Health insurance plan changes FAQ 2013-15 contract

You probably received a letter at home telling you about changes in your health insurance plan (the Minnesota Advantage Plan.) Here are some answers to your questions:

Q: Why is the health insurance plan changing now?

A: The changes were negotiated and are part of the 2011-2013 contract. The changes are being implemented now because the contract was only just ratified by the Minnesota State Legislature in March of 2013. The State Employee Group Insurance Plan (SEGIP) and Minnesota Management and Budget (MMB) have determined that it will implement the changes on April 1, 2013.

Q: What are the key changes being made to the health insurance plan?
A: A number out-of-pocket expenses have been increased. The major hit is at tiers 3 and 4. See the revised chart here: Minnesota Advantage Plan (effective April 1, 2013)

Q: Who is affected the most by these changes?
A: People utilizing Tier 3 or Tier 4 primary care clinics. Tier 3 and 4 co-payments have been substantially raised. These increases stem from the costs Tier 3 and 4 clinics charge as compared to Tier 1 and Tier 2 clinics. Simply put, Tier 3 and Tier 4 clinics charge substantially more for the same services provided by Tier 1 and 2 clinics.

Q: Will there be an “open enrollment”?
A: No. MAPE advocated for an open enrollment, but MMB has refused to grant the request for an open enrollment. MAPE’s focus now is to help members navigate the options they do have.

Q: Can I switch out of a Tier 3 or Tier 4 primary care clinic?
A: Yes. You can elect to change to a Tier 1 or Tier 2 primary care clinic within your current health plan. As an example, if you are in the Health Partners plan, you would need to switch to a Tier 1 or 2 clinic within the Health Partners network. Each plan (Health Partners, Preferred One and Blue Cross) are required to offer a Tier 2 or better primary health care clinic within 30 miles of your home.

Q: Will this change count against your one time change for the year?
A: No.

Q: If I switch primary care clinics, when does the change go into effect?
A: If you make the change before April 1, the change will go into effect on April 1. If you change later, the change will go into effect at the beginning of the month following your action to make the change.

Q: Do first-dollar deductibles and maximum out of pockets start over?
A: No. All out of pocket expenses paid as of Jan. 1, 2013, carry over.

Q: Is this an opportunity to change your flex-spending account?
A: No.

Q: Why didn’t you tell me this during open enrollment?
A: Different points during negotiations we received different viewpoints regarding insurance. (We were told, from MMB, last fall that there would be no changes for 2013, then we were told, that there may be implementation with open enrollment, then we all received the letter for the implementation for April 1.)

Q: Will there be another premium increase this year?
A: No.

Questions? Contact us at action@mape.org.