Heads up for health care plan changes

Don’t ignore that packet on health care benefits that’s about to arrive on your doorstep some time next week. It will tell you the changes in health benefits and costs for 2002-2003. And those changes might affect which plan works best for you.

With Open Enrollment, the annual period for switching plans is just around the corner—April 22 to May 3. “Your health care choices will remain unless you put in a request for a change,” said Vice President for Human Resources Jack Heuer. So it’s time to pay attention to the facts.

And the facts are that nationally, health care costs are on the rise. That means that premium costs are rising, too.

“Our out-of-pocket costs are still 4 percent lower than for labor markets in the Philadelphia area and 2 percent lower than the national average,” said Jack Heuer, Vice President for Human Resources.

Those figures come from a survey of 2,200 health plans—local, regional and national—done by Penn’s benefits consulting firm, Hewitt Associates.

“The benchmarks indicate that we manage our plans well and they remain financially effective in providing excellent benefits to employees,” said Leny Bader, Executive Director of HR and Benefits.

Even with Penn’s strong purchasing power and plan management, however, it has been difficult for the University to avoid the impact of the national market forces in healthcare (“Benefits,” Current, Feb. 21).

Here are some examples of how the changes in benefits will affect participants.

New at PENNCare

The network of doctors for PENNCare participants will grow for 2002-03 to include the doctors who are part of the Independence Blue Cross Personal Choice network. Most doctors in the Philadelphia area belong to that network, and patients who choose to use these doctors will pay lower deductibles than those who choose to use out-of-network doctors.

This means that many doctors who used to be considered out-of-network for the PENNCare plan are going to be in-network.

Single and married PENNCare subscribers will see their premium rise almost $18 and $46 a month respectively. For many, those increases are offset by the wider provider network.

For others, HR suggests considering the UPHS Point-of-Service (POS) Plan, with its lower premiums.

Costs for Plan 100

Aside from cost, the only change to Plan 100, which is available only to employees hired before July 1, 2001, is an increase in the premiums and the annual deductible. The latter rises from $200 to $300 for single participants and from $400 to $600 for families.

The premium rises $51 a month and $134 a month for singles and families respectively.

This is the most expensive plan the University offers and has the biggest dollar jump in premiums.

More mental health benefits

The number of mental health visits available to subscribers under three of the plans the University offers will rise to 60 visits per year from 30 visits in 2001-2002. This change applies to the UPHS POS Plan subscribers and the Keystone and the Aetna US Healthcare HMO subscribers receiving outpatient mental health care from a provider within their plan’s network.

The costs for these three plans also are going up, with the largest increase at $26 a month for families covered by Aetna US Healthcare. Keystone families will pay an additional $8.50 a month and UPHS POS families will pay an additional $10 a month. Increases for singles are at $10, $3.50 and $4, respectively.

These three plans require referrals from primary care physicians for other appointments.

Prescription drug changes

Generic drugs continue to offer a high percentage of savings both at the drugstore and through mail order. Each prescription order now has a minimum cost whether at retail or mail order.

Mail order drugs for ongoing conditions offer further savings over retail as well as the convenience of a 90-day-supply. Brand names without generics will offer the most savings at mail order.

The maximum out-of-pocket drug expense per year rises from $500 to $750 for singles, and from $1,500 to $2,000 for families; these amounts will now include both retail and mail order drugs.

Dental plans hold their own

The changes in dental costs and benefits balance out for the most part.

There’s more benefit money for participants of the MetLife Preferred Dentist Program. The annual maximum is going up from $1,000 to $1,500, beginning July 1, 2002, although orthodontia remains at $1,000. The increase in cost for the programs is $4 and $10 per month for singles and families.

A negligible cost increase of 28 cents for families and $5 per month for singles is what’s in store in the Penn Faculty Practice Plan.

Overall, Penn’s contribution to employee health care is at 82 percent in fiscal year 2002 and 80 percent in fiscal year 2003.

A second study by Hewitt, comparing Penn and its peer Ivy and research institutions, shows that Penn’s contributions are “more generous” vis-á-vis the level of benefits delivered and the inclusion of dental benefits, Heuer and Associate Provost Barbara Lowery reported (Almanac, March 5). The figures add up to what Heuer described as the Benefits staff’s “tremendous job managing our plans. The study also shows that our plans are 7 percent more financially efficient than the national and local average.”


HR offers advice on ways to save

With the rise in costs, I’m thinking of switching from PENNCare. What are my options?
Both the UPHS Point-of-Service (POS) Plan and the two HMOs provide excellent benefits and cost between 65 and 80 percent less than the PENNCare Plan for a single participant. Additionally, the UPHS POS Plan still provides some level of benefits if you go out of the network. If you want to remain with the same physician, you may want to see if he or she participates in the UPHS POS, Keystone or Aetna US Healthcare HMO networks. If so, it will be cost-effective to switch. Just be aware that these plans use the HMO “gatekeeper” approach (whereby your primary care physician must authorize visits to specialists).

To browse a list of the doctors in each plan’s network, go to www.hr.upenn.edu/benefits/medical/doctorsearch.asp.

What’s a Health Care Pre-Tax Expense Account, and can it save me any money?
It can save you from paying income taxes on money set aside in the account for non-covered health expenses. Expenses reimbursable from this account include medical and dental deductibles, co-payments and coinsurance amounts, prescription drug deductibles and vision expenses.

At the end of the plan year, any unspent money is forfeited. For information, see Almanac, Mar. 19.

How can I reduce my prescription drug costs?
This fastest-growing health care-related expense is projected to grow at 20 percent to 30 percent each year over the next several years. That’s why Penn is encouraging employees to purchase through the mail drugs they take on a regular basis. Penn’s plan offers significant discounts for brand names without generics that are filled by mail. In addition, think of how much time you’ll save by not having to drive to the drugstore each month to pick up your prescription. For information on prescription drugs by mail, contact Caremark at 1-800-378-0802 or www.rxrequest.com/upenn.

I’ve got some expensive dental work coming up this year. How do our dental plans’ annual maximums affect me?
The MetLife Plan will cover up to $1,500 worth of eligible dental work, except that orthodontia remains at $1,000. The $1,500 maximum represents a benefit increase of $500 from last year. The Penn Faculty Practice Plan has no annual maximum, but you must receive the treatment in a PFP Plan office.

Got health benefits questions?

Call 1-888-PENNBEN, or go to The Benefits Fair at

- Houston Hall, April 24 and 29, 10 a.m. to 2:30 p.m.

- Alumni Hall, New Bolton Center, April 30, 10 a.m. to 2 p.m., or

www.hr.upenn.edu/benefits

Need a computer for access?

Use a computer in Van Pelt-Dietrich Library Center or at Human Resources, fifth floor, 3401 Walnut St.

Want to know more about mail order prescriptions?

Contact Caremark at 1-800-378-0802, or www.rxrequest.com/upenn

Originally published on April 11, 2002