FAQs for 2010 Medical Plan Changes and Open Enrollment
The FAQs will be continually updated as more information becomes available.The FAQs listed below detail the following changes and employee responsibilities:
Medical Plan Changes
- Why are we changing medical plans to Blue Cross Blue Shield of New Mexico?
- Although United Healthcare has provided quality service for our employees for several years, BCBS of NM represents a significant overall lower cost to the plan and, in the majority of cases, a savings for LANS employees (lower premiums). BCBS of NM also offers a larger nationwide provider network and a local account administration, claims processing, and member services team, with a focus on local customer service, including one-on-one lobby service in the BCBS of NM Albuquerque service facility. Our account and member support teams will have first-hand knowledge and experience dealing with the issues and needs that arise here in Northern New Mexico.
- Will the plans administered by Blue Cross Blue Shield of New Mexico be different than those provided by United Healthcare and Anthem Blue Cross?
- Wherever possible, the existing benefit plans were duplicated with minimal change. BCBS of NM will offer most of the same benefit coverage as our current EPO (Exclusive Provider Organization), PPO (Preferred Provider Organization), and Definity plans. Detailed summary and comparison charts will be posted as soon as they will be available.
- Which medical plans will I have to choose from? Will I have the same number of options?
- We have removed the zip-code eligibility restrictions from our plan design. This means that no matter where you live, you will now be eligible for all of our medical plans. The plan offerings for 2010 will be:
- EPO National – replaces United Healthcare’s (UHC’s) EPO
- PPO National – replaces UHC’s Options PPO, PPO National, and PPO Out of Area
- CDHP (Consumer-Directed Health Plan) National – replaces UHC’s Definity
- Why are you eliminating the Anthem Core New Mexico plan?
- The Anthem Core New Mexico plan was offered for catastrophic coverage only, was under-utilized, and was not fiscally viable.
- How can I find out if my doctor or care facility is in-network with Blue Cross Blue Shield of New Mexico?
- BCBS of NM has one of the most comprehensive provider networks nationwide, and analysis has shown only minimal difference between United Healthcare in-network providers/facilities and BCBS of NM providers/facilities. You may check your individual doctor or facility’s network status online at www.bcbsnm.com. (The Provider Finder® feature is located in the middle of the page. You may search by Name or Location.)
- I live in the Albuquerque area, and I understand that the Presbyterian Medical Group will only accept Blue Cross Blue Shield of New Mexico coverage for those living outside the Greater Albuquerque Area. How does this affect me?
- If you live in Albuquerque or the Greater Albuquerque Area (for example, Rio Rancho), the Presbyterian Medical Group is considered to be Out of Network. However, there are 12 full service hospitals within the Blue Cross Network. Please see the Blue Cross and Blue Shield of New Mexico Provider Network in the Greater Albuquerque/Rio Rancho Area (pdf) for a complete listing of in-network hospitals, urgent care, and primary care groups.
- Will my semi-monthly premiums increase?
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Because both the EPO and CDHP (formerly Definity) premiums are being lowered for the 2010 plan year, most employees will experience a 7% decrease in premiums.
The current UHC PPO plans (Options PPO NM, PPO National, and PPO Out of Area) have been significantly underpriced in terms of premium contributions when compared to claims costs. Most PPO participants will see a 4% increase in PPO Plan premiums to achieve more appropriate pricing. However, because plan eligibility will no longer be based on home zip code, individuals in any of the existing PPO plans will now be eligible to participate in the less expensive EPO or CDHP plans through BCBS of NM.
2010 Semi-monthly employee contribution rates
- Will LANS continue to subsidize the majority of our semi-monthly premiums?
- Yes. The Laboratory continues to subsidize employee premiums at a rate of approximately 80% (depending on level of coverage and salary band). In the interest of full disclosure we will continue to provide both your cost and the employer cost on the semi-monthly premium sheets.
- Will my out-of-pocket costs increase? What about my co-payments, co-insurance, and deductible?
- Employees in the UHC EPO, Definity, and Options PPO NM will experience no increase in co-payments, co-insurance, or deductible in the equivalent BCBS of NM plan. However, if you are currently enrolled in the PPO Out of Area plan with UHC, selecting the new BCBS of NM PPO rather than the BCBS of NM EPO plan, for instance, would increase your out-of- pocket costs for services rendered out of network. Detailed summary and comparison charts will be posted as soon as available.
- Will my prescription coverage change with Blue Cross Blue Shield of NM?
- Co-payments will still be based on similar criteria and will vary based on the tier of the drug in question (Tier 1: $15; Tier 2: $30; Tier 3: $45). Because BCBS of NM uses a different formulary than UHC/MedCo, some drugs that are currently not covered may be covered by BCBS of NM or might be covered in a different tier. The formulary will be posted for review as soon as it becomes available.
- What about our Behavioral Health benefits through UHC? Who will provide this coverage in 2010?
- Mesa Behavioral Health will be our new provider for 2010, in conjunction with the change from UHC to BCBS of NM.
- If I am currently enrolled in Definity, what happens to any remaining balance in my HRA? Will it roll over to 2010 if I select the new CDHP coverage through BCBS of NM?
- Yes. As long as you haven’t exceeded the maximum rollover period (3 years) then your balance from Definity will roll over into the CDHP in 2010.
- Will retirees be affected by the change in medical insurance carrier?
- Yes. Retirees will be required to change their benefits away from UHC or Anthem Blue Cross, just like active employees. Retirees will continue to enroll and make changes through Hewitt’s Your Benefit Resources, online or via phone. Dates of Open Enrollment for retirees will differ slightly from actives and will be communicated directly by Your Benefit Resources.
- Will you monitor employee satisfaction with Blue Cross Blue Shield of New Mexico and the non-medical insurance carriers?
- The Benefits Office continually monitors satisfaction with all benefit programs. If you have concerns, complaints, or compliments for any insurance carrier, please contact the Benefits Office (667-1806 or benefits@lanl.gov). We consider which plans, if any, should be placed out to bid on an annual basis, based on performance and financial measures.
Eligibility Changes
- Are there any major changes to eligibility?
- Yes, there are two major changes in dependent eligibility, effective January 1, 2010:
- Step-Children will now have the same eligibility as any natural or adopted child. This means there will be no more tax and residency requirements on step-children.
- Grandchildren will no longer be an eligible dependent class. If a grandchild has been legally adopted, the grandchild will be enrolled as an adopted child with supporting court documentation. If a grandchild is a legal ward, the grandchild will be enrolled as a legal ward.
Both of the changes were examined thoroughly and benchmarked against best business practice and the predominant practices of our outgoing and incoming insurance carriers.
Flexible Spending Changes
- Since UHC will no longer be our medical insurance provider, who will administer my Flexible Spending Account as of January 1, 2010?
- Our new Flexible Spending Account (FSA) administrator is Payflex. Please stay tuned for additional information.
If you want to make FSA contributions in 2010; you must enroll during Open Enrollment, even if you are already contributing in 2009.
FSAs allow employees to put money aside on a pre-tax basis for their own and their eligible tax dependents’ eligible health care expenses (Health Care Reimbursement Account - HCRA) and/or eligible daycare expenses (Dependent Care Reimbursement Account- DCRA)
- Will the new FSA program work the same as our current program through UHC?
- All participants will be receiving a FSA debit card that can be used at a physician’s office, pharmacy, and for over-the-counter FSA reimbursable products, where accepted. The Payflex debit card has the added advantage of being accepted at most major pharmacy retailers.
Instead of rolling your medical claim over to your FSA at the time of a physician visit you may simply provide your FSA debit card.
Open Enrollment Process
- When will I receive more information about plan options, selections, and other changes for Open Enrollment?
- An Employee Guide for Open Enrollment will be made available to employees in September. The Guide will contain details such as plan changes, design changes, new coverage options, contact information, and premiums for 2010.
- Will the Benefits Office hold live informational meetings to explain my benefits and answer my questions about Open Enrollment? Will Blue Cross Blue Shield of New Mexico be in attendance?
- The Benefits Office, Blue Cross Blue Shield of New Mexico (BCBS of NM), and representatives from all of our non-medical insurance carriers held live information sessions during the beginning of October to present and explain your benefits. These information sessions are now available for viewing.
- Will I enroll online during Open Enrollment or send in a paper form?
- Most employees will sign up through Oracle Worker Self-Service. Oracle Self-Service instructions are available online. If you do not have appropriate Crypto-Card access to enroll online, a manual form will be sent to you during your last-name Open Enrollment window. Remember that every LANS employee and retiree must make an active election for BCBS of NM during this fall’s Open Enrollment.
We encourage you to contact us with any feedback, questions, or concerns to oeinfo@lanl.gov.
