New insurance plan for county employees

Board of Commissioners, Community, News
insurance

FANNIN COUNTY, Ga – Commissioners decided to move Fannin County to a fully-insured health insurance plan and off the partially self-funded policy. In previous years, the county chose to go to the self-funded insurance route.

United Healthcare will now serve as the county insurance provider with English and Alford acting as the insurance agent. English and Alford represented the county under a partially self-insured plan as well. The agency collected quotes from Benefit Support and Humana for self-insured and United Healthcare as well as Aetna for fully insured. The county also reached out to another company ACCG for a fully insured quote from Anthem Blue Cross Blue Shield.

Quotes were as follows:

  • Benefit Support – $2,779,637.28
  • Anthem Blue Cross Blue Shield – $2,743,497
  • United Healthcare – Option 1: $2,425,182, Option 2: $2,254,468
  • Aetna – $3,097,168.32
  • Humana – $2,558,360

With a fully insured plan, the insurance company assumes the entirety of the risk. In other words, Fannin County would only pay the contracted amount, no financial surprises. However, premiums might be higher than a self-insured option and the county could face a greater tax burden.

Under United Healthcare, county employees can choose from two plan options. Fannin could budget out an established amount each month.

“The plan, the providers, and the doctors seem to very closely matched what we have now, meaning that there would not be a lot of disruptions with employees having to go to different doctors,” explained Chairman Stan Helton.

Helton also discussed passing the reduced costs with Option Two on to the employees since the county receives a seven-percent reduction in overall costs. The weekly employee deduction would be seven percent less and could save a family $273 a year.

“That’s a pretty good saving for the county and another savings for the employees if they chose to take that,” stated Helton. “I’m pretty solid with going with United Healthcare and allowing the employees to choose which option they would want to go.”

Co-pays differ on the two options. On the first plan, there are no co-pays on primary care for children, but the second option has a lower co-pays overall.

Option Two offers a $0 client cost-share on primary care, mental health and substance abuse, and Tier 1 prescription drugs. Urgent Care copay is $50. Specialists’ co-pays don’t begin until the initial deductible is reached. However, on Option One, the specialist copay is $35.

For those who opt for Option Two, United Healthcare provides Fitbits to everyone. If employees achieve a predetermined number of steps, then United Healthcare will make a deposit to their HRA accounts. The maximum amount the insurance plan will deposit is $1,500 for the member and another $1,500 for the spouse. These deposits can go toward the specialists’ deductible.

United Healthcare would pay for the Fitbits; it’s not an additional cost for the county. Fannin can also choose to add benefits-to-cost-ratio (BCR) target on the plan, and if it exceeds the objective, the county can share in the surplus.

“If the county runs well, there will be surplus and that surplus will be shared back with the county 50/50,” explained United Healthcare representative Mark Bailey.

However, if Fannin had a poor year in claims, the debt wouldn’t carry over to the next year. The BCR could provide the county with a rate cap for the next plan year if they reach a certain number of participants. However, the members must meet the steps goals for the county to receive a cap.

Post One Glenn Patterson stated “I feel like fully insured would fit us better at this time. United Healthcare is very cost-effective, got a real good price. Of course, price is not everything. I think it’s a very reputable company. Covers claims well usually.”

He added that he liked their customer service, the plan options, and wellness incentives.

Post Two Earl Johnson didn’t disprove of the plan, but the agents, English and Alford, were a “train wreck.” The representatives couldn’t answer his questions or provide satisfactory information about the plans. Johnson wanted whoever represented employees during the claims process to provide seamless service.

“I left the workshop more confused when they all talked about Fitbits and what one does or doesn’t do. The part I really didn’t like is the agent said he been in this for 40 years, and he said he’d never had anyone complain. That’s kind of hard for me to imagine,” explained Johnson. “I would hope whatever is settled on this time; we stay with it a long time.”

He believed the county should spend the extra money and go with Anthem Blue Cross Blue Shield/ACCG. The company previously handled Fannin’s insurance. Johnson came off of county insurance last year because he felt the service didn’t meet standards.

“As far as my opinion, I know what we would be getting if we had them, and it was quite a pleasant experience in my first three years dealing with them. They are more expensive though and that’s something I’m always against – trying to get more bang for the buck. I know since we have switched from them, every year seemed not to live up to my expectations,” Johnson clarified.

With Anthem/ACCG, the process was more streamlined and easier to discuss claims or benefits. All claims and county benefits discussions would go through the same people. However, Fannin initially switched from the company ecause of the price tag.

Johnson agreed that a fully-funded insurance plan was the best option, and the county’s no longer “rolling the dice when someone gets critically sick or ill.”

Partially Self-Insured Option

Benefit Support only offered a partially self-insured plan. Under this proposal, Fannin assumed most of the risk and are expected to pay for employee medical claims out of general funds. However, once the claims reach a set amount, reinsurance will begin to cover claim expenses.

Benefit Support also lasered some employees. As a result, these employees would pay higher deductible because they are considered higher risk than others. The amount lasered was $1,255,000.

The supposed pro of a partially self-insured plan was to save money, but Fannin hasn’t saved any under the aforementioned benefits structure. Costs continued to rise because no one can predict insurance claims from year to year.

Last year, Fannin implemented a spousal carveout and smoking cessation program to try and bring costs down as well as keep premiums at the same rate. It’s unclear at this time if the county will continue these measures. All insurance agents favored keeping the spousal carveout.

Benefit Support Representative Lena Andrews affirmed the spousal carveout and smoking cessation program brought costs down. She didn’t have an exact number though because no one can predict claims. The total claims payment in 2019 was $1,678,000, and reinsurance paid out $572,000 as of April 2020. The maximum liability would be $3.8 million.

Andrews added that self-insurance was working for the county and that costs are $600,000 lower this year than last year. The perceived savings didn’t convince the commissioners who all agreed on a fully-funded plan.

Patterson moved to go with the fully funded United Healthcare plan and Helton seconded. They voted in favor of the motion and Johnson voted against.

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