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| Volume 2, Issue 27: November 16, 2007 |
New System Saves Steps in SEHI New Group Process This is a busy time of year for all of us, so we are happy to take something off your To Do list. You no longer need to sign and fax an approval on the final rates for new SEHI groups, since these rates are based on final enrollment. We will continue to provide you with the final rates to keep you informed. Please notify us within three days if you want to make changes to benefits due to the rate change. Otherwise, we will process the group as planned. This will expedite processing and eliminate an extra step for you. Optional Benefits—Clarifications Additional Accident Benefit Except for Idaho mandated plans, an additional accident benefit may be added to any medical plan that has a deductible, regardless of the type of plan. If this benefit is elected, it provides a $500 first-dollar benefit for eligible expenses incurred within 90 days of an accident. Any expenses in excess of $500 are subject to the regular plan benefits. Oregon First Dollar Preventive Care Rider The optional first dollar preventive care benefit is still only available on our Preferred and FlexPerks 80% deductible plans. So, for example, this benefit is not available for our Preferred FlexPerks FP 5000 plan. Please see the First Dollar Preventive Care benefit summary for more information. Generic Alternative Drug Information Mails to Select Members As you know, an easy and effective way for members to help keep their healthcare costs down is to choose a generic medication. According to the Generic Pharmaceutical Association (www.gphaonline.org), the cost of a generic can be, on average, 30 to 80 percent lower than its brand equivalent. While some medications do not yet have generic equivalents, many have generic alternatives—a different generic drug that treats the same condition. This week, we mailed brochures about generic alternatives to members using certain brand name medications, such as Crestor and Clarinex (view a sample generic alternative brochure). The brochures encourage these members to talk to their doctor about specific cost-saving generic alternatives that are now available. These alternatives have been reviewed by the U.S. Food and Drug Administration (FDA) for safety and effectiveness. We will be closed on November 22 and 23 for the Thanksgiving holiday. Our offices will reopen at 8:00 a.m. PST on Monday, November 26. Have a happy and healthy Thanksgiving Jamie Humphrey Fits the Pieces Together Like any health insurer, PacificSource is challenged with offering its members the widest possible network of providers at the lowest possible cost. We continually strive to expand relationships and negotiate the best contracts with providers and provider organizations. That’s where Jamie Humphrey comes in. |
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Jamie’s extensive experience in the provider contracting profession and his longstanding relationships with provider organizations here in the Northwest make him well suited to this challenge. He joined PacificSource in January with 12 years experience in provider contracting, including work for Providence Health Plan, HealthNet, and LifeWise. Outside of work, Jamie volunteers for several local organizations, and has been very active with the March of Dimes, Anne Ross House for battered women, Providence Child Center, and Emanuel Children's Hospital. He holds a BA degree in healthcare administration from Oregon State University, and is pursuing an MBA from Portland State University. “My major focus is the economics of the healthcare system and how each piece of the puzzle—physicians, hospitals, health plans, and government—fits together.” It’s clear that all the pieces need to connect, and how all the pieces fit together is central to what Jamie considers his greatest challenge in the workplace. “Balancing the needs of the provider community with those of our members can be difficult. The most important aspect is that individuals and employers have a choice when selecting a health plan. My goal as a Contract Account Lead is for PacificSource to be competitive in terms of reimbursement for medical services.” PacificSource is proud to sponsor Northwest community events that support healthy communities and health-focused organizations. We hope you will join us in supporting these events: Festival of Trees—McKenzie-Willamette Community Health Foundation Festival of Trees Festival of Trees—Providence Community Health Foundation Festival of Trees—Mercy Foundation and Children’s Healthcare Fund Festival of Trees Festival of Trees—Hospice of Redmond-Sisters |
“My goal as a Contract Account Lead is for PacificSource to be competitive in terms of reimbursement for medical services.” |
Questions? You’re always welcome to contact us! |
Eugene Bend Boise Medford |
Portland Manley Services Select Benefit Administrators |
