2013 Medical Plan Comparison (pdf)
Health Maintenance Organization (HMO)The health maintenance organization (HMO) provides all medical services through an extensive network of providers and hospitals in all six New England states. When you need medical treatment, you see your physician in the privacy of his or her office.
High Deductible Health Plan (HDHP) with Healthcare Reimbursement Account (HRA)The High Deductible Health Plan (HDHP) provides both in-network and out-of-network benefits.
This plan is part of the BCBS preferred provider organization (PPO) which replaced the traditional PPO plan for in-state employees. The traditional PPO plan is still available, but only to out-of-state employees residing outside of Massachusetts.
As part of WHOI's long-term strategy to contain healthcare costs and provide a more competitive and balanced 'total rewards' package to its employees, WHOI offers a HDHP as a lower cost medical plan option and pays 75% of the premium for this plan. The HDHP will cost employees about 45% less than the traditional HMO plan so there is great opportunity for employees to save considerable dollars.
As the plan title suggests, there is a calendar year deductible under this plan which will require employees to pay out-of-pocket for most services. Although the thought of taking on the risk for upfront out-of-pocket costs sounds scary, there is a limit to the amount of that risk. There is a calendar year deductible of $2,000 per member, capped at $4,000 per family. However, to help defray some of the cost for deductible charges under this plan, WHOI provides an employer-funded Health Reimbursement Account (HRA) which covers the first 50% of the annual deductible. For more information about the employer-funded HRA, please read the HDHP Plan Highlights and HDHP FAQs.
It is important to point out that routine preventive services and Rx are NOT subject to the deductible. Employees are only responsible for a $15 office visit co-payment, and the ordinary Rx co-payment ($15/$30/$50). Please note that these charges are not applied towards meeting your annual deductible.
Access BlueAccess Blue is a hybrid of the HMO and PPO plans. It is very much like the HMO except that one does not need a referral to any specialist in the network. The service area is limited to Massachusetts.
Preferred Provider Organization (PPO) (for out-of-state employees only)Effective January 1, 2010, the PPO plan is only available to those employees who reside outside of the HMO and Access Blue provider network. Out-of-state employees may also choose to enroll in the new High Deductible Health Plan (HDHP) which is also a PPO plan.
The Preferred Provider Organization (PPO) plan provides both in-network and out-of-network benefits.
When you use participating providers, you get the in-network level of coverage, which means your out-of-pocket costs are minimal. In this way, the PPO is similar to the HMO. The provider network is throughout all of the United States and includes almost 130 hospitals in 40 foreign countries.
The PPO also provides you with benefits if you choose to receive care from a non-participating provider. When you use non-participating providers, you will receive the out-of-network level of coverage. This coverage is similar to a traditional indemnity plan.
If you receive services out-of-network, the plan has an annual out-of-pocket expense maximum to protect you from large expenses. Once you have reached your annual out-of-pocket maximum, the plan generally pays 100% of covered expenses for the remainder of the calendar year.
For more information on what the plan covers, please refer to your PPO booklet. The PPO offers its members the same special discounts on eyewear and exams, alternative medicine, and wellness and safety programs as the HMO.