Your Health Plan, Reimagined
Understanding the PEHT Open Access Plan – Effective July 1
Starting July 1, the Public Education Health Trust is moving to a new way of paying for the care you receive. The benefits you rely on are not going away — but the way PEHT pays providers is changing, and that change is designed to lower healthcare costs for you and for PEHT over the long term.
This new approach is called Open Access. Here is what it means for you.
What is Open Access?
Open Access is a different way of deciding what a fair price for medical care looks like. Instead of starting with the hospital’s list price — which can be inflated well above what the care actually costs — the plan starts with a published benchmark.
For your PEHT plan, that benchmark is the higher of two reference points:
- The Medicare reimbursement rate for the same service, or
- The actual cost reported by the hospital or facility.
A fair margin is then added on top of that benchmark, and that becomes what the plan pays the provider. The goal is straightforward: pay a reasonable price for quality care, instead of paying inflated list prices.
Why is PEHT making this change?
Healthcare costs have been rising faster than wages for years. Industry analysts project medical costs will continue to climb at roughly 8.5% annually. For a self-funded plan like PEHT, that pressure ends up showing up in deductibles, premiums, and out-of-pocket costs for members.
Self-funded plans that move to Open Access typically lower their total healthcare spend by 15–30%. For PEHT, that means more of the Trust’s dollars stay focused on member care instead of being absorbed by inflated hospital pricing.
How is this different from what I have today?
| Traditional PPO (How it works today) | Open Access (Starting July 1) | |
|---|---|---|
| Starting price | Hospital’s chargemaster (often inflated up to 3,800%) | Medicare-based benchmark or actual reported cost |
| Network | In-network discount required for best benefits | You can see any provider that accepts the plan |
| What the plan pays | Negotiated discount off a high list price | Fair price (benchmark + reasonable margin) |
| Cost-savings impact | Modest, dependent on provider discounts | Self-funded plans typically lower spend 15–30% |
A real-world example
Consider a routine CT scan. The national average chargemaster price is around $3,821, even though the actual cost reported by hospitals can be a fraction of that.
| CT Scan – an example | Traditional PPO | PEHT with Open Access |
|---|---|---|
| Hospital chargemaster price | $3,821 | $3,821 |
| What the plan pays after discount/repricing | $1,582 (50% off chargemaster) | ~$250 (Medicare-based) |
| Savings vs. chargemaster | 59% | 93% |
This is a simplified illustration. Your actual share will depend on your deductible, copay, and out-of-pocket maximum as defined in the plan documents.
Will I still have access to my doctor?
Yes. Under Open Access, you are not restricted to a specific provider network the way you may have been under a traditional PPO. You can continue to see the providers you trust, including the direct-contract providers PEHT has historically partnered with in Alaska.
EBMS — PEHT’s plan administrator — will support you with finding providers, scheduling care, and understanding what the plan will pay.
What if a provider sends me a bill for the difference? (Balance billing)
Most providers accept reference-based pricing payments. Occasionally, a provider may send you a bill for the difference between what they charged and what the plan paid. This is known as a balance bill.
If that happens, do not pay the bill on your own. Contact EBMS member support right away. They have a team of member advocates whose job is to handle these situations on your behalf — negotiating with the provider so you are not stuck in the middle.
If you receive a balance bill: don’t pay it, don’t ignore it. Call the EBMS member support number on the back of your ID card. An advocate will handle it from there.
What do I need to do?
- Watch the mail. Your new ID card and welcome materials will arrive before July 1.
- Save the member support number. Program the number on the back of your card into your phone now, before you need it.
- Use it the way you always have. Visit your doctor, get the care you need. The plan pays the provider.
- Call before paying any unexpected bill. If anything looks wrong, an advocate will help you sort it out.
Frequently asked questions
Is this still the same plan I have today?
PEHT is the same. The benefits you rely on are still there. What is changing is how the plan calculates fair payment to providers — using a Medicare-based benchmark instead of a discount off an inflated list price.
Am I going to pay more out-of-pocket?
Open Access is designed to lower total costs over time, for PEHT and for members. Specific out-of-pocket amounts (deductibles, coinsurance, OOP max) are defined in your plan documents.
Where can I learn more?
Visit pehtak.com or call the PEHT office at (907) 274-7526. For questions about how Open Access works, contact EBMS member support using the number on the back of your member ID card.
Questions?
PEHT Office: (907) 274-7526
Imagine360 – Learn about reference-based pricing: imagine360.com/understanding-rbp
Sources: Imagine360, RAND Corporation (2022), Health Care Cost Institute, Mercer, PwC, Kaiser Family Foundation.