| Member Suggestions for 2009 Plan Designs |
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| Introduction |
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Establish Commuter Expense Reimbursement Account program.
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| Suggstions for 2009 Medical Plan Designs |
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Plan Design Changes
- Cover annual physical examinations for children under 18. (Each plan’s current schedule of coverage varies. Kaiser Permanente covers exams per the provider’s recommendations. )
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Regence
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Providence
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Samaritan
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Ages
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1/N yrs
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Ages
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1/N yrs
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Ages
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1/N yrs
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2-18
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3
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2-6
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1
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2-6
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1
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19-34
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5
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7-19
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2
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7-18
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2
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35-59
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2
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20-21
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5
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19-34
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4
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60+
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1
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30-49
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2
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35-59
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2
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50+
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1
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60+
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1
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- Cover massage therapy as an alternative care benefit.
- Cover medically supervised weight loss programs.
- Cover the cost of health club and gym memberships.
- Cover in-vitro fertilization.
Contract Changes
- All plans: Maintain mail-order prescription option.
- All plans: Add prescription tobacco cessation products (Chantix) to formulary.
- All plans: Increase retail pharmacy “standard fill” to more than 34-day supply.
- Regence: Require pharmacies to honor and automatically submit claims for primary and secondary coverage for those with dual coverage.
- Providence: Cover in-plan specialist services at the in-plan rate, even if referred by out-of-plan provider.
- Samaritan: Change service area to “live or work” in Linn, Benton or Lincoln counties.
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| Suggestions for 2009 Dental Plan Designs |
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Plan Design Changes
- Cover minimum of two cleanings per year (for all or for children); more based on risks.
- Increase annual benefit maximum.
- Kaiser: Cover cleanings, including periodontal, with no co-pay.
- Kaiser: Design plan to lower member costs (example: $10/visit for preventive; $20/filling; $50/major procedure).
Contract Changes
- Kaiser: Eliminate billing fee.
- Willamette: More flexible appointment setting policies, including quicker access.
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| Suggestions for 2009 Routine Vision Care Plan Designs |
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Plan Design Changes
- Cover annual exam for all ages.
- Cover annual exam for those 55 and older.
- Increase hardware allowance.
- Include 18-year-olds in children category.
Contract Changes
- Kaiser: Allow members to choose VSP for vision coverage.
- VSP: Allow “banking” of hardware allowance not used in single purchase.
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| Suggestions for 2009 Other Plan Designs |
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Establish Commuter Expense Reimbursement Account program.
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