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Summer 2005, Vol. 1, No. 3 | Back to Index
Test your HR Knowledge
How Well Do You Know Your Health Plan?
The Scenario:
Karen and her husband Jim left behind their home in Mashpee for a fun weekend of skiing in Sunday River, Maine. Jim was eager to put his ski lesson or two from the previous winter to good use; Karen was a downhill powerhouse during her college years at the University of Vermont. During their first morning at the resort, Jim and Karen headed up on the lift to the Jordan Bowl, where Jim insisted he show off his new-found skills to Karen on the !Carumba! (double black diamond). Jumping off the lift, Jim exuberantly passed Karen at a high rate of speed, turning to smirk triumphantly at her while zooming by. Karen called out to warn him about the upcoming trees around the bend, but alas - !Carumba! – Jim flew, limbs akimbo, straight into the dense pines.
Shortly after impact, Jim was evacuated off the mountain and brought by ambulance to Androscoggin Valley Hospital’s Emergency Room with serious head and spinal injuries. At Androscoggin, it was quickly determined that a surgical evaluation was necessary, and Jim was airlifted to Massachusetts General Hospital. After a consultation in the ER he was immediately transferred to the Surgical Unit; following the successful procedure, he was transferred again to ICU for recovery. After two weeks, he was deemed sufficiently improved and was discharged, with orders to continue short-term rehabilitation therapy on an outpatient basis. During his follow-up visit with his Primary Care Physician, Jim promised to stick to what he knows best – PlayStation, NESN, and watching his wife ski from the bunny slopes - for sports relief in the future.
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The Questions:
1. Karen and Jim are insured through the MBL’s Blue Cross Blue Shield HMO Blue New England Plan. Jim was seen in two different emergency rooms by two different groups of physicians.
a. How many referrals did Jim need to get in advance from his Primary Care Physician before he could be seen in the emergency rooms?
b What are Jim’s co-payments for Androscoggin Valley Hospital and Massachusetts General Hospital?
c. What is the maximum number of rehabilitation therapy visits per calendar year that Jim’s health plan will allow?
2. Did Jim get what
he deserved?
HINT: Find out more about the MBL Benefits Program through the HR homepage.
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The Reward:
Send your responses to ”Test Your HR Knowledge” to Peg MacSwain at pmacswain@mbl.edu by August 1st. All correct responses will be entered into a drawing for a $25 Gift Certificate to The Landfall in Woods Hole. The Prize Winner will be announced by “laball” on Tuesday, August 2nd. Good luck, and thanks for playing!!
The New Collecting Net is an employee newsletter published by the Communications Office. Comments and suggestions are welcome. Call (508) 289-7423 or e-mail us at
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