Healthcare GIC Keeps Insurance Rates In Check Main Menu
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MAY 2001 -
State Increase Well Below National Average - For the second straight year, members insured under the state Group
Insurance Commission’s Indemnity or OME plans will see a very small
increase in their monthly premium. In contrast, most members, insured
under one of the various HMOs, will see a double-digit increase in
their monthly premium for the second straight year.
Over the past several years the eleven member commission, through its Executive Director Dolores Mitchell, have worked hard to keep the Indemnity costs in check. The largest factor contributing to this success was the implementation of the market based reimbursement system in 1999. What this means to retirees is that instead of facing daunting double- digit inflation, the average premium increase for the Indemnity Plan (including OME) is 5%. Members, insured under an HMO, will face an average increase of 10.77%, more than double that of the Indemnity Plan. “Our preference would be to see a rate reduction, rather than an increase. However, in the current health care environment that is not realistic,” said Association Legislative Liaison Shawn Duhamel. “What is encouraging is that the GIC has been able to keep the rates well below the national average, which is still in double- digit territory. “It also must be pointed out that retirees have done their part to keep the costs down. Our members are living with increased managed care, higher copayments, and in some cases fighting with their doctors over unpaid bills all due to cost-control measures. Also, we should not forget that members were forced to endure a very rocky transition from Merck Medco to ExpressScripts.” Members should be aware that the new premiums take effect as of July 1, 2001. Therefore, the insurance withholding in the June pension check will be changed accordingly. New HMO Added As a result of recent restructuring, consolidations and altered business plans, the number of health maintenance organizations offered by the GIC has shrunk. In order to broaden the availability of the plans, the GIC has added Aetna/U.S. Healthcare to its offerings. Aetna, which is headquartered in Blue Bell, PA, covers nineteen million people nationwide. However, until now its presence in New England has been somewhat limited. As it enters the GIC, it has comprised a statewide network and has a contract with all but one eastern Massachusetts hospital. Its overall rates are comparable to those of the other six HMOs, with the individual rates roughly 4% lower than the others. In a policy change, the GIC has not required Aetna to establish a Medicare Plan as a condition of their contract. Past policy has been that each HMO doing business with the state would be required to offer a Medicare plan to eligible retirees. “Aetna is a good addition to the GIC. However, we have always made it clear that, in our opinion, the HMOs work best for active employees. I know many members are in HMOs and are happy with the plan, but they just do not meet the needs of most members,” explains Duhamel. “Members are better off in the Optional Medicare Extension, which is part of the Indemnity Plan. We hope that more will be done to promote the OME, thereby strengthening the plan.” |
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