Weigh Hospital Options Before Admission
If you are planning an inpatient hospital admission, talk with your doctor about your hospital options. In keeping with the GIC’s Clinical Performance Improvement Initiative, several of the GIC’s employee/non-Medicare hea
lth plans now tier hospitals based on quality and cost. The corresponding hospital copays can vary as much as $500. Members pay lower inpatient hospital copays/deductibles when they use Tier 1, and, in some plans, Tier 2, hospitals. Other non-Medicare health plans have a selective network of hospitals, and you want to be sure your hospital is in the network to have the lowest out-of-pocket costs:Inpatient hospital copays for tiered hospital plans:
- Harvard Pilgrim Independence Plan: Tier 1 $250, Tier 2 $500 and Tier 3 $750
- Navigator by Tufts Health Plan: Tier 1 $300 and Tier 2 $700
- UniCare State Indemnity Plan PLUS: Tier 1 $250, Tier 2 $500 and Tier 3 $750
Hospital copays are limited to four per person per calendar year or one per person per calendar year quarter for deductibles. The copay or deductible is waived if you are readmitted within 30 days in the same calendar year. All other non-Medicare plan PPO and HMOs have selective hospital networks. Members of these plans should contact their health plan to make sure that the hospital they would use is in the network. The UniCare State Indemnity Plan/Basic is a non-network plan and all hospitals across the country have the same deductible.
If you are a member of a tiered hospital network plan and are admitted on an emergency basis to a higher tier hospital, you may not be subject to the highest copay. Contact your health plan for details.
This information provided by the Group Insurance Commission.