Changes to Your Health Plan

Participation still comes at no cost to full-time colleagues, but there are other important changes

Like all employers, Lehigh Valley Health Network is confronted with rising costs and must continue to manage its expenses. Every year we analyze our compensation and benefits packages to be competitive in the marketplace. Most hospitals within a 60-mile radius of our health network require employees to pay to participate in a health plan. Again in 2009, our health network will not. “We worked hard to ensure our plan continues at no cost to colleagues,” says Mary Kay Grim, senior vice president, human resources.

However, based on a market review of hospitals and health networks in our immediate area, we are adjusting some sections of our health plan effective Jan. 1, 2009. For example, all health plan participants will have a $200 deductible that will not exceed $400 per family. Here’s an example of how this will work:

Mary and Bob Smith are married and have one child, Rachel. Mary works here and is covered by Choice Plus. As a family, they must meet a $400 deductible for 2009. The family’s first medical encounter of the year occurs when Rachel goes to the pediatrician.

• A $15 co-pay is collected at the time of service.
• The provider charges $95.
• The fee schedule, or allowed amount, is $85.
• Choice Plus would have paid the provider $85 minus Rachel’s $15 co-pay, or $70.
• Because the Smiths have not met their family deductible, $70 is applied to the deductible and Rachel’s provider may bill the Smiths $70.
• As a result, the Smiths have reduced their 2009 deductible by $70, leaving a deductible balance of $330.

To learn more about this example, visit the human resources Web site on in the intranet at lvh.com.

An excellent way to cover the cost of your annual deductible is by using a medical Flexible Spending Account (FSA). It allows you to put a portion of your earnings aside to pay for out-of-pocket medical expenses. You’ll save because the money in your FSA is not taxed, and it allows you to pay during the year using payroll deduction.

Here are some other changes to your health plan:

• Your annual Culture of Wellness benefit will increase from $500 to $700.
• Generic drug co-pays will decrease from $10 to $8. Preferred drug co-pays will increase from $15 to $20, and brand drugs from $30 to $40. Brand drugs will be filled only with a physician’s order.
• Choice Plus will be accepted at Careworks’ walk-in clinics.
• Same-sex domestic partners and qualifying dependents may be covered if they meet certain requirements.

You’ll soon receive a detailed benefits information packet by mail. “Review it closely, and during the open enrollment period (Nov. 10-Dec. 5) choose the benefits plan that best suits you and your family’s needs,” Grim says.

If you have questions, call the Benefits Help Line at 610-402-LVHR or submit them under “contact us” on the human resources Web site.

—Rick Martuscelli

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