What does a self-funded health plan mean and how does that affect City of Plano employees?
Self-Funded Health Plan
The City's self-funded health plan provides benefits to employees with our funds. When a claim is filed, the City pays the claim through our third-party administrator WebTPA. The City funds the cost of the claim and takes the risk in a self-funded plan. Being self-funded means the City and employees have a shared responsibility for our healthcare. This partnership allows the organization to offer options that best fit your needs, while also giving you the power to make educated decisions.
How can we work together to manage our resources better?
Taking an active part in your health can pay off big! Here are some factors to consider:
- Preventive Care
IT IS FREE! Preventive healthcare screenings, including vaccinations, are offered at no cost to you. An illness detected and treated in its beginning stages is less costly. More importantly, it can sustain your quality of life. You feel better, you save money, the City saves money – it’s a win-win all around.
Don’t have a primary care doctor for your preventive care visits? WebTPA can help you find a network provider.
- Location Matters
Where you go for care has a huge impact on cost. Hospitals are by far the largest healthcare cost. Any time you can avoid having a procedure in a hospital setting, you will save yourself and our health plan money. Ambulatory surgery centers generally have significant cost savings over hospital procedures. City partners Catalyst and Airrosti are lower-cost providers because they help reduce the total cost of care and keep you out of the hospital.
If you have to go to a hospital, do your research in advance to ensure you are going to a high quality and cost-efficient hospital. See North Texas hospital ratings on the Sage Transparency site. Filter by state to compare local hospital pricing and quality.
- Prescription Review
The City takes great strides to keep prescription costs affordable by providing Southern Scripts “cost plus” medications. Manufacturer coupons are also applied when available to reduce the price. Many medications are very expensive and the majority of the cost is funded by the City. Odds are, the drugs you see in commercials are costly. For example:
- Specialty medications such as Humira can carry an annual price tag of around $50,000.
- Medications like Ozempic can cost the plan around $12,000 annually.
If you take an expensive medication, it might require prior authorization. The clinical team reviews your file to ensure you are still using the medication for the condition. The purpose of this is to be sure unnecessary expensive drugs are not being dispensed.
- Chronic Condition Management
If you have chronic conditions like diabetes, high blood pressure, asthma, COPD or high cholesterol, get in touch with our Nurse Care Managers with Communitas. Take advantage of this free resource. Seek second opinions – physicians are human too and they make mistakes. Second opinions can either affirm a treatment plan or potentially identify a misdiagnosis. Our Communitas reps are:
214-226-8535 (call or text)
Contact your Benefits team whenever you’re in need.