Health Insurance 2012

Health Insurance 2012

by Bobbi Yeo, Canon for Administration and Finance

 You have probably begun putting your 2012 budgets together and may be wondering about increases to health and dental insurance premiums. We were just informed by the Episcopal Church Medical Trust on August 2 that we can expect an overall increase of about 7% to premium rates in the Diocese of Northern California. It might make you feel better to know that our Internet research indicates the projected increase in premiums nationwide will be approximately 8.5% for 2012.

We were also informed that there will be several plan design changes. The Cigna HMO will be eliminated and replaced by the Cigna OAPIN (Open Access Plus – In Network). Diocesan Administrators from across the country overwhelmingly approved this change due to access issues with the HMO. The OAPIN eliminates the primary care gatekeeper requirement for referrals to specialists and the inpatient copay is $100 less than the HMO. It is a larger network with an over 95% overlap with the HMO.

In order to control premium increases, administrators also agreed to increases in some copays and in the annual out-of-pocket maximums. Services were reviewed individually, and thoughtful consideration was given to each one.

I have had some involvement in these types of negotiations over many years and this is how it goes. Even with the Denominational Health Plan there is simply no way around it. Health care is expensive and the best we can do is find ways to control the annual increase. Rate increases for Northern California are slightly higher than those for other members of the Episcopal Church Medical Trust.

One factor affecting our rates is that our average age is four years higher than other dioceses. Another factor is that in 2010 the trust paid 112% more on our medical care than we paid in insurance premiums. If we all did this the trust would go broke very quickly. Most dioceses spend 80% of premiums paid, which allows for the cost of administrative overhead.

The Employment Practices and Benefits Committee will have a lot to think about given this news. There are a number of possibilities to consider in bringing down health care costs in our diocese:

-High Deductible Health Plans/Health Savings Accounts (HDHP/HSA) are known for lower annual rate increases. Given our current plan participation it doesn’t make sense to add this as an option. However, it may make sense to move to it as the only option as many other dioceses have done. Resistance to this idea is high, but it is one of our options.

-We will continue to find ways to encourage the use of the Employee Assistance Program (EAP) for mental health benefits. The EAP has been available to all employees and their family members and households since we began with the Episcopal Church Medical Trust. Utilization of the EAP can significantly reduce utilization of regular plan benefits as the providers are the same. Also, the EAP offers ten free visits for the employee and any family member for each issue presented.  If the employee or family member wants to continue treatment they can access the regular plan benefits while using the same provider. Click here for more information on the EAP.

-We will continue to find ways to encourage the use of our many preventative health benefits. Our coverage offers free annual physicals, three free dental cleanings per year, and a free annual eye exam through EyeMed. All of this preventative care helps with early detection of more serious issues. This is one of the reasons why Thea Mangels puts so much energy into promoting the cause of Wellness in our Diocese.

We have heard mostly positive feedback about the Episcopal Church Medical Trust, so we don’t understand the decline in enrollment, except that we have also had a significant decline in full-time employment over the past three years. We will research the correlation between these two facts, but we want to know if there is more to it.  We want to hear what you and your employees have to say about health care coverage in our diocese.  Please comment here or send your feedback directly to me at bobbi@norcalepiscopal.org or to Thea at thea@norcalepiscopal.org

 

1 comment (Add your own)

1. Marcia Engblom+ wrote:
One reason people might not appreciate or like Health Savings Plans is that, as I understand them the individual set aside a portion of their income, pre-tax for heath purposes. That is great is a person has income providing enough cash flow for that purpose. I would bet most of the clergy in Northern California don't have that kind of option. I know I don't.

Thu, October 20, 2011 @ 2:45 PM

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