Under a restructuring, DC 37 Med Team/Choice is no longer covering
out-of-network benefits, except for emergency care, and it is increasing
the copayment for in-network hospital stays.
The restructuring is occurring because Empire Blue Cross Blue Shield
(MedTeam's insurer) said it couldn't offer the previous plan for what
the city pays for health-care coverage.
"As we studied ways to deal with the rising cost of health care,
it made sense for us to make this transition, because only a very
small percentage of DC 37 Med Team participants actually go to out-of-network
providers," said Willie Chang, director of the union-run health
plan. "So, for most people, the change shouldn't be noticeable."
As the cost of health care continues to soar, the DC 37 Health and
Security Plan is working to ensure that members and retirees keep
the option of participating in the unique plan. Out of the 14 health
plans that the city offers to DC 37 members and retirees, DC 37 Med
Team/Choice is the only one that the union sponsors.
On July 1, DC37 Med Team/Choice became what's known in the health
care industry as an "exclusive provider organization" (EPO).
Under its old structure, the plan was a "preferred provider organization"
(PPO). There are essentially two differences between the EPO and PPO
programs.
Whereas PPO participants may get treatment out-of-network as long
as they are willing to pay a higher co-payment, EPOs don't provide
for out-of-network coverage, with the exception of emergency treatment.
With the restructuring, DC 37 Med Team/Choice's copayment for in-network,
inpatient hospitalization will increase from $100 to $250 for individuals
and from $250 to $625 for families.
Under the restructuring, participants will continue to enjoy the comprehensive
benefits offered by Empire Blue Cross Blue Shield's EPO program, which
has a network of 94,000 physicians and other health providers and
206 network hospitals in New York, New Jersey and Connecticut.
Empire will continue to provide participants with customer-centered
health care including doctor's office visits, preventive care, including
well-child and well-woman services, emergency care, maternity care
and hospitalization coverage.
As long as they receive care from Empire's network of providers and
hospitals, participants don't have to pay deductibles or file claim
forms.
Except for the increased copay for in-network hospital stays, all
other DC37 Med Team/Choice in-network benefits with the EPO program
remain the same.
Before receiving care, DC37 Med Team/Choice participants should check
with their providers to ensure that they are part of the Empire EPO
program or the BlueCard program.
If you have any questions about the DC37 Med Team/Choice EPO program
or want to verify a provider's participation, please feel free to
contact Empire's member services representative at 1-800-342-9816.
A list of participating providers is also on Empire's Web site. You
may also contact the DC37 Med Team Unit at DC37 Headquarters at 212-815-1313.