Finding a provider

A provider network is a list of providers and hospitals/facilities who contract to provide healthcare services to enrolled employees and their covered family members at a discounted cost. That discounted cost is passed to members (you and your covered dependents), who benefit from lower out-of-pocket costs (copays, deductibles and coinsurance) – plus a lower annual out-of-pocket maximum.

On the other hand, you will pay more to use providers and facilities that are not on the list. Those providers are out-of-network and when you use them, you will pay higher out-of-pocket costs.

Bottom line: It pays to use providers in our medical plan’s preferred networks whenever possible.

Two parts of a network: Providers and facilities

Each medical plan network has two elements that charge fees for healthcare – the people who provide the care and the place where care is received.

1. People = provider: The physician, advanced practice provider or other clinician who is providing the service.
2. Place = facility: The location where you are receiving the service. This may be a physician office, urgent care, emergency room, hospital, etc.

It’s important to understand that sometimes a provider may be in-network, but the facility is out-of-network. Or the opposite may be true.

Before you visit a provider, be sure to confirm both they and the location where you are seeing them are included in the health system network or are in-network. If not, it’s OK to proceed with the visit as long as you understand you’ll pay higher out-of-pocket costs for the provider and/or facility fees.

The provider networks in our medical plans

Both medical plans (HSA Advantage Plan and the Signature Plan) offer the same provider networks:

• Health system network – This will always be your lowest cost.
• In-network - This will be higher cost but offers flexibility (HCH Sync, Centrus Health Direct when seeking care in the KC region and the Aetna Signature Administrators nationwide network only when seeking care outside the designated KC region).
• Out-of-network – This will always be the highest cost.

Read Find a Provider to learn how to check which network your current providers are in and how to find new providers in your desired network.

When you choose a provider or facility in the health system network, your annual deductible, coinsurance and copays are lower compared to in-network providers and especially to those who are out-of-network. Your annual out-of-pocket maximum is also much lower.

The health system network includes health system facilities for covered services within The University of Kansas Health System in the Kansas City metro area, as well as Great Bend, the St. Francis campus in Topeka, and LMH Health/Lawrence Memorial Hospital.

Remember that networks are made up of both facilities and providers. As the health system expands, the health system network is growing to provide more access to care, while also becoming more complex. Some providers practicing at health system facilities are not employed by the health system, which means they are not part of the health system network.

Flexibility and choice are important, so our medical plans include an in-network option that gives you flexibility and choice while helping you save money. These are providers and facilities outside of our health system that have agreed to accept an approved amount for their services.

You will pay a lower annual deductible, coinsurance and copays compared to using out-of-network care. Your out-of-pocket maximum is also significantly lower compared to using out-of-network care.

Both the HSA Advantage and Signature plans offer access to a variety of in-network providers and facilities for covered services through our contracted networks.

• Local Kansas City region: Through the HCH Sync, Centrus Health Direct network, both medical plans give you access to nearly 10,000 providers in Kansas and Missouri. This area is designated in blue on the map. Saint Luke’s and HCA are not included.
  

• • When you are seeking care in this designated region, you must use a health system provider or a provider within this network to avoid out-of-network charges.
  • The counties in the designated blue area are:

    Kansas:

    • Atchison
    • Douglas
    • Jefferson
    • Johnson
    • Leavenworth
    • Linn
    • Miami
    • Wyandotte

    Missouri:

    • Bates
    • Caldwell
    • Cass
    • Clay
    • Clinton
    • Jackson
    • Lafayette
    • Platte
    • Ray

• Greater Kansas and nationwide: Both medical plans offer in-network coverage via the Aetna Signature Administrators nationwide network. This network should be used ONLY when seeking care outside the local Kansas City region designated in blue on the map. Some examples of who should use this network include:
  • Those living and/or working in the Great Bend and Topeka areas and all of greater Kansas.
  • Remote workers outside the Kansas City region.
  • College students living outside the Kansas City region.
  • Those traveling outside the Kansas City region.

For care in the designated local Kansas City network

When you need care in the local Kansas City region shown in blue on the map, use this search tool to find a health system provider or a provider in-network with HCH Sync, Centrus Health Direct.

• Providers in the heath system network are listed first and say "Health System Network" in blue type under their name.
• In-network providers are listed next and say "HCH Sync, Centrus Health Direct" in purple type under their name.

Search providers in local Kansas City region

For care outside the designated local Kansas City network

When you need care in greater Kansas or beyond, use this search tool to find in-network providers from the Aetna Signature Administrators nationwide network. This tool should be used ONLY when seeking care outside the designated local Kansas City network or you may pay out-of-network rates.

To get started, enter the area (city, county, state or Zip code) where you need care. Then enter the type of care you need.

Aetna Signature Administrators nationwide network

Search providers outside Kansas City region (greater Kansas and nationwide)

Simply put, receiving care from out-of-network providers is your most expensive option. You will pay more for getting care in multiple ways:

• The amount you’ll be charged is likely higher than the discounted rates offered in the health system network and by in-network providers. This is because out-of-network providers and facilities (such as HCA and Saint Luke’s) have not agreed to accept an approved amount for services.
• Your share of the cost is more with higher coinsurance and/or copay amounts.
• You’ll need to meet a higher – and separate – deductible for out-of-network care.
  • One exception: Coinsurance for emergency room visits is applied to the in-network deductible. This is to ensure cost isn’t a barrier when care is needed most.
• You’ll have a higher – and separate – out-of-pocket maximum. It is calculated separately from the expenses that apply toward the out-of-pocket maximum for health system and in-network care.

Given the big impact on your budget, it’s important to make sure both your provider and facility is in-network with the health system network or, depending on where you are seeking care, in the HCH Sync, Centrus Health Direct network for the local Kansas City region or the Aetna Signature Administrators network for care in greater Kansas and nationwide.