The ISMA group health insurance program renews on July 1 for all physicians with individual policies and many employer groups. Renewal packets were mailed the first week of May.
Starting July 1, prescription drug co-pays will apply to annual out-of-pocket maximums on all PPO plans. This enhancement will reduce prescription drug and overall costs for some subscribers.
Network out-of-pocket maximums will be raised slightly for the PPO 2500, PPO 5000 and HSA 5000/10000 plans, from $6,350/person and $12,700/family to $6,450/person and $12,900/family, in keeping with annually revised Affordable Care Act (ACA) limits.
The PPO 500 and Traditional 1500 plans will be discontinued due to low participation. Current PPO 500 subscribers will automatically be moved to the PPO 1000 plan. As a result of this change, the office visit co-pay will increase from $15 to $20, the deductibles and out-of-pocket maximums will be raised, and the premium will be lowered.
Current Traditional 1500 subscribers will be moved to the PPO 1500 plan. As a result of this change, co-pay benefits will be added for office visits, urgent care, emergency room usage and prescription drugs. Deductibles and out-of-pocket maximums will be changed, and the premium will be lowered. More details are provided in a letter issued to each affected subscriber.
A new PPO plan with a network deductible of $4,000/person and $12,000/family will be added. To help control the premium, this plan – unlike current plans – will have a $250/person prescription drug deductible that will apply before the prescription drug co-pay benefit applies. For the same reason, the maximum family deductible is three times the individual deductible, rather than two times the individual deductible like other PPO plans.
Also, a new Health Savings Account (HSA) PPO plan will be added. This will be the only HSA plan offering an “embedded” deductible that will be $4,000/person, with a maximum family deductible of $8,000. (Other HSA plans have either a Single or a Family deductible considered “non-embedded.”)
To help control the premium, this HSA plan will have a prescription drug co-pay benefit that will apply after the deductible is met. Those co-pays will apply to the out-of-pocket maximum, and all eligible charges, including prescription drugs will be covered at 100 percent after the out-of-pocket maximum is reached.