2011 Tenet Benefit Information Clarification
For our Tenet members Open Enrollment at Fountain Valley Hospital and Medical Center and Lakewood Regional Medical Center runs from November 8, 2010 thru November 23, 2010.
Due to some changes in the terminology the choices can be very confusing.
On Sept 24 Tenet and UNAC/UHCP held a discussion regarding changing the HMO to an EPO. (The major difference between an HMO and EPO is the EPO is self-funded by the employer) The Tenet representative stated: 'The EPO is an improvement over the HMO’ (and we do believe this is true). A PCP referral to a specialist is no longer required. Tenet also stated 'The EPO has the same providers and more. We will honor every component of the CBA. If the providers are not on the list we could grandfather them.'
In October, UNAC/UHCP received an email from Tenet stating, 'We will honor the components as negotiated for the HMO in our new UNAC contracts.' and 'Anthem believes that 100% of the physicians in the HMO are in the PPO Network and if they are not, all benefits will be paid at the in-network level.'
So, how then is it that the message being presented to both Fountain Valley and Lakewood is so confusing?
First, if you remember during negotiations when we looked at what medical insurance plans our members actually have, no one had opted for the High Deductible Plan (HDP) now the HSP. Therefore, we did not specifically address it in our bargaining except to say Tenet would provide one.
Now, Tenet seems to be promoting the HSP plan over the PPO or EPO. The HSP plan may be appropriate for members who are relatively healthy with few medical issues (the younger, healthier crowd). The truth is this HSP plan saves Tenet a LOT OF MONEY!! Each member must pay a deductible of $1200/single and $2400/family each year before benefits kick in. This is OK if you are using it as catastrophic insurance but most of us need coverage for routine and sick care.
Because the plan saves Tenet so much money they are willing to offer incentives to get folks to sign up, the one-time $450/$900, the $500/$1000 incentive and the 250 ‘healthy points’. There are many questions around these incentives. We have posed these questions to Tenet corporate and are awaiting answers. We will post these clarifications as soon as we receive them.
During our most recent contract negotiations we negotiated lower premiums for the HMO for UNAC/UHCP members. So for our UNAC members the premium for the HSP is higher than for the HMO BUT for non-union members the HMO premium costs more than the premium for the HSP. So Tenet promotes the HSP as costing less for the premium and offering incentives, failing to explain the big incentives are only the first year(there is confusion about the rollover) and even if they earn all 250 'healthy points' the deductible is still applicable before benefits kick in and then they still pay 20%. This is very minimal coverage.
We have looked over the 2011 Employee Bi-weekly Contributions –UNAC handout given during the presentation. The new EPO contribution is exactly the same as what we negotiated for the HMO. Then we looked at the 2011 Plan Comparisons: Medical. The benefits described under the EPO are also the same as the former HMO. Nowhere did we find evidence that the EPO deductible will be required to be paid before the other co-pays begin. The HMO did not work this way so this would be a change contrary to our CBA and we will have a very big issue with this. (If you look under EPO the deductible referred to refers to ‘non-Tenet’ services.)
Regarding the Rx Plan, the benefits as described are the same as before.
Here’s a reminder of the good work your bargaining teams accomplished for you at the 2010 negotiations. In our newly negotiated CBAs, Article 15, Paragraph 1501 states:
“Registered Nurses(/Professionals at FV) shall be eligible to participate in Tenet’s paid time off plan (PTO) and standard Tenet benefit plans, as amended from time to time, on the same terms, conditions and basis as other Facility employees, except as provided in this Agreement. Tenet shall continue to offer the following core benefit plans during the term of this Agreement: PTO, medical plan (HMO and a PPO) including a prescription drug plan, dental plan, vision plan, short-term and long-term disability plans, life and accidental death and dismemberment insurance, long-term care insurance, Retiree Medical Benefit Account (or other similar benefit with an equivalent Employer contribution) and 401(k) Plan.”
Please note the part that is highlighted. This means that if a non-union employee has a particular benefit then union members have that same benefit. (i.e.:’ healthy points’ applied toward the deductible is the same for all employees)
If someone from HR or anyone from Tenet makes a statement to the contrary please refer them to this language. Politely ask them to check with Tenet Corporate as this was negotiated.
So let’s look at specific questions:
1) Medco: the only Plan requiring meeting a deductible prior to applying Plan benefits is the HSP, remember the $800 for the EPO is for Non-Tenet
2) Tax deductions are the domain of the IRS, not under our control, negotiations or not. If our members are considering the HSP ask them to carefully read the info to understand what they are signing up for.
3) If the EPO does not have the same MDs as the old HMO or PPO please take the names and send them to your local officer or staff representative. Remember Tenet’s email: 'We will honor the components as negotiated for the HMO in our new UNAC contracts.' and 'Anthem believes that 100% of the physicians in the HMO are in the PPO Network and if they are not, all benefits will be paid at the in-network level.' We are concerned about the members whose physicians are not on the list. If an MD was covered under the former HMO then he/she should be covered the same under the EPO.
4) Non-union employees do not and should not have benefits not afforded to our members. Remember Paragraph 1501.
Thanks to our very dedicated members for bringing this to our attention. FVPA and LRNA along with UNAC/UHCP have served you well. Please send emails with additional questions to your local officers or staff representative. We’ll get you an answer.