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New Year, new health plan: what you need to know before you go
YNHHS reminds employees that the start of 2021 also saw the start of the new YNHHS medical plan, which went into effect Jan. 1.
The new, single medical plan offers three tiers of coverage based on the providers in each tier. Employees are not restricted to any one tier, but should be aware that copays, out-of-pocket costs, provider fees, deductibles and coinsurance are different, depending on the provider in each tier. The new plan is designed to significantly reduce out-of-pocket costs when using YNHHS Signature Tier 1 providers and facilities.
“The new Yale New Haven Health medical plan offers employees several options to obtain excellent health care at significant cost savings,” said Angel Bruno, vice president, Total Rewards. “It is very important that employees know which tier their provider falls in before seeking care so that there are no surprises later.”
Each tier consists of specific healthcare providers and facilities:
The Tier 1 – Signature Network is an expanded “in-system” network that includes YNHHS and certain other designated facilities and providers. Using providers and facilities in this network will mean lower copays and out-of-pocket costs, as well as set copays and no deductibles or coinsurance for inpatient or outpatient visits.
The Tier 1 – Signature Network includes:
- Hospitals: Yale New Haven, Bridgeport, Greenwich, Lawrence + Memorial and Westerly hospitals; and Trinity Health of New England (St. Mary’s in Waterbury, St. Francis in Hartford, Johnson Memorial in Stafford Springs)
- Other facilities/services: YNHHS outpatient facilities, including blood-draw stations; NEMG (including its walk-in facilities); YNHHS urgent-care facilities; Physician One urgent-care centers; Trinity Health’s Mount Sinai Rehabilitation Hospital in Hartford; and Trinity-owned outpatient surgical centers
- Primary care clinicians from Northeast Medical Group (NEMG); Community Medical Group (CMG); Yale Medicine (YM); WestMed* (those participating with Anthem CT); Trinity Health of New England; and SOHO HEALTH, Trinity’s clinician network (those participating with Anthem CT). Note: gynecologists and geriatricians are considered specialists.
- Specialists include any clinicians on the medical staff at a Yale New Haven Health facility, as well as specialists from YM, NEMG, CMG, Trinity Health of New England and SOHO HEALTH, Trinity’s clinician network (who participate with Anthem CT)
Tier 2 – Anthem PPO Network includes facilities and providers that are not part of YNHHS Signature Tier 1, but covered by Anthem. A deductible applies to most services; and the cost to the patient for some services (such as inpatient hospitalization, outpatient surgery and lab services) will be a percentage of costs (coinsurance).
Tier 3 – Out-of-Network includes facilities and providers that are not within the YNHHS Signature Tier 1 or Anthem PPO networks. Using providers and facilities that are out of network will result in the highest deductibles; and the cost to the patient for most services will be a percentage of the maximum allowable amount. For tiers 2 and 3, all copays and coinsurance costs for covered services are applied toward the annual out-of-pocket maximum.
Employees who need routine or emergency medical care when out-of-state may access Anthem’s extensive national network of hospitals and providers, which would be covered at Tier 2 levels.
“We strongly encourage employees to ‘know before you go’ when it comes to getting the care you need,” Bruno said. “Please be aware of the costs and coverage associated with that care so you can make the best decisions for you and your covered dependents.”
There are resources to help you determine if your provider is in the Signature Network and the potential costs of your visit or procedure:
- Patient resource coordinators can help with explaining tier coverage and potential costs, finding a Tier 1/Signature Network provider, making appointments and dealing with billing issues. To reach a patient resource coordinator, call 475-246-9970.
- A search tool to find providers in the Tier 1 Signature Network is on Infor, HRConnect, Employee Self Service and the YNHHS Employee Portal.
- Charts showing what you will pay for care and how certain services are covered are at www.ynhhsbenefitsconnection.org.
*Discussions are under way to include WestMed NY-based providers.
