New MUSC Health Plan preserves choice, lower costsTweet By Mark Lyles
MUHA Chief Strategic Officer
Beginning Jan. 1, 2014, more than 18,000 MUSC employees and their dependents will be offered a new insurance plan that has enhanced preventive benefits and lower overall out-of-pocket costs.
The MUSC Health Plan was established in partnership by the South Carolina Public Employee Benefits Authority and MUSC leadership to improve the health and wellness of the MUSC workforce by encouraging patients and health care providers to partner with one another in the delivery of effective, coordinated medical care.
During the Open Enrollment Period, employees and their dependents enrolled in the Standard State Health Plan (SHP) will automatically be enrolled in the MUSC Health Plan, a plan that offers enhanced benefits. Members of the MUSC Health Plan who choose to receive patient-centered care within the MUSC Health Plan Network will get many types of preventive services at no cost and will have lower out-of-pocket expenses.
The MUSC Health Plan’s preventive care benefits include blood pressure, cholesterol, depression and obesity screenings; tobacco cessation counseling; numerous vaccines; well-women visits and screening pap smears; and other preventive health services at no cost.
Also, for many MUSC outpatient doctor’s office visits, MUSC Health Plan members will be required to pay a single copayment with no deductibles or coinsurance. For information about the new benefits offered by the health plan, visit musc.edu/medcenter/MUSChealthplan/index.html.
Employees still have choices
Employees covered by the MUSC Health Plan who choose to receive care outside of the network (for example, at another hospital or a non-MUSC owned or affiliated doctor’s office), will continue to have their current Standard SHP benefits: individual or family deductibles must be met, copays must be paid, and co-insurance will apply.
Also, employees and dependents enrolled in the BlueChoice HMO or SHP Savings Plan may remain in these plans or elect to join the MUSC Health Plan for 2014.
All new employees who begin receiving health benefits at MUSC on or after Jan. 1, 2014, will become members of the MUSC Health Plan.
MUSC Health Plan members will receive care through the Patient Centered Medical Home model that focuses on comprehensive, patient-centered care delivered by MUSC’s team of professionals and coordinated by a MUSC primary care provider. All MUSC primary care and specialty physicians and advanced practice providers will be included in the MUSC Health Plan Network.
Additionally, to expand its ability to deliver primary care services, the MUSC Health Plan Network will partner with like-minded physicians and practices that are committed to delivering quality, patient-centered care.
In November, a web-based tool will be launched to enable MUSC employees to select a clinic and a primary care physician within the network who will coordinate health care delivered to members of the MUSC Health Plan.
MUSC Health Plan — Frequently Asked Questions
What is the MUSC Health Plan?
A new insurance plan created in partnership by PEBA and MUSC to offer benefits and lower total costs to MUSC employees and dependents that choose to receive care in the MUSC Health Plan Network.
Will employees pay more to be a member?
No. Employee premiums for the MUSC Health Plan (the amount withdrawn from employee paychecks) will not increase in 2014. And although other state employees will have their deductibles, copayments and coinsurance maximums increase by 20 percent in January 2014, the MUSC Health Plan is designed to have lower out-of-pocket costs for members who choose to receive their care from a member of the MUSC Health Plan Network.
Is my physician in the network?
All MUSC primary care and specialty physicians and advanced practice providers will be members of the network.
What are the new benefits offered by the plan?
There are three levels of benefits offered by the new plan and employees may choose the option that is best for them and their dependents:
- Choice One: MUSC Health Plan members who receive care in the network will have lower total out-of-pocket costs and receive many preventative services at no cost.
- Choice Two: Members who receive care outside of the MUSC Health Plan Network but within the Standard SHP Network will continue to receive Standard SHP benefits, the same benefits as other public employees enrolled in this plan. Every general hospital in South Carolina is included in the Standard SHP Network. Out-of-state hospitals that participate in the nationwide Blue Cross and Blue Shield Network will also honor SC SHP benefits to MUSC Health Plan members and their dependents, such as college students or dependents who live outside of the Charleston area or in another state.
- Choice Three: Members who receive care outside of the Standard SHP Network will receive Standard SHP out of network benefits.
What is a Patient Centered Medical Home?
A PCMH emphasizes care coordination and communication. It serves to facilitate partnerships between patients and health care teams to provide high value care in the most ideal settings. There are various organizations that provide standards on how PCMHs may operate and are recognized. Practices that provide patient care in a PCMH model deliver superior patient care centered on a patient’s individual health needs and focus on health and wellness.
Do employees have to change their primary care physician?
In order to receive the benefits and lower total out-of-pocket costs, members of the plan must be seen by physicians or providers in the network. If members of the plan receive care from outside the network, then Standard State Health Plan benefits apply.
What are the MUSC Health Plan benefits?
What preventive care will be offered at no cost?
A list of preventive services that are billed at no cost to members of the MUSC Health Plan will be provided. Visit musc.edu/medcenter/MUSChealthplan/Free_preventive_services.pdf.
Does MUSC have enough pediatric primary care physicians in the network?
MUSC will partner with high value pediatric practices in order to expand the network’s capacity to deliver coordinated care to pediatric patients.
Can employees enrolled in the Standard SHP switch to BlueChoice or the Savings Plan in October?
Only employees and dependents enrolled in the BlueChoice or SHP Savings Plan may remain in these plans for 2014. Employees who are on the Standard SHP will be automatically enrolled in the plan.