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Fewer state-offered health maintenance organizations will be available to
Carolina employees in 2000-01, and those remaining will charge higher premiums.
State Health Plan premiums will stay the same as current rates provided that
N.C. Gov. Jim Hunt's funding proposal to shore up the plan is included in the
upcoming year's state budget.
According to the Raleigh office that oversees health insurance coverage for
state employees, the state -- pending signed contracts -- will offer five HMOs
in 2000-01. The five are: Coventry Health Care of the Carolinas, Doctors Health
Plan, Generations Family Health Plan, Prudential HealthCare and WellPath
Select.
These HMOs' availability will be based on employees' home or work addresses.
All but Coventry will be available to employees working or living in Orange
County. Coventry will not be available to employees living in counties that
surround Orange, either.
Two HMOs now serving Orange County -- Blue Cross Blue Shield of North Carolina
Personal Care Plan and Partners National Health Plans of North Carolina
(formerly Kaiser) -- will drop out in 2000-01. Others dropping out are: Optimum
Choice of the Carolinas, QualChoice of North Carolina, The Wellness Plan of
North Carolina and United HealthCare of North Carolina.
Pending signed contracts, all four of the 2000-01 Orange County HMOs will
increase monthly premiums. Premiums will range from $253.86 (employee coverage
with Generations) to $786.02 (employee/family coverage with Doctors).
The state will continue to contribute $187.98 toward employees' HMO coverage.
That means increases in employees' monthly out-of-pocket costs will range from
$28.78 to $142.10, depending on the HMO and coverage choice. (See chart for
details).
Jack Walker, executive administrator of the State Health Plan, said HMOs are
raising premiums because they are losing money. They tend to attract people
with more health problems, he said, and that leads to the HMOs having to pay
out more in claims, which forces them to raise rates.
And those higher rates drive more healthy people away from HMOs and to the
State Health Plan with its lower premiums. That leaves an even larger
percentage of high-expense people in the HMOs, leading to more rate hikes or
HMOs deciding to drop out, Walker said.
To prevent higher jumps in rates, the state will permit HMOs to increase the
maximum co-payment they can charge. Call the Benefits Department at 2-3071 for
details.
State Health Plan premiums and out-of-pocket costs will remain the same in
2000-01 if the budget passed by the N.C. General Assembly includes $50 million
that Hunt has proposed to make up a funding shortfall in the plan.
The state now covers the entire cost to insure employees, $187.98 per month.
The monthly out-of-pocket cost for employees with children's coverage is
$117.16; $281.04 for employee/family coverage.
But if the General Assembly's budget does not include Hunt's $50 million,
premiums for the State Health Plan will increase by 8 percent, according to
Laurie Charest, associate vice chancellor for Human Resources. That would be
the case despite this year's rates being approved with the understanding that
they would remain unchanged in 2000-01, she said.
The General Assembly now is in session to work out a 2000-01 budget and hopes
to approve a spending plan by the end of this month.
Any rate increases in health insurance will take effect Oct. 1. Employees will
have the chance to switch or add dependents to their insurance plans during an
open enrollment period in August.
Employees now on HMOs not offered next year will have to enroll in another plan
to keep insurance. Booklets with detailed information on health insurance
options -- called It's Your Choice -- will be sent to employees to consult
during the enrollment period.
Employees are urged to review these booklets to learn of any changes in their
current plan.
Change in employee monthly out-of-pocket costs
| PLAN* | EMPLOYEE | EMPLOYEE/CHILDREN | EMPLOYEE/FAMILY | |||
| . | 99-2000 | 2000-01 | 99-2000 | 2000-01 | 99-2000 | 2000-01 |
| State Health Plan | $0.00 | $0.00 | $117.16 | $117.16 | $281.04 | $281.04 |
| BC/BS Personal Care | 45.12 | not offered | 207.32 | not offered | 422.74 | not offered |
| Doctors | 58.12 | 112.30 | 229.80 | 321.92 | 455.94 | 598.04 |
| Generations | 37.10 | 65.88 | 193.96 | 242.88 | 402.36 | 478.04 |
| Kaiser/Partners | 32.48 | not offered | 186.10 | not offered | 390.20 | not offered |
| Prudential | 30.24 | 71.46 | 182.30 | 252.40 | 384.32 | 492.76 |
| Wellpath Select | 31.00 | 72.54 | 183.60 | 254.18 | 386.32 | 495.52 |
* State Health Plan available to all eligible employees;
HMOs listed are/were available in Orange County; check with Benefits Department for other counties.
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