The University will continue to contribute approximately 75 percent of the total cost of health insurance plans and 55 percent of the dental insurance plans for full-time employees. HMO premiums will decrease in 1995 due to the favorable claims experience, low medical inflation and competition within the health care industry. Currently the University's Blue Cross plan offers a hospital network which provides higher coverage if care is received at a network hospital and lower coverage if care is received at a non-network hospital. Both primary care and specialty physicians who participate in the Blue Cross network have agreed to accept the Blue Cross allowance as payment in full. Providers may not bill members for the balance between what a physician charges and the amount of the Blue Cross payment.
Members remain responsible for the payment of applicable deductibles and coinsurance amounts.
Because network physicians bill Blue Cross directly for most services, there will most likely be no claims forms to complete. Non-network physicians do not accept the Blue Cross payment schedule. As a result, physicians may bill members for the amount over the Blue Cross allowance. Effective Jan. 1, Diversified Pharmaceutical Services, Inc., a national pharmacy benefit management firm, will replace Blue Cross as administrator for the Plan A prescription drug program. Blue Cross will continue as administrator for Plan A hospital and physician benefits.