The Legislature approved a new government health insurance contract with higher deductibles and higher premiums late Monday, the last day to avoid even higher rates, after senators expressed frustration with having to vote under the gun with no options.
The plan lessens premium increases in exchange for new patient fees.
Government Employees Services Commission/Health Insurance Board Chair Clemmie Moses and the board’s consultant, Steve Burrows of Buck Consulting, detailed the proposed changes for the senators.
Renewing the existing medical plan with no changes in benefits or charges would cost 22.4 percent – or $29.3 million – more for Fiscal Year 2014 than the $140.9 million the same coverage cost for FY13.
The board put together a plan that would have held cost increases to 15.2 percent, by adding some co-payments and cost sharing, but Gov. John deJongh Jr. rejected the plan, saying the budget could only absorb a 10 percent premium increase. So the board revised their work and voted to recommend a plan that holds cost increases to 10.5 percent.
In-network deductibles for a single person would go from the current $200 to $500 and out-of-network from $600 to $1,000. For families, the in-network deductible would go from $400 to $1,000 and out-of-network from $1,200 to $2,000. Emergency room treatment would have a $50 deductible, while there currently is no deductible. There would also be a $100 hospital co-pay.
The reduced benefits will cause the plan to lose its grandfathered status under Health Care Reform, according to Burrows and Moses.
The Patient Protection and Affordable Care Act requires non-grandfathered health plans to cover preventive care services with no cost-sharing. Since Aug. 2, 2012, non-grandfathered plans must also provide additional preventive services for women with no cost sharing.
GESC recommends covering retirees eligible for Medicare through United HealthCare’s "AARP Medicare Supplement Plan N," which provides "comprehensive benefits but with some out-of-pocket expenses," he said.
Members will be allowed to buy up to have less out-of-pocket expenses by paying about $50 per month. Prescription drug benefits will be provided by United HealthCare under a fully pooled Employer Group Waiver Plan. "This plan will duplicate the current prescription benefits while lowering premiums,” according to Burrows.
Dental insurance premiums will increase by nearly 5 percent from the current $4.4 million price tag.
Voting to approve the contract were Sens. Judi Buckley, Diane Capehart, Donald Cole, Kenneth Gittens, Clifford Graham, Myron Jackson, Shawn-Michael Malone, Terrence "Positive" Nelson, Clarence Payne, Sammuel Sanes and Janette Millin-Young. Voting no were Sens. Alicia "Chucky" Hansen and Tregenza Roach. Sen. Craig Barshinger abstained. Sen. Nereida "Nellie" Rivera-O’Reilly was absent.
