UPDATE (March 16, 2009):
Ohio University and Holzer Reach One-Year Agreement for Tier 1 Status
March 4, 2009
Dear Ohio University Faculty and Staff,
Last week's e-mail from Executive Vice President and Provost Kathy Krendl and Senior Vice President Bill Decatur noted a decision made to change the status of Holzer Clinic and Holzer Hospital in our employee PPO Health Plan. I would like to share with you a more detailed explanation as to why -- after an earlier discussion with Holzer -- the university determined that these providers will no longer be considered part of our Tier 1 list of providers, effective July 1.
Ohio University continually monitors health plan expenses and strives to offer employees a comprehensive health plan that provides protection for employees and their family members and promotes healthy lifestyles. A recent review of costs associated with primary care indicated that care provided by Holzer costs the employee health plan 35 percent more than primary care provided by other health care providers. On average, the employee health plan pays $34.51 more for a primary care office visit at Holzer than it does for other providers. The analysis also revealed higher fees for specialty and other care provided by Holzer.
The analysis also indicated that the employee health plan would spend an additional $400,000 for every 5 percent increase in the number of employees seen by Holzer. Failure to address this situation would jeopardize the university's ability to continue to offer a comprehensive and cost-effective health plan for employees and their family members.
Allowing one health care provider to maintain higher fees creates an unfair marketplace for providers in the region. The result could be all providers pushing to match higher fees or some providers not being able to compete and survive.
As a result, Holzer Clinic and Holzer Hospital will be considered a Tier 2 provider within the employee health plan. This designation will pertain to all Holzer locations, including but not limited to locations in Athens, Pomeroy, Jackson, Gallipolis, Sycamore and Lawrence.
The Tier 2 designation provides employees with continued access to Holzer, but with an increase in office visit co-pays, deductibles and co-insurance. Employees who choose not to absorb the increased cost sharing can access care at the many high-quality Tier 1 providers in the Athens area and across the region and state.
The following chart contains the major plan design changes for Holzer providers and locations, as reflected in the Tier 2 column. As also indicated in last week's e-mail, Tier 1 plan design may change if action is taken on recent Budget Planning Council recommendations regarding health care.
Benefit Chart
| Tier 1
| Tier 2
|
| Providers | Anthem PPO In-Network | Anthem Non-Network
Holzer Clinic, Holzer Hospital |
Office Visit Co-pays
(Including physical therapy, speech therapy, etc.) | $15* | $45 |
| Deductible | $0* | $600/ $1,200
individual/ family
|
| Co-Insurance | 90% plan
10% employee*
| 50% plan
50% employee
|
Co-Insurance Limit
| $750/ $1,500*
individual/ family
| $2,500/ $5,000
individual/ family
|
| Preventive Care | $15 office visit co-pay*
Allowed services paid 100%
(Vaccines, screenings, etc.) | Paid at 70%, not subject to deductible |
*Subject to change on July 1, 2009 per potential action on health care changes recommended by the Budget Planning Council.
A more detailed chart will be available at www.ohio.edu/hr in the coming weeks.
If you have questions regarding the status of Holzer Clinic and Holzer Hospital within our health plan, please contact me at 740-593-1639 or fialko@ohio.edu.
Cordially,
Greg Fialko
Director of Benefits
Ohio University Human Resources
