The Catalyst

MUSC Health Plan: Frequently Asked Questions

Effective Jan. 1, all MUSC and MUHA employees who were previously enrolled in the Standard State Health Plan are now enrolled in the MUSC Health Plan.
MUSC Health Plan participants who receive care within the MUSC Health Plan Network, which is based on a Patient–Centered Medical Home model, will now have lower total out of pocket costs.
Employees’ premiums for the MUSC Health Plan will be the same as the Standard SHP and will not increase in 2014.

Here are answers to several of your frequently asked questions regarding the MUSC Health Plan:

Q: If I already have an MUSC Primary Care physician will I have to “reselect” my current physician when the program is rolled out?
A: No, you will automatically be assigned to that physician.

Q: MUSC has so many primary care providers in so many locations. What information is available to help me and my family decide which primary care doctor might be best suited for me and my family?
A: The select a doc tool contains links to all of our providers’ specific profile pages, including his/her degree, residency, clinical interests, bio, photo, locations, and a brief “get to know” video if one is available. http://mcintranet.musc.edu/musc-health-plan.

Q: Can my OB-GYN be my Primary Care Physician?
A: No, OB–GYN is recognized as a specialty, not as primary care. For the MUSC Health Plan, specialty copayments apply to OB–GYN outpatient and inpatient services. However, no referral is necessary for a well-woman exam.

Q: Where can a list be found of existing Primary Care providers who are not employed at MUSC?

A: You can review in–network physicians through the same Blue Cross Blue Shield website as you have in the past.  www.southcarolinablues.com  (Click on “find a provider” on the right side of the page)

Q: I just received a letter that my MUSC primary care physician is leaving the practice and that a new physician has been hired. Do I need to choose another primary care physician? Or will the new physician “automatically” take over the departing doctor’s patients?
A: You may pick any other MUSC primary care provider that you prefer. And you can always change at anytime. The full list of doctors is available on the MUSC Health Plan website and will be updated periodically.

Q: I wish to change my OB-GYN from an outside group to an MUSC OB–GYN. Do I need to get a referral from my primary doctor (I am already assigned to someone in Family Medicine)?
A: No referral is necessary for a well–woman exam.

Q: Will there be any “facility charge” bills associated with the MUSC Health Plan? In the past, there were two bills sent for every doctors visit: one for the physician and one for the facility charges.

A: For care delivered in-network at MUSC by an MUSC provider, you will only be responsible for the copay amount for the service. However, facility fees will still apply in hospital-based clinics for state employees and other patients who are not insured by the MUSC Health Plan.

Q: Will I have coverage out of state and out of country under the new plan?

A: The MUSC Health Plan includes the “in” and “out” of network coverage through the Standard SHP plan. There are SHP in-network providers in other states and other countries (through the BlueCard program). You can review providers on the website: https://www.southcarolinablues.com/web/public/sc/ (Click on “find a provider” on the right hand side of the page). If you are in Charleston, out of the state, or in another country, BCBS would still pay out–of–network benefits at 60 percent after you have met the deductible.

Q: In the past I have had to go to a facility like LabCorp to have labwork drawn. Will any phlebotomy centers like these be considered in-network for the MUSC Health Plan?
A: If you get any covered lab work drawn at MUSC, you would pay a simple copay of $20 starting Jan. 1. If you go elsewhere, your claims will be processed as they are today via the Standard State Health plan.

Q: How does the MUSC Health Plan affect the State’s dental or vision plans? 

A: The MUSC Health Plan is separate from the dental and vision plans that are offered for state employees to choose.

Q: Since switching to the MUSC Health Plan, why have I noticed different copayments for certain medications?

A: Our prescription drug plan has advantages of lower copays when using our on–campus pharmacies. The entire state changed to Catamaran Health Benefits Processor on Jan. 1, and there is a formulary associated. Some medications may have changed tiers (copay levels) from the Medco/Express Scripts Plan in 2013 to the Catamaran Plan in 2014. This will affect all state employees, not just those at MUSC. Please check the benefits website to see about the tier level of your specific medications: https://www.catamaranrx.com/uploadedFiles/Documents/Physicians_Page/CATAMARAN%20NATIONAL%20COMPREHENSIVE%20FORMULARY_010114.pdf

A short video explaining highlights of the MUSC Health Plan by Dr. Mark Lyles, MUSC medical center chief strategic officer, can be viewed (password protected) at http://academicdepartments.musc.edu/com/theBuzz/2013_12_13_MUSCHealthPlan_Lyles 

January 13, 2014
 
 
 

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