Page 49 - FOP March 2017 Newsletter

the maximum out-of-pocket amount is the same $1,500 as in 2016.
One more point: When the collective bargaining agreement was ratified in late 2014, it provided that these changes would not be in effect for the Lodge’s bargaining unit until 2017. They were applicable to all other City employees more than two years ago. The implementation of these changes in 2017 is not a change in the collective bargaining agreement; it is in fulfillment of the Lodge’s insistence at the time that the changes not be implemented until after the new Blue Choice network had been operational for a period of time to allow working out any bugs. In fact, the Blue Choice network is now larger than when it was first implemented.
Why doctors’ office co-pays are not coinsurance?
When you go to the doctors’ office and use a Tier One or Tier Two physician, you have a co-payment for most visits. You don’t have to meet the deductible for a doctor’s office visit to be covered by the plan. This provision is designed to encourage you to seek care when you need it. For example, if an officer went to the doctor’s office for a visit for a possible strep throat in 2016, the officer would have had to meet the $350 deductible before the plan paid anything.
In 2017, the cost of the visit and the in-office strep testing only require the officer to pay the office visit co-pay, and the plan pays the rest. The office visit co- pays do not count toward your deductible, but they do count toward your out-of-pocket limit.
Is preventive care covered?
Starting Jan. 1, 2017, most preventive care is cov- ered by the plan. If the medical service or test is an A or B recommendation (as identified by a federal task force on preventive health), you won’t pay for the service out of pocket as long as you use a Tier One or Tier Two provider. Out-of-network preventive ser- vices aren’t covered. This means that childhood im- munizations and well-women’s care (mammograms, PAP smears, reading fees) will be covered in full as long as you use a Tier One or Tier Two provider.
If doctors were in the PPO in 2017, are they in the new OPT Network?
Any doctor who has a PPO contract is either Tier One or Tier Two in the OPT Network. Also, if your doctor is a Tier One provider, he/she must have ad- mitting privileges to a Tier One hospital. So, if your doctor charges you a $20 co-pay for a visit, you can ask the doctor to refer you to a Tier One hospital for any required hospital services. d
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