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Facing an 18 percent hike in health insurance premiums in the coming year, Trimble County Judge-Executive Randy Stevens asked Fiscal Court on Monday to consider a a new plan that could save money for both the county and its employees.
Bob Davis of Peel and Holland Insurance of Frankfort, outlined the alternative plan offered by Anthem through the Kentucky Association of Counties. The plan, he said, would lower monthly premiums paid by the county for each employee covered, and would greatly reduce out-of-pocket expenses for prescriptions, office visits and medical tests for employees.
On the surface, the plan appears to increase the deductible amount employees would be required to pay. Under the county’s current plan, employees pay a $250 out-of-pocket deductible for individual coverage and $750 for family coverage.
Under the proposed plan, the deductible would be $2,000 for individuals and $4,000 for families.
However, under one formula provided by Davis, the county would set aside funds in an account that would pay $1,500 of the deductible for individuals and $3,000 of the deductible for employee/spouse, employee/child and family coverage. Each employee would receive a debit card with either $1,500 or $3,000, which they would use to pay for office visits, prescriptions, tests and other medical needs. Once the amount on the debit card is gone, employees then would pay for these services out of pocket until the full deductible is met.
Davis assured the court that these debit cards cannot be used for anything other than approved medical payments. “The card is coded, so it knows how the money’s being spent,” he said. “You can’t go to Appleby’s and buy dinner using this card.”
Under the current plan, once
deductibles are met, employees continue to make co-payments of $15 for office visits, $100 for emergency-room visits, $50 for urgent care and 20 percent of the total for all other medical services. These co-payments do not count toward the plan’s deductible. The out-of-pocket maximum is $1,500 for individuals and $3,000 for family plans.
The new plan has no co-payments. Employees would pay full price for office visits and services and retail prices for prescriptions, all of which count against the plan’s deductible, Davis said. Once the deductible is met, the employee pays nothing out of pocket for the rest of the year.
Davis and Stevens stressed that the new plan gives employees access to the same physicians and medical facilities they use now.
As an example of how much an employee could save, Davis told of a man in another county who was paying $125 each month for co-payments for prescriptions under a plan similar to the one the county has now. Under the proposed plan, once the $500 or $1,000 deductible is met, he pays nothing for his prescriptions. By the end of the year, the man saved $1,000 on the cost of prescriptions alone.
Davis said employees also could enroll in a flex-spending account, in which they could save – before taxes – the amount needed to meet their portion of the deductible.
Additionally, the new plan focuses on preventive care, Davis said. Regardless of the deductible, all preventive-care services are covered100 percent by Anthem, including cholesterol, diabetes and cancer screenings, routine blood and urine tests, and immunizations for hepatitis, influenza, tetanus, pneumonia and childhood diseases.
The county is paying $250,718 this year for employee insurance. The total cost for the proposed plan would be $262,864, including $72,000 set aside to fund the county’s portion of the co-payments, for a 4.84 percent increase. Renewing the current plan for 2009-10 would cost $296,610, an 18.3 percent increase.
Should the county decide to pay the entire portion of each employees’ deductible, which Davis provided as a second option, the total would be $270,510 – including $96,000 for the deductible payments – an increase of 7.89 percent.
The only catch, Stevens said, is that the county’s current plan is based on a calendar year, from Jan. 1 to Dec. 31. If approved, the new insurance plan would start on Sept. 1; any payments made toward the deductible for the current plan would be voided, and the process would start over.
Either way, Stevens said the court has to look at alternatives. “We’ve got to do something because of this 18 percent rate hike. Next year, it’s gonna be worse.”
Stevens said for the county to make the switch by Sept. 1, a vote on the plan would be required at the July 20 Fiscal Court meeting. That meeting starts at 5:30 p.m.