Agenda - 10-02-1995 - IX-C - Laserfiche WebLink

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4 clearly define and limit any potential financial liability beyond the monthly premium for Trust participation. As of this date, it appears any liability beyond the monthly premium for the contract period would arise only in the circumstance in which the Trust as a whole exceeded its loss expectations, experienced a deficit and the Trust Board of Trustees levied a special assessment on the Trust members. If the Board elects to pursue the Trust option, participation in the Trust is only recommended contingent on negotiation of a satisfactory Interlocal Agreement within the necessary time frames. Absent this, the County may pursue Option A, B, or C by contracting directly with Blue Cross. If the County enrolled in the Trust and then decided to discontinue participation in the future, it could do so only on the renewal effective date. This would require Board of Commissioners' action and at least 90 days advance notice to the Trust. Preferred Provider Plans Options B and C provide for changing the current BC/BS Traditional Plan to a BC/BS Preferred Provider Plan. A Preferred Provider Plan is like a Traditional Plan in that it has deductibles, out-of-pocket limits and co-insurance amounts. The difference is that the Preferred Provider Plan provides for two tiers of benefits: One tier applies to services received from"preferred care" providers and the other tier applies to "non-preferred care" services. The reason for cost savings under the preferred care benefits is that BC/BS has negotiated lower rates with the preferred providers. A Preferred Provider Plan may cover hospitals only or both hospitals and physicians. The plan quoted in Options B and C is called "PPO Select" and it covers both hospitals and physicians. Attachment 2 outlines the plan benefits. Attachment 3 compares the benefits of the PPO Select preferred provider plan to those of the current Traditional Plan. In terms of the preferred care benefits,the deductibles and out of pocket limits are the same as the current Traditional Plan and the co-insurance amount is 90 percent rather than the current 80 percent. For the non-preferred care benefits the deductibles and out of pocket limits are higher than the current Traditional Plan and the co-insurance amount is 80 percent, the same as the current plan. Under a Preferred Provider Plan, the employee may still choose the hospital or physician from whom he or she receives care. The plan provides financial incentives for choosing the preferred providers. A key question evaluated has been whether to pursue the option of a hospital and physician or hospital only preferred provider plan. In this regard,the following is noted: