Medical Coverage

In 2018 there will be no change to our medical plan administrators with Anthem and Cigna continuing to partner with Pearson, and there are no increases in your copays for any plans. The battle, though, to manage costs while maintaining the highest level of care and service wages on, creating the need to increase payroll contributions, deductibles and out-of-pocket maximums (all other plan details, remain the same).

Here are the payroll contribution increases you can expect in your benefit plans next year (please note that there are no design changes to the Kaiser HMO).

2018 Payroll Contribution Change

  • 3.3%Basic PPO
  • 3.3%Enhanced PPO
  • 3.3%Kaiser
  • 0.0%Delta Dental PPO
  • 0.0%Cigna DHMO

2018 Deductible and Out-of-Pocket Maximum Changes

Enhanced PPO Basic PPO
In-Network Out-of-Network In-Network Out-of-Network
Deductible (Single / Family) $800 / $1,600 $1,600 / $3,200 $1,000 / $2,000 $2,000 / $4,000
Out-of-Pocket Max
(Single / Family)
$2,500 / $5,000 $5,000 / $10,000 $3,000 / $6,000 $6,000 / $12,000

Dental Options

The MetLife Dental PPO will not be offered in 2018.

Your options for the upcoming year are the Delta Dental PPO and Cigna DHMO (in select areas), and here’s what you need to know:

  • You will have access to the Delta Premier® and the Delta PPO networks.
  • You will pay less out of pocket when you use the smaller Delta PPO network.
  • With the Cigna DHMO, you must use a participating, in-network dentist in order to be covered. If you don’t, the plan will not pay for your out-of-network services.

If you are currently enrolled in the MetLife PPO and do not make a dental election during Open Enrollment, you will automatically be enrolled in the Delta PPO for 2018. Learn more about the two choices available to you.

Orthodontic Work in Progress?

For members with orthodontic work-in-progress, Delta Dental will continue to manage your lifetime benefit. Delta will upload the benefit you’ve received from MetLife to date and continue to pay benefits until you reach the lifetime maximum benefit. Once enrolled, you’ll want to advise your orthodontist’s office of the change in dental plans and have them submit your orthodontic claim to Delta Dental of Minnesota. For any other work in progress, Delta Dental pays benefits as of the completion date, so any work that began prior to 1/1/2018 and will end after 1/1/2018 will be covered. You should not lose any benefits in the switch to Delta Dental.

Looking ahead at your vision service plan.

You will see a slight increase in your vision care cost of, on average, $3.70 per month. However, beginning in January, your vision benefits will now cover in full the choice of one of the following lens enhancements for you and each covered dependent when you use an in-network provider.

  • Progressive lenses—Plastic (Standard, Premium & Custom) or
  • Tints/Photochromic adaptive lenses or
  • Anti-reflective coating or
  • Polycarbonate lenses for children

Remember, the vision care program is designed to help pay for routine eye exams, glasses and contact lenses. Learn more about your vision benefits. Treatment of a vision-related illness or injury is covered under your medical plan.

35–40%off the usual and customary charge, for all other lens enhancements.

Surgery Decision Support (SDS)—It’s Required

It is so important to understand all of your options before you decide to have surgery, and getting that information can be stressful and time-consuming. Stop and think for a moment about a few of the questions you might have about an upcoming operation:

  • Are there other treatment options available?
  • Where can I get a reliable, second opinion?
  • What doctors and hospitals have the best results for your diagnosis?
  • What questions should I ask when I meet with the doctor/surgeon?
  • What can I expect during and after the surgery?

Five surgeries have been identified that are associated with more than one treatment option and, because they are typically scheduled in advance, allow time to learn more about alternatives.

These are:

  • Hip Replacement
  • Low Back Surgery
  • Knee Replacement
  • Hysterectomy
  • Weight Loss Surgery

Beginning in 2018, you must participate in SDS

If you or your covered spouse or your covered dependent have a physician-confirmed diagnosis and recommendation for one of the above procedures (emergencies excluded). Not doing so will result in paying an additional $1,000 at the time your claim is processed.

With SDS you have access to your own Nurse Ally to guide you in understanding your options. Recommendations for top-rated specialists and hospitals in your area and plan network who are experienced with your diagnosis will be gathered for you. The goal is to provide assistance to you, rather than you doing all the legwork, then letting you decide what’s best for you. You’ll learn more when you receive further information from Consumer Medical, the administrator of the SDS program, in your home mailbox. Get a better idea of how the program works.

Be assured that you have full control and the final say over your medical care and decisions. The SDS program will not tell you what treatment to have or what doctor to see. Decisions are 100% yours to make. Pearson just wants you to have the most information to make the best choice for you.