Spouses with access to other medical insurance plans are getting bumped from Ottawa County’s employee insurance plan.
The move, coupled with increased premiums for single and family policies that also take effect Jan. 1, 2014, is an effort to curtail the insurance plan’s downward spiral. If nothing had been done, consultant projections place the county‘s self-insurance healthcare plan in the red about $1 million dollars by early 2014.
Part of the soaring costs had to do with significant claims filed since the beginning of the year.
“We’ve had an unusually high claim year,” Sass said. “Out of the last seven, I’d say it was one of the highest.”
County leaders hope the insurance plan changes and a drop in claims in the upcoming year will steady the health insurance plan’s financial course.
The spousal restriction is expected to save about $300,000, said Jim Sass, president of the board of county commissioners. Spouses of county employees who have healthcare coverage available to them through their employer must enroll in a single policy, he explained.
Dependents will be allowed to remain on the county plan.
The county portion of a single policy is $516 per month. The employee portion for the same policy will be $62 per month.
The county cost to cover a family will be $1,369 per month. The employee’s share in the family policy will now be $150 monthly.
“We’re trying to bring it up to a standard for the counties our size,” Sass said of the employee share.
The decision to hike the employee premium amount is, in part, based on a State Employee Relations Board report that outlines average employee plan costs at municipalities across the state, the commissioner said.
“We are working up to that,” he said.
Commissioners also have considered restrictions on those covered by the plan who smoke.
“We have talked about it, but we don’t have any plans to do anything yet,” Sass said.
A prescription management plan is included in the new plan along with a home delivery option.
Deductibles will be $750 single and $1,500 family both in-network and out of network. The out-of-pocket maximum for in network will be $1,500/$3,000, including deductible. Out-of-network maximum will be $3,000/$6,000, including the deductible.
The co-pay for an emergency room visit will be $150. That amount is waived if the person is admitted.
Part-time employees will have to work 1,560 hours per year to be eligible for coverage. Previously, part-time staffers who worked for the county for five continuous years were enrolled on a pro-rated basis, according to the motion passed unanimously by the three-person board.
Commissioners also opted to begin enrollment in a Consult-A-Doctor program with new benefits.
The program costs the county $2.75 per month per employee enrolled on the health insurance plan as well as $3.95 for each employee kit.
The program allows participants to call in to a doctor on call regarding health issues.
For example, if a person has a sinus headache or feels flu symptoms coming on, the person can call and have a prescription for a Z-Pak called into their local pharmacy and it doesn’t cost them anything, Sass explained.
Employees will have to use their discretion regarding health matters in these cases, he added.
“We are in no way encouraging employees to avoid the doctor when serious matters come about,” Sass assured.