Insurance benefits of county workers under consideration
Jul 23, 2013 | 1550 views | 0 0 comments | 12 12 recommendations | email to a friend | print
Upshur County Commissioners Court met in special session Monday afternoon with three men who handle the health insurance coverage for county governmental workers to discuss how the county might be able to lower insurance costs.

The court had recently approved seeking proposals on health insurance for the first time since 2004. They must be filed by July 30 for the court to consider.

Attending Monday’s meeting were Jeff A. Mund of The Mund Group, Ltd. in New Braunfels; and two representatives of Group and Pension Administrators, Inc., in Dallas, Matt McCuen and Mgr. of Account Services Benjamin Nix.

Mund’s firm hires the Dallas firm to act as “third-party administrators” whose system reviews medical bills, and decides how much of them to pay.

Under its self-funded plan, the county covers 375 persons—175 employees, along with workers’ spouses and children, according to Hahn. He warned the court that the “worst thing to do” is ask workers to both pay more money toward their insurance costs and lessen benefits.

“You got a great plan. It’s how we tweak” it that matters, Mund told the court. Despite medical costs rising, the county’s costs have dropped, he said, indicating that was due to his work.

However, he summarized seven potential “options” for changing the current plan, while pointing out that he wasn’t suggesting the court implement any of them.

They included establishing a deductible for certain cases, allowing employees to “voluntarily” buy dental coverage (rather than the county continuing to automatically cover it), requiring employees to make higher co-pays for doctor visits, adding a small amount onto workers’ costs for covering spouses and families, raising premiums for workers who won’t take “wellness” examinations, and establishing separate plans for smokers and nonsmokers.

Another option is offering workers a choice between two plans.

As the 1-hour and 53-minute meeting was about to conclude, County Judge Dean Fowler said the court had “to study” the issue. Afterward, he told The Mirror changes in the insurance plan are possible.

Mund told the court that “your homework is to digest what we’ve shared with you today” and make a decision.

He said the county can spend up to $75,000 per year in medical costs per person on its current plan, and that a higher deductible would lower premiums. He said each person insured now costs the county $441 monthly.

The county is about $160,000 better off in its program now than last year, he said, prompting Pct. 3 Comm. Frank Berka to respond that the county had been $283,000 over its insurance budget last year (before he took office).

McCuen told the county its insurance cost was 31.6 percent below the national norm, but its plan had been driven yearly “by a handful of people with pretty serious conditions.”

While the county’s method of paying is drawing a discount of about 81 percent off medical bills, “one issue the county has is that a lot of your employees have chronic conditions” such as high blood pressure, diabetes, mental health and back problems, McCuen said.

Some 30 percent of the county’s costs involved only four employees, and 41.1 percent of total expenses went for the 10 most-costly workers, he added.

He added that the current plan design is “25 percent richer” than the typical U.S. employer’s, which means it’s better for county employees who “pay less for health care.” Nevertheless, the county has never come near the maximum $2,370,000 it could be out in one year on medical costs, McCuen said.

He also suggested county employees are underutilizing preventive care, which could reduce long-term costs, and said the county possibly could encourage its use.

Nix said one option was raising the current deductibles. The $500 for an individual and $1,500 for a family in network could be hiked to $750 and $2,250 respectively, and the out-of-network deductibles of $1,000 for an individual, $3,000 for a family, could be raised to $1,500 and $4,500 respectively, he said.

That would have saved the county $45,000 in the last 12 months, Nix said.

Judge Fowler said only 30 persons had met the $500 deductible this past year, so changing the amount “only affects a few people.”

When Pct. 2 Comm. Cole Hefner asked if the vast majority of workers were only going to the doctor, dentist and pharmacy, Nix said yes.

Fowler and Nix said that potentially increasing premiums is what most worekrs were concerned about. Discussion brought out that employees’ next two concerns are co-pays and the prescription drug benefit.

Nix said raising workers’ out-of-pocket limit (not including deductibles) from $2,000 per individual and $6,000 per family in-network, to $4,000/$12,000—and from the current $4,000/$12,000 out- of-network to $5,000/$15,000 would also create savings.

Nix said only 12 of the 30 workers Fowler cited had met the current out-of-pocket maximum.

McCuen said that if someone received a $900,000 kidney transplant, it was reasonable to ask they pay $4,000 of it.

Nix discussed raising the co-pay for doctor visits from the current $25 for any physician to $35 for general practitioners and $50 for specialists.

“A change in the co-pay will affect the most people in the plan,” Fowler said.

Berka and Hefner raised the issue of dental costs, which Mund said were $90,000 last year. Mund said those benefits could be partly reduced, or that a cap could be placed on them.

After the meeting, Pct. 1 Comm. Paula Gentry, a former deputy in the Gladewater branch of the County Tax Assessor-Collector’s office, said, “I cannot see us passing this cost on to people (county employees) that haven’t had a raise in seven years.”

She said she has needed a Magnetic Resonance Imaging (MRI) test on one of her knees for some time, but can’t afford it.

Mrs. Gentry told The Mirror that the court and workers need to “meet in the middle,” and be more conscious of limiting abuse of benefits, such as visiting the emergency room when a less-expensive visit to a doctor’s office would suffice.

(During the meeting, Mund said emergency room visits were “not a problem for” the county.)

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