FREQUENTLY ASKED QUESTIONS

AMBIGUITY IN THE AMR BENEFITS PROGRAM

There seems to be some ambiguity in the details of our benefit plans this year. Like every year, some things get simpler and somethings become more complicated in figuring out our health care benefits.

We want to get out in front of this and assist our members in making informed decisions. So we are taking the following steps to provide some focused clarity for our members.

WHAT ARE THE FOUR TYPES OF HEALTH PLANS?


We have four medical plans available to us:

  • Preferred Provider Organization (Gold Plan)

  • High Deductible Health Plan with HSA - High Option (Silver Plan)

  • High Deductible Health Plan with HSA - Low Option (Bronze Plan)

  • Safety Net Plan

The range in bi-weekly premium costs are shown in descending order above. Obviously, the higher the premium per pay period, the lower the cost of the deductible.

These costs are reflected in the take care take charge benefits solver page.

IMPORTANT TO NOTE ON THE GOLD PLAN

Three important things to note in the Preferred Provider Organization (Gold Plan):

  • The Gold plan has the least deductible, but it has the highest premiums.

  • The Gold plan can only use a Flexible Spending Account (FSA). The FSA is a specific amount of tax deferred money that goes into a spending account that you have to spend (on approved health items) by the end of the year or you loose the money. The (FSA) DOES NOT ROLL OVER!

  • Also, the AMR/Employee 75%/25% Premium pay noted in Section 11.02 (Health Insurance) (b) of the SDAPP CBA, does NOT apply to this health plan.


 

IMPORTANT TO NOTE ON THE SILVER PLAN

Three important things to note in the Preferred Provider Organization (Silver Plan):

  • The Silver plan has lesser costing Premiums then the Gold plan, but it has higher deductibles.

  • However, the Silver plans allow for the use of a Health Savings Account (HSA). The HSA is a specific amount of tax deferred money that goes into a Health Savings Account that you can use (on approved health items). Whatever you do not use, stays in the Health Savings Account and the (HSA) DO ROLL OVER EACH YEAR!

  • Also, the AMR/Employee 75%/25% Premium pay noted in Section 11.02 (Health Insurance) (b) of the SDAPP CBA, DOES apply to this health plan.

HOW CAN I FIND INFORMATION ON THE PLANS?

Specific information is available under the "My Benefits" tab on the TakeCareTakeCharge website.

Go to "Plan Details" on the left panel under > Medical and you will find PDF files that explain the particulars about each of the four plans

IS IT IMPORTANT TO UNDERSTAND DIFFERENCES OF HMO AND PPO PLANS?

 

It is important to understand when looking at the plans provided, that HMO Plans differ from those of PPO Plans.

 

HMO PLANS (HEALTH MAINTENANCE ORGANIZATION)

 

HMO plans tend to be more affordable, but you’ll usually get less coverage and more restrictions. Additionally, HMO plans require you to schedule your visits to specialists and other practitioners through a referral from your Primary Medical Doctor (PMD). This can delay your access to these providers and extend your time to see these specialists by as much as 2-4 weeks.

 

IMPORTANT: Though it is listed as an PPO Plan on the Takecaretakecharge website, All Kaiser Permanente (Gold, Silver and Bronze, Safety Net plans) are ALL HMO Plans with more restrictions of coverage and providers than the other PPO (Anthem and United Health Care) plans offered.

 

That may be a contributing factor to the cost differences of Kaiser GOLD plan vs the other Carrier’s Silver plans.

 

PPO PLANS (PREFERRED PROVIDER ORGANIZATIONS)

 

PPO Plans generally offer greater flexibility in seeing specialists, have larger networks than HMOs and offer some out-of-network coverage.

 

IMPORTANT: Although not listed on the Taecaretakecharge website as such, all Anthem and United Health Care Plans (Gold, Silver, Bronze and Safety Net) are all true PPO Plans.

WHAT ARE THE THREE CARRIERS WE CAN CHOOSE FROM?

In developing the AMR new exchange, AMR decided to focus on three best-in-class carriers:

  • Anthem

  • UnitedHealthcare

  • Kaiser Permanente (where available)

WHAT ARE (Insurance) CARRIERS?

Carriers are organizations that provide services connected to medical plans, like claims payment and member service.


 

IS THERE ANY DIFFERENCES BETWEEN ANTHEM AND UHC CARRIERS?

Technically there is no difference in the premium costs and services costs between the two carrier plans that AMR has provided.

  • However, there may be differences in the payment and costs of things like medical appliances and durable goods (CPAP and CPAP Supplies) and injectable and other durable medical supplies.

  • There are also differences in the in network physician lists for each of the two plans.

HOW CAN I FIND OUT ABOUT THE DIFFERENCES IN SERVICE AND APPLIANCE/SUPPLY COSTS?

Though the costs schedules of the Anthem and United Health Care plans are the same, there are differences in the network provider lists, prescription formularies and costs of durable medical equipment and supplies.

 

Many of our members and their families have special medical and pharmaceutical needs that will require specific answers to determine the best insurance plan and carrier to fit theirs and their loved ones needs.

 

AMR has a Benefit Administrator Department that is open Monday through Friday 6am to 7pm Mountain Time.

The staff of this center are very knowledgeable and can provide you absolute specifics to questions pertaining to specific cost coverage, medication formularies and other important questions.

This will be very important for those employees that have special needs, specific medications and other important questions to help them make informed decisions for themselves and loved ones.

Please call: AMR Benefit Administrator Department at 888-216-0899

WHAT DOCTORS AND HOSPITALS ARE IN THE CARRIER NETWORKS?

All medical carriers offer provider networks. Doctors and hospitals (Ex: Sharp, UCSD, Scripps, ect...) who participate in these networks offer their services at a discounted rate that’s been negotiated with the carrier.

That is why some doctors are available with Anthem and United Health Care plans, and some are not.

NOTE: it is important to look for your Primary Medical Doctor (PMD) when choosing a particular Carrier Network.

if they are not listed, you may need to choose a different network or seek a different PMD that is listed in your area. Depending on your specific needs, this can be an issue for you so, so do your homework!

NOTE: Using an in-network doctor will allow you to pay less.

WHERE CAN I FIND A DOCTOR OR HEALTH PROVIDER IN MY AREA?

We have put together a comprehensive guide to completing this process and seeking a medical provider. 

Click Here for more assistance and links to these resources.

WHAT SPECIFIC NETWORK PLAN CAN I REFERENCE TO FIND MY DOCTOR?

  • The AMR network for Anthem is the "National PPO (BlueCard PPO)" network

See www.anthem.com or call (866) 251-1699 for a list of network providers.

 

  • The AMR network for United Health Care network is "Choice Plus"

See www.myuhc.com or call 1-888-586-8672 for a list of network providers.

 

WHAT IS KAISER PERMANETE?

Kaiser Permanete is a combination Carrier Plan and Provider Network. If you choose Kaiser, your plan coverage and provider network of providers and hospitals comes from the same source.Their doctors and facilities are located through out San Diego and Riverside Counties.

See https://kp.kaiserpermanente.org/brand_sep for a list of network providers in your area.

 

IMPORTANT: Though it is listed as an PPO Plan on the Takecaretakecharge website, All Kaiser Permanente (Gold, Silver and Bronze, Safety Net plans) are ALL HMO Plans with more restrictions of coverage and providers than the other PPO (Anthem and United Health Care) plans offered.

I'M GETTING MARRIED IN FEBRUARY AND MY FIANCÉ HAS MEDICAL INSURANCE THROUGH TRI-CARE. CAN I DROP MY AMR INSURANCE AND USE HER INSURANCE INSTEAD?

Yes you can, You may make changes to your insurance benefits (add or cancel coverage) under what is called a "qualifying event"

A Qualifying Event can be any of the following events:

  • A gain or loss of other coverage

  • Marriage

  • Divorce

  • Child Birth

 

MY WIFE OR HUSBAND HAS MEDICAL INSURANCE, CAN I USE THEIR INSURANCE AND AMR INSURANCE. TOGETHER.

 

Yes you can, one will be considered your primary and the other would be your secondary insurance.

You will need to check with each on what percentage they will pay of your bill and whether or not one could be used to pay the "deductible" costs of the other.

 

CONTACT US FOR ASSISTANCE

As always, please feel free to email me if you have questions, Tony@mysdapp.org