The new plans are as follows: Commonwealth Indemnity Community Choice (UniCare); Harvard Pilgrim POS; and Navigator by Tufts Health Plan. These three plans are viewed as the new face of managed care and are set to replace traditional HMOs.

In addition, the GIC will continue to offer coverage under four traditional HMOs. Each of the HMOs is currently available through the GIC and are as follows: Health New England, Fallon Direct Care, Fallon Select Care, and Neighborhood Health Plan.

Members, who are insured in one of the four remaining HMOs, one of the Medicare HMOs, the Indemnity Plan, or Optional Medicare Extension (OME) will not be required to switch their coverage. However, anyone insured in the non-Medicare Harvard Pilgrim or Tufts-run HMOs must choose a new insurance provider during the GIC's open enrollment period.

While most retirees and survivors are enrolled in either the Indemnity Plan or one of the Medicare supplement plans and are not impacted by the changes made to the managed care plans, Association officials are nonetheless concerned about what the future may have in store.

A key component of the new Harvard Pilgrim, Tufts, and UniCare plans is a system which tiers hospitals and eventually doctors. The tiering is designed as a ranking system of sorts, which places (beginning July 1) hospitals in three categories based on the efficiency of the services provided. The copayments for each hospital vary by tier. In other words, a hospital in tier one will have lower copayments than a tier two hospital.

A similar system is being developed, whereby doctors will be ranked and placed in one of four tiers. The physician ranking system is scheduled to be online by July 1, 2005. At that point, anyone, enrolled in a health plan using the tiering system, would have to choose which tier they wish to utilize. Their health insurance premiums would then be adjusted based on the choice made. Again, a doctor in tier one would be less expensive than a doctor in tiers two - four.

GIC officials claim that this system will put doctors and hospitals on notice that they are being held responsible for the quality of the services they provide. "This new system is something that we have concerns with and are going to watch very closely. Tiering is not part of the Indemnity or Medicare plans now and that is how we want things to stay," commented Duhamel. "The GIC is trying to fight costs by going after the doctors, but I am afraid that all this type of policy does is put retirees square in the middle."