As announced after the June 2009 Board of Directors meeting, several changes to the Medical Plan are effective January 1, 2010:
- Changes to out-of-pocket costs - Several out-of-pocket costs have changed for both medical and surgical care and prescription drugs. These changes simplify the Plan, as well as help us comply with the federal "mental health parity" mandate, which requires that benefits for medical and surgical services cannot exceed those for mental health.
- A new health management service provider - ActiveHealth Management
replaces and expands upon the services formerly provided by CareAllies, including pre-certification, case management, and specialized support for individuals with certain chronic conditions. ActiveHealth Management also brings with it personalized health information and support capabilities, such as a 24-hour nurse line. - Expanded coverage for children with congenital developmental disabilities - In response to an overture to the 218th General Assembly (2008), the Medical Plan covers "habilitative" services for dependent children with developmental disabilities, including autism spectrum disorders, Down syndrome, cerebral palsy, intellectual disability, and spina bifida. The covered services include specified therapies to promote growth and improve function.
- An increase in the maximum lifetime benefit - To keep pace with changes in the cost of living, the maximum lifetime benefit payable under the Medical Plan for each member, spouse, and dependent child increased from $3 million to $3.5 million.
For a more detailed overview of the changes and your Medical Plan for 2010, please read the Your Healthcare Benefits in Brief booklet, which was mailed to active members at the end of December. You can also view our e-learning modules:
- Medical Plan Changes for Active Benefits Plan Members
- Medicare Supplement Program Changes for Retired Benefits Plan Members
If you have questions about the Medical Plan changes or your healthcare benefits, please call the Board at 800-773-7752 (800-PRESPLAN).