At their January 28 and January 29 respective meetings, the School Employees’ Health Benefits Commission (SEHBC) and the State Health Benefits Commission (SHBC) approved enhancements to the School Employees’ Health Benefits Program (SEHBP).
The highlights of the enhancements are as follows:
NETWORK
The Commissions approved a transition period retroactive to April 1, 2008, and ending on December 31, 2009. During this transition period, out-of-pocket charges from Horizon-contracted providers who are not in the Direct 10 network will be limited to $500 per covered person. After the transition period, the out-of-pocket maximum for all out-of-Direct 10-network doctors will revert back to the $2,000/individual and $5,000/family Direct 10 maximums.
COORDINATION OF BENEFITS
The Commissions approved coordination of benefits between the Direct 10 and Direct 15 plans. Those members currently covered by both plans will have their coordination of benefits retroactively calculated to April 1, 2008. To receive those retroactive reimbursements, members must send their E.O.B. (Explanation of Benefits) forms to Horizon. A special open enrollment will be offered for active members for the purpose of switching plans to take advantage of this coordination. Any active member that elects a new medical plan during this open enrollment will have their new insurance plan and coordination of benefits go into effect May 1, 2009. The open enrollment period will be:
Ø February 1, 2009 through February 28, 2009
Boards of Education will receive a letter from the Division of Pensions announcing this special open enrollment (See attached). Any member wishing to make a change must go through their respective board office.
$10 COPAYMENT TOWARDS IN-NETWORK MAXIMUM
The Commissions agreed to allow the in-network $10.00 office visit charge to count towards the $400 maximum out-of-pocket charge under Direct 10 for in-network services. This portion of the agreement is also retroactive to April 1, 2008, but is not a transition and, therefore, has no ending date.
Should you have any additional questions, please contact your local UniServ Office.
June 4th, 2009 at 1:12 pm
$10 copay is not that bad.