Health plan expands coverage; monthly premiums up $1-$3

By Dan Heuchert

Bucking a national trend, the University's health plan will raise premiums only slightly next year while greatly expanding the scope of benefits.

For the first time, the plan will offer vision and orthodontic benefits, as well as some coverage for complementary and alternative therapies. The drug plan will no longer bar access to certain drugs. Premiums will rise by only $1 per month for employee-only and employee-plus-one coverage.

Premiums for family and "double-state" enrollees will rise by only $3 per month.

A nationwide survey reported that health insurance premiums for large businesses -- those employing 1,000 or more -- are expected to rise by 12.2 percent for active employees and 13.3 percent for retirees still receiving benefits. Federal employees will pay an average of 10.5 percent more.

Linda Way-Smith, the University's director of employee benefits, says conservative management has softened the blow at U.Va, where increases range from 1 percent to 7.7 percent.

"We have been slightly more successful at controlling costs than was projected in the past couple of years," she said. The savings, plus greater-than-required reserves, allowed the plan to absorb most of the expenses associated with the new benefits and drug cost increases, she said.

"[The slight increase is] nothing people should count on happening [regularly]," she warned. "It's not something that is going to be an annual event."

With the open enrollment period beginning Oct. 30 and continuing through Dec. 8, full information about changes to the health plan are scheduled to be mailed shortly, Way-Smith said. The changes take effect Jan. 1.

Among the highlights:

• The plan includes a vision benefit through First American Vision Services. Participating providers offer up to 20 percent off eye exams, up to 50 percent off retail frames, 20 to 30 percent off retail lenses, 20 percent off the initial set-up for contact lenses and 50 percent off replacement contacts. In addition, there is a 25 percent discount on laser eye surgery at TLC Laser Eye Centers in Northern Virginia, plus up to $200 in travel expenses.

About two-thirds of local opticians are expected to participate in the plan, Way-Smith said.

• The plan will offer a $1,000-per-person lifetime benefit for orthodontic coverage. After paying a $50 deductible, employees and the plan split evenly the next $2,000 in costs. The employee then picks up all costs in excess of $2,050.

• Acupuncturists and massage therapists will offer a discount to plan participants through a complementary and alternative medicine provider network.

• Dependents who receive immunizations and inoculations at their out-of-town student health centers will be covered as if the shots were given in a network physician's office.

• An option is being added to chiropractic coverage, allowing employees to visit a chiropractor within the network without a referral from their primary care providers (with a $30 co-payment and an 80-20 split of additional charges).

There are also changes in the existing benefits, chiefly in mental health and drug coverage.

The mental health plan previously based its charges on whether the participant was referred for health care by a physician, or was self-referred. However, the plan was seeing substantial growth in both costs and utilization of mental health services, Way-Smith said.

The new plan offers three options. The first option is entry into the system through a referral. If referred by your primary care physician, you pay $10 per visit; if referred by the Faculty and Employee Assistance Program, the co-pay is waived altogether.

"We think it will help us to get people to the right providers faster," Way-Smith said. "It may keep people out of the system altogether if they can get the services they need at FEAP."

Participants retain the right to see mental health providers of their own choice, either inside the network ($30 co-pay per visit) or outside (pay half the cost). However, if participants choose the latter option, they must make sure that the mental health professional submits a treatment plan to QualChoice -- the plan's third-party administrator -- for approval before the fifth visit. If there is no approved treatment plan in place, the participant must pay all of the costs.

The prescription drug benefit is being converted from a two-tiered system to a three-tiered one -- covering generic, "preferred brand" and "non-preferred brand" medications -- with the amount of the required co-payment dependent upon the cost of the drugs selected. The purpose is to urge employees to consider lower-cost drug options, Way-Smith said.

The cost to the participant for a 30-day supply of a generic drug purchased at retail will be $8 or less, compared to $12 for a preferred brand and $25 for a non-preferred brand. There is a substantial discount for mail-order purchases.

As has been previously, some very expensive drugs require pre-approval from QualChoice.

The changes in the drug benefits "actually bring us in line with what other local plans are doing," Way-Smith said.

Human Resources will offer a series of information sessions on the benefit changes. More information is also available through the Web at http://www.hrs.virginia.edu/ or via e-mail at openenrollment@virginia.edu.