Law Enforcement Health Benefits Inc.

2233 Spring Garden Street 19130 | Philadelphia Pennsylvania | 215-763-8290

John J. Gaittens, Administrator

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KNOW DRUGS IN THE NORTHEAST



CORA'S Community Conversation Series - Part 1

Wednesday, November 1, 2017, 6:00 - 8:00 PM

CORA Services Conference Center

8540 Verree Road, Philadelphia, PA 19111

Presenters:

AnnMarie Schultz, CEO-CORA
Mary K. Doherty, Director of Government & Strategic Partnerships - CORA
David Fialko, Certified Prevention Specialist-The Council of Southeast Pennsylvania, Inc.

As Part of Mayor Kenney's Task Force to Combat the Opioid Epidemic, CORA hosted the largest Community Listening Session in the City to begin public conversation about the impact of opioids on our communities. CORA actively listened.

CORA invites you to join us as we continue the conversation...

  • Receive in-person training in overdose reversal through NARCAN administration
  • Actively discuss drug addiction and misuse
  • Hear updates on the work of the Mayor's Task Force
  • Learn about recovery education
  • We believe that the solution to addiction/misuse lies in the community.
    Please join us to become part of the solution.

    Sign-up today! No Fee to attend, but registration is required.
    Please call 215-342-7660 or visit www.coraservices.org.

In-Network Services Restored!

Independence Blue Cross and Tower Health Reach Agreement

Independence Blue Cross and Tower Health announced they have agreed to a new three-year contract, effective immediately, that ensures Independence members continue to receive in-network health care coverage at Jennersville, Pottstown, Phoenixville, Brandywine, and Chestnut Hill hospitals, facilities and the physicians they employ. Reading Hospital System, now Tower Health, will also remain in the Independence network. The new contract applies to all lines of business -- commercial, Medicare and FEP.

The Tower Health system includes the following entities:

  • Reading Health in West Reading
  • Reading Health Rehabilitation
  • Hospital in Wyomissing
  • Reading Health Physician Network
  • Brandywine Hospital
  • Chestnut Hill Hospital
  • Jennersville Regional Hospital
  • Phoenixville Hospital
  • Pottstown Memorial Medical Center
  • Surgery Center of the Main Line
  • Surgery Center at Limerick
  • Blue Bell Surgery Center
  • Pottstown Medical Transport
  • Pottstown Clinic Company
  • Phoenixville Clinic Company
  • Coatesville Clinic Company
  • Chestnut Hill Clinic Company
  • West Grove Clinic Company
  • Phoenixville Specialty Clinics
  • Schuylkill Internal Medicine Associates
  • West Grove Family Practice
  • Jennersville Family Medicine
  • Coatesville Cardiology Clinic
  • Phoenixville Orthopedic Specialists
  • Coventry Clinic Company
  • Village Medical Center Associates

ANOTHER WIN FOR FOP LODGE 5! YOUR MEDICAL BENEFITS ARE SECURE FOR THE DURATION OF THE NEW CONTRACT!

As you know, the City of Philadelphia proposed radical changes to our health benefits which could have resulted in up to $4,000.00 per year in Out of Pocket costs for each family.

NOTHING HAS CHANGED!!! The terms and conditions of your Medical Benefits are exactly the same!

  • The City DID NOT get out of pocket Employee Contributions.
  • The City DID NOT get out of pocket Co-insurance.
  • The City DID NOT get INCREASED Co-pays.

Once again, President McNesby and his team did an outstanding job in protecting your benefits, as they have done in every contract in which they have been involved. The FOP and LEHB diligently worked side by side to ensure your benefits remained untouched in the new 2017 Arbitration Award.

We didn't do it alone! We needed your help to protect those benefits and you came through! The Medical Presentation was held in Liberty Ballrooms A & B, which are designed to accommodate 800 people. The room was packed and it was necessary to bring in additional chairs!

You, your family and friends clearly sent the message to the Neutral Arbitrator, "Our Police Officers have earned their benefits and deserve to have them continue unchanged!" The FOP, LEHB and all of our members stood united and together ensured security for our families throughout the next three years.

STAY IN-NETWORK! DON'T LET OUT OF POCKET COSTS AFFECT YOU OR YOUR FAMILY MEMBERS!

As you know, Police Officers make it a habit to be aware of their surroundings and to constantly evaluate locations and situations for threats. It is unfortunate that the same mindset should be used when dealing with healthcare providers and facilities.

The best advice we can offer to avoid large out of pocket expenses is to stay in the Blue Cross network. If you refer to the LEHB website, www.lehb.org look at the Blue Cross Blue Shield Summary of Benefits and Coverage, click on "Summary of Benefits 2017" you will see that if you stay In-Network, there is NO deductible and the plan pays 100% of the costs unless otherwise noted.

However, if you go Out of Network, you will be subject to a deductible ($500.00 for Single and $1,000.00 for Family) additionally, the plan will only pay 50% of the In-Network allowable rate. The following simplified example will demonstrate how your costs could be significant. (This example does not include lab fees and other customary charges which can be very significant).

A member's adult dependent goes to an out of network addiction treatment facility. Their charge per day is $2,548.16 times 30 Days for a total cost of $76,444.80.

IBC will pay 50% of the In-Network daily rate. The daily In-Network rate is $454.00, 50% is $227.00 times 30 Days equals $6,810.00 The member will be charged the $500.00 Deductible, leaving $6,310.00

The Out of Network facility charged a total of $76,444.80 IBC would pay $6,310.00. The Out of Network facility could "balance bill" the member $70,134.80

NOTE: Per the Affordable Care Act, the balance-billed portion of your out-of-pocket expenses won't be credited toward your out-of-pocket limit.

Therefore, the member could be responsible for the full balance of $70,134.80

Specific Terminology: Always ask the Provider or the Facility if they are IN the Blue Cross Network. Some Providers/Facilities try to mislead the member by saying "we accept Blue Cross" or "we accept all insurance." That does NOT mean that they are "In Network" or will accept the Blue Cross payment as payment in full. You would be subject to pay the balance.