As insurance brokers specializing in employee benefits for the past twenty years, we work with businesses and have seen a steady trend regarding UMASS as seen by the plans our clients shift from traditional co-payment plans.

 

Co-Payment Plans

Ten years ago, all our clients had plans whereby employees had co-payments for all their services and it made no difference where they had them completed.  If their plan called for a $500 hospitalization, a subscriber paid $500 whether they went to UMass or Saint Vincent’s (MedCity).   Now maybe 10% of our clients have these plans being replaced by Deductible, Tiered plans and Restricted Networks.

 

Deductible Plans

The easiest way to explain these plans is to point what is covered with a co-payment:

  • prescriptions
  • annual well-care physical-these are actually free
  • PCP and Specialist Office visits for routine services

Everything else goes towards deductibles

  • hospitalizations
  • day surgeries
  • MRI-CAT-PET scans
  • blood works, x-rays and other diagnostic testing

If you are now an employee with a $2,000 deductible and your PCP or specialist just ordered an MRI or blook work, you will now have an incentive to find the lowest possible price and seek out facilities like Quest Diagnostics and MRI Shields.

That is why you see commercials like these:

 

Tiered Plans

These plans put hospitals in different tiers; for example, you can pay $250 at Saint Vincent’s (MedCity) or $3,500 at UMASS.    The subscriber still has the ability to go to UMASS, but it will cost them $3,250 then Saint Vincent’s (MedCity).

Under the old co-payment system it would have cost the employee the same at both hospitals.

 

Restricted Networks

Locally Fallon has one network called Select that includes UMass, but another network with 10% lower rates called Direct that does not include UMass.  Harvard (Focus Network) and Tufts (Select) have similar premium reductions with networks that do not include UMass.

 

Now you add all of these three together and you can see how the marketplace has created products, that employers are buying, which are driving their subscribers away from UMass.

If you are an employer that has any questions on their health insurance, send me an e-mail.