Empire Plan Changes Coming 1/1/11

If you’re in the state’s Empire Plan, look for these benefit changes, authorized in the 2007-2011 PS&T contract, to start January 1, 2011.

These changes are:

Annual Deductible for Basic Medical coverage and for Mental Health and Substance Abuse coverage increases from $375 to $388.

Annual Coinsurance Maximum for Basic Medical coverage and for Mental Health and Substance Abuse coverage increases from $1,033 to $1,069.

Non-Network Hospital Reimbursement under Basic Medical coverage and Mental Health and Substance Abuse coverage has been reduced from $500 to $0 for the enrollee, the enrollee’s spouse or domestic partner, and for all dependent children combined.

In addition to these negotiated benefit changes, additional changes to the Empire Plan take effect January 1, 2011, under the federal health reform law known as The Patient Protection and Affordable Care Act.

These changes are:

Annual Maximum for Routine Health Exam under Basic Medical coverage decreases from $250 to $0.

Maximum for Routine Newborn Child Care under Basic Medical coverage decreases from $150 to $0.

Annual Maximum for Non-Network Chiropractic Treatment and Physical Therapy decreases from $1,500 per person to $0.