Budget negotiations: Insurance renewed at 0 cost increase for county

By Kristen Tribe | Published Saturday, August 4, 2018

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Wise County managed to renew its health insurance with no increase in cost for the base plan but a 7.8 percent increase on the buy-up plans, which will be absorbed by those policyholders.

The county buys insurance through the Texas Association of Counties pool, and the provider is BlueCross BlueShield. The county pays for every employee to have the base plan, and it pays 50 percent on dependent coverage, totaling an estimated $3.5 million annually.

An employee who chooses a buy-up plan, which has richer benefits, pays the difference between the base plan and buy-up.

“(The insurance company) is willing to do a 0 percent increase on the base plan, but they need to make some more money on the buy-up because that’s where they’re spending the most,” said Wise County Judge J.D. Clark.

Last year 60 people were on the buy-up plan and had $3.1 million in claims for a 328 percent loss, while 267 people on the base plan had only $2.76 million in claims and an 80.3 percent loss ratio.

Wise County had the highest number of catastrophic claimants in the TAC pool with 88, 25 of which were over $50,000. The top 10 claimants made up 61.5 percent of what was spent, according to numbers from broker Stephens, Bastian and Cartwright.

“So you can see it’s not that all our employees are using our insurance like crazy,” Clark said.

Other Wise County group statistics compared to the TAC pool include:

  • Hypertension is 29 percent greater than the average.
  • Obesity is at 9 percent versus the norm of 4.4 percent.
  • There were 600 out patient surgeries versus the norm of 104.
  • Out of 106 claimants last year, 28 could have been handled in a lower level of care.

Due to the higher than normal utilization trends and in an effort to keep the county’s expense from going up, some copays and deductibles were increased on both plans. On the base plan, the deductible went from $2,500 to $3,000. Out-of-pocket maximum went from $7,150 to $7,350. Specialist copays went from $50 to $60, and inpatient and outpatient facility copays are $250. Pharmacy copays are increasing by $10 each to $25, $55 and $75.

On the buy-up plan, the out-of-pocket maximum increased from $4,000 to $4,200.

At the recommendation of the insurance company, Clark also suggested commissioners consider implementing a spousal affidavit to confirm employees’ spouses do not have coverage elsewhere before they join the county plan and a tobacco affidavit to curb tobacco use and insurance claims tied to the habit.

No decision was made on the affidavits this week, but they will be discussed at the Aug. 13 meeting. Read more about the affidavits in an upcoming issue of the Messenger.

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