3.C.
Employee Benefit Trust Board Meeting
- Meeting Date:
- 03/11/2020
- Department Head:
- Maria Munoz
- Submitted By:
- Maria Munoz, HR Technician, Human Resources Department
ITEM:
Discussion and possible 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 the Third Party Administrator and not Blue Cross Blue Shield. If an employee were 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 for Complex Imaging. The contract will be provided before or at the meeting.
If ESurgeries is approved, Plan Document would need to be changed to add prior authorization for Complex Imaging. The contract will be provided before or at the meeting.
RECOMMENDATION / SUGGESTED MOTION:
I MOVE TO APPROVE THE ESURGERIES CONTRACT.
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