Plan Changes for 2020

The Health Trust Board of Trustees has approved the following changes to the Health Trust health plans, effective January 1, 2020.

Urgent Care Services. The Health Trust will reduce the copay for services received at an urgent care facility to match the copay for services received at a walk-in center.  Instead of a $150 or $200 Emergency Room copay, members who receive care at an in-network walk-in or urgent care center will pay a specialist copay – between $20 and $40 per visit, depending on your medical plan.

The Health Trust encourages its members to seek care with a provider that delivers the most appropriate, quality care for the best value.  However, we recognize that it can be confusing to determine which facilities are walk-in centers and which are urgent care facilities.  Many of the facilities on Anthem’s approved walk-in center list have the words “urgent care” in their name, or featured on their signs.  This change is being made to encourage utilization of the most appropriate sites of care and to decrease that confusion.

New walk-in and urgent care facilities have recently opened in many areas of the state or have increased the services they offer on-site.  They also often operate at convenient hours.  This can make walk-in centers or urgent care facilities a wise option if you need non-emergency care, versus a much more expensive emergency room visit.

Pleas refer to the list of approved walk-in centers.  Once this change becomes effective on January 1, 2020, the list will be updated to include urgent care facilities.

Hearing Aids.  In accordance with Maine state mandates, the Health Trust Board recently voted to expand coverage for hearing aids under the POS and PPO plans to include coverage for adults age 19 and older.  Hearing aids will be covered when medically necessary, limited to one hearing aid per hearing impaired ear, every 36 months.

Hearing aids for members through age 18 will be covered without being subject to a dollar limit; hearing aids for members age 19 and over will be subject to a benefit maximum of $3,000 per covered hearing aid.

Copay Maximums. There will be an increase in the in-network copay maximum for all of the active medical plans.  It is important to note that this change will not affect your deductible or coinsurance amounts, nor will it change the copay that you pay for individual services or prescription drugs (with the exception of the copay for urgent care services, which will decrease, as described above).   It simply allows for a greater overall maximum out-of-pocket amount for in-network copays.

This change is consistent with the principles adopted by the Board in 2017, of making plan design changes which impact average participants to a minor degree and heavier users to a more moderate degree, as one way to help keep overall costs down.  The copay maximum will still be lower than is permitted under the Affordable Care Act.  Please refer to the plan summaries for details specific to your medical plan.

If you have questions about these changes or your benefits, please contact Health Trust Member Services at 1-800-852-8300.  The Member Services Representatives are available to take your calls Monday through Friday, from 8:00 a.m. – 4:30 p.m.

Plan Change Updates letter – November 2019

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