By Bryan Carroll
Last summer, IBEW members at PG&E began charting a new course for their medical benefits.
Instead of settling for another increase in premium cost-sharing, members of Local 1245 are bucking the industry trend and trying something different. The major focus of the new approach at PG&E is preventive care–to get members healthier and reduce costs to both the employees and the employer. A key element is the relationship between the member and the primary care physician.
When people keep a closer relationship with their primary care physician–and get treatment for issues that can lead to serious chronic conditions such as diabetes and heart disease–they accomplish two things: they keep themselves healthier in the short term, and delay or avoid many chronic disease conditions and associated costs in the long term.
Since PG&E’s health care costs in a given year primarily determine the premiums for the following year, delaying or avoiding the onset of costly medical conditions also helps lower costs for everyone.
As in 2013, there will be only two health care providers in 2014: Anthem Blue Cross and Kaiser Permanente. Unlike 2013, there will be a single medical plan for 2014–the Health Account Plan. It’s the same medical plan, available through Anthem or Kaiser. The main difference will be the provider networks. In the meantime, here are five basic concepts to keep in mind:
Deductibles: This is the amount you pay before coverage kicks in.
Annual Out-of-Pocket Maximum: This is the most you’ll ever have to pay in a year for covered services, and it includes amounts you’ve paid toward the deductible.
Coinsurance: This is the percentage you pay (10-20%) of the cost of the service you receive, while the plan pays the remainder (80-90%).
Health Reimbursement Accounts (HRA): Money you are given and/or earn through a quick health and tobacco screening which can effectively eliminate your deductible.
Free Doctor Visits and Drugs: Four free visits to primary care doctors for each covered member and dependent. A large list of free medications for common conditions.
In August, over 100 IBEW 1245 members will receive a full day of training on the 2014 medical changes. They’ll learn how the new plan works; get tips on how to be a smart medical plan user; and walk through real-life scenarios.
In September and October, these members will be available in job site meetings all over the PG&E system to explain how IBEW members can benefit from this new approach to medical care.