Saving money while maintaining quality health insurance coverage levels is an unlikely feat, but the Seafarers Health and Benefits Plan (SHBP) has pulled it off, thanks to a new affiliation with First Health Network.“This is an effective way of reducing costs without sacrificing quality and without placing any additional burden on our participants,” said SHBP Administrator Bill Dennis. “First Health is a very large, highly regarded network that matches up well with our participants’ home zip codes. I think it’s a win-win situation.”
The Plan’s Board of Trustees sent a letter and network membership card to each participant confirming the agreement with First Health Network as this issue of the LOG went to press. That letter notes that the agreement—effective Nov. 1, 2004—should help eliminate applicable out-of-pocket costs for Seafarers. Another expected plus is that Seafarers using the network no longer will have to worry about doctors’ charges exceeding the “reasonable and customary” coverage limit, since the network and its participating physicians agree to a set fee schedule.
Another recent communication from the SHBP board points out that “out of network claims [will] continue to be processed and paid in accordance with the Rules and Regulations of the Plan and may result in a balance bill to the participant.” In other words, while treatment outside the network is an option, members would continue to be responsible for applicable co-payments as well as fees beyond the “reasonable and customary” amount.
As reported last month, the health benefits plan of an SIU-affiliated union earlier this year joined the First Health Network, and the results have been clearly favorable for that plan, its participating members and eligible dependents.
“Using the network makes sense for members because they save money and they don’t have to deal with paperwork, since the network doctors and hospitals file the claims for them,” Dennis added.
More than 4,500 hospitals and some 425,000 physicians and ancillary providers participate in First Health Network. According to the company, 99 percent of hospitals and 96 percent of physicians and ancillary providers normally renew their respective contracts with the network.
First Health requires pre-certification (pre-approval) prior to a scheduled hospital admission or surgery. In the case of an emergency hospitalization or surgery, the network must be notified within 48 hours after admission.
Each SIU hall will keep a list of the First Health Network participants. Individuals also may call the network at 800 839-1980 to check whether or not their doctor participates, or visit the web site www.firsthealth.com (use login ID SHBP) for an electronic directory.
According to recent studies, health insurance premiums paid by U.S. employers increased 11.2 percent this year. A study by the Kaiser Family Foundation and the Health Research and Educational Trust showed that it costs about $10,000 per year to insure the average family. As part of that expense, workers pay approximately $500 per year for single coverage or roughly $2,600 for family coverage.
This marks the fourth straight year that premiums increased by 10 percent or more. In 2003, the jump was 13.9 percent.
Those aren’t the only figures on the rise. According to the Kaiser study, workers’ out-of-pocket costs have increased by 60 percent during the past four years. Also, the U.S. Census Bureau recently noted that the number of uninsured Americans increased to 45 million last year.
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