Floyd County government employees will see their health insurance premiums rise 10 percent across the board next year — although officials hope many will see some out-of-pocket savings from several benefit changes.
"It's been a high-claim year for Floyd County ... This is an adjustment to get back in line," said consultant Chuck Shaw with Garner & Glover.
While Blue Cross/Blue Shield administers the plan, the county's insurance is self-funded.
Assistant County Manager Gary Burkhalter said the Administration and Finance Committee spent several months looking at ways to address a projected shortfall. A 15-percent increase "gets us back into a positive position," he said, but they recommended just a 10-percent hike.
"Both employer and employee will get that," Burkhalter said.
The county pays about 75 percent of the cost and employee premiums cover about 25 percent. Burkhalter said Blue Cross/Blue Shield estimated they'll also have to pull about $234,000 from the insurance fund balance to cover expenses next year.
Commission Chair Rhonda Wallace said most businesses pay less than 75 percent toward their employees' policies. The committee also rejected a recommendation from Shaw to raise the co-pays to $40 and $60 from $30 and $40.
"We're keeping benefits a lot of other companies are cutting out," Wallace said. "We haven't increased premiums in several years, but when you don't do it gradually you have a higher increase all at once."
The enrollment effective date is being bumped back a month, to Nov. 1, to allow time for the changes approved by the County Commission this week.
Shaw said a major change to the family plan sets a maximum deductible for the entire family instead of having separate deductibles for the employee, spouse and children. Separate deductibles for in-network and out-of-network care also is expected to produce savings, he said.
The new plan also covers chiropractic care after a $40 specialty co-pay instead of as part of the deductible. Shaw said the change was adopted due to the number of inquiries from employees.
Other services will likely go up, as they're moved from the co-pay category to the side where the deductible must be met before coverage kicks in. Employees also must pay a share of the cost for the services, including allergy injections, outpatient surgery, in-hospital physician services and the rarely used benefits of skilled nursing, home health care, hospice and ambulance.
Emergency room visits also will require a $200 co-pay and 20 percent of the cost instead of a flat co-pay.
"We're trying to get employees to understand the ER is not your doctor ... It's convenient for some, but it's the most expensive medical care," Shaw said.
The county policies offer discounts for nonsmokers and those who participate in a wellness program. Burkhalter said the free employee health clinic — for primary and urgent care, disease management and generic prescriptions — is also seeing a lot of activity. It's been open nearly a year and he expects to have enough data soon to run a cost-benefit analysis.