LoboHealth Plan
Beginning July 1, 2019, there will be a new health plan in place for employees who are enrolled in BlueCross BlueShield (BCBS) or UNM Team Health (UNMTH).
In order to provide a simplified and financially predictable medical benefit structure, UNM is combining the current UNMTH and BCBS medical insurance plans into one new plan – UNM LoboHealth.
The new plan – UNM LoboHealth – will reduce administrative redundancy and continue to provide UNM employees and dependents with expanded health care choices. UNM LoboHealth will also increase utilization of the Tier 1 network and provide a framework for more sustainable benefits into the future. (Translation: there will be more providers available in the network, enhanced customer service, and lower out-of-pocket expenses!)
The Presbyterian Health Plan will remain the same.
Plan Changes to Expect
The following comparison and examples describe what the costs and services will look like when the populations of the BCBS and UNMTH plans are combined.
Plan Comparison Examples of Major Plan
Category Costs FY20 Medical Plan
Network Choices
Timeline
The UNM LoboHealth plan was developed by Benefits and approved by the various groups represented below. BlueCross BlueShield and UNM Team Health plan participants will automatically be enrolled in UNM LoboHealth effective July 1, 2019, unless they elect the Presbyterian Health Plan during Open Enrollment. Open Enrollment for health, life, and disability insurance benefits is tentatively scheduled to take place April 24 – May 10, 2019.
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Frequently Asked Questions
The proposed change sets the foundation to continue providing valuable medical coverage while striving to manage costs. The proposed UNM LoboHealth plan will provide prioritized scheduling and lower out-of-pocket costs for participants who access the UNM LoboHealth network at the time of service.
You may continue to access the Tier 2 (BCBS national network) with no approval required at the time of service, and continue to pay the same out-of-pocket costs you pay today. As a current BCBS participant moving to UNM LoboHealth plan, you will also experience a larger Tier 1 network of providers and facilities, prioritized scheduling within the Tier 1 (UNM LoboHealth) network, and lower out-of-pocket costs that are predictable and simplified for budgeting purposes if you choose to access the UNM LoboHealth network at the time of service.
The proposed UNM LoboHealth network (Tier 1) will be the current UNMTH network of providers. You will also gain access to Tier 2 (BCBS national network) providers without needing approval. If you access the UNM LoboHealth network, you will save money with lower out-of-pocket costs. You can also choose to access a Tier 2 provider at the time of service without approval, and pay slightly higher out-of-pocket costs.
Yes. If you are currently accessing Tier 2 BCBS providers, you may continue to do so and you will pay the same out-of-pocket costs at the time of service that you are paying today.
There is no change to our Prescription Drug Plan coverage, in either plan design or the provider. Express Scripts will continue to provide prescription drug coverage for the UNM LoboHealth plan.
If you remain a Presbyterian participant, this proposal will not affect you. The Presbyterian plan will remain the same.
If you are currently accessing Tier 2 BCBS providers, you may continue to do so and you will pay the same out-of-pocket costs at the time of service that you are paying today. If you currently access Tier 1 providers, your out-of-pocket costs will be lower at the time of service. UNM LoboHealth is committed to identifying expanded solutions to meet the needs for our Branch Campus employees and will continue to provide updates as we move forward.
A toll-free number will be provided in the 2019 Open Enrollment Guide when it is published online. This number will also be listed on the back of your UNM LoboHealth member ID card that will be mailed to you in July.
You will be able to call the BCBS customer service number listed on your UNM LoboHealth ID card to find a Tier 1 or Tier 2 in-network provider. If you want to schedule a visit with a primary care physician in the UNM LoboHealth network, you will be able to call the UNM LoboHealth customer service number on the back of your ID card. Or, the BCBS customer service center will be able to connect you to a UNM LoboHealth team member to assist with prioritized scheduling.
BCBS will administer the plan and process claims. BCBS will work directly with the UNM LoboHealth administrative team to issue ID cards, Explanation of Benefits statements, Benefit booklets, and to address claims inquiries for members.
Nationwide access to BCBS providers will continue at the Tier 2 level and you will continue to pay the same out-of-pocket costs for Tier 2 providers that you pay today. If/when you are in New Mexico you can utilize the UNM LoboHealth Tier 1 network for any services, and you will have access to a broader Tier 1 network at a lower cost for most services.
The UNM LoboHealth customer service team will assist you with scheduling prioritized appointments. UNM LoboHealth will establish and publish an access guarantee and periodically report UNM LoboHealth access statistics.
If services are not available within the UNM LoboHealth Tier 1 network and you access a Tier 2 BCBS provider, you will be responsible for the Tier 2 network out-of-pocket costs. As a reminder, your out-of-pocket costs are still protected by the annual $3,000 out-of-pocket maximum per individual. The annual out-of-pocket maximum includes all out-of-pocket costs paid by you including flat dollar copays, deductibles, coinsurance and prescription drug out-of-pocket costs.
For the 2019-2020 plan year, the enhanced UNM LoboHealth Tier 1 coverage is cost neutral. However, it is anticipated that the UNM LoboHealth plan will result in more sustainable overall health care costs in the long-term.
Initially, the proposal to consolidate BCBS and UNMTH coverage to UNM LoboHealth was presented to and comments were provided by Faculty & Staff Benefits Committee, Faculty Senate, and Staff Council Executive Committee. These campus constituent groups are elected by their respective employee groups to provide an avenue for employees to stay informed about proposed UNM changes, as well as to gather feedback to be brought forward to leadership.
Following discussions with the campus constituent groups above, the proposal was presented and approved to move forward by the UNM Senior Leadership Team, the Regent’s Finance & Facilities Committee, and the Board of Regents (BOR).
UNM LoboHealth will go live July 1, 2019. Please send your questions to HR Benefits via the “Additional Questions?” section below. FAQs on the website will be updated as additional questions are received, so please check back regularly.
Any medical services that have flat dollar copays do not require you to meet the deductible. If you receive medical services that have a coinsurance, you will generally be required to meet the annual deductible. You are not required to meet the annual deductible for prescription drug services.
So, when accessing covered medical services that require coinsurance, each covered person must first meet their individual $600 deductible before coinsurance is applied to that person’s medical expenses. After your individual deductible has been met for the year, you will pay coinsurance until you reach the annual out-of-pocket maximum.
The out-of-pocket maximum per plan year (July 1 –June 30) includes expenditures toward the deductible, medical and prescription copays, and coinsurance. UNM LoboHealth, regardless of whether you are using UNM LoboHealth Tier 1 or Tier 2, will apply co-pays and coinsurance toward the out-of-pocket maximum.