Not quite sure where to post this message but in any event, for about the 10th year in a row, we've received a notice from our Human Resources Dept. that our county employee health insurance premiums are being raised. This time, the notice we received indicated that the premiums are being raised 9.4% which is obviously much greater than the rate of inflation. I'm assuming that most Texas counties, like ours, are participating in the CountyChoice program offered through TAC and administered by Blue Cross. Our new rates are $540.38/monthly for insurance for the employee only and $692.38/monthly for family coverage. Our county is paying for coverage for the employee, but the employee has to pay for coverage for the family. I'm curious as to how we compare with other counties, particularly those that are going the self-insured route or are participating in a plan outside of the TAC pool. This expense is gobbling up a huge percentage of our county budget and the premiums for employee's families is becoming almost unaffordable for those at the lower end of the pay scale. Your thoughts and ideas?
That is basically how we operate here too. Although, we only pay approx. $100 for family coverage with the employee premuims being fully paid....that is how the Comm. Ct. justifies keeping the salaries well below the City and other govermental units.
While that might seem high, it is relatively cheap. Health insurance costs have been going higher and higher--when both the employer and employee portion are added together, the total cost for full family coverage can easily range as high as 1,300 per month under some coverage plans that I have seen offerred to counties several years ago. That cost comes to a just about $9.00 per hour assuming 160 hours worked in a month, and with the cheaper plans, the total cost for both the employee and employer portions added up to $750 per month---In other words, even with the cheapest plans, the total cost for health insurance is approaching the amount of the salaries paid to some of employees!!!!I do NOT want to think about what those costs might total for next year
The employee's premium of $540.38 is paid by the county. If you want to insure your spouse and children, you have to pony up $692.38 a month out of your own pocket. That's a total of $1232.76 in combined premiums. If there are any counties out there that are getting family coverage for $100/month, I'd like to know how they are doing it so I can share it with my human resources dept.
I don't know what the county is paying, but, dependant coverage is aroung $85 per month and family is around $100. Once again that is why salaries tend to be lower than other counties or municipalities....it all goes to offset the health insurance. If you like, I can find out what the true cost is to the county.
I would love to know. I just continue to be amazed at how health care costs keep going up so much faster than the rate of inflation. I understand there is the whole big problem of indigent health care but didn't we vote in favor of a Tort Reform law a couple of years ago that was advertised as an effort to cause health care costs to go DOWN? If I did the math right, under our county insurance policy it costs $14,793.12 a year to insure one family. That's before the insured pays a single penny in co-pays or deductibles when health care is actually accessed. That is money which is being sucked directly out of the community which could otherwise be used to benefit the local economy. I continue to wonder about the feasibility of the county going totally self-insured or whether there are other viable options available such as health savings accounts which could reign in some of these skyrocketing costs.
Many counties subsidize the family side of the coverage. Our county is no different in that regard. We are self insured and our costs have tended to rise at a similar rate. Although no one likes to hear it our health care in this country is getting slightly worse every year while our costs increase. Why? Not because of tort reformn, or the lack of it. Our administrative costs (INSURANCE COMPANIES) are some of the highest in the world. On the other hand those countries with government health care have increasing longevity (probably the most consistent indicator of the health of your citizens) and flat costs.
Our citizens think Medicare when they hear government health care but that system is messed up because no one wants to fix it and because the private insurance world has better lobbyists. It is of course not in the private insurance world's best interests to fix a competitor, now or in the future.
Upon checking, our insurance for county employees cost the county $435. To insure the entire family, the premuim is $1238 of which the employee only pays around $100....the county picks up the rest. My Treasurer tells me her research indicates we are one of the few counties that provide that benefit to such a degree. Ray is in a much better position to discuss self-insured than I, but having been the legal rep. for a small (10,000) city that was self-funded, I did not see a lot of benefit and it seemed to be a much greater hassle. The bidding process alone was enough to make your head spin.....PPO v. non-PPO, prescription card or not, deductable or co-pay, etc. It was difficult to compare bids every year and make sure the stoploss policy overlapped enough to cover those excessive claims that might occur around the end of each coverage term. Before I became invloved with the city, a claim was made that did not hit the stop loss coverage(due to a mistake or bad info from the 3rd party administrator when the stoploss policy was purchased) and the hickie on that one claim was $44,000 to the city for that one employee. Our county owned hospital's board elected to try self-funded 2-3 years ago with promises of big savings....they returned to the county insurance plan the next year. I never saw much savings between the two options. The traditional coverage was higher in the beginning but once the claims came through, the self-funded ended up costing about the same and no one was ever happy with the benefits. I don't think there is a good answer to this problem at present.
As pointed out above, the real problem for smallself-insured governmental bodies and businesses, is that the one major medical problem can result in a huge bill for that one year that causes all sorts of misery.
The other really big problem is finding a proper third party administrator that can truly keep costs down. It is something of a secret in the insurance-medical business as to the real price of mercy.
The very largest companies use their market strength to force severe price reductions. For example, in the absence of medical insurance, eye surgery that might cost you anywhere from 10,000 to 15,000 to repair a damaged retina will cost only 1,500 to 2,500 to a very large carrier through their contracts with the hospitals and doctors. In the absence of this market strength, this discount becomes less and less for smaller carriers and self insured parties.
And you are still subsidizing the medical and insurance companies out of your own pocket, even with insurance. For this eye surgery, you will receive a bill for $10, 000. You will pay 20% under the typical insurance policy, and other amounts under various PPO plans and so forth.
However, 20 % of $10, 000 is $2,000 that comes out of your pocket, but the insurance company check to the doctor is for only $1,5000 despite the bill being 10k. So you on paper you pay 20 percent of the cost, but you paid about 60% of the actual cash transaction. The same is true for those routine doctor visits. Deceptive? Well, standard practice in the industry for many years......
LV, The whole concept of medical service pricing and insurance payments can be a mystery to the average consumer, and frustrating to those who get a glimpse of how things really work. My wife and I confronted this reality a year or so back when we discovered that her insurance did not cover an unanticipated pregnancy. I promise you that's a situation you don't ever want to find yourself in unless you happen to be independently wealthy. The most important thing we learned is how much of the cost of medical care is actually negotiable. And you can't be afraid to ask questions. Hospitals and doctors may have 3 or 4 different prices for the same medical procedure such as labor and delivery--what insurance companies pay, what the government pays, what the consumer who can pay everything "up front" pays, and what the consumer who has to "pay it out over time" pays. It's a business, just like buying and selling cars, and it pays to be informed. And if you're not careful, you'll be blindsided by all sorts of "hidden" costs from folks you never even heard of. We got bills from anesthesiologists, pathologists, labs, and radiologists for sometimes for services that we never requested, never knew of, and in some instances were not even actually performed. Of course, being a lawyer and having been in civil practice before, I was somewhat familiar with the process and was able to negotiate with many of these providers for reduced rates and in some instances the cancellation of bills altogether. But it's a pain!
