A summary of the current offerings for out-of-network coverage as reported to the Department is listed below.
Insurer
Aetna CDPHP
Current Out-ofNetwork Reimbursement Both FAIR Health and Medicare Fee Schedule. FAIR Health.
Healthnow
Medicare Fee Schedule. Both FAIR Health and Medicare Fee Schedule. FAIR Health, Medicare Fee Schedule, and proprietary fee schedule set by GHI. FAIR Health and proprietary fee schedule set by Healthnow.
HIP
FAIR Health.
Independent Health
FAIR Health.
Empire
Excellus
GHI
MVP
Oxford
UnitedHealthcare
Comments Medicare Fee Schedule used for small group coverage. Large groups have choice of Medicare Fee Schedule or FAIR Health. Moving to Medicare Fee Schedule as small groups renew on and after 1/1/12 and as large groups renew on and after 4/1/12.
Medicare Fee Schedule used for small group coverage. Large groups have choice of Medicare Fee Schedule, FAIR Health, or in certain cases a proprietary fee schedule set by GHI.
Medicare Fee Schedule. Both FAIR Health and Medicare Fee Schedule. Both FAIR Health and Medicare Fee Schedule.
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