What Does it Mean to You?

The much anticipated Supreme Court decision upholding the Patient Protection and Affordable Care Act (federal health care reform) means that GIC members will not lose benefits that were implemented effective July 1, 2011:

  • Expansion of dependent children coverage up to the age of 26
  • No cost sharing (copays and deductibles) for certain preventive care services, such as mammograms, scheduled immunizations, routine OB/GYN visits and physicals

The GIC and our plans continue to roll out federal health care reform.  New Summaries of Benefits and Coverage will be distributed to each plan’s members before the start of the spring annual enrollment period.  These documents will provide a summary of the plans’ benefits, exclusions and cost-sharing requirements in a uniform format.  Your 2012 W-2 tax form will show the aggregated employer and employee health insurance premium costs for informational purposes only. The Health Care Spending Account maximum election amount will change to $2,500 for the 2013 calendar year.

Massachusetts continues to take the lead on health care reform. Legislation initially proposed by Governor Patrick to rein in health care costs passed on the last day of the legislature’s formal sessions.  This Health Care Cost Control law encourages adoption of new ways of paying for care and increases price transparency.  It encourages a shift from the fee for service model – where doctors and other providers are paid by the number of procedures they perform – to new payment models that promote better coordinated care with a focus on primary care.  The GIC and the state’s Medicaid program are required to move to alternative payment systems in keeping with these goals.  The GIC’s all-health plan procurement for coverage effective July 1, 2013, which is now underway, will integrate these objectives by including spending targets for our insurers.  Although we do not know which health plans will emerge from this procurement, we anticipate that they will look forward to the challenge of remaining leaders on health care reform.

Although benefits, plan options, and rates for the next fiscal year will not be known until late winter, here are some possible ways GIC members might be affected by the new state legislation and all-health plan procurement.  The new health care climate may:

  • Require you to choose a Primary Care Provider - who might be a nurse practitioner, an internist, gynecologist, or family practitioner;
  • Realize stabilized and reduced annual health insurance premium increases;
  • Result in changes in provider options or incentives for getting care at high quality, low cost providers;
  • Give you greater access to provider cost information; and
  • Create additional opportunities for you to take advantage of wellness incentives.

It’s an exciting time for health care in Massachusetts and the GIC looks forward to again being a leader in these endeavors.

This information provided by the Group Insurance Commission.