1. Lane Community College Proposed plan and benefit changes for 7/1/17 – all plan and benefits changes are subject to bargaining
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2. Agenda What is SmartChoice? New Plan Option, Plan D
Alternative Care Changes
4th Quarter Carry Over Removed
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3. SmartChoice Network is one of PacificSource’s Coordinated Care Networks
What is a Coordinated Care Network? An integrated network of providers working collaboratively with PacificSource to drive positive health outcomes, improve member experience, reduce cost of care and provide market differentiation.
Care is coordinated through a designated primary care provider.
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4. SmartChoice - A Coordinated Care Network
Goal of SmartChoice
Establish a primary care physician relationship, with self-referral capabilities to specialists
Shared vision that includes member engagement and openness to innovation
Network of high quality providers providing member access - both geographic and specialty
Alignment with Triple Aim: better health, better care, and lower costs
Primary Care Physician Requirement
How we contract
Development of Medical Homes
Shared savings alignment (pay for performance, cost-effectiveness, and quality metrics)
Providers paid on value, rather than volume
Network adequacy determined by travel time and distance
Nominations are welcome - by providers and members
Engaged Providers = Engaged Members

5. Primary Care Physician (PCP) Rules
How to Pick your PCP
Online – - Find a provider
Once find your PCP, click “Set as PCP” button
Paper form
Can change your PCP if needed
Will be effective first of the month following update to PacificSource
If you don’t select a PCP, you’ll receive a letter from PacificSource reminding you to select one.
Currently, 93% of total PSN providers within a 25 mile radius of Eugene area in SmartChoice.

6. Common Network Questions
What happens if my doctor leaves the network?
Most PacificSource contracts require a 6 month contract termination clause. PacificSource notifies members who’ve seen that provider within the 6 months prior to contract termination
Can I keep seeing my provider after they leave my network?
For some types of care, PacificSource offers a 90 day transition period to find a new provider. Your claims pay at the participating benefit level, however you can still be balance billed the difference in the billed charge and the allowed charge. Contact PacificSource for more information.
Can a doctor in my network turn me away because I have SmartChoice?
There is nothing in the PacificSource contract that limits the number of patients a provider can have in their practice.
However, a provider can always adjust when a practice is considered full and not accepting new patients. This is not tied to SmartChoice, but normal within any provider group.
The PacificSource website says the provider is “accepting new patients”, however I called the doctor and was told they are not.
The PacificSource website is only as current as the information we have from the doctors office. If we aren’t notified, we won’t update our website.
Engaged Providers = Engaged Members

7. 2017/18 Changes – Management & Classified
Move to a consoled alternative care benefit across all plans
Management – changes the way out of network providers are paid
Classified – Changes to the current management plan, which is modified for payment of out of network providers
Add a Plan D option
Eliminated the 4th quarter carry-over benefit
No major change in dental plans

8. Plan Changes - effective 7/1/17
Benefit
Change
SmartChoice Plan D (new plan)
SmartChoice Network
Deductible $1,300/person
Out of Pocket $5,000/person participating provider
Classified Alt Care Changes
$2,500 combined max
$25 copay par/nonpar
Member at risk for balance billing for nonpar services i.e. billed over allowed charges
Management Alt Care Changes
$2,500 combined max remains
Already set up with $25 copay for participating providers; Nonpar also now $25 copay

9. Select the best Plan for you and your family
All Management and Classified employees now have seven medical plan options
All plans now have the same pharmacy, alternative care and vision coverage – only difference is deductible, out-of-pocket maximum and provider network.
How to choose your medical plan?
Choose your deductible & out of pocket maximum that best fit your and your family’s needs.
Choose your network - PSN or SmartChoice
The SmartChoice panel in Lane County has approximately 85% of the providers also in the PSN Network. The percentage is even higher match up when looking at the providers LCC members actually see.
The SmartChoice plans are a great option for members to consider.
Other considerations
Premium cost from your paycheck
Services pay the same on all plans (i.e. $25 copay, 100% preventive care, 20% co-insurance)

10. Plan deductibles and out-of-pocket maximums
Individual in/out Network
Family in/out Network
A (PSN & SC)
$500/$1,000
$1,250/$2,500
$2,000/$3,250
$4,250/$7,000
B (PSN & SC)
$750/$1,500
$1,875/$3,750
$3,250/$5,250
$6,875/$11,250
C (PSN & SC)
$1,000/$2,000
$2,500/$5,000
$4,000/$6,500
$8,500/$14,000
D (SC only)
$1,300/$2,000
$2,600/$5,000
$5,000/$6,500
$10,000/$14,000
To get the best benefits – “stay in network” – SmartChoice may not save you any money if you go out of network.

11. New Plan Option - Plan D SmartChoice Network Only
Like Plan Options A,B & C except for increased deductible and out-of- pocket maximum levels
Lowest premium cost option

12. Classified Alternative Care
Current Benefit
New Benefit 7/1
Services include
Massage, Chiropractic Manipulation & Acupuncture
No change
Maximum Benefit
24 visits massage & acupuncture; 24 visits chiro
$2,500 combined – no visit count
Cost per claim
Deductible first, then 20% co-insurance
$25 copay for both, participating or nonparticipating providers
Balance billing - Nonparticipating providers
None
Can happen. This means if the provider charges above the PacificSource allowed fee, you can be billed by the provider for the difference between billed and allowed

13. Management Alternative Care
Current Benefit
New Benefit 7/1
Services include
Massage, Chiropractic Manipulation & Acupuncture
No change
Maximum Benefit
$2,500 combined
Cost per claim
$25 copay participating providers
Deductible then 40% co-insurance for nonparticipating providers
$25 copay for both, participating or nonparticipating providers*
Balance billing- Nonparticipating providers
Can happen. This means if the provider charges above the PacificSource allowed fee, you can be billed by the provider for the difference between billed and allowed

14. What action to take?
Submit a new enrollment form ONLY if you wish to make changes to your plan(s) or dependent(s) enrolled.
No action is needed if you do not wish to make any changes.
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