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Participant Benefit: Site of Care Incentives

Carpenters Benefit Plans | Apr 13, 2023

for Active participants & Pre-Medicare retirees effective May 1, 2023

To incentivize the use of lower cost services, Carpenters Health Plan has removed or reduced the cost for lab and radiology services, respectively, when specific facility-types are used.

Costs for our participants and health plan are significantly less when you use independent labs, such as LabCorp and Quest facilities. In fact, there is significant access to both LabCorp and Quest facilities in our most populated areas.
To incentivize independent lab use, the copay and deductible for labs performed at LabCorp and Quest facilities have been removed. Participants and families are encouraged to use LabCorp and Quest labs whenever possible to eliminate personal out-of-pocket cost.

Please note: There is no change to out-of-pocket costs for facility labs, such as hospital labs.

LabCorp / Quest labYou pay $0 copay / 0% coinsurance
Facility / Hospital-owned labYou pay deductible & 20%

Radiology services at hospital system-owned facilities cost more than twice the amount of radiology services at free-standing facilities. Free-standing facilities include locations such as Metro Imaging or Diagnostic Imaging Centers in St. Louis and Kansas City, respectively.

To incentivize radiology services at free-standing facilities, the Plan is implementing a standard $25 copay with no deductible for services performed at free-standing facilities. This includes Carpenters Wellness Center referrals to Metro Imaging.

Please note: There is no change to out-of-pocket costs for radiology services performed within hospital-owned radiology centers.

Free-standing facility You pay $25 copay / 0% coinsurance
Hospital system-owned facilityYou pay deductible & 20%*
**Individual deductible is $300. Assuming deductible has been previously met, on average,
20% coinsurance due for a hospital system-owned facility would be approximately $96.

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