There are four basic types of health care plans in the marketplace. Managed care refers to actions the health care plans take to control the cost and use of the health care system. Managed care plans combine physicians, hospitals and insurance plans into a single network. The plan that has the most managed care is the Health Maintenance Organization, or HMO. HMOs require your Primary Care Physician (PCP) to direct all your medical care, and you must use their network doctors and facilities. HMOs typically do not pay for medical expenses if you use a provider who is not in the HMO network.On the other end of the spectrum are indemnity or fee-for-service plans. These plans allow you to go to any doctor or facility and pay a percentage of the actual billed fees.In between those two plans are Preferred Provider Organization plans (PPO) and Point of Service (POS) plans. PPO plans have contracts with doctors and hospitals to provide services at a discount from their normal fees, and the plan pays a percentage of these discounted rates. If a participant uses a doctor outside of this network -- referred to as going out of network -- the plan will pay a percentage of reasonable and customary fees, which are rates that most doctors in the area will charge for the procedure, and which are generally higher than the in-network discount rates. The doctor may bill you for the balance or difference between his fees and what the plan will pay. The POS plan is an HMO plan that allows you to access care from a non-HMO network provider. You select the level of benefit when you access services by choosing care from an HMO provider or a non-HMO preferred provider. The level of managed care and payment for services will depend on your choice of providers.
In a May 4 letter to all full-time, benefits-eligible employees, CEO Gary Pruitt announced that McClatchy’s dental plan provider will change from Delta Dental to CIGNA in 2008.
Two dental plan options will be offered. One plan will cover preventive care only and the other provides for more comprehensive coverage. Both plans use the CIGNA Dental PPO network.
You can search online at the CIGNA website to see if your dentist is in the network. Click on the “Find doctors or dentists by specialty” link in the lower middle portion of the homepage. Select the “Dentist” option below the bolded question “What Type of Provider are you looking for?” On the following page, where CIGNA asks you to “Select your dental plan,” choose the “Managed care plan with open access to dentists for the CIGNA Dental PPO.”
If your dentist is not in the network, you can request CIGNA to recruit your dentist by downloading and submitting the nomination form. CIGNA will actively reach out to all dentists nominated by McClatchy employees.
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