Federal Diary Live
With Stephen Barr
Washington Post Staff Writer
Wednesday, Oct. 31, 2001; Noon EST
Which health care plan to choose is a difficult decision for everyone, including federal employees. How do you know which one is right for you?
For 2002, Blue Cross and Blue Shield will abolish its "high option" and offer employees and retires the choice of joining either its "standard option" or its new "basic option." Even as Blue Cross restructures its plans for employees, 28 health maintenance organizations, including the George Washington Health Plan and the Free State Health Plan, are dropping out of the Federal Employees Health Benefits Program.
 |
| Steve Gammarino |
The transcript follows.
Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
Stephen Barr: Thank you for joining us today, especially Steve Gammarino of Blue Cross and Blue Shield. Steve directs Blue Cross' Federal Employee Program, which covers half of all enrollees in the government's employee and retiree health care benefits program.
To get the discussion going, I'd like to start by asking Steve to give us an overview of the important benefit changes we'll see in Blue Cross for 2002.
Once again, Steve, thanks for taking time from your busy schedule to take questions today.
Steve Gammarino: For 2002 we have three significant changes. First, a new, more affordable, Basic Option will be offered. Second, the current High Option will be merged with our Standard Option. And third, the Point-of-Service pilot program will be discontinued. We believe that the 2002 offerings are of the highest quality and will continue to provide choice for our members at a superior value.
The new Basic Option is a Preferred Provider Organization-only benefit package that will be available to all federal and retirees no matter where they live or work. It includes features such as no deductibles, no referrals required, copayments for many services, chiropractic care, and preventive dental coverage. Basic Option offers choice, access and simplicity at a more affordable price.
For more information, federal employees and retirees can go to our Web site at www.fepblue.org or call our Open Season Hotline at 1-800-411-BLUE. Don't forget that Open Season runs from November 12 through December 10th.
Columbia, Md.: I'm one of your many Standard Option folks who plan to switch to Basic at open season. For prescription drugs, copayments are listed. Does this mean I need to pay copayments in addition to the drug price at the pharmacy? Also, for dental care, are the Maximum Allowable Charges being used under Basic Option, too? Thank you for this opportunity to ask questions.
Steve Gammarino: Super question Columbia, MD! Under Basic Option, you are only responsible for the prescription drug copayment or coinsurance when you use a preferred pharmacy. Those copays are $10 for generics, $25 for formulary brand name drugs, and 50% coinsurance ($35 minimum) for non-formulary brand-name drugs for up to a 34 day supply.
For preventive dental services covered under Basic Option, you will pay only a $20 copay per evaluation. We will reimburse the preferred dentist up to the maximum allowable charge.
When you are choosing your plan, we encourage you to look at the provider directory to make sure that your providers are preferred.
Ellicott City, Md.: My 18-year-old son will start college next year, in another state. Will there be any problems for him to be covered by my Blue Cross FEHBP plan?
Steve Gammarino: Under both Standard Option and Basic Option, Blue Cross and Blue Shield provides coverage throughout the country, regardless of where you are located. You may want to contact the local Blue Cross and Blue Shield plan in the area where your son will be attending college to obtain a provider directory and get additional information.
Somewhere, USA: I have the Standard Option insurance now and Medicare. For Medicare-covered individuals, would the Basic Option be a better choice? What factors should one consider in making this decision?
Steve Gammarino: Thanks for asking this question. When selecting your health plan, you need to take into consideration your health status and health needs. Under Basic Option, you must use preferred providers even when Medicare is primary, while under Standard Option you can go to any provider. Standard Option also offers mail service pharmacy benefits -- $10 for generics and $35 for brand-name drugs up to a 90 day supply. Basic Option offers only retail and internet pharmacy benefits -- $10 generics, $25 formulary brand name drugs, and 50% coinsurance ($35 minimum) for up to a 34 day supply.
Arlington, Va.: So how will the coverage for the current Standard Option change? And do those of us who have that option need to do anything?
Steve Gammarino: Thanks for your inquiry. You will be receiving the 2002 Service Benefit Plan brochure in the mail. You can also read the brochure online at www.fepblue.org. Page 8 of the brochure details the changes for 2002.
The changes for Standard Option are minimal. Noteworthy changes include:
Change in mail service pharmacy copays to $10 generics and $35 brand name for up to a 90 day supply.
Increase in catastrophic out-of-pocket to $4000 for preferred providers and $6000 for preferred and nonpreferred providers.
IF you currently have Standard Option and want to remain in it, you do not have to do anything.
Huntsville, Ala.: My mother and stepfather have Medicare as their primary healthcare and Blue Cross Blue Shield as their secondary. I have not seen a brochure detailing the difference in the new BC/BS plans, but we are trying to determine if they should sign up for the new plan which will be less expensive for them. Any information you can provide will be appreciated.
Steve Gammarino: See above answer. You will be receiving a brochure in the mail. Or you can go to our Web site at www.fepblue.org. You can also call our Open Season Hotline at 1-800-411-BLUE.
Oxford, Pa.: Every year it seems more and more health plans are dropping coverage for federal employees and we have less and less to choose from. Why is this happening?
Steve Gammarino: It is unfortunate that plans are leaving the program. However, the Blue Cross and Blue Shield Service Benefit Plan has been in the FEHBP since its inception in 1960 and we are committed to providing comprehensive benefits at an affordable price for federal employees, retirees, and their families.
Generally in the health care industry, there is increasing consolidation among health plans and the FEHBP is not immune to these outside pressures. Although there are fewer health plans to choose from, the addition of the Blue Cross and Blue Shield Service Benefit Plan's new Basic Option, will give you an additional choice that we hope you will consider.
Atlantic City, N.J.: Part of my family's health care needs requires the services of providers who are NOT preferred providers. Would I be better off NOT choosing the Basic Option?
Steve Gammarino: Thanks for your question.
If you use non-preferred providers, Standard Option is a better choice for you and your family.
Bethesda, Md.: We currently have BCBS Service Benefit Plan-Standard (Self & family). My husband will also have the Original Medicare Plan (both Part A and B) in December. He is an annuitant and I (his spouse) am a Fed retiree. Would my $250 calendar year deductible be waived under BCBS-Basic (Self & family)? Thanks for your help.
Steve Gammarino: Under Basic Option, there is no calendar year deductible. Remember that you must use preferred providers under Basic Option. For further comparison between Standard Option and Basic Option, may we suggest that you carefully review the Blue Cross and Blue Shield Service Benefit Plan Brochure.
Hope this helps.
Stephen Barr: Steve, we're getting lots of questions on one topic: dental benefits. Most of our questioners are enrolled under family coverage and are seeking ideas on how to maximize their dental coverage. Others would like you to discuss how BC/BS covers orthodontics. I know this is a complicated subject, but clearly our questioners are looking for some guidelines to follow.
Steve Gammarino: Unfortunately, because of escalating health care costs OPM has decided to limit dental coverage, thus we have not been able to increase our limited dental benefit for many years. It is our understanding that OPM has been looking into ways of offering dental coverage such as a stand alone benefit.
To maximize your benefits under Standard Option, you and your family members should use Preferred dentists, with whom your out-of-pocket costs will be limited to the difference between our payment and the Maximum Allowable Charge--this should provide you with some savings.
Under Basic Option, we cover preventive services such as exams, bitewing X-rays, cleanings and sealants for children in full after a $20 copay. (You must use Preferred dentists.)
We do not offer coverage for orthodontics under either Option.
Clifton, Va: Why have the Standard Option rates increased so dramatically?
Steve Gammarino: Our premium increases are similar to what is happening across the rest of the country. These cost increases are primarily due to increased use and costs of prescription drugs, increased costs and use of provider services, and costs associated with advances in medical technology. Moreover, the FEHBP is dealing with an aging workforce which contributes to the increased health care costs. For example, the average age of the Blue Cross and Blue Shield Service Benefit Plan enrollee is 60 years old and the average FEHBP enrollee is 54 years old.
It is important to note that for the Service Benefit Plan, 93 cents of every premium dollar is spent on medical benefits.
Washington, D.C.: I have GWUHP as my family insurance carrier and have been with them since 1987, but it will not be participating in the FEHBP next year. My concern is that I have an ongoing medical condition and when I switch to a new carrier that my current doctor accepts, will the new carrier accept me with this condition or will I need to provide the reason why I will be switching to a new carrier? In addition to discussing this in general, would BC/BS allow me to switch to one of its plans?
Steve Gammarino: Good question. In the FEHBP, all carriers must accept any federal employee or federal retiree. There are no pre-existing condition limitations in the FEHBP. You are free to choose any plan that participates in the FEHBP during Open Season.
Ocean Pines, Md.: An earlier discussion here mentioned that OPM had a guide concerning the relationship between the federal health program and people with Medicare. I've not been able to locate such a guide on the OPM Web site. Does your web site provide a link? Thanks for your help.
Steve Gammarino: The OPM guide on Medicare and FEHBP can be found at www.opm.gov/insure/health. Look towards the bottom of the page.
In addition, we are updating our brochure "Medicare and You." It will be updated on the web in November and can be found at www.fepblue.org.
Washington, D.C.: I have a very rare genetic disease that requires treatment from a variety of specialists on a regular basis. I have been enrolled in the High Option BCBS for federal employees and understand that this will now switch to Standard. What substantial changes should I expect? By how much will my bi-monthly premium drop? Thanks!
Steve Gammarino: May we suggest that you call our Special Open Season customer service center for High Option enrollees at 1-877-844-4031. This is a toll free number and is available Monday through Friday from 7 a.m. to 11 p.m. EST.
King George, Va: I'm a new federal employee and am still trying to make sense of FEHBP. What is the main difference between the basic and standard option? Is there a PPO aspect of the standard option?
Steve Gammarino: Thanks for your question. See some of the above questions and answers that compare Basic Option and Standard Option. Also, may we suggest that you go to our website at www.fepblue.org to review our Standard and Basic Option 2002 offerings. In addition, you can call our Open Season Hotline at 1-800-411-BLUE.
Stephen Barr: Once again, we've run out of time today and did not get to all of your questions. Thank you for sending them, and thanks to all of you who take the time to read this transcript. We'll be back here at noon next Wednesday for a second discussion group focused on the 2002 changes in the Federal Employees Health Benefits Program. See you then!
ncG1vNJzZmivp6x7uK3SoaCnn6Sku7G70q1lnKedZMSxedKrrWikmauysLrLoqWeZ2BmfLG7y6KropujZLOmsMSrmKWcmZa%2Fun2PbGhpaV6dwa4%3D