October 9, 2003

By Anne Bromley

Employees 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.

Both 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.)

Copayments 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.

The 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 state’s plan.

Consistent 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.

Employees 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. (The schedule of meetings will be printed in the Oct. 24 issue of Inside UVA.)

"Plan 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.

The 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.

These changes do not affect other plan benefits such as pharmacy and dental benefits.
The benefits office will e-mail employees details about information sessions before open enrollment begins.