Chicago Police Sergeants' Association
2013 Medical Plan Information
If you are enrolled in the PPO Medical Plan, you will be getting new insurance cards in the mail, if you haven't already. There are a couple changes in how the plan will be covering your medical needs. The changes were agreed upon by the LMCC, of which we, and all but one of the city unions are members of. Last week, I attended a meeting about this and I briefly had the changes explained to me.
After January 1, most primary care PPO doctor's office visits will be covered at 100% after a $25 co-pay, and specialist visits will be covered at 100% after a $35 co-pay. These visits will not be billed to you (after the co-pay), nor will they count against your deductible. So you don't have to pay for the first visits to meet your deductible. Before, you had to pay up to a $350 individual deductible before the insurance picked up the remaining 90% the rest of the calendar year. Some exceptions to this include any hospital charges billed for the doctor visit, emergency room services, surgical procedures, and any medical supplies provided by the doctor. PPO doctor visits related to any hospital service or admission, as well as all PPO hospital charges are covered after the deductible at 90% as they are currently.
Medically necessary lab work, MRI, PET, and CAT scans that are done at independent labs or free-standing facilities not owned or billed by a hospital, such as Quest Labs, will be paid 100% by the plan. Be careful though, as sometimes it's hard to tell whether a facility or doctor's office is part of a hospital. To be sure that you can take advantage of this benefit improvement, ask if a hospital will do the billing. If so, find another lab. If you have necessary lab work or scans performed at a hospital facility, they will be covered at the current rate of 90% in-network and 60% out-of-network. You'll be on the hook for the rest as you are currently. Under Illinois law, you are free to choose where to have lab tests and scans done. Also, remember that scans must be pre-certified by Telligen.
The wellness benefit is no longer capped at $600. This benefit is now covered at 100% per the Affordable Care Act. A list of covered preventive services and their guidelines can be reviewed in the attached material. No co-pay is required if the doctor visit is ONLY for these preventive services. If any other medical services are provided during that visit a co-pay will be required.
Everything else is covered the same as it is currently.
Please familiarize yourself with the attached information as I've just summarized the highlights. This is pretty much the same information that you received in the mail back in October. Unfortunately, very few of us, myself included, read through that material unless we are making a change in coverage. I hope this makes sense to you. I'm no benefits expert by any means, but I try. This plan is beneficial for the majority of employees who visit their doctor a few times per year. For those that have chronic conditions and have to go to the doctor very often, I don't think it works out any better than before. I'm not the only member of the LMCC that is skeptical about this, but the plan will be continually monitored to see what the benefits are to the covered members. We'll get some numbers probably after the first quarter. I'll keep you posted.