The Medical Plan's third party administrator, indicated that currently there are 245 female participants between the age of 50 and 65. Females 65 years of age and older are usually participating in a Medicare supplement policy and the Medical Plan would have to cover these tests for individuals with a Medicare supplement policy. DHT's third party administrator provides the usual and customary rate for the bone density testing. Historically, the department and the plan members have shared in any premium increases necessary because of increases in benefits. Until the commission makes a decision, we can only provide the cost to the medical plan.
State law does mandate access on one annual visit.
DOS states this would increase their capitated rate when the health plans re-bid their contracts. DOS states the fiscal impact to the Division of Medical Services is unknown. As evident in the HCP plans, the open access plans are considerably more costly than those requiring a PCP referral to a specialist. In some cases there could be a cost savings by not duplicating services. One cannot predict how many would directly access these providers or for what services.