Why the Change?• Cost Savings – The change in the plan will save both IDMI and the employees money.• Control – The new structure gives us greatly flexibility and makes changes easier.• Protection – Depending on the full implementation of the current health care laws, the Group High Deductible plan may become overly burdensome for a company our size.
What is the Change?• Structure – The medical trust account of our current plan will not change.• Overall Plan – The group plan will go away with each employee being issued individual policies.• Network / Carrier – There will be no change in that the bulk of our policies will be through Cigna.• Coverage – No change in coverage, however, there will be certain advantages and additional coverage.
What are the Disadvantages?• Applications – Everyone will have to resubmit an application.• Medical Coverage Cards – The coverage will be implemented using two cards: One standard medical card from Cigna and one Supplemental Card.• Eligibility – Certain employees with conditions may not qualify as an individual with Cigna.
How will the Two Card Work? • This will be the ‘standard’ medical coverage card you are used to using.Cigna • It will be a high deductible plan with coverages very similar to the coverages we have now. • This will be the supplemental medical coverage card you will now use at each visit. 2ndCard • It will cover a portion of your deductible and any ‘gaps’ in coverage that the new plan has.
What if I Don’t Qualify?• For those that do not qualify for the Cigna plan, the application will be resubmitted to the state assigned plan.• The state assigned pool is not the respective state version of Medicare (e.g. PeachCare).• All insurers by law are required to participate in a state assigned pool for those individuals that are turned down for coverage and their employer does not offer a group policy.• Once submitted, you will be assigned to a medical carrier. It may be Blue Cross Blue Shield, Aetna, or even Cigna.
What is my coverage on state plan?• The coverage will be the same.• As discussed, by using our supplemental coverage card, that we control, it will augment the plan to make it the same as other employees.• Your issued card from the assigned carrier will be the same card as if you applied individually straight to them.• The coverages will simply be the state mandated coverage.
Other Points• Being an individual plan, if you leave the company you can choose to pay the premiums and take your coverage with you.• Many doctors are already becoming very familiar with using two cards, a primary and supplemental.• If you have claims during a given year, the carrier can not adversely raise your premiums. The rate will stay the same.• Certain drug programs and prescriptions will be reduced.
What are the costs?• Depending your plan (individual, family, etc.) and your length of service with IDMI, your premiums will be reduced as outlined below: Discounts for Length of Employment Years Premium Reduction Deductible Reduction 3 25% 5 50% 50% 10 75% 100%• For those with less than 3 yrs, your withholdings will stay the same.
Deductible Costs?• The deductibles / out of pocket will stay the same as they are now.• Using the supplemental card, this is how we accomplish that. However, the way you pay your deductible will now be spread out.• All out of pocket money will be in the form of co-pays: 30 OP Hospital / Alt Care Facility $500 copay 40 Emergency Room $200 copay• So the deductible will not be front end loaded.
How is it we can save money?• The plans themselves have very high deductibles.• While they are ‘Individual Plans’ the law does not allow the insurance carriers to adversely target an individual because of claims.• Any increases must be across the board for your particular demographic category.• In other words, you and every individual in the state make up a ‘group’• Our implementation goes direct to the carrier with no agent involved.
Summary• Your coverage will not be changing.• Your payroll deductions will not increase and will decrease for many.• Your out of pocket will be spread out over the year, rather than a huge amount up front.• IDMI is maintaining its medical trust account to provide the flexibility needed.• Lastly, we are changing TPA providers that implement this plan (i.e. we will no longer be using Capital Administrators)