Description of Open/Closed Panel System
Medical Providers The Fund offers two distinct benefit programs – a self-insured version of the Blue Cross/Blue Shield Blue Card™ PPO program, as well as a self-insured version of Aetna’s HMO program. The Blue Card™ PPO program is a preferred provider program with both in-network and out-of-network benefits. To become an in-network provider under Blue Cross/blue Shield Blue Card™ PPO program, contact the Provider Relations Department at Horizon Blue Cross and Blue shield of New Jersey. The Aetna HMO program follows the IPA HMO model. In-network benefits, with referrals through a primary care physician, are the only benefits offered. There are no out-of-network benefits. To become a network provider under this program, contact the Provider Relations Department at Aetna Healthcare in Blue Bell, PA. Prescription Drug Benefit Regardless of the medical benefit program selected by our participant, all participants enjoy coverage under the Fund’s Prescription Drug program. This program is a administered through Express Scripts. Questions concerning participation in Express Scripts network should be directed to Express Scripts at 1-800-467-2006. Dental and Vision Care Programs Regardless of the medical benefit program selected by our participant, all participants enjoy coverage under the Fund’s Dental and Vision Care programs. These programs are administered under both an open and closed panel system. Preferred providers under the closed panel system enjoy increased patient volume due to financial incentives to the patient and expedited claims payment to the provider.