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Insurance information meetings begin with
large crowds, many questions

The Idaho Department of Administration Friday announced that an open enrollment newsletter has been published online that will address many questions raised about the insurance plan transition. Go to the
Department of Administration
site and download the "Open Enrollment Benefit Focus" newsletter.

Idaho employees turned out en masse this week at the first informational meetings about changes in employee health insurance plans. Representatives of the state’s new plan provider (Blue Cross) and the state Department of Administration welcomed capacity crowds in Boise Monday.

Following a 30-minute visual presentation, representatives of both entities turned the meeting over to employees who asked specific questions about coverage and costs.

The overview included a history of the insurance remarketing effort, a commitment by the Idaho Legislature to increase allocations for health insurance, and a schedule of anticipated costs for employees.

Lawmakers approved a 15 percent budget increase to cover anticipated costs of the state’s portion of health insurance and six percent for dental insurance. No increases were budgeted for life/disability insurance and the Employee Assistance Program (mental health).

That commitment brings to $6,493 the amount of state support for full-time employee benefits, or $541 per month. In fiscal year 2005, the state will contribute an additional $820 per full-time employee ($68.33 per month).

All state employees participating in the health insurance program must re-enroll during the open enrollment period (May 1-28) because of the transition from Regence BlueShield to the new provider, Blue Cross. Even those who wish to decline coverage will need to indicate that choice, according to Department of Administration representatives.

Informational meetings, such as those in Boise Monday, are offered to help employees determine which insurance options best meet their needs. They will have two health insurance alternatives from which to choose – a traditional plan similar to the one provided by Regence, and a Preferred Provider Option (PPO) that is tied to a network of preferred health care professionals.

The traditional plan will include an annual deductible of $350 per individual with a maximum annual deductible of $1,050 per family. Co-insurance, after the deductible is met, is 20 percent for employees and 80 percent paid by insurance. The out-of-pocket maximum is $4,300 per person and $8,600 per family. (Note: These rates are the same as the current plan).

The PPO offers lower costs if individuals choose health care from participating providers. It involves a slightly smaller network of providers, preferred pricing and a difference in payment levels for in-network and out-of-network services. It does not require a primary care physician and no referrals are required to see a physician.

Under the PPO, the deductible for in-network care is $250 per person, with a maximum of $750 per family. Co-payments are 15 percent employee, 85 percent from insurance. Out of pocket maximums are $3,250 per individual or a maximum of $6,750 per family, including the deductible. Office visits would cost a $20 co-pay per visit for exams only. Wellness exams also would require a $20 co-pay and then 100 percent of covered services.

Because Delta Dental and Vision Services Plan will continue as providers of dental and vision coverage, respectively, there will be no changes resulting from the transition. Employees may add dependents to both plans during the open enrollment period, if they choose. They also can enroll or re-enroll in the flexible spending account that sets aside pre-tax dollars for medical expenditures.

The Department of Administration and Blue Cross are committed to make the transition as smooth as possible. The informational meetings will continue throughout the state in April to help employees become better informed about their options and enrollment requirements. All employees are strongly encouraged to take advantage of the meetings and will be allowed to attend during regular work hours, if convenient.

In addition, Blue Cross will introduce an online enrollment form that will make the process easier, faster and more accurate. (See accompanying story.) The online process will debut in May during the open enrollment period.

Traditional Plan

Deductible $350 individual/$1,050 family
Co-Insurance 80%-20% after deductible
Out of Pocket Max. $4,300/$8,600 annually
Wellness Benefit $250 per person annual benefit for listed procedures. No deductible
Well Baby Nursery Subject to deductible and co-insurance
Pharmacy Benefit Unchanged

 

Without Dependent Vision
Employee $28.50 per Month
Employee + Spouse $70.00 per Month
Employee + Child $46.00 per Month
Employee + Children $63.00 per Month
Employee + Spouse + Child $85.00 per Month
Employee + Spouse + Children $95.00 per Month

Preferred Provider Organization (PPO)

  In Network Out of Network
Deductible $250/$750 $500/$1,500
Coinsurance 85%-15% 70%-30%
Out of Pocket Max $3,250-$6,750, includes deductible $6,500-$13,500, includes deductible
Office Visit $20 Co-pay/visit, exam only Subject to deductible and coinsurance
Wellness $20 CO-pay, 100% of covered services No benefit except for screening mammography and Coinsurance
Well Baby Nursery Subject to deductible and Co insurance Subject to deductible and Coinsurance
Pharmacy Unchanged Unchanged

 

Without Dependent Vision Rates
Employee $23.00 per Month
Employee + Spouse $59.00 per Month
Employee + Child $38.00 per Month
Employee + Children $53.00 per Month
Employee + Spouse + Child $72.00 per Month
Employee + Spouse + Children $80.00 per Month

Dental Plan

No Benefit Changes
Employee $4.25/Month
Employee + Spouse $25.50/Month
Employee + Child $21.25/Month
Employee + Children $33.00/Month
Employee + Spouse + Child $37.00/Month
Employee + Spouse + Children $43.00/Month

Vision

No Benefit Changes
Employee $0
Employee + Spouse $2.00
Employee + Child $3.00
Employee + Children $3.00
Employee + Spouse + Child $4.00
Employee + Spouse + Children $6.00

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