Health Benefits Report
By Kevin Lyons
After five years of discussion, planning and collaborating, Integrity Health opened the doors to what we hope is the first of many First Responder Partnership Health Centers (FRPHCs). It is no longer an idea on paper, but rather bricks and mortar and people … our people.
The FRPHC is designed completely around our needs as first responders. That means same-day appointments for our members and their dependents, age 2 and up. That means not just medical appointments, but mental health access from an in-network provider with same-day or next-day appointments with a clinician who is trained to understand us and the stresses and hazards of our jobs. That means downstream care coordination to assist those of us who have manifestations affecting our health past the realm of primary care.
The center provides medical care for primary care and minor emergencies, testing for everything from the flu to COVID to STDs, and the ability to X-ray and suture on-site. There is also PT, OT, chiropractic, acupuncture and a pharmacy on-site. They will accommodate those last-minute physicals for work and even for your kids’ sports, understanding our crazy schedules. Everything is under one roof and all at the lowest possible cost to you, seven days per week.
As the center nears the first month of service, there are a few issues that we want to make sure are clear to our members.
The first is that the copay waiver, approved by the State Health Benefits Plan, is for those first responders and dependents who are enrolled in the State Health Benefits Plan. If you are a first responder who is on another plan, you are still encouraged to use the FRPHC, but in accordance with DOBI regulations, the copays and cost shares cannot be waived. You will still receive the same treatment and experience that all other first responders are entitled to.
The next important item is that unfortunately, those who are enrolled in a Medicare Advantage plan, or who just use Medicare, are not eligible. This is not our choice; it is due solely to the fact that Medicare does not allow facilities to select which patients can use a facility that accepts Medicare. One of our core principles is that only first responders and their families are accepted at the facility.
Having explained this, it is important to know that retirees under age 65 who are not on Medicare or Medicaid are qualified and encouraged to be seen at the facility.
Due to the change of leadership at the Department of the Treasury, we have run up against an unforeseen issue that has delayed the copay waivers at the on-site pharmacy. Over the last nine months, the health benefits section has changed assistant directors, and the Treasury has changed two assistant treasurers. They have also lost other key people in the policy and planning section, all of whom were understanding of our needs.
This is in no way meant to disparage the people who have moved into these spots, as I have found them to be competent, hardworking people who are doing their best despite being short-staffed and not having the personnel they need to run a $6-billion-a-year plan, but rather to point out that they have looked at the original resolution in what I consider is a hypercritical manner and do not believe that the prescription waiver was part of the original pilot. It’s important to know that these interpretations were made behind closed doors without even discussing it with any of the original drafters of the resolution.
Over the past week, we have had what we believe are some good-faith discussions with Treasury that we hope will bear fruit. We hope that they will understand the philosophy of our program and understand that not only our members, but also the residents and taxpayers of New Jersey, will bear the fruit of this project.
In closing, I hope you know that NJSPBA President Pat Colligan and Executive Vice President Marc Kovar endorsed this project because we want our members and their families, whether it is a cop who saw something horrific or a teenager who needs to know from a clinician that everything is OK, to have access to mental health-care. But just as important is that you take care of your bodies. Forty percent of people who died from COVID were diabetic, think about that. Let’s make our bodies, minds and souls healthier.
Please call 609-249-7073 for an appointment or go to www.frphc.com.