Princeton Weekly Bulletin October 12, 1998
University alters health care options
By Justin Harmon
Beginning October 19, many Princeton faculty and staff will need to elect a new form of health insurance, as the University alters the array of options it provides.
In January, the indemnity plan administered by Aetna U.S. Healthcare, known as the Princeton Health Care Plan, will be discontinued and replaced by a preferred provider organization (PPO) plan administered by United HealthCare.
While all current employees including those currently enrolled in a health maintenance organization (HMO) plan or the Oxford point-of-service (POS) planwill have the option of switching, employees currently enrolled in the Princeton Health Care Plan will have to confront this choice. The University has lengthened the regular open enrollment period to four weeks, from October 19 to November 13, to allow them time to consider.
If they do nothing, faculty and staff who currently maintain "employee only" coverage in the Princeton Health Care Plan's Standard Plan option (the only form of coverage for which the University currently assesses no monthly premium) will default into a new catastrophic health care plan, which will have no monthly premium but will offer indemnity coverage only after a $4,000 deductible is met.
Faculty and staff with all other types of coverage in the Standard and Premium plan options ("employee and spouse," "employee and family," etc.) will default into the new PPO plan while maintaining the same type of coverage. With the exception of the catastrophic health care plan, all University plans will require the employee to pay a monthly premium.
The PPO plan comprises a network of credentialed service providers, who commit to discounted rates. An individual can receive care from within the network, or go outside the network at a higher cost. When the individual chooses to receive care within the network, there is no paperwork, and the individual makes a $10 copayment for office visits and pays 10 percent of other expenses, such as inpatient hospital care, after a deductible has been met. When the individual receives service outside the network, the PPO plan functions more like an indemnity plan: The individual pays for office visits out of pocket and submits paperwork for reimbursement of 80 percent of the outlay, after the deductible is met.
Unlike the University's POS plan and its various HMO plans, the PPO plan does not require that the member select a primary care physician, and a referral from a primary care physician is not required to receive care from an in-network specialist.
This week, United HealthCare will mail a brochure to all faculty and staff at their home addresses. The brochure will broadly outline the terms of the PPO plan and compare them to those of the other plans that will be available. It will also describe specific terms for prescription coverage, precertifica-tions, ongoing care that spans a transition into the plan, emergency care and coverage while traveling. The Human Resources Office will mail faculty and staff individual statements reflecting their current coverage, as well as instructions on how to enroll in the coverage they want.
Next week's October 19 issue of the Princeton Weekly Bulletin will include a chart comparing specific benefits of the various health care plans, including deductibles, coinsurance limits, life-time maximums, hospital and outpatient coverage, and cost per month to the employee. Accompanying articles will treat such questions as how employees might want to evaluate such matters as the optimal sum to set aside in a Health Benefits Expense Account in light of a decision to change health care plan coverage.
Human Resources has made additional materials available online at the Web page describing the new PPO option (www.princeton.edu/hr/ben/ppohome.htm). Included is a link to the Web page on which United HealthCare provides a searchable database of participating physicians and hospitals (www.provider.uhc.com/princeton).
The provider list is a work in progress, notes Director of Benefits Michele Davis. Both Princeton and United HealthCare wrote to approximately 850 providers recommended by Princeton faculty and staff, inviting them to apply to participate in the new plan. United HealthCare made follow-up calls to physicians' offices, and encouraged them to call Davis for information and assistance. To date, providers who have completed con-tracts with United HealthCare include the 240 primary-care and specialty physicians associated with the Prince-ton Physicians Hospital Organization all of whom have admitting privileges to the Medical Center at Princeton as well as the Princeton Medical Group and other large groups in the areas surrounding Princeton and Yardley, plus 21 of the top 25 hospitals used by enrollees in the Princeton Health Care Plan.
"If employees survey the United HealthCare Web site and don't see the name of a provider they recommended," said Davis, "we invite them to call the doctor and encourage him or her to get in touch with us. Doctors' offices can be overwhelmed with the requirements of the new managed care environment, and it often helps to have the doctors themselves know that their participation in a particular plan matters directly to a client."