Health plan being implemented

Scott Csernyik

4/29/2002 12:00:00 AM

Benefits officials have been implementing a health care plan intended to provide basic coverage to enrolled members of the Saginaw Chippewa Indian Tribe of Michigan.

The self-funded Blue Cross Blue Shield program, which covered 1,210 members as of May 1, was passed by the previous Tribal Council on Dec. 3, 2001.

"The whole intent of the program was to provide a basic coverage to members who otherwise may of have to rely on the clinic having enough funds through Indian Health Service," stated Benefits Manager Connie Sprague. "This is not the type of insurance where you pay a premium and the insurance company is responsible. This is self-funded, which means any charges incurred are the Tribe's responsibility."

Enrollment forms for the health care coverage program were solicited by Feb. 15 so there could be a March 1 start date. Sprague said it is imperative that members provide the correct information to their health care providers so it matches information in the database.

"Social security numbers need to be correct, as well as date of birth and using correct names," she explained. "It's important to have the correct information for billing purposes."

The plan does include deductibles and co-pays, which are listed in the "benefits at a glance" information provided to program participants. Sprague said members need to understand having to pay a deductible is more cost efficient than paying the entire medical bill.

"It'll be a lot easier looking at a $2,000 bill, whether it be for one individual or a family, as opposed to something that could cost you $20,000 to $30,000 if you didn't have this coverage," she stated during the April 7 community meeting.

Sprague also stressed the importance of members being familiar with their current coverage for eligibility. Some plans do not allow additional coverage considerations.

"Please remember that not all health care providers are Blue Cross Blue Shield participants," added Sprague. "If you are using providers that are not participants, this is considered out-of-network which will effect the amount paid or even if the service is covered.

"In order to find out if a provider is a participant, one needs to ask if they are Community Blue PPO participants." For more information about the members program, contact Bonita Hoggs at (989) 775-5618. Additional phone numbers for customer service can be found on page 5 of the Blue Cross Blue Shield benefits guide.

The following is "benefits at a glance" information in summary form. For more detailed explanations, please consult the benefits guide.