I had a chance to look this over for a friend of mine who is retired and currently has the Blue Cross family plan.
Three Plans
One is from Blue Cross and the other two are from Fallon. The two Fallon plans are the same plan design just different networks,
Direct and
Select (City of Worcester is calling it
Advantage). Direct is smaller network mainly the old Fallon Clinics and if you are not already in the Direct network, it is hard to get a PCP. Select, on the other hand, matches up with Blue Cross except that they only have access to the Boston Hospitas through their Pea
ce of Mind program.
My fiiend doctors do not accept Fallon Direct, so his choices are to stay with Blue Cross or go to Fallon Select. he does not want to change doctors
- Blue Cross total premium is 1652.49
- Blue Cross employee cost will cost 413.12 per month
- Fallon total premium is 1339.12
- Fallon Select employee cost 349.78 per month
- 63.34 per month difference
- 760.08 annual difference
Benefits
There really is not much difference between the two plans, some slights ones with co-payments and extra like fitness benefits etc. The real difference is in the tiering of hospitals when it comes to day surgeries and hospitalizations. What is this?The plans are starting to put hospitals in dfiferent categories.
Blue Cross will charge, you either 150/200/500 for day surgeries and hospitalizations depending on which hospital you go to, after plan year deductible is paid (250).
Click here for the list. Medical City or Saint Vincets (Enhanced Hospital) will cost 150, while UMASS (Belmont or Lake Ave) will cost 500 (Basic). Please note Harrington considered basic.
Fallon will charge 150/300 for day surgeries and 250/500 for Hospitalizations depending on which hospital you go to, after plan year deductible is paid (250)..
Click here for their list. All the hospitals in Worcester would be in the first tier so day surgeries will cost 150 and hospitalizations will cost 250 at UMASS or Med City (Saint Vincent's).
What should he choose?
First his doctors utilizie UMASS so it would cost him more if he had Blue Cross (500) versus either (150 or 250) if he had Fallon. So he went with Fallon Select right?? No he did not. He likes the fact that Blue Cross has the Boston Hospitals in the network and does not have to go through Fallon's Peaace of Mind Program. It was worth the extra 63.34 pre month to him.
Flat Dollar
In the end the City of Worcester would rather see my friend go with Fallon since the premium for Blue Cross.
- Blue Cross monthly total premium is 313.37 more per month then Fallon or 3760.40 annual
- Employee total monthly premium is only 63.32 more per month then Fallon or 760.08 annual
- The City of Worcester is paying nearly 3,000 more towards the cost of an employee choosing Blue Cross over Fallon.
The City sould institute a falt dollar amount towards the cost of an employee's healthcare to accurately reflect the true cost of the underlying premium.