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Wednesday, February 1, 2023
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Medical Deductible, Premiums Going Up for Workers

Sept. 28, 2004 — The estimated 30,000 V.I. residents who rely on the government for medical and dental coverage will probably see an increase in their medical deductible — how much they pay before the insurance payments kick in — while their medical premiums also increase. On the other hand, dental premiums might go down.
The present plans expire Oct. 1. Health Insurance Board of Trustees members testified before the Senate Committee of the Whole Tuesday about the proposed new plans.
Paulette Rabsatt Simmonds, chairperson of the Health Insurance Board, urged the senators to support the proposed renewal agreements with medical carrier CIGNA and dental carrier MetLife.
Currently, 16,245 employees and retirees plus their dependents are covered under the government's medical and dental insurance policies. This totals to about 30,000 individuals.
Simmonds said this year the Health Insurance Board utilized the Department of Property and Procurement to send requests for proposals for consulting services instead of seeking proposals on its own as the Insurance Board did last year. Mellon Consulting was hired in June, leaving the board with three months to work on the renewal contracts.
On July 29, MetLife presented a proposed 5 percent reduction in dental coverage for the plan year beginning Oct. 1, while maintaining the existing design and benefits, Simmonds said.
"Our consultants held the position that the recommended reduction in premiums seemed very conservative," Simmonds said, adding that they continued negotiating.
The board's negotiating efforts resulted in a 17.41 percent decrease in premiums for the upcoming year for a total of $3.3 million. The premium with the 5 percent decrease would have amounted to $3.8 million.
However, on the medical side, the government will observe a 6.55 percent increase in premium with CIGNA, amounting to $77,639,518.
Simmonds said this is down from an originally proposed 12.86 percent increase in premiums that would have amounted to $82.2 million. Simmonds told the senators the board was able to buy down the rate increase with funds set aside in the premium stabilization reserve.
Government employees will see two changes in their coverage beginning Oct. 1: a change in their deductibles and a change in their out-of-pocket maximum. Deductibles represent the amount of the medical expenses that the individual is responsible for each year before reimbursements are received from the insurance carrier. The out-of-pocket maximum refers to the amount the individual pays each year before the insurance covers medical expenses at 100 percent.
The deductibles have now doubled for medical expenses within the network of doctors. Single individuals will now pay $100, as opposed to $50, and a family will now pay $300, as opposed to $150. Out-of-pocket maximums have jumped from $1,500 to $2,000 for a single individual and from $3,000 to $4,000 for a family.
"Even with the recommended increase, the deductibles still remain considerably below industry norms and norms for state and municipalities in particular," Simmonds said.
Sen. Emmett Hansen II told Simmonds they needed to focus on education programs geared at lowering risk factors, which would lower the premium rates. But Simmonds said that would be something the Department of Health should handle.
Several senators told Simmonds she should have tried to get the contract to them sooner.
Simmonds told the senators that she negotiated through bad weather to try to make the renewal of the insurance policies a possibility.
"It was not an easy task," Simmonds said, adding they are endeavoring to do better.
Sen. Celestino White told Simmonds she should be careful in taking advice from the legislators, who are also two days away from the budget deadline and have not yet finalized a budget.
"It doesn't make sense; it's hypocrisy," White said to Simmonds. "Continue to be diplomatic and wise."
Sen. Ronald Russell excused himself from the hearing after giving condolences to the family of the 4-year-old boy slain in a drive-by shooting, saying he was going to "reflect on what the territory was coming to."
The Senate will vote on the health insurance contract this week.
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