Because PSE represents over 30,000 public school employees and their families, affordable, available health insurance is a high priority for our union. Paying careful attention to ALL the options available to you during the open enrollment period could prevent you from facing serious consequences that could raise your out-of-pocket responsibility and/or require you to change medical providers.
Rates are going up again, continuing a troubling trend over the past several years. Rising costs hit everyone hard, especially lower-wage workers. I want to call your attention to a few critical areas of our health insurance options so you can make informed decisions for yourself and your family.
If your open enrollment period has already closed, this is for information purposes only.
In addition to premiums, co-pays, and deductibles, a critical issue is the “preferred provider list.” A doctor who is “on the list” has agreed to accept the insurance company reimbursement and co-pay amounts. An “out of network provider” does not. The insurance company pays the provider a fixed amount and the additional cost is the responsibility of the patient’s family.
What is different this year is that some plans are changing their preferred provider networks. As such, hospitals, clinics, and doctors that have been participating will no longer be “on the list” after January 1, 2017.
Out of Pocket Maximums
There are annual out-of-pocket maximums that apply to the preferred provider network. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits. The out-of-pocket limit doesn’t include your monthly premiums. It also doesn’t include anything you may spend for services your plan doesn’t cover. Going out of network is considered a “non-covered” expense. The maximum out-of-pocket limit for any 2016 marketplace plan is $6,850 for an individual plan and $13,700 for a family plan.
Get more information here.
Keep in mind, these impacts will be different for each employee. Those members with serious, ongoing health issues in their family should pay special attention during open enrollment.
PSE has been addressing the high costs of health insurance and inadequate funding for benefits with the Legislature for many years, and will be doing so again in January 2017. It is important to let your union leaders know about the kind of health care issues you are encountering.
Thank you for everything you do for our students and our public schools and universities. Have a great year!
PSE State President
Paraeducator, Rosalia School District