3.B.
Employee Benefit Trust Board Meeting
- Meeting Date:
- 12/11/2019
- Department Head:
- Maria Munoz
- Submitted By:
- Maria Munoz, HR Technician, Human Resources Department
ITEM:
Discussion and action on any and all matters regarding the contract approval of ESurgeries Network. (Susan Posada, Consultant and Broker)
SUMMARY:
ESurgeries Network is only available in the employer market, making it a unique voluntary surgical management program. They contract with top area surgeons to perform many surgical procedures in ambulatory surgical centers rather than in outpatient hospitals. This program will have the same principles as the Incentive/Win-win program but with greater savings because of the direct rates with TPA and not Blue Cross Blue Shield. If an employee was to utilize ESurgeries, the following would be waived: Deductible, Co-insurance & Co-pays
If ESurgeries is approved, Plan Document would need to be changed to add prior authorization to Complex imaging and effective date of changes would be 02/01/2019.
Staff is currently working on negotiating changes to the form of contract ESurgeries provided.
If ESurgeries is approved, Plan Document would need to be changed to add prior authorization to Complex imaging and effective date of changes would be 02/01/2019.
Staff is currently working on negotiating changes to the form of contract ESurgeries provided.
RECOMMENDATION / SUGGESTED MOTION:
I MOVE TO CONTINUE THIS ITEM TO THE NEXT MEETING OF THE BOARD.
Fiscal Impact
Fiscal Impact:
Fiscal Impact:
No program set-up fee. Plan sponsor shall pay ESurgeries an amount equal to 20% of the total amount payable for services provided pursuant to a Single Case Agreement.
No program set-up fee. Plan sponsor shall pay ESurgeries an amount equal to 20% of the total amount payable for services provided pursuant to a Single Case Agreement.
Attachments
- ESurgeries proposal agreement
- ASC Common Elective Procedures
- ASC cost savings material
- ASCs Material