Deadline for sign up Saturday, free information seminar set for Friday
Piedmont Healthcare and WellStar Health Systems have partnered to start their own health plan for employees and Medicare beneficiaries in the counties they serve.
Beginning next year, Piedmont Healthcare and WellStar Health Systems will contract with Medicare to provide a Medicare Advantage product, said representative Cory Scott. The plan will be offered in 11 counties where they have hospitals, five of which are Piedmont facilities and five are WellStar.
“We are right now in the middle of our annual enrollment period for Medicare Advantage,” Scott said. “We’ve gone past the 3,000 mark with enrollments throughout all those 11 counties.”
Scott said the biggest advantage to the Piedmont WellStar Medicare Choice (HMO) plan is that they are a “local provider-owned health plan”.
“That means that the direction and decisions of our health plan are driven by our provider owners,” he said. “I think that’s probably the most important differentiator for our plan. We also have a very nice benefit package.”
Scot said the plan has a $0 premium with a $3,900 out of pocket maximum. There is a $10 co-pay to see a primary care doctor, a $30 co-pay for specialists and a $195 co-pay per day for the first seven days for in patient services at a hospital.
“The combination of being provider owned and locally owned along with an attractive benefit package has really put us in a positive position as we go into 2014,” Scott said.
Scott said under the plan, patients can see doctors in both the Piedmont and WellStar systems who are employed or affiliated doctors within those two networks. And, he said, in an emergency situation, those enrolled in the plan are covered anywhere in the world for emergency care at the in-network benefit coverage. For urgent care, he said, clients are covered in-network anywhere in the United States.
“If you are on vacation and got the flu or you cut your finger and you need stitches. When that occurs you call member services and tell them you have an urgent need and they direct you to our national travel network and you go there. You pay your urgent care co-pay and your done.”
Scott said even traveling in a Georgia county without a Piedmont or WellStar hospital, clients would still be covered in-network at any hospital for emergency services.
The plan also carries a drug plan that utilizes 65,000 pharmacies nationwide along with local pharmacies.
“Benefits are kind of secondary,” Scott said. “I think the real advantage of this plan and the part I like and why I like working here is we are owned by two local healthcare systems who are tied to this community and have been serving this community for over 100 years. I live in Cobb County and I like the fact that I work for a company that serves my community. At the end of the day this health care plan is about our providers.”
Enrollment in the Piedmont WellStar Medicare Choice (HMO) plan ends December 7. There is a free information seminar planned this Friday, Dec. 6 at the senior center. For more information or to enroll call toll free 1-855-222-1048.