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.
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Idaho employees turned out en masse this week at the first
informational meetings about changes in employee health insurance
plans. Representatives of the states 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 states 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 |