What is the new Additional Cost Tier?
• Outpatient upper endoscopy • Spine surgery for pain • Knee and hip replacement • Arthroscopies for knee or shoulder Members are encouraged to start a dialogue with their provider and to explore less invasive treatment alternatives if possible. There is a $500 copayment for Additional Cost Tier procedures on Plans 3 through 8, plus the applicable deductible and coinsurance. Alternative care is listed on the benefit summaries as a coinsurance amount; however, it also indicates that “services will be covered the same as any other benefit would be under the plan up to the combined benefit maximum.” Plans 3 through 5 have an office visit copayment. Does this copayment also apply to alternative care providers? Yes. If a member seeks services from an alternative care provider, benefits are reimbursed just like any other service up to the combined maximum of $2,000 per plan year. Therefore, office visits on Plans 3 through 5 would be subject to the copayment, in lieu of the coinsurance amoun
