Weâ€™re proud to announce that even with the positive Health Care Reform Changes (below) we are not increasing the premium rates for Core Health Insurance (CHI) for the next year.
The changes will take place for dates of service incurred on or after May 1, 2011 for all existing clients and new members moving forward:
- The eligible dependent child age will increase from 24 to 26.
- All benefits will be paid as per the amounts listed in your current Schedule of Benefits which may be higher in some cases than the â€œup toâ€ payout amounts previously paid. This means that if a client has a claim submitted for a specific benefit, the plan will pay the full benefit amount, even if the charge is less than the benefit amount. The provider is paid directly, and then any difference is sent directly to the insured.
- The doctor office visit co-pay benefit will be replaced by an indemnity (flat dollar) amount for a doctor visit benefit, which is a flat dollar amount. This amount should provide very similar out of pocket expense as stated above, however, that expense may be higher or lower depending on the plan you enrolled into (Physician, Value, Gold, and Platinum).Â A clientâ€™s out-of-pocket expenses will almost always be less when they visit a doctor in the Beech Street network.
Example: Previous visit to the doctor: The client was responsible for a $30 co-pay. Current benefit change means that when the client visit the doctor, the claim is sent to our claims department and re-priced, and then the plan will provide a flat benefit ($100 Physician, $110 Value, $120 Gold, and $125 Platinum). The doctor will be paid directly.Â If the benefit amount exceeds the charge, the client will receive a check for the difference.Â If the charge exceeds the flat benefit amount, the client will be responsible for the difference.