County Commission approves insurance plan

Even though insurance claims were higher than they’ve ever been in the history of Marion County, the commissioners by a 2-1 vote, agreed to stay with the same plan as this year with one exception at the meeting March 25.

The first motion, presented by Commissioner Randy Dallke was in keeping the plan exactly the same as it was this year, but that failed for lack of a second. After it failed, Commission chairman Kent Becker came back with a motion to keep the same plan, but with the one exception on the drug plan. It passed 2-1 with Commissioner Dianne Novak casting the dissenting vote.

The major difference is that in the current BCBS plan, the drug component is $15, $30 and $45, based on generic, more expensive generic and brand name products respectively. The new plan will be a five-tier plan with prescriptions at $15, $50, $75, $150 and 20 percent up to $250. 

In a five-tier plan, the first tier is low-cost generics, medium-cost generics, higher-cost prescriptions or brand name drugs, higher cost prescriptions than in the third tier to include some specialty drugs and the fifth tier is the highest prescription drugs, most being specialty drugs.

Based on Becker’s motion, the commission didn’t make a decision on how much each employee will pay for single or family insurance coverage, but will need to decide by Friday, March 29, at its payday meeting.

County Clerk Tina Spencer did have some potential costing scenarios for the selected plan, which could be $54.44 for a single employee and no cost for dental. The county for a single would pay the remaining $635.09 for health and $44.21 for dental totaling $689.30. 

With more than 105 county employees, previous breakdowns for health and dental were about 85 carrying the single plan and 60 with dental, and 14 in family plans with 45 carrying the dental insurance.

Based on a family cost scenario, the employee and family cost would be $590.51 and dental cost $55.05, leaving the county’s portion $1,477.31 for health and $99.26 for dental totaling $1,576.57.

County Clerk Tina Spencer said the approximate cost for insurance in 2019 would be $817,525, but that will vary based on the number of contracts in each plan, and any new employees added.

Special insurance meeting

During the special insurance meeting last week, Bruce Schultz, BCBS group enrollment representative, told the commissioners that based on claims it was a “tough run” in 2018.

“Claims were higher than they’ve ever been in the history of Marion County,” Schultz said, “and the projected loss ratios for health and dental were significant in this claim year.”

The following information is a breakdown from the past six years of paid claims provided by Schultz to include:

In 2018, paid claims totaled $958,748.

In 2017, paid claims were $871,809.

In 2016, claims totaled $955,700.

In 2015, paid claims exceeded $649,491.

In 2014, paid claims totaled $543,450.

In 2013, paid claims totaled $440,72.

Three months prior to the special meeting, Schultz said that even though higher pharmacy rates are not unique to Marion County, the county’s prescription cost is moving at an overwhelming pace.

During the first nine months of this year (2018), the plan paid $205,416. In 2017, the plan paid $165,500 and in 2016, the plan paid $138,500, he said.

“The reason for health insurance claims to be high could be a combination of many factors from medical to prescriptions to dental,” he said.

Dental plan unlimited

“The county’s dental contract doesn’t have an annual limit, which is very nice for the employees,” Schultz said.

Thus far in 2018, the dental plan paid $65,216 with costs in 2017 at $60,420 and in 2016, $44,622.

Other than the drug costs, Schultz said, “what we as a company do, and those trends drive what all of us pay.”

One of the reasons, Schultz said he wanted to visit with the commission is so they don’t get blindsided.

“We want to be proactive,” he said. “One of the concerns now is that as we get closer to the end of the year, claims have a tendency to go up (based on deductibles being met).”

Offering a glimmer of hope, Schultz said that when there’s a tough claim year, it could be followed by a phenomenal year. “Maybe we are due,” he said.

During the same period from 2013 through 2018, Schultz made the projected loss ratios available to the commissioners. Included in the ratio:

For 2018, health was up 98.66 percent; dental, 122.72 percent; no drugs included.

For 2017, health was up 153.58 percent, dental, 106.74 percent, drugs, 107.90 percent.

For 2016, health was at 116.97 percent, dental, 87.14 percent, drugs, 108.41 percent.

For 2015, health was at 89.20 percent, dental, 84.56 percent, drugs, 116.22 percent.

For 2014, heath was at 56.08 percent, dental, 72.54 percent, drugs, 108.40 percent.

For 2013, health was at 61.79 percent, dental, 62.56 percent, drugs, 112.84 percent.

In 2019,  the project loss ratio for health is at 108.38 percent; dental, 104.88 percent and drugs were not included.

High deductible health plans

Of the three insurance representatives discussing options for county employees in 2019, all saw benefits to a High Deductible Health Plan or HDHP, but none saw value in a self-funded proposal at this time.

Schultz said BCBS was looking at a 9 percent increase based on Marion County’s claims, but he was able to secure a 2.5 percent reduction or net of 6.2 percent.

“A lot of companies were not interested in bidding (based on Marion County’s history),” he said.

Regarding a HDHP, Schultz said he likes these, but he knows people are hesitant to move into it.

The concept of spending less on health care by having a higher deductible allows people to put money into a Health Savings Account or HSA.

“(The HSA) is an incredible tool in the long-range,” he said, “but I would encourage it. Putting money into an HSA could build for the long term. Some have $80,000 to $100,000 for medical expenses if the need arises.”

Even with a high deductible of $3,000, the risk is still limited because if someone needs by-pass surgery at a cost of $275,000, their liability is still only $3,000, Schultz said.

Brian Rose with Aetna also talked about HDHP and its benefits to the insured.

Another option Rose said is a plus for his company is the opportunity to know ahead of time what an insured is paying for.

“If I need an MRI, upper body and no contrast,” he said, “I can get on my computer and look at different places to see what the best deal is. The program will actually show what the deductible and co-insurance is, for those who want to look at it.”

Tatro said she is also on a HDHP and has two chronic conditions, but doesn’t come close to meeting the deductibles.

“But because I have been building up my HSA, I have budgeted it and the money rolls over every year, I still have that money to use,” she said.

Spencer noted that one of Aetna’s options is similar to the BCBS plan in place with the county today.

After more than two hours of discussing the pros and cons of higher deductibles, consumer-driven plans, flexible spending accounts and HSAs, the decision was to stay primarily with BCBS based on the decision of two of the three commissioners.