Benefits Syracuse University
Prospective Employeesspacer Facultyspacer Staffspacer Retirees
Benefits
Syracuse University selects POMCO as Medical Plan Administrator
Effective 1/1/09

Frequently Asked Questions

Why did SU change vendors from Excellus to POMCO?

SU recognizes that it is good business practice to periodically review all aspects of its medical plan. As a form of due diligence, we evaluate potential plan design changes every year. In addition, earlier this year HR conducted a medical plan survey in order to better understand what our employees see as their highest priorities in a health plan. Partly as a result of this feedback, we undertook two significant projects: evaluating alternative plan designs and seeking competitive bids for the administration of our plans. The competitive bid process resulted in the selection of POMCO as the administrator for our medical plans effective January 1, 2009.

How was POMCO selected?

SU hired Hewitt Associates, a nationally recognized benefits consulting firm, to assist in the competitive bid process. In the past, Hewitt has successfully navigated benefits-related improvements for the University including the retiree health plan changes in 2006, and the move from prescription drug vendor Caremark to Medco in 2007.

As part of the process, Hewitt developed a comprehensive Request For Proposal (RFP), which was distributed to five area medical plan administrators including both Excellus and POMCO. The RFP covered a broad range of topics including:

Responses to the RFP were analyzed by Hewitt on a side-by-side basis and presented to the University's Administrative Benefits Committee (ABC) who then conducted interviews with the top four candidates.

The Chancellor's Health Care Advisory Committee was consulted on proposed changes to the administration of the plan. In addition, extensive reference checks were conducted on each of the finalists, including calls to local self-insured employers and other higher education institutions. On our behalf, Hewitt also interviewed leaders in the provider community.

POMCO's strong financial offering, dedication to customer service, reputation in the Syracuse community and flexibility in accommodating the unique needs of the University and its members made that vendor a good fit for the needs of SU faculty and staff.

How is POMCO different from Excellus?

POMCO is a third party administrator, which means that their services directly fulfill the needs of SU's self-insured plan. The University has been self-insured since 1997. Self-insured plans are an alternative and less costly financial strategy for providing medical benefits in which the employer, not an insurance company, assumes direct responsibility for funding the health care costs of its covered employees and their dependents. Excellus is an insurance company that also serves as a Professional Benefits Administrator (PBA), POMCO is solely a PBA, with a singular focus on the services that SU needs as a self-insured institution. POMCO manages the benefits plan design, pays eligible claims and maintains, tracks, and generates health records and reports.

What will happen to BluePoint and OrangePoint options?

The BluePoint and OrangePoint plan designs will remain as options for 2009 but with POMCO as the medical administrator rather than Excellus. Medco will continue to administer the prescription drug benefits. As is the case every year, the plan design and contributions will be evaluated to determine if modifications are needed.

There will also be a new plan option effective January 1, 2009. This deductible/co-insurance-based plan will be administered by POMCO, and is expected to have lower premiums than either of the University's current plans. Details and plan design information will be available on the HR web site in early fall.

How do employee contribution rates look for 2009?

Employee contribution rates are still in the approval process and have not yet been finalized. In the past, faculty and staff contributions increased 10% in 2006 and 2007, and 8% in 2008. Early projections indicate less than an 8% increase in 2009 rates. Rates will be posted on the HR web site when they are available in early fall.

How do I know if my health care provider(s) accept POMCO?

You can search POMCO's provider directory online (choose POMCO/Multiplan Allied).

If you are referred to a physician during the remainder of the 2008 calendar year whose services you anticipate will continue in 2009, confirm he/she will accept your current Excellus insurance, and confirm he/she will accept POMCO beginning in 2009.

What can I do if my provider does not accept POMCO?

If there is a physician or other health care provider whom you think POMCO should add to its network complete the online form and POMCO will contact them and invite them to become a preferred provider.

Will I have network doctors available if I or any of my dependents reside outside of the Syracuse area?

Yes. POMCO, like Excellus BlueCross BlueShield, has an excellent expanded network outside of the Syracuse, NY area. POMCO is able to offer this network by partnering with MultiPlan, a company that specializes in building and managing national preferred provider networks. MultiPlan has one of the oldest and largest independent preferred provider organization networks in the country. By offering the MultiPlan network along with their own, POMCO is able to provide seamless national network coverage to its members.

Faculty and staff can determine if their specific providers are in POMCO's network, including the expanded MultiPlan network, by searching POMCO's online directory (choose POMCO/MultiPlan Allied). Faculty and staff can also call the HR Service Center at 443-4042 and a service center analyst will search the online directory upon request.

Did the University consider that the change to POMCO may be disruptive because employees may have to switch to another doctor?

Yes. Access to doctors is a very important factor for our faculty, staff, and their families in choosing and effectively using a health plan. As part of the selection process for the new plan administrator, we asked our outside consultants to advise us and they performed both a geo-access analysis and a network disruption analysis.

The geo-access analysis groups all of our current members (including spouses and children) by three-digit zip code, and determines if there are providers within a specified geographical area. For example, 99.9% of members had at least 2 POMCO network primary care physicians within a 5, 8, or 20 mile radius (for members with zip codes classified as urban, suburban, or rural, respectively). Other categories of providers analyzed included hospitals, pediatricians, OB/GYN providers, and specialists. In each case, the results were comparable to Excellus' network access.

The geo-access analysis is helpful but does not address whether a particular provider is included in the new network. For this, we relied on a network disruption analysis. In this evaluation, a file of all medical providers utilized by SU members and the dollar amounts of the claims incurred by SU members were matched against POMCO's network. The analysis concluded that 97% of actual claims incurred in 2007 would have been in the POMCO network and 91% of providers utilized in 2007 would have been in the POMCO network. Both network analyses included claims and providers from outside the Syracuse area and are roughly comparable to that for Excellus' network.

Of course, there will be some disruption. If there is a physician or other health care provider whom you think POMCO should add to their network complete the online form and POMCO will contact them and invite them to become a preferred provider.

Will POMCO honor prior authorizations from Excellus?

Yes. We have arranged a file transfer with this information so that there is seamless coverage for those employees that had a prior treatment authorization with a provider that accepts POMCO insurance.

What about prescription coverage?

The University's prescription drug coverage, administered through Medco, will not be affected by the change from Excellus to POMCO. Enrollment in the prescription drug plan continues to be contingent on enrollment in one of the medical plan options.

When will I receive my new medical insurance card?

Benefits-eligible employees and graduate assistants that are enrolled in a medical plan will receive their POMCO medical insurance cards in the mail no later than January 1, 2009.

Helpful Links

Questions? Contact the HR Service Center at 443-4042.