Premiums Are Reduced for HMO Option

Spotlight On Health Benefits

Volume C, No. 9September, 2000

Last year, participants in Local 802’s Health Benefit Plan gained an important new option – access to an HMO plan, which includes hospitalization coverage. The HMO option has been available since April of 1999 to members eligible for the plan who live in New York City, Long Island and Westchester.

This summer the Plan Trustees took steps to make this option more widely available, by reducing the premiums required to participate. Effective Aug. 1, for members eligible for Plan A, the monthly premium for individual coverage has dropped to $40 from the previous level of $69, a savings of 42 percent. The monthly premium for family coverage has been reduced to $211 from its previous level of $263 per month, almost a 20 percent savings.

Members eligible for Plan B will now pay a monthly premium of $137 per month for individual coverage, down from $152, and $389 for family coverage, down from $399.

Gaining the HMO option has been important to many 802 members because hospitalization coverage is not part of the regular Health Benefit Plan, and has not been available through Local 802 since our Blue Cross Hospitalization Plan was eliminated more than ten years ago. Until the HMO option became available, even those members who made plan eligibility (especially for the lower Plan B) still had to purchase a full HMO to be adequately covered.

Members who are eligible for Plan A or B now have a choice: they may retain their MagnaCare/ULLICO benefits, or opt out of those benefits and select the MagnaHealth HMO instead. Selecting this option requires them to pay an additional premium on a monthly, quarterly or semi-annual basis. However, the cost is far less than it would be on the open market, since the trustees apply the value of a member’s current benefits toward the cost of the HMO. Members also benefit from discounts received because the coverage is negotiated as part of a group.

Local 802 Plan Administrator Dan Jaffe points out that, while the HMO option is an important opportunity, it may not be the best choice for every member. “For many people, the decision on whether to enroll in an HMO depends upon whether they can locate participating providers with whom they are comfortable,” he said, “or whether their current providers are affiliated with MagnaHealth.” Although MagnaCare (the HBP’s current Preferred Provider Organization, or PPO) and MagnaHealth (the new HMO option) are owned and operated by the same parent company, they are separate organizations, each with its own provider directory. Participating provider directories may be reviewed at the Fund Office.

Many 802 members have found MagnaCare providers and are receiving all of their health care for only a $10 co-payment for each doctor’s visit, with no need to meet a deductible each year. Others are seeing a mix of MagnaCare and non-MagnaCare providers, with 80 percent of “reasonable and customary” charges of the non-MagnaCare doctors reimbursed after they meet their annual deductible. This flexibility will not exist for members who enroll in MagnaHealth. They will be limited to health care providers affiliated with the HMO.

There are a lot of issues to be weighed before you decide to switch. Questions concerning your particular needs should be made to the Fund Office. Applications, accompanied by the monthly premium, must be sent in at least 45 days in advance of the month coverage is to begin. For example, with an Oct. 1 start date, your premium must be paid by Aug. 15.