Bowdoin College PPO Health Plan Preferred In-Network Providers
Why does the College offer a “Preferred In-Network” benefit for the Bowdoin College PPO Health Plan?
The Preferred In-Network benefit helps both you and the College get the best value out of the money spent on health care. Rising healthcare costs are a challenge for everyone, and this is one way to receive high quality care at a lower cost.
What does it mean to use a “Preferred In-Network” provider?
If you choose to receive covered services from a Preferred In-Network provider, you will have:
- Lower deductible
- Lower out-of-pocket costs
Who are the Preferred In-Network providers?
- Lincoln County Healthcare (Damariscotta)
- Maine Coast Memorial Hospital (Ellsworth)
- Maine Heart Center (Portland)
- Maine Medical Center (Portland)
- MaineGeneral Health (Augusta/Waterville)
- Mid Coast Hospital (Brunswick)
- New England Rehabilitation Hospital (Portland)
- OA Centers for Orthopaedics (Brunswick/Portland/Windham/Saco)
- Pen Bay Medical Center (Rockport)
- Southern Maine Health Care (Biddeford)
- Spring Harbor Hospital (Westbrook)
- St. Mary's Regional Hospital (Lewiston)
- Stephens Memorial Hospital (Norway)
- Waldo County General Hospital (Belfast)
- York Hospital (York)
What are the savings and how are the savings applied to the plan?
For services billed directly by one of the preferred in-network facilities listed above that are normally subject to the deductible and the coinsurance, the deductible is reduced to $200 per individual/$500 per family (regular in-network deductible is $500/$1,000). Services are then covered at 90% and the out-of-pocket calendar year maximum is reduced to $1,750 per individual/$3,500 per family (regular in-network $3,000/$6,000). For OA Centers for Orthopaedics, in addition to savings on charges subject to the deductible and coinsurance, the copayment for office visits and physical therapy visits is reduced to $20 versus the regular in-network copayment of $50 per visit for a specialist office visit. The negotiated savings to the plan by using one of these providers is applied to lower your deductible and reduce your out-of pocket maximum that would otherwise be charged for services at these providers.
What happens if I go to a provider that is not on the Preferred In-Network provider list?
You can use any Anthem in-network provider in Maine and across the United States. If you wish to use a provider who is not a Preferred In-Network provider, you may do so and the regular in-network deductible is $500 per individual/$1,000 per family. Services are then covered at 70% to the regular in-network out-of-pocket maximum of $3,000 per individual/$6,000 per family. The plan also provides out-of-network benefits, but it is important to remember that the reimbursement for out-of-network benefits is significantly lower. Out-of-network benefits are subject to the deductible and then covered at 60% of the maximum allowance.
How did the College choose these providers and why isn’t my hospital on the list?
Bowdoin College is concerned about employees’ health and well-being. The College also wants to make sure we get the best value for the money that you and the College spend on healthcare. It is also important to find providers in our community that provide quality care at a reasonable price. When you choose a doctor or hospital, the price is important, but the quality of care and the outcome is even more important.