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Lucas County Employee Medical Plan Options
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Lucas County Employee Medical Plan Options
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Lucas County Health Plan
Self-Insured 80/20 Plan
Administered by: Health Care Payer’s Coalition
419-244-0135
Click here to access network provider directory
Group No. TH341931LC1
Paramount Health Care, Inc.
80/20 HMO Plan
Member of ProMedica Health System
(419) 887-2525
Click here to access network priver directory
Group No. 005102
Comparison of Benefits Chart
Program Year 2007 (March 1, 2007 through February 29, 2008)
Lucas County offers two medical plan options for eligible employees and their eligible dependents for the 2007/08 program year: Paramount Health Care (PHC), an 80/20 HMO plan with a $10 PCP office visit co-pay and a $15 specialist office visit co-pay; and the Lucas County Health Benefit Plan, an 80/20 plan with a $10 PCP office visit co-pay and a $15 specialist office visit co-pay. The benefit levels through each of these two plans are not the same. Please refer to the PHC certificate of coverage and the Lucas County Plan Document for more details and the brief comparison for comparative information on benefit levels.
Each of these plans uses a unique network of
participating hospitals, physicians and other medical providers.
Before enrolling in either of these plans, be sure to ask your physician(s) if they intend to
continue to participate in either Paramount or the FrontPath network of
participating providers.
Paramount pays up
to 80% of medically necessary services when PCP authorized and performed
by network providers. The patient pays 20% of the discounted cost of
approved, covered services performed by a PHC participating medical
provider. When patients use a PHC medical provider for a PCP authorized
service, their annual maximum out-of-pocket expense is limited to $1000
per covered person, or $2000 for an entire family per plan year.
Copayments/Co-Insurance for Mental Health/Chemical Dep., DME, Prosthetics,
Home health, outpatient physical/-occupational/speech therapy, vision
rebate, do not
apply toward Out of Pocket maximums. Those who enroll in Paramount who seek non-emergency medical services outside the PHC network, will be required to pay 100% of the actual cost of the medical services.
The Lucas County Plan pays up to 80% when medically necessary services are performed within the FrontPath network. The patient pays 20% of the discounted cost of approved, covered services performed by a FrontPath participating medical provider. When patients use a FrontPath medical provider, their annual maximum out-of-pocket expense is limited to $1500 per covered person, or $3000 for an entire family per plan year. Payments for emergency room and urgent care facilities do not accumulate toward satisfying out-of-pocket maximums. Once you reach your out-of-pocket maximum, if you continue to use medical providers in either the FrontPath or Paramount network, you will not be responsible for any additional out-of-pocket expenses, except for applicable co-pays, such as for office visits, emergency room and urgent care facilities.
Those who enroll in the Lucas County Plan who seek non-emergency medical services outside the FrontPath network will be required to pay 40% of the actual cost of covered medical services. The $1500 per individual and $3000 per family out-of-pocket maximums do not apply for non-emergency services provided by medical providers who do not participate in FrontPath.
There is no employee payroll
deduction charged to participate in either of the medical plans offered
unless you enroll your spouse as primary through Lucas County in either Paramount or the
Lucas County Plan.
If you enroll your spouse as primary in either of these medical plans, you will be charged a monthly fee through payroll deduction based on the amount of your gross annual household income. (Please refer to Spouse & Dependent Eligibility Summary for additional spouse primary information).
Employees and spouses who are court ordered to provide coverage for eligible dependent children that reside beyond the local medical service area, may obtain coverage through the Lucas County Plan with benefits consistent with the FrontPath in-network level of benefits. Copies of marriage certificates, divorce decrees and child support court orders must be submitted with your application.
The Health Care Payer’s Coalition (HCPC), a local, not-for-profit purchasing cooperative, administers the Lucas County Health Plan and the Lucas County Dental Plan. If you are enrolled in the Lucas County Health or Dental Plan, any questions or concerns you have regarding eligible expenses, claim payments, pre-determinations, etc. must be directed to Health Care Payer’s Coalition at (419) 244-0135.
The network utilized for the Lucas County Plan is
FrontPath. FrontPath is not the name of your insurance company, nor do they pay claims,
administer the Lucas County Health Plan or answer questions related to such.
FrontPath is only the NETWORK associated with the Lucas County Health Plan.
Only questions regarding participation of a provider under the Lucas County Plan should be directed to FrontPath at (419) 891-5206.
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