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USNH Medical Plan Options. April 20, 2011. Definitions. Copay – an amount paid by the insured person each time a medical service is accessed Plan deductible – amount that must be paid before insurance “kicks in” Premium – annual amount charged for health plan.
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USNH Medical Plan Options April 20, 2011
Definitions Copay – an amount paid by the insured person each time a medical service is accessed Plan deductible – amount that must be paid before insurance “kicks in” Premium – annual amount charged for health plan
What options could accomplish these goals and save $2 million? The SPPC reviewed two basic options for the majority of the cost savings: • Increase annual % of premium paid by employee • 1.5% increase (above current contribution) for all tiers saves $750k per year • Employee cost-individual $126(4.85), two party $253(9.73), family $379(14.58) or: • Implement an annual Plan deductible • $200 individual/$400 family saves $1,372,000
Two Conceptual Plan Design Models Two conceptual models have been developed for review: Both models include: a) a reduction in the incentive to waive coverage ($173,000 in cost avoidance) b) establishment of a Physical, Speech, Occupational therapy copay of either $5 or $10 ($105,000 to $210,000 in cost avoidance) c) establishment of a high tech imaging copay of either $50 or $100 ($105,000 to $210,000 in cost avoidance) d) no copay for designated preventative services, including but not limited to, routine physical and gynecological exams, preventive screenings, routine vaccinations, annual childhood check-ups
Two Models Alternative 1 - “Minimize Cost at Point of Care” (Increased Premium Contribution) Spreads the cost over all participants by increasing employee contributions 1.5% and adds small increases to current copays for frequently used services such as visits to the Primary Care Physician and Specialist. Alternative 2 - “Behavior Change and Consumerism” (Deductible) This option introduces a $200/$400 annual deductible and increases the copay for Specialist office visits. This model increases employee awareness of medical costs and engages employees in managing those costs.
Alternative 1 - Minimize Out of Pocket Costs at the Point of Care * Includes reducing the medial waiver payment from $800 to $550 and employees covered by a USNH medical/dental plan are not eligible for the waived medical/dental coverage payment. ** Physical/Speech/Occupational therapy (also includes cardiac rehab visits). *** High tech imaging includes MRIs, CAT scans and PET scans. All other imaging including X-rays are covered in full.
Alternative 2 – Behavior Change and Consumerism 7 * Includes reducing the medial waiver payment from $800 to $550 and employees covered by a USNH medical/dental plan are not eligible for the waived medical/dental coverage payment. ** Physical/Speech/Occupational therapy (also includes cardiac rehab visits). *** High tech imaging includes MRIs, CAT scans and PET scans. **** Current hospital inpatient and outpatient copays remain. All hospital (inpatient and outpatient), diagnostic imaging, x-ray and lab subject to the deductible and applicable copays. 7
Next steps SPPC meets on May 19th Vote on a recommendation for a new medical plan design USNH Administrative Board meets on May 26th Review SPPC’s recommendation, approve/disapprove proposed medical plan design Plan design changes approved will be implemented on January 1, 2012.
