Health Care Plan Open Enrollment for July 1, 2010

Health Care Plan Open Enrollment for July 1, 2010

Open Enrollment – April 26 to May 7, 2010

Employee Contributions (Effective July 1, 2010)

Managers, Faculty, SPFPA and Nurses - Deductions Based on 26 pays

SINGLE CONTRACT / Highmark PPO Blue / Highmark Indemnity / Geisinger Health Plan HMO / Keystone Health Plan Central HMO / Keystone Health Plan East HMO / UPMC HMO
FULL-TIME EMPLOYEES
Healthy U Participant (15% of cost) / $34.34 / $47.77 / $36.36 / $45.64 / $44.92 / $39.01
Non-Participant Healthy U (25% of cost) / $57.24 / $76.14 / PARTICIPATION IN WELLNESS PROGRAM NOT REQUIRED
PART-TIME EMPLOYEES
Healthy U Participant (57.5% of cost) / $131.65 / $168.37 / HMO COVERAGE NOT OFFERED TO PART-TIME EMPLOYEES
Non-Participant Healthy U (62.5% of cost) / $143.10 / $182.55
TWO-PARTY CONTRACT / Highmark PPO Blue / Highmark Indemnity / Geisinger Health Plan HMO / Keystone Health Plan Central HMO / Keystone Health Plan East HMO / UPMC HMO
FULL-TIME EMPLOYEES
Healthy U Participant (15% of cost) / $76.14 / $105.89 / $80.12 / $92.83 / $92.39 / $86.43
Non-Participant Healthy U (25% of cost) / $126.90 / $168.80 / PARTICIPATION IN WELLNESS PROGRAM NOT REQUIRED
PART-TIME EMPLOYEES
Healthy U Participant (57.5% of cost) / $291.88 / $373.26 / HMO COVERAGE NOT OFFERED TO PART-TIME EMPLOYEES
Non-Participant Healthy U (62.5% of cost) / $317.26 / $404.72
FAMILY CONTRACT / Highmark PPO Blue / Highmark Indemnity / Geisinger Health Plan HMO / Keystone Health Plan Central HMO / Keystone Health Plan East HMO / UPMC HMO
FULL-TIME EMPLOYEES
Healthy U Participant (15% of cost) / $93.31 / $129.78 / $98.31 / $134.92 / $127.49 / $105.94
Non-Participant Healthy U (25% of cost) / $155.52 / $206.88 / PARTICIPATION IN WELLNESS PROGRAM NOT REQUIRED
PART-TIME EMPLOYEES
Healthy U Participant (57.5% of cost) / $357.71 / $457.46 / HMO COVERAGE NOT OFFERED TO PART-TIME EMPLOYEES
Non-Participant Healthy U (62.5% of cost) / $388.81 / $496.01

Employee Contributions (Effective July 1, 2010)

Faculty - Deductions Based on 20 pays

SINGLE CONTRACT / Highmark PPO Blue / Highmark Indemnity / Geisinger Health Plan HMO / Keystone Health Plan Central HMO / Keystone Health Plan East HMO / UPMC HMO
FULL-TIME EMPLOYEES
Healthy U Participant (15% of cost) / $44.65 / $62.09 / $47.27 / $59.34 / $58.39 / $50.72
Non-Participant Healthy U (25% of cost) / $74.41 / $98.98 / PARTICIPATION IN WELLNESS PROGRAM NOT REQUIRED
PART-TIME EMPLOYEES
Healthy U Participant (57.5% of cost) / $171.15 / $218.88 / HMO COVERAGE NOT OFFERED TO PART-TIME EMPLOYEES
Non-Participant Healthy U (62.5% of cost) / $186.03 / $237.32
TWO-PARTY CONTRACT / Highmark PPO Blue / Highmark Indemnity / Geisinger Health Plan HMO / Keystone Health Plan Central HMO / Keystone Health Plan East HMO / UPMC HMO
FULL-TIME EMPLOYEES
Healthy U Participant (15% of cost) / $98.98 / $137.66 / $104.16 / $120.68 / $120.11 / $112.36
Non-Participant Healthy U (25% of cost) / $164.97 / $219.44 / PARTICIPATION IN WELLNESS PROGRAM NOT REQUIRED
PART-TIME EMPLOYEES
Healthy U Participant (57.5% of cost) / $379.44 / $485.24 / HMO COVERAGE NOT OFFERED TO PART-TIME EMPLOYEES
Non-Participant Healthy U (62.5% of cost) / $412.44 / $526.14
FAMILY CONTRACT / Highmark PPO Blue / Highmark Indemnity / Geisinger Health Plan HMO / Keystone Health Plan Central HMO / Keystone Health Plan East HMO / UPMC HMO
FULL-TIME EMPLOYEES
Healthy U Participant (15% of cost) / $121.31 / $168.72 / $127.80 / $175.40 / $165.73 / $137.72
Non-Participant Healthy U (25% of cost) / $202.18 / $268.95 / PARTICIPATION IN WELLNESS PROGRAM NOT REQUIRED
PART-TIME EMPLOYEES
Healthy U Participant (57.5% of cost) / $465.02 / $594.69 / HMO COVERAGE NOT OFFERED TO PART-TIME EMPLOYEES
Non-Participant Healthy U (62.5% of cost) / $505.46 / $644.81
Highmark PPO Blue / Highmark Indemnity / Geisinger Health Plan HMO / Keystone Health Plan Central HMO / Keystone Health Plan East HMO / UPMC HMO
FULL-TIME EMPLOYEES
Single, Two-Party and Family Contracts
Healthy U Participant / 1.5% of salary / PARTICIPATION IN WELLNESS PROGRAM NOT REQUIRED
Non-Participant Healthy U / 3% of salary
PART-TIME EMPLOYEES / HMO COVERAGE NOT OFFERED TO PART-TIME EMPLOYEES
Single / $114.48 / $147.08 / Plus 1.5% for employees participating in Healthy U
OR 3% if Non-Participant in Healthy U
Two-Party / $253.81 / $326.08
Family / $311.05 / $399.63

Pennsylvania State System of Higher Education Group Health Program

2010 - 2011 Health Plan Comparison

Highmark PPOBlue (Preferred Provider Organization) / Health Maintenance Organization (HMO) / Highmark Indemnity
In-Network / Out-of-Network
General Features / In-network providers accept Highmark allowance as payment in full. / Services performed by out-of-network providers are paid at 80% of allowance after a deductible. Providers can bill employees for charges above allowances. / Payment in full to participating providers for medically necessary surgery, diagnostic services and inpatient services. Services must be authorized by HMO primary care physician. Covered services vary by HMO. No payment for services out of the HMO network. Must select a primary care physician. / Participating providers accept Highmark allowance as payment in full for the service-employee is responsible for the appropriate deductible and co-insurance amounts. Non-participating providers can bill members for charges above the allowance. Covers medically necessary surgery, diagnostic services, therapy, inpatient services, office visits, and medical equipment. Eligible medical expenses are covered at 80% after the deductible. Not necessary to select a primary care physician.
Covers medically necessary surgery, diagnostic services, therapy, inpatient services and preventive benefits. Not necessary to select a primary care physician.
Deductibles / No deductible. / $250 per person/$500 per family deductible per year. / No deductible. / Applies to all services - $750 per person/$2250 per family deductible aggregate per year.
Co-payments and/or Co-Insurance / $15 for office visits and for physical, speech and occupational therapy and chiropractic visits. / After deductible, employee pays 20% until $1500 per person/$3000 per family out-of-pocket maximum is paid. / $5 to $15 for primary care physician visit. Co-payments for other services vary by HMO. / Applies to all services - In addition to deductible employee pays 20% until $750 per person out-of-pocket maximum is paid/$2250 per family.
Lifetime Maximum / Unlimited. / $1,000,000/person. / Unlimited. / Unlimited.
Physical Exams and Health Guidance / $15 office visit co-payment. Includes routine physical examinations for adults and children along with certain diagnostic screenings. Pediatric immunizations, gynecological exams and Pap tests are covered. / Employee pays 20% after deductible for adult and pediatric exams and certain preventive care. Deductibles do not apply for gynecological exams, Pap tests, and pediatric immunizations. / Preventive care is covered after office visit co-payment and includes routine physical examinations for adults and children, pediatric immunizations, gynecological exams and Pap test. Diagnostic screenings vary by HMO. / Routine adult physical examination are covered at 100%; no deductible. Employee pays 20% for state mandated pediatric immunizations, routine mammograms, and gynecological exams and Pap tests with no deductible.
Emergency Room Services / $50 co-payment. Co-payment waived if admitted. / Co-payments vary by HMO. Covered if considered a medical emergency as defined by the HMO. Co-payment may be waived if admitted. / Employee pays 20% after deductible.
Mental Health-Inpatient / Unlimited. / Employee pays 20% after deductible. / Coverage varies by HMO. See HMO literature. / Employee pays 20% after deductible.
Mental Health-Outpatient / $15 office visit co-payment. / Employee pays 20% after deductible. / Employee pays 20% after deductible.
Prescription Drug Coverage-same for all plans / No deductible; $0/$15/$30 co-payment for 30-day supply at retail; $0/$30/$60 co-payment for 90-day supply through mail order.

Plan Service Areas and Contacts

HIGHMARK PPOBLUE
(866) 727-4935
www.highmarkblueshield.com / Offered in all counties in Pennsylvania
GEISINGER HEALTH PLAN HMO
(800) 631-1656 Pre-enrollment questions
(800) 447-4000 Current members
www.thehealthplan.com / Offered in the following counties:
Adams, Bedford ­, Berks, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clearfield, Clinton, Columbia, Cumberland, Dauphin, Elk ­, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northampton, Northumberland, Perry, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming and York
­ Denotes partial county
Keystone Health Plan Central HMO
(800) 669-7061
www.capbluecross.com / Offered in the following counties:
Adams, Bedford ­, Berks, Bucks ­, Carbon ­, Centre, Chester ­, Clearfield ­, Clinton ­, Columbia, Cumberland, Dauphin, Franklin, Fulton, Huntingdon ­, Juniata, Lancaster, Lebanon, Lehigh, Luzerne ­, Lycoming ­,Mifflin, Monroe ­, Montgomery ­, Montour, Northampton, Northumberland, Perry, Schuylkill, Snyder, Sullivan ­, Union and York
­ Denotes partial county
Keystone Health Plan East HMO
(800) 626-8144
www.ibx.com / Offered in the following counties:
Berks, Bucks, Chester, Delaware, Lancaster, Lehigh, Montgomery, Northampton and Philadelphia
UPMC HMO
(800) 644-1046 Pre-enrollment questions
(888) 876-2756 Current members
www.upmchealthplan.com / Offered in the following counties:
Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Somerset, Venango, Warren, Washington and Westmoreland
HIGHMARK INDEMNITY (closed to new enrollments)
(866) 727-4935
www.highmarkblueshield.com / Offered in all counties in Pennsylvania
HIGHMARK PRESCRIPTION DRUG – MEDCO HEALTH (included with all medical plans)
(866) 727-4935 (Highmark Customer Service number)
www.highmarkblueshield.com / Offered in all counties in Pennsylvania