Health Benefit Changes Starting January 2006

Dental Enhancements

Enhancements and other changes to the health benefits negotiated in the 2003-2007 PS&T contract will take effect January 1, 2006.

“We've received a number of complaints about the GHI dental plan’s out-of-network differential,” said PEF health benefits specialist Lorraine Simpkins.

When basic and major restorative services are performed by a non-participating dentist, the GHI plan has been paying 80 percent of the allowable charge.  The enrollee has to pay the remaining 20 percent of the allowable charge (referred to as the out-of-network differential), plus the difference between the non-participating dentist’s actual charge and the allowable charge.  Starting January 1, GHI will pay 100 percent of the allowable charge for both participating and non-participating dentists.

“The penalty for using non-participating dentists has applied even in situations where no participating dentist was available. Members will be glad to know that the differential will no longer apply in 2006,” Simpkins added.

Also under the GHI Preferred Dental Plan, the annual maximum benefit will increase from $1,800 to $2,300 per person, per year.

Empire Plan Changes

Simpkins said the new year also will bring changes for members enrolled in the Empire Plan.  The benefit for hearing aids is improving, but members using a non-participating provider will see their costs increase.

The maximum reimbursement for hearing aid evaluation, fitting and purchase of hearing aids will increase from $1,200 to $1,500 per hearing aid per ear.

The Empire Plan Basic Medical Program annual deductible for medical services performed and supplies prescribed by non-participating providers will increase from $309 to $322.

And if your expenses under the Empire Plan Basic Medical Program exceed $1,548 (up from $1,486), the plan will pay 100 percent of the total charge or the “reasonable and customary” charge, whichever is less.

These changes result from a 4.2 percent hike in the medical component of the Consumer Price Index for Workers (CPI- W) for the period July 1, 2004 through June 30, 2005.