Changes in Health Plan Offer Added Choices

By Sean Smith
Staff Writer

The Benefits Office has announced that effective May 1, the University's Pilgrim Advantage Plan will become the Harvard Pilgrim Preferred Provider Organization Plan, giving subscribers additional choices in health care providers while prompting minor changes in coverage.

The office also announced that employee contributions will increase by approximately 6 percent for both the Harvard Pilgrim PPO Plan and the Harvard Pilgrim HMO Plan. In addition, the Delta Dental Plan employee contribution will rise 10 percent, in part because the University has increased the annual maximum benefit.

Benefits Manager John Burke explained that the adoption of the PPO plan is a result of the continuing integration of the Harvard and Pilgrim health insurance carriers, which merged four years ago.

"Last year, we changed our Harvard Community Health Plan to the integrated Harvard Pilgrim HMO Plan," he said. "Adopting the integrated PPO plan completes the process."

With the merged networks, Pilgrim Advantage subscribers will now have a total of more than 23,000 in-network providers available to them, Burke noted. Changes in benefits include a reduction of the deductible from $350 to $250 for individuals and $700 to $500 for families, a $2 increase in the office visit copayment to $5, as well as new provisions for physical, speech and occupational therapy.

Burke added that the routine physical examination schedule under the current Pilgrim Advantage plan will no longer apply in the new PPO plan.

"This means that, if you're in a certain age group where your physical was usually given every two years instead of one, you will not be on that time-table any more," he explained. "You can get a routine physical any time you or your physician feel is appropriate."

Burke added that Advantage subscribers are scheduled to receive new ID cards and member handbooks by the end of the month. Current Advantage ID cards should not be used after April 30, he said.

In announcing the new medical and dental rates for the coming year, the Benefits Office noted that employees who wish to subscribe to a health or dental insurance plan, or change health plans must do so this month.

Rates for the Harvard Pilgrim PPO Plan will be: $247.08 for the total individual premium, with a monthly employee cost of $37.08 and a University contribution of $210; the family premium will be $667.16, with an employee contribution of $133.44 per month.

The total individual premium in the Harvard Pilgrim HMO Plan will be $222.16, with an employee contribution of $33.32, and a family premium of $559.86 with a $120 monthly cost to employees.

Burke said that the University has increased the Delta Dental Plan maximum benefit from $1,000 to $1,200 per year. The individual premium will be $24.46, with an employee cost of $9.80 per month, and $82.98 for families with an employee contribution of $33.20.

All rate changes will take effect in May.

During the open enrollment period in April, eligible employees may switch coverage from one plan to another, enroll in a medical or dental plan for the first time, or change membership between individual and family plans. Information about plans is available on a table outside the Benefits Office in More 380. Applications must be submitted by Wednesday, April 28.

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