Wednesday, March 31, 2010

The Health Plans Panel

Plan administrator Greg Mason, explaining the intricacies of the Motion Picture Industry Pension and Health Plan.

Last night at TAG's General Membership Meeting, Greg Mason of the Motion Picture Industry Health Plan held forth about the various moving parts of the Animation Guild's (and twenty-four other IATSE labor unions') health coverage. To wit:

* The Motion Picture Industry Health Plan covers 110,000 paticipants (42,00 active participants and their families; also 12,000 retirees.)

* A new Summary Plan Description book (to replace this SPD) will be out later in 2010.

* The Plan has three basic health coverage options:

1) Blue Shield/MPI Health Plan. (PPO)

2) Kaiser Permanente (HMO)

3) Health Net (HMO)

(Open Enrollment into HMOs: first month of eligibility and July of each calendar year. Participants can move from the HMOs to the Blue Shield Plan the first of any month.)

* The Health Plan (number one, above) has three tiers -- each tier costing more to participants.

Tier One -- Motion Picture and Television Fund Clinics. (7 Clinics throughout Southern California -- co-pays of $5 per visit. Referrals to specialists via clinics (total of 587 specialists in network) -- also $5.)

Tier Two -- Blue Shield Network. The network pays 90% of the contracted rate. Office visits for most Blue Shield doctors -- $30. Out of pocket costs for in-network hospital stays capped at $1000.

Tier Three -- Out of Network -- Plan pays 50% of usual and customary charges. Other 50% paid by participants/patients.

* It's important to be a good health care consumer; ask if a doctor and surgical center are in the Blue Shield Network; ask if a second surgeon is covered. Contact the Plan or doctor if you believe there has been a billing error.

* Emergency Rooms are covered 90%, but when a patient enters an out-of-network hospital, it's important to transfer to an in-network hospital after patient is stabilized.

Prescription Drugs/ Medco: Drug Plan pays for brand drugs when generics are available only up to the generic price. Maintenance medications (that is, long-term prescriptions) must be ordered through Medco after the first two 30-day prescriptions. (Drug costs are rising 18-23% annually.)

* New Federal Health Legislation: Some of this year: No co-pays for preventive health examination, no lifetime caps, child coverage continued to age 26 years) will be communicated to particpants when the government issues its regulations.

After Mr. Mason finished his presentation, representatives from Kaiser Permanente) and Health Net reviewed the bells and whistles from their plans:

Kaiser Permanente -- * $15 co-pays for doctor visits in KP hospitals and medical facilities. * Kaiser Permanente has a presence in 9 states. * If participants use Kaiser Pharmacies (they are also eligible for the Health Plans Prescription Drug benefit), they're entitled to $9 co-pays for many generic drugs.

Health Net -- * $15 co-pays for doctor visits. * Health Net contracts a broad array of physician groups and hospitals in Southern California. * St. Joseph Hospital in Burbank is a Health Net contractor.

Lots of questions got asked. Members wanted to know the impact of the recently-passed Health Care legislation and why prescription drugs get pricier every couple of years. All in all, it was a useful session.


Chip said...

Was there an answer to why prescription drugs get pricier every couple of years? I mean, other than the venal profiteering of the pharma companies?

Also--does anyone know if St. Joseph's hospital is part of the Blue Shield Network?

Anonymous said...

I'm curious about the cost of prescription drugs, too. Is it because of folks buying their brand-name prescriptions from online Canadian pharmacies, leaving fewer customers for American pharmacies?

*random guess*

Steve Hulett said...

St. Joseph's is part of th Blue Shield network.

Also part of Health Net HMO, according to the Health Net representative.

Brand prescription drug prices go up because they can. The patent-holder can charge what they like.

(Lipitor, a statin drug, is now being advertised on radio and teevee, with the announcer urging people to "accept no substitutes," because there are now other generic statin (cholesterol lowering) drugs that lower cholesterol just fine.)

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