the wrong address.

    Hudson is the same at Marlboro.  See .11 for the rates.

    
    
    
    	I was wrong in my earlier reply Digital did plan this and very
    	badly.....
    
    	My yearly cost will go up $500.00 more per year with Fallon than	
    	the person a few cubes away for the *same coverage* at the *same
    	facility* with the *same doctor*. I've heard of other people who will 
    	see differences of up to $800.00 this year.
    
    	This is not an insignificant increase....
    
    	$500.00 could take care of:
    
    		- 1 month child care
    		- 10 weeks of groceries
    		- more than half my Mass. car insurance rate		  
    		- etc.
    
    							Mike
    							----
    							

Just as an aside, for comparison of weekly cost:

Harvard Community Health Plan (HMO only, without Healthnet):

DEC, in the low-cost areas:	Individual:	$ 2.43
				Family:		$14.02

DEC, in the high-cost areas:	Individual:	$ 7.72
				Family:		$28.43

Man-off-the-street:		Individual:	$35.30
  (does not include		Couple:		$70.60
   prescriptions)		Family:		$91.15

Since DEC will pay you $20/week if you opt out, I would suspect DEC is paying
somewhere between $27.72 and $35.50 per week to HCHP for individual employees
and somewhere between $48.43 and $91.15 for employees with 2 or more dependents.

/john

    Colorado Springs, Co
    
    
    				Individual	Family
    	HealthNet Program	$ 2.30		13.01
    	Lincoln			$ 1.30		 8.01
    	HMO Colorado		$ 2.94		10.24
    	Health Network Co.	$ 1.17		10.41
    	DMP #1			$ 5.50		21.75
    	DMP #2			$10.25		34.00
    
    Woodland Park .LT. 15 miles away
    
    	DMP #1			unk		$ 8.50
    
    Pissed and enjoying it less.
    	Greg
    

    
    
    	My wife and I both work for DEC and we just had a baby. 
    
    	We were planning on her opting out and me covering both
    	of them under the family plan.
    
    	According to her PSA you could only choose the opt out 
    	option back in December. ( Not having the old mail concerning
    	this I don't remember whether this is what it actually said
    	or not but I do seem to remember some discussion about a change in 
    	family status .... )
    
    	Furthermore even though she's now covered under my insurance
    	she's forced to continue to pay the single rate every week.
    
    	Somehow this doesn't sound right.....
    
    	I've sent mail off to my personnel rep asking for a confirmation
    	and explanation of the above but haven't heard back yet.
    
    	Has anyone else been in this position before ?
    
    						Mike
    						----
    	

    re .18
    
    I remeber a discussion which went something like.  If I had opted out
    due to my spouse having insurance which covered both of us, then she
    lost the insurance due to a change in her employment status. I could
    opt back in.
    
    I do not remember anyone bringing up the option of opting out due
    to a child birth or other status change which would force/allow me
    to pick up family coverage when I previously only had single coverage.
    
    The opt/out provision was intended to be a yearly decision much like
    the dependant care and optional medical payments provisions.  Status
    changes do not allow you to increase/decrease your dependant care
    deduction, so I can see possible argument exists for not allowing your
    wife to opt out.  But she could have been reinstated in, if something
    had happended to you which made it necessary to let her back in!!
    
    I would push this one up to the group personnel manager or to benefits
    and compensation committee before I would let it go.  BTW, why didn't
    you change to the family plan and have her opt/out in November, knowing
    she was pregnant!  I would have discussed this with them back then to
    make sure I knew my options.
    
    

    it was explained to us that ONLY a change in employment or marital
    status would be sufficient to change the insurance.  they will have a
    yearly "open enrollment" period for everyone else.
    
    i'd say that if you and your wife were married when the enrollment
    period was over last year, (you knew she was pregnant then, didn't
    you?), and you were both THEN employees of DEC, and you still are, then
    you will have to (or should) wait until the next open enrollment.  I am
    quite sure a change in dependants is NOT reason to make an exception.
    
    tony

    My husband's open enrollment period is different from mine. As of 
    May 1 I am covered by his Bay State policy, but I must maintain my 
    HealthNET until December. There's no other way for us to handle it
    because of the date discrepancy.
    
    Linda

    Before OPT-OUT gained you any money... I exitted the Health plan in the
    middle of the year. My wife's employer picked up more of the tab than
    DEC if she chose Dependant coverage. Sure enough, now that you get a
    rebate for OPTing OUT Her plan cost's more and is in danger of
    disappearing so I'm back covering us through DEC.
    
    
    But...There is no way they can stop you from chosing NO coverage for
    one person. You might not get any money back until the next open
    enrollment but You shouldn't be charged for the one who drops coverage.
    I did have to sign something saying that I realized that I would have
    NO COVERAGE and could not get in until the next open enrollment.
    
    Pasco
    

    
    
    re .18 and .19
    
    
    	Back when they were sending out PSAs to talk about the changes in 
    	health coverage she did ask that exact question and was told by 
    	the particular person giving the talk that having a baby is a
    	change in family status so yes she was eligible for opt out....
    
    	Since then her group has reorged *and* the supporting personnel
    	group has also reorgged now a differnet interpretation is being 
    	rendered. 
    
    	Since she had already fielded that question with her PSA back in
    	early December and was told it was OK to wait we did, and I didn't
    	pursue the matter.
    
    	I'm pursuing it now though....
    
    re.20
    
    	Right. That's what I thought. Yeah you wouldn't have any personal
    	coverage but you would still be covered under my family plan.	
    
    	This seems to be a classic case of the left hand not knowing what
    	the right hand is doing.
    
    							Mike
    							----
    	
    
    	

    This is from the 1988 Benefits book:
    
    "If you don't have dependent coverage and wish to add a new dependent,
    you need to fill out the GIA form.  Again, you have 31 days from the
    date of marriage, birth or adoption to enroll this new dependent in the
    plan without providing evidence of insurability.  (Only the newly
    eligible dependent can be added at this time without going through the
    evidence of insurability process.)"
    
    Page 1.9
    
    In other words, you should be able to add your baby to your health
    insurance plan.  As for dropping your wife's coverage, I don't think
    that is possible.
    

    
    While we're on the subject of DEC spouses...
    
    When we decided at open enrollment time that one of us should opt
    out, we didn't really think it would matter which one got the
    Health Care Reimbursement Account and which one of us opted out, 
    but just today we found out why it matters...
    
    I opted out and my wife added me to her HMO and also chose the HCRA.
    Since we are both on the same 'policy' for the HMO, whenever either 
    one of us has expenses beyond that covered by the HMO, those expenses 
    can be paid with the HCRA. But, we each have separate dental policies, 
    so when my wife has dental costs beyond those covered by the dental 
    plan she can pay them with the HCRA; unfortunately, I cannot do that 
    because I am not a dependent on her dental policy.
    
    The even more interesting part is that if, for example, we both get
    new eyeglasses which are not covered by any policy at all, we can both
    use the money from the HCRA.
    
    I understand, now, the reasoning why it works this way - basically
    because I am a dependent on her HMO (and we pay for that) and I am
    not a dependent on her dental (it would cost me $2.25/week to become
    a dependent there), but we never realized this at open enrollment time.
    
    Maybe this was obvious to others at open enrollment time, but we 
    certainly did not realize that whichever one of us had the expected
    greater uncovered dental costs should have opened the HCRA. 
    I guess now we know...
    
    It just seems kind of strange to me that the only difference between
    being able to use the HCRA more or less, is that it is in her name 
    rather than mine.
                
    

Now wait a minute....

Though not _exactly_ the same situation, I was explicitly told by my PSA
that I could drop my dependent coverage at any time -- a change of family
status was only required if you wanted to _add_ coverage.

My wife's open enrollment period is from now until 10 May.  With no children,
it makes more sense for each of us to take our own single coverage.  I'm
going to be really annoyed if I was given incorrect information.

/john

    are you surprized that YOUR PSA tells you one thing and MINE tells me
    another?

    I'd just LOVE to get on board one of the HMO's I've heard/read about
    thru DEC's new plans...
    
    But, I am REQUIRED  to select DMP1 OR DMP2.  Because my dependant kids
    live in another state, and MY HMO couldn't be THEIR HMO.  And DEC can't
    find a way to reconcile this little problem.  A lot of us Non Custodial
    Parent's are plagued by this.  The result is that our insurance cost's
    are higher than they have to be.
    
    I don't mean for this to sound like a wailing cry for symmpathy...
    because I'm glad to be able to provide SOME insurance for the kids, but,
    it points to another "inequity".
    
    tony

    
    
    
    	My PSA did some homework surrounding all this stuff and right
    	there in black and white somewhere in the Policies and Procedures
    	manual it's spelled out that if two DEC employees are married
    	and they have a baby.
    
    	  - One of the pair can drop their independant coverage
    	    and be covered under the others family plan
    
    	  - The person dropping their individual health care plan
    	    is then eligible for opt-out
    
    	This must all be done within 31 days after the person comes
    	back to work.
    
    	After all this my PSA called my wife's PSA and everything has
    	been straightened out.
    
    
    						Mike
    						----
    

    RE: .25

    > can be paid with the HCRA. But, we each have separate dental policies, 
    > so when my wife has dental costs beyond those covered by the dental 
    > plan she can pay them with the HCRA; unfortunately, I cannot do that 
    > because I am not a dependent on her dental policy.

    I think you might be confusing the "automatic" reimbursement feature of
    HCRA with "coverage".  According to the mailing I just got, if you have
    HCRA and file a Digital Dental Plan claim, any charges over the amount
    covered will be automatically paid from your HCRA account; one does not
    have to mail in a separate HCRA form for the difference.  If you are
    covered by your own dental plan, they can't automatically pay from your
    wife's HCRA account, but you can still file a HCRA form for the difference.

    My wife is a Digital employee.  I added dependent dental last
    enrollment period (for our kids).  When I asked, I was told that my
    wife should still file claims under her own individual employee
    coverage (you cannot "opt-out" of dental) and that I would have to file
    a HCRA form to get back the uncovered amount. 
    
    Steve

On a slightly different track... Just found out the hard way that drugs
prescribed by a dentist are *not* covered by JH dental if you opted out of the
JH medical plan for an HMO (i.e. loss of PCS card)... Same is true for any other
medical professional prescribing drugs who is not associated with the HMO e.g.
opthmalogist.  (My PSA was surprized too!).

re: 1308.31                 Health Plan Inequities                     31 of 31
>--------------------------------------------------------------------------------
>On a slightly different track... Just found out the hard way that drugs
>prescribed by a dentist are *not* covered by JH dental if you opted out of the
>JH medical plan for an HMO (i.e. loss of PCS card)... Same is true for any other
>medical professional prescribing drugs who is not associated with the HMO e.g.
>opthmalogist.  (My PSA was surprized too!).

    I'm not sure if this is true all around, but my son (17 1/2 ) was
    having tooth problems. The Dentist called our HMO (Fallon Clinic),
    and whomever they talked too must have been impressed because the HMO 
    provided the drugs (Motrin and 'penicillin') for the usual co-pay.
    
    _be
    

Re:    <<< Note 1308.32 by AHIKER::EARLY "Bob Early, Digital Services" >>>

>			The Dentist called our HMO (Fallon Clinic),
>    and whomever they talked too must have been impressed because the HMO 
>    provided the drugs (Motrin and 'penicillin') for the usual co-pay.
    
The same is essentially true in our HMO (Health Network in Colorado Springs).  
They seem to cover any drug prescribed by a non-HMO doctor (including Dentists)
as long as they are contacted in advance for approval.

So check with your (.31) HMO and you may have coverage there.  If not, you 
probably chose the wrong HMO  :-(

-  David