First let's clarify that there are two plans - both administered through our carrier, United Healthcare: they are referred to as the Value and Buy-Up. The terms "In-System, In-Network and Out-of-Network" are not referring to the Medical Plans they are referring to the providers, facilities and services you use once you elect a plan. So when you are reviewing those medical plan grids in your 2015 Benefits Resource Guide (pages 4-9) understand - the Blue is Value and the Teal is Buy-Up They are two different plans with just a few basic differences. Now is when the terms "In-System, In-Network and Out-of-Network" come into play.
- In-System means you are using a North Shore-LIJ healthcare provider, facility or service.
- In-Network means you are using a United Healthcare provider, facility or service.
- Out-of-Network means you are using a healthcare provider, facility or service outside of the health system and the United Healthcare network
No Differences Here!
There are no differences in the Value and Buy-Up Plans when you use in-system providers, and North Shore-LIJ facilities and services.
There are no differences in the Value and Buy-Up Plans when you use in-system providers, and North Shore-LIJ facilities and services.
Value Plan
In-System has no annual deductible and no coinsurance
In-System has a copay of $20 for primary care and $40 for specialty care
In-System has a copay of $20 for primary care and $40 for specialty care
Buy-Up Plan
In-System has no annual deductible and no coinsurance
In-System has a copay of $20 for primary care and $40 for specialty care
Differences Here
The differences in Value and Buy-Up Plans come up when you use in-network and/or out-of-network providers and facilities.
In-System has a copay of $20 for primary care and $40 for specialty care
Differences Here
The differences in Value and Buy-Up Plans come up when you use in-network and/or out-of-network providers and facilities.
Value Plan
In-Network/United Healthcare has an annual deductible or $750 for an Individual and $1,500 for Family.
In-Network/United Healthcare has a coinsurance of 30%
In-Network/United Healthcare has a coinsurance of 30%
Buy-Up Plan
In-Network/United Healthcare has an annual deductible or $500 for an Individual and $1,000 for Family
In-Network/United Healthcare has a coinsurance of 10%
In-Network/United Healthcare has a coinsurance of 10%
Value Plan
Out-of-Network has an annual deductible or $2,500 for an Individual and $5,000 for Family
Out-of-Network has a coinsurance of 50%
Out-of-Network has a coinsurance of 50%
Buy-Up Plan
Out-of-Network has an annual deductible or $1,000 for an Individual and $2,000 for Family
Out-of-Network has a coinsurance of 30%
To Sum it Up
If you want to have access to out-of -network providers, facilities and services you may want to consider paying a bit more per pay check for the Buy-Up Plan.
Most employees chose the Value Plan - in fact, in 2014 the health system had 80% domestic utilization.
Visit HealthPort-HR-Benefits and print out a copy of the 2015 Medical Plan Options.
Out-of-Network has a coinsurance of 30%
To Sum it Up
If you want to have access to out-of -network providers, facilities and services you may want to consider paying a bit more per pay check for the Buy-Up Plan.
Most employees chose the Value Plan - in fact, in 2014 the health system had 80% domestic utilization.
Visit HealthPort-HR-Benefits and print out a copy of the 2015 Medical Plan Options.
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