Your Benefit Board is sprinting toward the deadline for decisions on 2012 health benefits. Projections show renewal of current plan designs would put insurance reserves below recommended levels, so the Board is discussing a range of plan-design options with the goal of cutting costs while providing quality plans.
One option would put more procedures on the Additional-cost Tier in the Providence Choice and Statewide plans. Procedures on this tier typically have alternatives that may provide equal or better outcomes with less cost and risk. Additional copays act as incentives for members to learn about the alternatives and discuss them with their providers, first.
Another option could require state employees to pay a monthly surcharge when they cover a spouse or domestic partner who could get insurance through the spouse’s or domestic partner’s employer. PEBB plans could also charge a monthly amount to members who use tobacco. Surcharges like these usually fall in the range of $25-$50 per month.
A different prescription plan design or adjustments to current plans could act as an incentive for members to switch from brand name drugs to generics.
HEM plans could offer a cost break for members who contract to assess their health risks and take actions to lower them. Providers would have access to member results; employers and plan sponsors wouldn’t. Financial breaks would be big enough to be incentives but not so big they would price other plans out of reach.
Other options include changes to cost share. Examples are higher out-of-pocket maximums and implementation of deductibles.
The Board’s next regularly scheduled meeting is April 19.
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