Empire
Plan Changes Coming in ‘07
If you’re in the
state’s Empire Plan, look for the benefit changes in the table below,
authorized in the 2003-2007 PS&T contract, to start January 1, 2007. In
addition to changes in copayment amounts, there will be two changes to the
Empire Plan Basic Medical Program. The
annual deductible for medical services performed and supplies prescribed by
non-participating providers will increase from $322 to $335.
And, if your expenses under
the Empire Plan Basic Medical Program exceed $1,610 (up from $1,548), the plan
will pay 100 percent of the total charge or the “reasonable and customary”
charge, whichever is less.
These changes result from a
4.0 percent hike in the medical component of the Consumer Price Index for
|
Benefit
|
2006
Benefit Level |
2007
Benefit Level |
|
Network
Hospital (BC) |
|
|
|
Emergency Room |
$50 copay |
$60 copay |
|
Outpatient Physical
Therapy |
$15 copay |
$18 copay |
|
Par
Provider (UHC) |
|
|
|
Office Visit,
Surgical Procedures, Radiology and Diagnostic/Lab |
$15 copay |
$18 copay |
|
Managed
Physical Medicine (MPN) |
|
|
|
Physical/Occupational
Therapy and Chiropractic Care |
$15 copay |
$18 copay |
|
Managed
Mental Health (ValueOptions) |
|
|
|
Outpatient Mental
Health Visits |
$15 copay |
$18 copay |
|
Outpatient Substance
Abuse Visits |
$15 copay |
$18 copay |
|
Emergency Room |
$50 copay |
$60 copay |