PERS Select: Value-Based Insurance Design
Value-Based Insurance Design (VBID) aims to improve the quality — while lowering the cost — of health care by empowering choice. Depending on the organization and their plan, that means enhanced care, better wellness education programs, fewer unwarranted medical procedures, and accessible cost incentives.
The new PERS Select Basic plan will adopt VBID beginning in 2019. The plan offers the benefit of working with a personal doctor to guide and coordinate your health care. And the more preventative care you elect, the lower your deductible and some forms of coinsurance.
Some benefits of the new PERS Select Plan:
- Get treatment without seeing a specialist, in most cases, or elect to see a specialist without a referral
- Make empowering decisions about your own health and care
- Learn healthy habits that help prevent and detect diseases
- Incorporate your family and community to build a healthier you
The new plan will:
- Change copays for primary care, specialists, and urgent care
- Award credits to reduce your annual deductible
- Eliminate hospital tiering, so you can access any hospital in your network at one coinsurance rate
- Eliminate coinsurance for inpatient delivery, after enrollment in the Healthy Moms program.
Benefits comparison:
| In-network benefits for a common medical issue | 2019 PERS Select | 2018 PERS Select |
|---|---|---|
| Coinsurance (plan/member) | Plan pays 80%/You pay 20% | Plan pays 80%/You Pay 20% |
| Deductible | Individual $1,000* Family $2,000* *Incentives reduce deductible to: Individual $500 Family $1,000 |
Individual $500 Family $1,000 No incentives |
| Primary care | $10 copay for visits with personal doctor $35 copay for visits with other doctors |
$20 copay |
| Specialist | $35 copay | $20 copay |
| Laboratory tests | No copay for preventive 20% coinsurance |
No copay for preventive 20% coinsurance |
| Inpatient maternity (delivery) | Inpatient covered in full when enrolled in Future Moms program 20% coinsurance (without enrollment) |
20% coinsurance |
| X-ray/imaging | 20% coinsurance | 20% coinsurance |
| Mental health / Behavior health / Substance abuse physician visit | $10 copay | $20 copay |
| Inpatient mental health | 80% preferred provider 60% non-preferred provider |
80% preferred provider (Tier 1 hospital) 70% preferred provider (Tier 2 hospital) 60% non-preferred provider |
| Inpatient | 80% preferred provider 60% non-preferred provider |
80% preferred provider (Tier 1 hospital) 70% preferred provider (Tier 2 hospital) 60% non-preferred provider |
| Maximum coinsurance out-of-pocket | $3,000 individual $6,000 family |
$3,000 individual $6,000 family |
| Out-of-network coverage | 40% coinsurance | 40% coinsurance |
This summary is meant only as a brief description of some of the programs for which members may be eligible. All insurance contracts and plans have limitations and exclusions that apply. Refer to and read all plan documents for more complete descriptions. For more information, visit the Anthem Blue Cross website or contact Anthem Blue Cross Member Services at (877) PERS-PPO or (877) 737-7776.