State employee insurance rates were set on Friday, August 20 at the Employees Benefit Council and the State and Education Employees Group Insurance Board. The day brought good and bad news for employees.
OPEA had been concerned that the loss of an 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 used to supplement stagnant incomes.
According to OPEA’s preliminary calculations, the benefit allowance difference for 2011 ranges from a gain of $107 for employees carrying two children to a loss of $28.91 for employees only insuring themselves and a spouse.
Following is the benefit allowance for 2011.
Employee $608.53
Employee plus child $826.21
Employee plus children $954.19
Employee plus spouse $1,247.24
Employee plus spouse and child $1,465.92
Employee plus spouse and children $1,592.90
To view 2011 rates click here.
While the benefit allowance will still cover the price of HealthChoice, employees with HealthChoice will need to use more of their benefit allowance to cover the cost of insurance. According to OPEA’s calculations the range is $2 more for employees covering two children to $103 more for those carrying spouses only.
Aetna will be leaving the state plan in 2011. Also, reports indicate CommunityCare will be changing its provider network in the Oklahoma City area.
Spouse rates continue to climb because of adverse selection. Employees with spouses who cannot work insure them with the state, causing usage and cost to increase. For example, the HealthChoice 2011 rate increase for employees was only 2.5 percent or $11. However, the spouse rate increased by 10 percent or $64.
While the cost will increase for some, 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.”
Medicare retiree rates are anticipated to increase slightly and will be set in the middle of September.
Posted on
Mon, August 23, 2010
by Trish Frazier