Changes to state health benefits first introduced last year affect everyone. This message explains how you can avoid out-of-pocket costs beginning March 1 - particularly when using labs, radiology and other imaging services.
State employees will continue to have 100 percent coverage ($0 copay) for lab tests, X-rays and other high-cost imaging services, like MRIs and CT scans, when they select a preferred "Site of Service" (SOS) provider.
Site of Service (SOS) providers are labs, radiology and imaging centers that have proven to deliver high-quality, low-cost services.
They are generally community-based providers that operate apart from an acute care hospital and offer only outpatient services.
Using a Site of Service (SOS) provider will allow you to pay nothing for lab, radiology and imaging services. However, if you obtain these services at an in-network provider that is NOT a Site of Service (SOS) provider, here is what you could pay out of pocket:
Before going to a preferred Site of Service provider always call ahead to ensure they perform the tests or services you require.
Choose the Find a Doctor link and follow the prompts. Providers listed under Lab/Pathology/Radiology programs will have an "SOS" indicator beneath their names if they are in the Site of Service program.
Under the "Benefits" drop-down menu at the top of the page, click on "Find a Doctor or Facility." Scroll down to the section for "Site of Service Lab and Radiology in Connecticut" Where you can choose from "CT Preferred Radiology Centers" or "CT Preferred Laboratories." Each link will produce a list of all Preferred SOS providers for radiology or laboratories.
No. Services associated with an inpatient hospital stay are always covered at the applicable member copay: - $0.
No; however, the member will be subject to an ER co-pay of $250 (copayments may be waived if admitted).
If your doctor believes it is medically necessary for you to use a non-preferred Site of Service (SOS) lab or radiology provider you must have the doctor fill out a medical necessity waiver form for lab and radiology services in order to have out-of-pocket costs waived.*
No. Costs for lab and radiology services associated with ongoing cancer treatment at a non-preferred provider can be waived by filling out a medical necessity waiver form.*
No. Costs for radiology services at non-preferred providers associated with pregnancy can be waived by filling out a medical necessity waiver form.* Please note that lab services associated with a pregnancy will only be waived if utilizing a non-preferred provider was found to be medically necessary.
No. Radiology services at non-preferred providers for patients under the age of 10 can be waived by filling out a medical necessity waiver form.*
If a preferred Site of Service (SOS) lab or radiology provider is not available within a reasonable distance of your home or that of your dependent the cost share can be waived by filling out a medical necessity waiver form.*
The preferred Site of Service (SOS) program only applies to lab or radiology services obtained in Connecticut and counties bordering Connecticut in New York, Massachusetts and Rhode Island.
*The Lab and Radiology waiver form can be found at http://www.osc.ct.gov/benefits/medical.htm