2013 Employee Benefits Guidebook - Administration Home

MEDICAL PLANS
EBMS MEDICAL BENEFITS
EL PASO COUNTY MEDICAL EPO PLAN:
In 2013 you will have one medical plan option – the El Paso County Medical EPO Plan
administered by Employee Benefit Management Services (EBMS).* With this plan you have
access to the County Employee Health Centers and a customized El Paso County Cofinity
Network.
The custom Cofinity Network uses only Penrose Hospital and Penrose affiliated providers and
facilities to serve the Colorado Springs service area. Any non-emergent, medical services must
be provided through a provider or facility contracted with Cofinity for this custom network. If
you have procedures performed at a Memorial facility (now University of Colorado Health) or
other non-contracted facilities (other than true emergencies and/or certain medical procedures
not available through Penrose that have been pre-approved by the CareLink Care Management
team), it will not be covered. You may find out if a provider is in the custom El Paso County
Cofinity Network by calling Cofinity Provider Network Customer Service by logging on to their
website at www.cofinity.net/EPCDirectory/Index.aspx.
This plan has a $2,000 individual deductible ($6,000 Family Maximum) that applies to some
services such as inpatient hospital services, surgery, and ambulance.
See the EBMS Summary of Benefits on the following pages for additional information on
deductibles, co-pays and co-insurance.
*Please note that our medical plan administrator has the same acronym but is NOT the same as
the El Paso County Employment, Benefits & Medical Services (EBMS) Department.
GENERAL INFORMATION: Once you make your elections you may not change or cancel
your benefits or change enrolled dependents until the next open enrollment period, unless you
have a Qualifying Life Event.
GRANDFATHERED HEALTH PLAN:
El Paso County believes this Medical Health Plan is a “grandfathered health plan” under the
Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the
Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that
was already in effect when that law was enacted. Being a grandfathered health plan means that
your Plan may not include certain consumer protections of the Affordable Care Act that apply to
other plans, for example, the requirement for the provision of preventive health services without
any cost sharing. However, grandfathered health plans must comply with certain other consumer
protections in the Affordable Care Act, for example, the elimination of lifetime limits on
benefits.
2013 Employee Benefit Guidebook
Updated August 2013