CONTENTS
If you are enrolling in a medical plan, first decide if you want a preferred provider plan (Uniform Medical Plan) or a managed care plan. If you decide on a managed care plan, you will also need to choose whether you want a “classic” plan or a “value” plan. To learn more about the differences, read on.
Each plan’s website contains information about participating doctors and pharmacies, certificates of coverage and plan books. Please contact the plan directly to request information and/or to download claim forms.
The UW’s preferred provider medical plan is Uniform Medical Plan. Under this plan, you are free to choose any provider worldwide for medically necessary services. Your choice of providers and facilities will determine your benefit level. Visiting a preferred provider results in the highest benefits. You may self-refer for services from any approved provider including specialists. This plan includes a calendar-year deductible for most services.
Starting January 1, 2008, a new plan called Aetna Public Employees Plan became available to PEBB employees. Like a PPO, enrollees in the Aetna Public Employees Plan can see any provider in the network without a referral, including specialists. Like a PEBB managed care plan, Aetna will cover services from network providers only, except for emergency care. Enrollees pay flat copays (rather than annual deductibles) for most services like office visits. And since PEBB determines the benefits, the Aetna plan covers basically the same services and supplies as all other PEBB plans.
For more information, please see Aetna's FAQ page.
With a managed care plan, you use the provider's facilities and hospitals for your care, and you must be referred by your primary care provider (PCP) for any specialized care, or care outside of the plan's facilities. It is not necessary for all family members to use the same physician.
Managed care plans all provide similar medical benefits. The main differences among the managed care plans are:
The only difference between a “classic” and “value” managed care plan is in your out-of-pocket costs. There is no difference in the level of service and coverage or the provider network. With a “value” plan you will pay a lower monthly premium, but higher co-pays when you visit a doctor or use other health plan services.
The UW’s managed care plans are:
For information on 2008 PEBB plan changes, see Public Employees Benefits Board website.
How do you know whether the “classic” or “value” plan is right for you? That depends on how you and your dependents use your health care. You should consider the number of office visits you make in an average year, the number and cost of prescription drugs you use, and the number of foreseeable hospital visits you anticipate (pregnancy, chronic conditions, etc.).
If you or a family member has a chronic condition requiring ongoing medical management including prescription drugs, regular office visits, and specialty care, you could pay more with a value plan.
If you and your family are in good health and rarely use health care services, you may save money with a value plan.
You should also consider differences in the monthly rate, annual deductibles, co-pays, coinsurance, and annual out-of-pocket expenses when deciding between a value plan and a classic plan.
Managed care medical plans use very few claim forms. The doctors, labs and pharmacies file most necessary claims directly.
The Uniform Medical Plan provides this service if you are using a preferred provider. A non-preferred provider may or may not file claims for you. You can either download the Uniform Medical claim form from Benefits & Work/Life’s forms site or request Benefits & Work/Life mail the form to you.
Medical & Dental
Insurance Topics
Don’t just choose a medical plan because you were covered by that plan with another employer. UW’s coverage will not be the same. Contracts with health insurance providers are specific to the employer. It is your responsibility to know the limits of your coverage under the state insurance contracts.
Uniform Medical Plan Enrollees—be sure to take advantage of your FREE health care benefits today! Read more.