Lane Community
College
Proposed plan and
benefit changes for
7/1/17 – all plan and benefits
changes are subject to bargaining
Agenda
What is SmartChoice?
New Plan Option, Plan D
Alternative Care Changes
4th Quarter Carry Over Removed
SmartChoice Network is
one of PacificSource’s
Coordinated Care
Networks
• What is a Coordinated Care
Network? An integrated network of
providers working collaboratively
with PacificSource to drive positive
health outcomes, improve member
experience, reduce cost of care
and provide market differentiation.
• Care is coordinated through a
designated primary care provider.
SmartChoice - A Coordinated Care Network
Goal of SmartChoice
How we contract
• Establish a primary care physician
relationship, with self-referral capabilities to
specialists
• Development of Medical Homes
• Shared vision that includes member
engagement and openness to innovation
• Network of high quality providers providing
member access - both geographic and
specialty
• Alignment with Triple Aim: better health,
better care, and lower costs
Primary Care Physician Requirement
• Shared savings alignment (pay for
performance, cost-effectiveness, and quality
metrics)
• Providers paid on value, rather than volume
• Network adequacy determined by travel time
and distance
• Nominations are welcome - by providers and
members
Primary Care Physician (PCP) Rules
How to Pick your PCP
• Online – www.pacificsource.com - Find a provider
• Once find your PCP, click “Set as PCP” button
• Paper form
Can change your PCP if needed
• Will be effective first of the month following update to PacificSource
If you don’t select a PCP, you’ll receive a letter from PacificSource reminding
you to select one.
Currently, 93% of total PSN providers within a 25 mile radius of Eugene area
in SmartChoice.
Common Network Questions
What happens if my doctor leaves the
network?
Can a doctor in my network turn me away
because I have SmartChoice?
• Most PacificSource contracts require a 6 month
contract termination clause. PacificSource
notifies members who’ve seen that provider
within the 6 months prior to contract termination
• There is nothing in the PacificSource contract that
limits the number of patients a provider can have in
their practice.
Can I keep seeing my provider after they leave
my network?
• For some types of care, PacificSource offers a
90 day transition period to find a new provider.
Your claims pay at the participating benefit
level, however you can still be balance billed
the difference in the billed charge and the
allowed charge. Contact PacificSource for
more information.
• However, a provider can always adjust when a
practice is considered full and not accepting new
patients. This is not tied to SmartChoice, but
normal within any provider group.
The PacificSource website says the provider is
“accepting new patients”, however I called the
doctor and was told they are not.
• The PacificSource website is only as current as the
information we have from the doctors office. If we
aren’t notified, we won’t update our website.
2017/18 Changes – Management & Classified
• Move to a consoled alternative care benefit across all plans
• Management – changes the way out of network providers are paid
• Classified – Changes to the current management plan, which is
modified for payment of out of network providers
• Add a Plan D option
• Eliminated the 4th quarter carry-over benefit
• No major change in dental plans
Plan Changes - effective 7/1/17
Benefit
Change
SmartChoice Plan D
(new plan)
• SmartChoice Network
• Deductible $1,300/person
• Out of Pocket $5,000/person participating provider
Classified Alt Care
Changes
• $2,500 combined max
• $25 copay par/nonpar
• Member at risk for balance billing for nonpar
services i.e. billed over allowed charges
Management Alt Care • $2,500 combined max remains
Changes
• Already set up with $25 copay for participating
providers; Nonpar also now $25 copay
• Member at risk for balance billing for nonpar
services i.e. billed over allowed charges
Select the best Plan for you and your family
All Management and Classified employees now have seven medical plan options
• All plans now have the same pharmacy, alternative care and vision coverage –
only difference is deductible, out-of-pocket maximum and provider network.
How to choose your medical plan?
1. Choose your deductible & out of pocket maximum that best fit your and your
family’s needs.
2. Choose your network - PSN or SmartChoice
• The SmartChoice panel in Lane County has approximately 85% of the providers also in the PSN
Network. The percentage is even higher match up when looking at the providers LCC members
actually see.
• The SmartChoice plans are a great option for members to consider.
3. Other considerations
• Premium cost from your paycheck
• Services pay the same on all plans (i.e. $25 copay, 100% preventive care, 20% co-insurance)
Plan deductibles and out-of-pocket
maximums
Deductible
Out of Pocket Maximum
Individual in/out
Network
Family in/out
Network
Individual in/out
Network
Family in/out
Network
A (PSN & SC)
$500/$1,000
$1,250/$2,500
$2,000/$3,250
$4,250/$7,000
B (PSN & SC)
$750/$1,500
$1,875/$3,750
$3,250/$5,250
$6,875/$11,250
C (PSN & SC)
$1,000/$2,000
$2,500/$5,000
$4,000/$6,500
$8,500/$14,000
D (SC only)
$1,300/$2,000
$2,600/$5,000
$5,000/$6,500
$10,000/$14,000
Plan
To get the best benefits – “stay in network” – SmartChoice may not save you any
money if you go out of network.
New Plan Option - Plan D
• SmartChoice Network Only
• Like Plan Options A,B & C except for increased deductible and out-ofpocket maximum levels
• Lowest premium cost option
Classified Alternative Care
Current Benefit
New Benefit 7/1
Services include
Massage, Chiropractic
Manipulation & Acupuncture
No change
Maximum Benefit
24 visits massage & acupuncture;
24 visits chiro
$2,500 combined – no visit count
Cost per claim
Deductible first, then 20% coinsurance
$25 copay for both, participating or
nonparticipating providers
Balance billing Nonparticipating
providers
None
Can happen. This means if the provider
charges above the PacificSource allowed
fee, you can be billed by the provider for
the difference between billed and allowed
Management Alternative Care
Current Benefit
New Benefit 7/1
Services include
Massage, Chiropractic
Manipulation & Acupuncture
No change
Maximum Benefit
$2,500 combined
No change
Cost per claim
• $25 copay participating
providers
• Deductible then 40% coinsurance for nonparticipating
providers
$25 copay for both, participating or
nonparticipating providers*
Balance billingNonparticipating
providers
Can happen. This means if the
provider charges above the
PacificSource allowed fee, you can
be billed by the provider for the
difference between billed and
allowed
No change
What action to take?
Submit a new enrollment
form ONLY if you wish to
make changes to your plan(s)
or dependent(s) enrolled.
No action is needed if you do
not wish to make any
changes.