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News
Your source on union-negotiated health care
benefits
Kaiser enrollees options;
Chart below compares HMOs, Ohio Med PPO
April
1, 2005 - OCSEA Director of Health Care Policy and Human Resources
created the chart below to help Kaiser enrollees get through this difficult
period of choosing another health care plan and new doctors. The State
will not renew its contract with Kaiser July 1.
"Our contract provides that the state will offer
up to two HMOs per county, so with greater competition the stakes
were higher with regard to the possibility that one of
the HMOs currently offered could get knocked out," Steger
said. " In fact the state wanted to offer only 1
HMO per county but we insisted on 2 per county, and in the end we were
able to keep the 2."
As usual, the Planning Sub committee did a thorough
job of putting together an RFP with the consultants that would score the
bidders in financial and non-financial areas. In the end, a small, but
fairly popular HMO—Kaiser—got bumped out by Aetna.
This change impacts about 1,200 state employees, including
940 are OCSEA members, in the NE section of the state. The counties
impacted include: Cuyahoga, Lake, Lorain, Portage, Stark and
Summit counties.
Union members who are affected are advised to do the
following:
- First take a deep a breath. Yes no one likes to change
doctors, but we all have to sometimes even if only because our doctor
retires. Or if you retire and move away you will change doctors. You
may not like this, but you will survive it.
- Review the chart below and other related information.
- Next, decide which type of health plan you want
an HMO or the Ohio Med PPO.
Key differences between the HMOs and the Ohio
Med PPO
"We are disappointed that Kaiser didn’t score
high enough to win first or second place. But we also know that the industry
is changing and other HMOs are really improving their business
practices in a number of care management, disease management
and pharmacy areas, where Kaiser didn’t score as well.
That doesn’t mean that Kaiser is not a good HMO,
because we know it is, it just came out third in a very tight
race," Steger continued.
"I and the JHCC committee members know the process
that led to this outcome was a thorough one. That is why the
JHCC recommended we stand by the results of the evaluation. It is unfortunate
that some members will be impacted by this and will have to change plans/doctors.
Ultimately, while the JHCC plays an important role in deciding the process
to determine how vendors will be evaluated and selected, it is ultimately
the state’s decision to decide which plans to offer."
The union has already asked the state to work with the
plans to allow for continuity of care for those folks who are
terminally or critically ill, or pregnant, and allow them to
stay with their Kaiser doctor for a time. The consultants
are asking all the HMOs how they could handle that.
See Related
More HMOs available; Aetna
is back, Kaiser and SummaCare are gone
Medco is back for Ohio Med
Enrollees July 1st
Medical Mutual will keep
Administering the Ohio Med PPO
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