New health plan offers options
By Anne Bromley
will have a choice between two programs in an updated U.Va. health
plan reviewed by the Board
of Visitors Oct. 3. The new option is a direct access program
that will eliminate the requirement of going to a primary care
physician before seeing a specialist in the Southern Health physician
network. The other option, the Point of Service program, is the
same as the existing plan, and will still require PCP referrals.
programs include cost increases in different ways. The Point of
Service program has higher monthly premiums but keeps co-insurance
payments for services such as diagnostic tests and X-rays the
same as the existing plan. The Direct Access program offers lower
monthly premiums but employees will have to pay some fees. (See
table on premium costs.)
will be the same for both programs, but will increase from this
year. For example, the copayment for a visit to the PCP will cost
$15. This is the first copayment increase since 1995.
University, which is self-insured, is making the changes in response
to employee requests for more options and is following the state
in offering a direct access plan. U.Va. benefits remain more extensive
than the states plan.
with national trends, the increases are driven by increased medical
and pharmaceutical costs, plus having more people using more medical
services, said Leonard W. Sandridge, executive
vice president and chief operating officer. The aim of the
changes is to maintain enough funds to cover claims and keep costs
from rising as much as they have in the past two years.
must make their choice during the open enrollment period from
Nov. 3 to Dec. 12, or they will be switched automatically to the
Direct Access program. Information sessions will be held throughout
Grounds during this time to explain details and answer questions.
participants need to compare what their out-of-pocket costs will
be under each program in comparison to their premium savings,
said director of benefits Linda Way-Smith. Some people might prefer
to pay lower premiums month to month, for a considerable savings
over a year; some might prefer to pay a higher premium and not
have to meet a deductible or make co-insurance payments.
Point of Service program retains the three options of the current
plan: going to the PCP first and getting a referral to a specialist
if necessary, going to a specialist without a referral (this option
is most similar to the Direct Access program, but the monthly
premiums and fees, such as deductibles and maximum out-of-pocket
charges, are different) and going to a physician outside the approved
network. For both programs, choosing a physician outside the network
is the most costly option.
changes do not affect other plan benefits such as pharmacy and
benefits office will e-mail employees details about information
sessions before open enrollment begins.