The University announced this week that it will offer four new health plans in 1997 -- three point-of-service plans and a new health maintenance organization, HMO Blue -- as a result of a decision by Blue Cross Blue Shield to discontinue HealthFlex Blue and Bay State. Harvard will also introduce a policy to provide assistance for those who have an unusually large number of office visits requiring co-payments.

An HMO is a health plan in which doctors provide managed care at a center or as part of a network, making referrals to specialists within and, under special circumstances, outside the HMO as needed. A point-of-service plan is a health plan that offers managed care benefits within a network of providers, but also allows members the option of paying more to go outside the network at any time to receive care.

According to Provost Albert Carnesale, the Health Plans Subcommittee of the University Benefits Committee (UBC) has been reviewing Harvard's health care options during the past year in light of changing conditions in the health care market. The subcommittee was particularly concerned about the increasing premiums for, and ultimately the discontinuation of, HealthFlex Blue and Bay State -- both Blue Cross plans.

"Because we were concerned about the high costs of those plans for 1996," said Carnesale, who chairs the UBC, "we worked with Blue Cross Blue Shield and the other insurers to come up with less costly alternatives for 1997. At the same time, we were aware of the importance of HealthFlex Blue as Harvard's only existing point-of-service plan -- that is, a plan which gives members the option of paying higher fees to use providers who are outside the plan's regular network."

When Blue Cross notified the University in the spring that it would not offer Health FlexBlue or Bay State in 1997, the UBC sought proposals for a point-of-service plan from Harvard's HMO providers. As a result, there will be three new point-of-service plans this year: Tufts Total Health Plan, Pilgrim Select, and HCHP Added Choice.

In addition, most of Harvard's current health plans will remain available: Harvard Community Health Plan (HCHP), Harvard University Group Health Program (HUGHP), Healthsource CMHC (formerly Central Mass), Pilgrim Health Care, Tufts Health Plan, and Blue Cross Blue Shield out-of-state.

Help with High Co-Payment Expenses

The UBC and the HUCTW (Harvard Union of Clerical and Technical Workers) Joint Committee on Benefits have both reviewed the impact of co-payments on Harvard's faculty and staff. Both committees recommended a co-payment stop-loss policy to ease undue financial hardship for individuals or families who must make many office visits each year. A stop-loss policy establishes a ceiling on the expenses one needs to pay for a certain kind of health care service.

Beginning in 1997, the University will reimburse faculty and staff for annual co-payment costs above the following limits:

For those making less than Individual Family

$45,000 per year

$100 $250

For those making $45,000

or more per year $200 $500

Those wishing to participate in the reimbursement program will need to save their original receipts and file a claim. Details of the claim process will be outlined in the CHOICES enrollment packet which will be mailed to all benefits-eligible faculty and staff in October.

There will be a limited fund to provide financial assistance for those who exceed the stop-loss for co-payments in 1996. Those faculty and staff members earning less than $45,000 per year and all HUCTW members will be eligible to apply for assistance from the Office of Work and Family. Those eligible to apply will be notified in an upcoming mailing.

More Information Coming

A Benefits Bulletin outlining all the 1997 changes to Harvard's health care benefits will soon be mailed to all benefits-eligible faculty and staff and retirees under age 65. In addition, the annual personalized CHOICES enrollment packets to be sent out in October will include more information about the new health plans. Open enrollment will run from Oct. 15 through Nov. 10.

In the meantime, anyone with a question is invited to contact the Benefits Office by phone (617) 496-4001, or by e-mail benefits@harvard.edu.

SEPARATE BOXES

The Committees

The University Benefits Committee (UBC) was convened by President Rudenstine in May 1995 to advise and inform the Provost on University-wide benefits policies for members of the Harvard community who are not represented by a union. In addition to the Provost, UBC membership includes six faculty members and six members of the administrative or professional staff. Many more individuals serve on its three subcommittees: health plans, retirement, and administration.

The Joint Committee on Benefits, formed as a result of the 1995 contract with HUCTW, considers benefits policies as they pertain to HUCTW staff. This committee is composed of University faculty and administrators and union representatives.

Both committees monitor the performance of Harvard's benefits in light of individual and institutional needs, and make recommendations to the Provost for changes within the limits of available resources.

10 HEALTH PLAN OPTIONS FOR 1997

Blue Cross Blue Shield out-of-state

Harvard Community Health Plan (HMO)

HCHP Added Choice (POS)*

Harvard University Group Health Program (HMO)

Healthsource CMHC (formerly Central Mass) (HMO)

HMO Blue (HMO)*

Pilgrim Health Care (HMO)

Pilgrim Select (POS)*

Tufts Health Plan (HMO)

Tufts Total Health Plan (POS)*

* = new offering in '97

HMO = Health Maintenance Organization

POS = Point-of-Service Plan