OPEA

State employee insurance rates were set on Friday, August 20, and revised on September 1, at the Employees Benefit Council and the State and Education Employees Group Insurance Board. The rates are for the calendar year beginning January 2011.  The rates will be good and bad news for state employees.

OPEA has been concerned that the loss of one HMO would cause the benefit allowance to plummet, costing employees hundreds of dollars. Since the benefit allowance is calculated on the average of the high option plans, the loss of one of the plans could cause the allowance to fall, leaving state employees with fewer benefit dollars to supplement stagnant incomes.

While the benefit allowance will still cover the price of HealthChoice, employees will need to use more of their benefit allowance to cover the cost of insurance. According to OPEA’s calculations, employees choosing HealthChoice will lose from -$11.96 for employee only health insurance to -$91.45 for employees carrying a spouse and two children in benefit allowance dollars in the new plan year.

To view the insurance rates and the benefit allowance at the Employee Benefits Council website click here.

The spouse rate continues to climb dramatically because of adverse selection. Employees with spouses who cannot work insure them with the state, causing usage and costs to increase. The HealthChoice 2011 rate increase for employees was only 1.5 percent or $6.68. However, the spouse rate increased by nine percent or $56.86.

While the benefit allowance will decrease, the news is not all bad. State plans have made adjustments in plan design that should greatly benefit employees and their families. Since the co-pay for HealthChoice was increased to $50 in January, OPEA has met several times with OSEEGIB leadership to discuss concerns with the sudden change. At their rate setting meeting, the OSEEGIB Board voted to move the co-pay for primary care visits down to $30, with specialist remaining at $50. The lower co-pay applies to general practice, internal medicine, obstetrics/gynecology, pediatricians, physicians assistants and nurse practitioners.

In addition, well-baby and well-child visits are free. Adult participants will have one preventive office visit with lipid and comprehensive metabolic panel at no cost for lab or co-pay for the office visit.

The HMOs will also be making plan changes to help state employees and their families and comply with the recent federal healthcare legislation. No-charge services will include:

• Blood pressure, diabetes, and cholesterol tests
• Colonoscopies
• Routine vaccines for diseases such as measles, polio, or meningitis
• Flu and pneumonia shots
• Counseling, screening and vaccines for healthy pregnancies
• Regular well-baby and well-child visits, from birth to age 21

“The changes in preventive care and lowering the co-pays should be beneficial for state employee families,” said OPEA Policy and Research Director Trish Frazier. “With problems detected and addressed earlier, families will stay healthier.”

“Unfortunately, the loss of one of the HMOs in the benefit allowance calculation, will cost some state employee benefit dollars at a very difficult time,” Frazier concluded. “OPEA is especially concerned rural areas are still not provided choices that employees who reside in urban areas are offered. The association will continue to work on obtaining the best value for benefit dollars and allowing all to have choice.”

OSEEGIB and EBC Consider Elimination of Fee

Less than two weeks after the initial rates had been set, the Oklahoma State and Education Group Insurance Board and the Employees Benefits Council met on Wednesday, September 1, to discuss what to do with an additional $6 million. The funds were added to the initial 2011 premiums to comply with HB 2437, which required insurance plans to pay a provider fee of one percent of claims. The State Supreme Court ruled the fee unconstitutional.

OPEA appeared before OSEEGIB on behalf of state employees and encouraged the board to consider further reducing HealthChoice co-pays of not only office visits but also on pharmaceuticals.

“State employees are grateful that in your last meeting you lowered the co-payments, we also know that today you are faced with lowering premiums or co-payments even further,” said OPEA Membership Representative Jimmy Durant.

“We would encourage you to assist state employees in these hard times and not only reduce office co-pays but also those on prescription drugs,” Durant added. “While it is a tough choice of what to do with the money, we appreciate the help you will provide state employees today, to provide relief in these hard economic times.”

Some of the board listened and member Michael Clingman moved to reduce the co-pays to $25 for an office visit and $40 for a specialist.

“These are real people and they have been forced to take furloughs and RIFs, and it is not fair that state employees and teachers have the highest co-pays of any one in the state,” said Clingman making his motion.

Member Frank Stone seconded the motion. Unfortunately, the motion failed.

The board then voted to use the additional $6 million to lower the premiums they had established in their previous meeting.