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Health Plan Hikes Hospital Copayment

Donna Young

Tufts Health Plan Inc. of Waltham, Mass., has initiated a new benefit plan that offers employers a way to save money on insurance costs but puts more financial responsibility on members for hospital care.

Members covered under the new plan must now pay a higher insurance copayment if they seek medical services at a teaching hospital instead of a community hospital.

Catherine Grant, Tufts spokeswoman, said the new plan was created to address concerns about increases in premiums, in addition to requests from employers and consumers for more choices in health care.

She said the Massachusetts area has a high concentration of teaching facilities that "generally charge more for services." The amount of the copayment depends on the contract negotiated between Tufts and the employer and on which teaching hospital the member selects.

Under the new plan, Tufts has designated nine Boston-area hospitals as teaching facilities: Deaconess Medical Center, Boston Medical Center, Children’s Hospital, Dana–Farber Cancer Institute, Massachusetts General Hospital, Massachusetts Eye and Ear Infirmary, New England Baptist Hospital, New England Medical Center, and Brigham and Women’s Hospital.

Other New England teaching facilities participating in the Tufts plan include Baystate Medical Center in Springfield, Mass., Rhode Island Hospital in Providence, UMass Memorial Medical Center in Worcester, Mass., and Lahey Clinic in Burlington, Vt.

Grant said Tufts continues to offer employers its standard health-maintenance-organization plan for those companies willing to pay the higher premiums to cover employees. But, she said, employers would save 2–9 percent on premium costs by adding the new option to their benefit plan.

Dolores Mitchell, executive director of the Group Insurance Commission for the Commonwealth of Massachusetts, said she is concerned that Tufts’ new benefit plan is setting a trend for managed care companies to design their plans strictly based on hospital billings rather than on quality measures.

"There are several ways to measure a hospital’s care," Mitchell said. "Health plans should not rule out standards of care when making decisions about coverage."

Grant said that, by making various benefit structures available to employers, Tufts gives companies that are struggling financially the opportunity to continue providing health insurance benefits to employees.

"It is really up to the employer as to the type of plan they choose to go with for their employees," she said.

In addition to the hospital copayment option, Grant said Tufts offers other options that would enable employers to lower their premiums, but employees would pay higher copayments for prescription drugs, services from specialists, and same-day surgical procedures.