In a small but significant victory thanks to your objections, the board revised its proposed rates for diagnostic services in Group Health. After objections from Local 443 member Katie Nelson, PEBB members Federation Executive Director Greg Devereux, state Personnel Director Eva Santos and former HCA Administrator Margaret Stanley, the board recessed and consulted with actuaries and came back with the revision.
Under the package adopted by the board, the co-pays for MRIs, CTs and PET scans will now be in line with the co-pays proposed for specialists of $30 in Group Health Classic and $40 in Group Health Value. The original proposal was to impose $100 co-pays for diagnostics in Group Health.
What this means in the complicated world of benefit design is that premiums will go up less than $2 more than the original 2012 package. More on those rates later.
Nelson was the only member of the public to comment on the diagnostics and also the new health savings account options, dubbed “Consumer Directed Health Plans.”
She said diagnostic testing helps in early detection and keeps costs down in the long run.
“When you put a $100 co-pay on a diagnostic test, you will price many state employees out of the market…,” Nelson said.
“I find that unacceptable.”
Devereux questioned why the health care companies needed more money when state employees are battling the recession with pay cuts and other sacrifices.
“I don’t know why providers need to get increases during this time period,” he said.
“It is just surprising to me. And ultimately I think there will be a tremendous backlash.”
The board did OK bringing co-pays for radiation and chemotherapy in Group Health in line with co-pays for other services -- $30 for radiation in Group Health Classic and $40 in the value plan, and $15 for chemo in GHC Classic and $20 in GHC Value. But it took it a lot of objections and explanation by Health Care Authority staff before it came to a vote.
Devereux voted to oppose all of the increases for active state employees.
Now, under your negotiated contracts – and as a sign of the times – premium shares for all plans and all tiers will go up (except for Kaiser Classic, which will drop). They’ll reflect the 25 percent change in premium share from the current 12 percent to 15 percent of total premium costs. Because of weighted averaging and medical inflation, the dollar increase varies from plan to plan and tier to tier. Details on those rates later.
The benefits board also OK’d changes to some other out-of-pocket costs, lowering some while raising others. Most of those changes come in Group Health, so we’ll detail some of those here. Group Health deductibles will not change in 2012.
In Group Health Classic, office visit co-pays for primary care, urgent care and mental health will drop from $25 to $15, while the co-pay for specialists will increase to $30.
The out-of-pocket maximum for families will drop from $6,000 to $4,000. But the co-pays for several other services will increase or start: dialysis (to $30); radiation and chemotherapy as we mentioned earlier ($30/$15); ambulatory surgical center (to $150); and emergency room (to $150).
As we mentioned, the board also approved the legislatively mandated health savings accounts, renamed “Consumer Directed Health Plans.” The idea is you’d get $700 to spend on health costs, and if you don’t get sick, you keep the money. But if you roll the dice and do get sick, you’d face deductibles as high as $2,800 and, in Group Health, total out-of-pocket costs would be capped only when you hit $10,200. This may make sense to some when open enrollment rolls around in November – and we will work to give you information you need to make an informed decision. We don’t want you to roll the dice, lose and get fleeced with extraordinarily high health costs under these new health savings accounts.
Nelson, who is also a member of the Federation Statewide Executive Board called these health savings accounts “health insurance lottery” that “prey on the innocence of our youngest employees.”
As promised, here are the monthly premium rates for all plans and all tiers starting Jan. 1, 2012. They will carry the notation that they will increase to no more than the original amount proposed last week because of the revision downward of diagnostics costs in Group Health:
Group Health (three plans to choose from)
Group Health Classic:
- Employee – from $71/month now to no more than $102/mo. in 2012;
- Employee and spouse/partner – from $152/mo. now to no more than $212/mo. in 2012;
- Employee and children – from $124/mo. now to no more than $177/mo. in 2012;
- Full family – from $205/mo. now to no more than $287/mo. in 2012.
- Employee – from $30/mo. now to no more than $55/mo. in 2012;
- Employee and spouse/partner – from $70/mo. now to no more than $118/mo. in 2012;
- Employee and children – from $53/mo. now to no more than $95/mo. in 2012;
- Full family – from $93/mo. now to no more than $158/mo. in 2012.
- Employee – no more than $29/mo. in 2012;
- Employee and spouse/partner – no more than $66/mo. in 2012;
- Employee and children – no more than $49/mo. in 2012;
- Full family – no more than $86/mo. in 2012.
Kaiser Classic:
- Employee – from $105/mo. now to no more than $92/mo. in 2012;
- Employee and spouse/partner – from $220/mo. now to no more than $192/mo. in 2012;
- Employee and children – from $184/mo. now to no more than $160/mo. in 2012;
- Full family – from $299/mo. now to no more than $260/mo. in 2012.
- Employee – no more than $27/mo. in 2012;
- Employee and spouse/partner – no more than $62/mo. in 2012;
- Employee and children – no more than $46/mo. in 2012;
- Full family – no more than $81/mo. in 2012.
Uniform Medical Plan Classic:
- Employee – from $60/mo. now to no more than $85/mo. in 2012;
- Employee and spouse/partner – from $130/mo. now to no more than $178/mo. in 2012;
- Employee and children – from $105/mo. now to no more than $147/mo. in 2012;
- Full family – from $175/mo. now to no more than $240/mo. in 2012.
- Employee – no more than $30/mo. in 2012;
- Employee and spouse/partner – no more than $68/mo. in 2012;
- Employee and children – no more than $51/mo. in 2012;
- Full family – no more than $89/mo. in 2012.
Posts
No comments:
Post a Comment