What are my choices?
Rensselaer offers eligible employees three health plan options: The Rensselaer Health Plan (RHP), The Rensselaer HMO Plan, and Mohawk Valley Physicians' Health Plan (MVP).
What type of coverage is available?
You may choose individual, two-person, or family coverage under all these plans.
When can I enroll?
- You may enroll within 30 days of your date of employment. Coverage will be effective the first of the month following your date of employment.
- You may enroll in or change medical plans during the annual Open Enrollment period; coverage becomes effective the following January 1.
- You may add or remove dependents during the annual Open Enrollment period, coverage becomes effective the following January 1.
- You may also add or remove dependents or cancel coverage within 30 days of a qualifying family status change (see glossary) to be effective on the date of your status change.
How much does it cost?
Rensselaer pays 81 percent of the cost of medical coverage for you and your dependents if you are considered a full-time regular or fixed-term employee by Rensselaer.
If you are scheduled to work at least 1,440 hours per fiscal year and are not considered to be a full-time employee, Rensselaer pays 50 percent of the cost.
If you are a part-time employee scheduled to work 20 hours or more per week (between 1,040 and 1,439 hours per year), you are eligible to participate in any of the health care plans by paying the entire health insurance premium.
If Rensselaer contributes to the cost of health coverage for you, your share of the cost is deducted from each paycheck on a pretax basis. Rates are set and announced on an annual basis and are effective each January 1.
 Medical/Health Insurance Rates Chart
What do the three plans have in common?
All of the health care options offered by Rensselaer are managed-care plans in which networks of participating doctors provide low-cost preventive and sick care to their members.
- The Primary Care Physician
The Primary Care Physician (PCP) is the key to making the most of your health plan. When you enroll in a plan, you select a PCP for yourself and one for each member of your family from the plan's provider directory.
Your Primary Care Physician will provide routine care such as check-ups, treat illnesses that do not require a specialist, and coordinate all aspects of your health care by referring you to specialists and hospitals as needed. If you are not satisfied with your PCP, you may change to another one.
- High-Quality Health Care
Care coordinated by a Primary Care Physician ensures that one doctor has a complete picture of your health needs and medical history and is aware of all aspects of your health care.
All participating physicians are carefully screened and subject to periodic review by the networks. Each plan's administrators assess the education, experience, credentials, administrative procedures, and standard practices of all health care providers before admitting them to their networks.
- Emphasis on Prevention
Because these plans cover the cost of such services as routine check-ups, well-baby visits, and preventive screenings such as mammograms, it is easier to stay healthy without spending a lot of money. When you see a network doctor, all you pay is the plan's preset visit fee (copayment).
- Comprehensive Coverage
When you are referred to a specialist by your Primary Care Physician, you pay only the plan's copayment for each office visit. All treatment and hospital expenses are covered in full. Prescription drugs are also covered and can be purchased at reduced prices.
How do the plans differ?
The HMOs
The Rensselaer HMO Plan and Mohawk Valley Physicians' Health Plan (MVP) are Health Maintenance Organizations (HMOs) that have made agreements with doctors in the community to provide total programs of preventive and sick care to their members.
In these plans, care is paid by the plan except for small copayments, regardless of the nature or extent of treatment. Copayments vary from plan to plan, and the network of providers is different for each plan. There are no claim forms or deductibles for any of the HMOs.
If you choose to join one of the HMOs you must have all care coordinated by your Primary Care Physician. If you do not, you will be responsible for paying the full cost of all health care, although there are certain exceptions for emergencies.
The Rensselaer HMO Plan and MVP are HMOs consisting of networks of providers who work out of their own private offices. Many of these physicians see other patients who are not members of the HMO.
These HMOs may appeal to employees who:
- have established relationships with doctors who participate in one of the networks.
- prefer to have a Primary Care Physician arrange all medical care.
- like the idea of a low preset fee for all services
- dislike filing claim forms.
- prefer a health plan without an annual deductible.
The Rensselaer Health Plan (RHP)
The Rensselaer Health Plan (RHP) is what is sometimes called an "open-ended HMO." It is administered by Capital District Physicians Health Network (CDPHN). In The Rensselaer Health Plan, every time you need health care you may choose to coordinate your care through your PCP for the low preset fee (copayment) or to go to any doctor outside the network and pay a greater share of the cost. If you decide on a doctor or facility outside the network (or see a network provider without referral from your Primary Care Physician), you will still receive benefits from the plan. However, you will pay a larger share of the costs, and you will have to file claim forms.
RHP: Deductibles
If you decide to go out of the network, you will pay a deductible of $300 for individual coverage ($900 for a family) before collecting benefits from the plan. After you have met the deductible, the plan will pay for 70 percent of the cost of most covered expenses up to the reasonable and customary amount (see glossary); you will pay the remaining cost. However, no matter how large your health care costs, you will never need to spend more than $3,000 for individual coverage ($9,000 for a family) in one calendar year as long as care is medically necessary.
RHP: Prescription Drugs
With membership in The Rensselaer Health Plan, employees are able to purchase prescription drugs at reduced prices at 500 affiliated pharmacies. When a prescription is filled by any of the participating pharmacies, a three tiered program applies ($10/$25/$40). When filled by any other pharmacy, the employee pays only 30 percent of the cost after meeting the annual deductible.
RHP: Convenience and Security
You can be sure that The Rensselaer Health Plan will never prevent you from seeking care from any provider of your choice.
This plan may appeal to employees who:
- have established relationships with doctors who participate in the network.
- like the preventive care aspects of an HMO.
- prefer to reserve the right to receive health care from any physician or provider of their choice.
- are willing to pay more to ensure unlimited choice of providers.
- live outside the RHP network service area.
- are planning to take a leave of absence or go on sabbatical (contact Human Resources for details).
RHP: What do I do if I don't live in the area?
If you live outside the area served by the network of doctors and services, you can still join The Rensselaer Health Plan and be eligible for benefits of the Traditional Plan.
You will be free to select any doctor, but because you will not be able to select a network PCP, you will not be eligible for the routine and preventive-care aspects of the plan. You will have to meet a deductible ($100 for an individual; $300 for a family) and pay for 20 percent of most covered expenses after you meet your deductible.
Although you will not benefit fully from the managed-care aspect of the plan, you will be eligible for excellent health-care coverage. Both your deductible and coinsurance are more advantageous than if you lived in the area and chose out-of-network care. This traditional coverage is also administered by CDPHN.
Compare the Benefits
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