In this example you belong to a PPO, are using an in network provider, and have no office visit co-pays. The normal fee for the doctor's visit is $100 but the health care plan has negotiated a discounted fee of $80 with the doctor. The plan will pay 80 percent of the negotiated fee, or $64 (80 percent of $80), and you will pay 20 percent or $16. (20 percent of $80). While you are there, the doctor takes a throat culture and sends it out to an in-network lab. The doctor's office will bill the health care plan directly for services and then send you a bill for your share of the fees, which will be $16 (20 perecent of $80). The lab's normal changes are $110 but they have agreed to accept a discounted fee of $90. The lab will bill the health plan directly; the plan will pay 80 percent of the negotiated fee, or $72 (80 percent of $90), and the lab will bill you for your share of the fees ($18 or 20 percent of $90). Your total costs for the office visit plus lab work is $34.If you have dual insurance and the secondary plan pays 100 percent Coordination Of Benefits (COB), the amount that you owe will be paid according to the secondary plan's benefit design.
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.
HealthWorks News
Provider Search/DocFind
Look up local doctors and hospitals in Aetna's DocFind website that has been specially customized for McClatchy employees. Nominate a physician to join Aetna's network.
Aetna Pharmacy
Find out if a drug you are taking is on McClatchy's drug formulary. You can research medications, refill prescriptions online, and learn how drugs interact at Aetna's pharmacy site.
Wellness Center
Read the latest national health news plus information and interactive features on workplace health, fitness, sports medicine, disease and more.
Medical Plan eValuator
Determine which Aetna plan is the best fit for your budget, lifestlyle and health care needs.
Aetna Navigator
Track your claims, request ID cards, compare hospitals in this around-the-clock, self service website for Aetna members.
Health Risk Assessment
Aetna's "Simple Steps to a Healthier Life" website offers a secure, personalized, health and wellness program for Aetna members. Begin by taking the Health Risk Assessment, a questionnaire designed to help identify some of your health needs.
In this example you belong to a PPO, are using an in network provider, and have no office visit co-pays. The normal fee for the doctor's visit is $100 but the health care plan has negotiated a discounted fee of $80 with the doctor. The plan will pay 80 percent of the negotiated fee, or $64 (80 percent of $80), and you will pay 20 percent or $16. (20 percent of $80). While you are there, the doctor takes a throat culture and sends it out to an in-network lab. The doctor's office will bill the health care plan directly for services and then send you a bill for your share of the fees, which will be $16 (20 perecent of $80). The lab's normal changes are $110 but they have agreed to accept a discounted fee of $90. The lab will bill the health plan directly; the plan will pay 80 percent of the negotiated fee, or $72 (80 percent of $90), and the lab will bill you for your share of the fees ($18 or 20 percent of $90). Your total costs for the office visit plus lab work is $34.If you have dual insurance and the secondary plan pays 100 percent Coordination Of Benefits (COB), the amount that you owe will be paid according to the secondary plan's benefit design.