|2017 Benefit and Plan Changes|
2016 has been a tumultuous year, for many reasons, and healthcare was no exception. Small Group Plan market rate increases ranged from 25% to up to 75%, largely driven by increased healthcare costs and legislation governing the small group plan market. Although many of our Contributing Employers are "small", by definition, PHBP is itself a Large Group Plan, and therefore is protected from the Small Group Plan market rate increases. Nonetheless, the Large Group Plan market average rate increases were significant as well, so we faced an additional challenge of keeping our high quality, without charging our customers large increases.
With minimal plan changes, PHBP was able to achieve a premium rate increase of only 9.82%. Plan changes largely focused on our "Out-Of-Network" benefits, and Pharmaceutical Plan. Detailed plan changes are as follows:
- Increased Out-Of-Pocket maximum from $2,000 to $2,500 (in-network) and from $4,000 to $5,000 (out-of-network),
- Increased copay from $20.00 to $25.00,
- Increased Out-of-Network deductible from $1,000 to $1,500,
- Increased Out-of-Network co-insurance from 40% to 50%, and
- A Pharmaceutical Plan Change to the "Essential Formulary List"
In addition to the benefit changes listed above, Plan rules were changed to include:
- Additional job categories in post-production, digital, and virtual reality for employers not signed to the IATSE National Commercial Agreement. Full details are listed in the 2017 Participation Agreement, attached here.
- Administrative Charges for Staff Employers. Full details are included in the Participation Agreement, but also can be found here.