ACTIN Choice offers Members who select it a wide range of providers, but as a result, the cost to employees and to their employers is considerably greater. Members are not required to select a PCP but may see any provider in network. ACTIN Choice offers care by 2 groups of providers: ACTIN’s network of providers and First Health’s network of providers. ACTIN’s network of providers is substantially the same as offered in the ACTIN Care plan, though Members in ACTIN Choice need not select a specific PCP but may see any doctor in network. First Health’s network of providers is wide, including a high percentage of hospitals and physicians in the Chicago area. The cost to the Plan when a member receives care from a provider in First Health’s network of providers is about double the cost of care when a Member receives care from a provider in ACTIN’s network of providers. The out-of-pocket cost to Members of receiving care by these two tiers of providers (ACTIN’s network of providers and First Health’s network of providers) reflects the difference in the cost of care as follows:
ACTIN Network of Providers
- Deductible: Individual $750/family $1500 (does not apply to Emergency Department visits and Emergency Hospitalizations)
- Co-insurance 10% (does not apply to PCP or Specialist visit)
- Co-Pay: PCP $30/visit; Specialist $60/visit
- Out-of-pocket Maximum: Individual $2500/ family $5000
First Health Network of Providers
- Deductible: Individual $4500/family $9000 (does not apply to Emergency Department visits and Emergency Hospitalizations)
- Co-Insurance: 30%, all services
- Out-of-Pocket Maximum: Individual $5350/Family $10,700
The deductible bucket in ACTIN Choice can be filled by both networks of providers. For instance, if a Member sees providers in ACTIN’s network and pays $750 in deductibles, the Member owes no more deductible for the calendar year for further care from a provider in ACTIN’s network. If the Member then receives care from a First Health provider, $750 of the deductible bucket for First Health providers is filled but the Member will still pay the balance of the deductible owed for care by First Health providers. In this example, after a Member pays $750 for care by ACTIN providers the Member’s remaining deductible for care by First Health providers is $5350-$750=$4600.
In another example, if a Member receives $500 of care from First Health Providers and then receives care from an ACTIN provider, the Member’s deductible for care by ACTIN Providers is $750-$500=$250. If the Member had received $750 of care from First Health Providers, then the Member would owe no deductible for additional care received from ACTIN providers and owe $4600 of deductible for any care received by First Health providers.