Pennsylvania Association of

Community Health Centers

Supporting Pennsylvania's health centers in increasing access to quality primary health care for all


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Friday, May 11, 2018

May 11, 2018 Outreach and Enrollment News

Southwest Community HealthChoices Listening Session

The Office of Long-Term Living (OLTL) and the Pennsylvania Health Law Project will be hosting a Listening Session on Wednesday, May 23 from 10:00 am to 3:00 pm at the Allegheny County Assistance Office, 301 5th Avenue, Room 3023, Pittsburgh, PA 15222. Community HealthChoices participants, family members, caregivers and others are invited to speak at the session. OLTL will provide updates and presentations on transportation, continuity of care and person-centered planning. Consumers or providers interested in speaking must RSVP with your name and any accommodation requests to: jmeinert@phlp.org or 215-625-3663.

 

Changes in Tiered Network Contracts for Providers Possible

Tiered health insurance plans provide benefits based on a ranking system that groups hospitals and providers primarily according to what the insurance company pays for care. These plans are either Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Point of Service (POS) or Exclusive Provider Organizations (EPO). This tiering plays a major role in networks under the ACA's Health Insurance Marketplace. With tiered networks, it is less expensive for consumers to receive care at a hospital that is ranked in a more preferred tier because they would have lower co-payments and/or deductibles. Meadville Medical Center moved from Tier 2 to Tier 1 in their agreement with a health plan in their region. This lowered copays, deductibles and out-of-pocket maximums for new enrollees/patients. Because of this change, more consumers are choosing the hospital and affiliated practices. Navigators and CACs should be aware of network tiering when working with consumers to choose health plans on the Health Insurance Marketplace.

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