Monday, April 17, 2000
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Cost of health-insurance coverage to increase this fall
By Larry B. Dendy
ldendy@uga.edu

University employees and retirees won’t make a decision on their new health insurance coverage until November, but they will begin paying more for their current coverage in August.
Those two decisions have been finalized, though much still remains unsettled as the University System Board of Regents continues to work on details of a new insurance plan for system employees, according to Loretta Harper, UGA’s associate vice president for human resources.
The board of regents central office staff and the state Department of Community Health have negotiated a contract with a PPO (Preferred Provider Organization) called Medical Resource Network/Georgia First. The new arrangement is necessary because the current indemnity plan is running a huge deficit, expected to reach $33 million by June 30.
Harper spent an hour at the April Staff Council meeting presenting the latest available information on the new insurance plan and responding to questions. While she didn’t have an answer to every question, she did say that:
• An open enrollment for the new health-insurance plans will be held in November and the plans will go into effect Jan. 1, 2001. The new plan will include a PPO and possibly an HMO (health-maintenance organization) option. In addition, the current indemnity plan will also be offered in the open enrollment.
• Increases in deductibles and out-of-pocket charges for the current indemnity plan have been approved by the board of regents, but no effective date has been set for the new charges. But premiums for that plan will increase Aug. 1, and possibly again Jan. 1. The size of the first increase hasn’t been determined. Earlier reports had indicated costs might go up as much as 50 percent, but Harper said she’s had some indication it could be slightly smaller.
• Premiums for the PPO also haven’t been set, but they will probably be about the same as the indemnity-plan premium before any increase.
• The new plan will include a consumer-choice option. This allows enrollees to use a physician or hospital that is not part of the PPO or HMO, but at an additional cost.
• The lifetime cap for both the PPO and indemnity plans will be $2 million (up from $1 million in the current indemnity plan). The PPO will include chiropractic care.
• Deductibles and co-payments will increase under the indemnity plan. The individual maximum will rise from $200 under the current indemnity plan to $300 under the new indemnity plan. The maximum will be $300 under the PPO for in-network services and $400 under the PPO for out-of-network services. The family maximum will jump from $400 under the current indemnity plan to $900 under the new indemnity plan; under the PPO it will be $900 for in-network services and $1,200 for out-of-network services.
• The new indemnity plan and the in-network PPO will both include $500 for wellness/preventive care. This will not be covered under the out-of-network PPO.
Many provisions of the PPO are still being ironed out, Harper said, but some are settled. One definite decision is that the plan won’t provide coverage outside of Georgia except for emergencies. Enrollees who need non-emergency care in another state or country will have to pay the going rate for doctors and hospitals. One exception is that in some states bordering Georgia some doctors and hospitals may be part of the PPO.
Harper said the PPO will not be a “gatekeeper” model that requires enrollees to choose a single primary-care physician. People in the plan will be able to use any physician in the network at the in-network coverage rate.
She also emphasized that the network will not be static and will change as physicians and hospitals join or drop out. Many of the 8,500 doctors and 146 hospitals currently under contract with MRN and Georgia First are expected to be available to UGA employees and retirees, and other doctors and hospitals may join, she said.
The most current information is on the human resources Web page called “What’s New” (www.busfin.uga.edu/human_resources/whatsnew.html), but Harper cautioned that this changes constantly. She also encourages employees to e-mail questions to the human-resources employee-benefits office (benefits@uga.edu) or to call the office (542-1814).

ON THE WEB
Names of doctors and hospitals now in the PPO are available at the MRN/Georgia First Web site (www.healthygeorgia.com/main/default.asp; choose “The Medical Resource Network” link).
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