| Description of Change | 2013-14 Benefits (Page numbers reference 2013-14 Benefits Booklet) |
2014-15 Benefits (Page numbers reference 2014-15 Benefits Booklet) |
| Increase in individual out-of-pocket maximum (Both Hall Health and In-network) | Maximum: $1,125(p. 10) | Maximum: $1,425(p. 1) |
| Increase in family out-of-pocket maximum (Both Hall Health and In-network) | Maximum: $2,250(p. 10) | Maximum: $2,850(p. 1) |
| GAIP no longer considered to be secondary or excess coverage | ‘Note: This coverage is blanket disability insurance. Coverage provided is “excess” only and does not contain a “coordination of benefits” provision.'(first page – no page number) |
See Coordination of Benefits (p. 41) |
| Skilled Nursing Facility coverage reduced | Limited to 90 days/plan year(p. 15) | Limited to 60 days/plan year(p. 4) |
| Durable Medical Equipment coverage reduced | Lifewise covers 90% of allowable charge after deductible for both in-network and out-of-network (p. 14) | Lifewise covers 90% in-network and 60% out-of-network(p. 4) |
| Abortion (Out-of-network) coverage reduced | Lifewise covers 80% of allowable charge after deductible(p. 13) | Lifewise covers 60% (Listed as 40% coinsurance) (p. 5) |
| Removal of $1,000 Hall Health benefit | “If your benefits at Hall Health exceed $1,000 in a plan year (services that meet the federal preventive guidelines do not accrue to this maximum), any additional services received at Hall Health will be paid at the network provider benefit level in the student Medical Plan Summary, subject to the deductible and coinsurance.” (p. 10) |
$1,000 Hall Health benefit removed |
| Outpatient Rehabilitation at Hall Health coverage reduced | Lifewise covers 100% of allowable charge after deductible up to 12 visits/plan year(p. 15) | Lifewise covers 90% (Listed as 10% coinsurance), up to 25 visits/plan year(p. 4) |
| Transplants (Office Visits at Hall Health) coverage reduced | “Paid as any other sickness” (p. 15)Relevant coverage category would be the “Outpatient” coverage category (p. 13), which covers 100% of allowable charge after deductible |
Lifewise covers 90% (Listed as 10% coinsurance)(p. 5) |
| Transplants (Out-of-network) coverage eliminated | “Paid as any other sickness” (p. 15)Relevant coverage categories would be the “Inpatient” coverage category (p. 12) and the “Outpatient” coverage category (p. 13). For both categories, out-of-network coverage is 60% of allowable charge after deductible |
Not covered(p. 5) |
| Dental Accidents coverage reduced | For Hall Health, in-network, and out-of-network, Lifewise covers 100% of allowable charges after deductible up to $1,500/plan year (p. 14) |
Not available for Hall Health. For in-network and out-of-network, “Covered as any other service” (p. 5)Presumably, this means “Office and Clinic Visits” (p. 1), which covers 90% for in-network and 60% for out-of-network (Listed as 10% and 40% coinsurance, respectively). |
| Family Deductible (In-network and out-of-network) | “Family Deductible” is not specified in 13-14. Instead, there is a deductible of $75/person each quarter, up to $300/person each plan year(p. 12) | “Family Deductible” added: $150 per quarter, $600 per plan year(p. 1) |
| Prior Authorization added | No prior authorization required | Some drugs may require prior authorization (p. 10) |
| Specialty Drugs | “Specialty drugs” is not a category in the 13-14 booklet. Drugs are covered as follows (p. 13): Hall Health
In-network
Out-of-network
|
Lifewise covers 50% (Listed as 50% coinsurance)(p. 3) |
| Oral Chemotherapy Drugs | “Oral Chemotherapy Drugs” is not a category in the 13-14 booklet. Drugs are covered as follows (p. 13): Hall Health
In-network
Out-of-network
|
Lifewise covers 90% (Listed as 10% coinsurance)(p. 3) |
| Hearing Care (Out-of-network) coverage reduced | Lifewise covers 75% of allowable charge after deductible(p. 14) | Since “Hearing Care” only covers annual hearing testing, the equivalent category for 14-15 is “Preventative Care”. Out-of-network preventative care is not covered(p. 2) |
| Alcohol and Chemical Dependency coverage reduced | Both in-network and out-of-network: Lifewise covers 100% of allowable charge after deductible(p. 13) | In-network: Lifewise covers 90% after deductible (Listed as 10% coinsurance). Deductible waived for the subcategory of “Outpatient Facility.”Out-of-network: Lifewise covers 60% after deductible (Listed as 40% coinsurance). (p. 3) |
| Hall Health Outpatient Services coverage reduced | Lifewise covers “100% of allowable charge after deductible for the following services/supplies: treatment by a doctor or surgeon, office and clinic visits, outpatient services, diagnostic x-ray and lab, surgical services, surgical dressings and casts, prosthetic appliances, rehabilitative care when prescribed by physician” (p. 13) |
Relevant 14-15 categories: Office and Clinic Visits: Lifewise covers 90% after deductible (Listed as 10% coinsurance)(p. 1) Diagnostic X-ray, Lab and Imaging (All diagnostic x-ray, lab, and imaging except for preventative screening and tests): Lifewise covers 90% after deductible (Listed as 10% coinsurance) (p. 2) (p. 3) Hospital Services (Outpatient Care): Lifewise covers 90% after deductible (Listed as 10% coinsurance) |