By Jessica Connor
Those covered by S.C. Conference health insurance got the chance last month to select the new Consumer-Driven Health Plan for 2012 — if they wished.
Hundreds of United Methodist clergy and conference employees across the state receive benefits through the conference office, and up until now, they have had one option for coverage: the traditional PPO (Preferred Provider Organization).
But PPOs are expensive for the participant and the Annual Conference, so in June, the conference approved a new plan from the Board of Pensions and Health Benefits to offer two choices to participants. Beginning with 2012, participants choose from either the traditional PPO or the new Consumer-Driven Health Plan, which is a high-deductible plan featuring a Health Reimbursement Account that can roll over from year to year. The HRA is funded at $1,000/participant ($2,000/family).
The CDHP, teamed with a new pharmacy benefit featuring a percentage co-pay on any drug beyond a generic Tier 1, is expected to save the conference money.
I think it s an exciting time in the next few years with health care reform, and we ll have some great opportunities for cost savings in the local church that we ve never had before, said the Rev. David Anderson, conference benefits officer.
Insurance participants had to elect one of the two options before Nov. 17, during open enrollment. Anyone interested in the new CDHP must now wait until next fall to elect the plan for 2013 coverage unless they have a change of life (marriage, death, baby, etc.).
Anderson said the new health care option fuses participant responsibility with pro-active responsibility and consumerism that could foster better stewardship. He said the conference will probably always offer two plans for people to choose between, that the new CDHP is not for everybody, but it can be a big help to some. It encourages better dialogue between doctor and patient, he said, instead of people simply going along with costlier treatments because they are steered in that direction by ads they see on television.
Herman Lightsey, chair of the conference Board of Pensions and Health Benefits, said the new option is important to the church and its pastors and staff.
From the General Conference to our Annual Conference, the emphasis has been on doing the right thing, Lightsey said. These changes are not simply about dollars. It is about balance and keeping our promise to the 25-year-old clergy and the 65-year-old clergy, and the church for the long term. Our Annual Conference is in good shape compared to others because of this attitude, commitment and resolve to always try to do the right thing, not always the popular thing. But that kind of sounds like what Jesus taught us to do.
Premiums are similar for the PPO and the new CDHP: Individual coverage for the CDHP costs $179/month, versus $198/month for the B750 PPO. The benefit to the participant comes more in the ability to roll the money in the HRA from year to year without limit “ as well as the knowledge they are potentially helping to save the conference some money.
CDHP enrollees will get an HRA debit card that they can swipe at doctor offices, pharmacies and elsewhere until that $1,000 is depleted. Then they have to rely on their own funds until their deductible is met. If any of that $1,000 is not used, then all or part carries over to the next year. They can also put tax-free dollars into a Flexible Savings Account linked with that debit card for medical use, but those dollars are use it or lose it and do not roll over past one year, so they are used first.
Both plans include the new pharmacy benefit, where Tier 1 generic drugs are a fixed-rate co-pay: $12 at a retail pharmacy and $20 for Medco by Mail (a three-month supply). Anything beyond Tier 1 generic will be a percentage pay in 2012: 25 percent co-pay on preferred Tier 2 brand-name drugs, and a 30 percent co-pay on non-preferred Tier 3 drugs.
All other wellness plans, such as behavioral health coverage, vision, Virgin HealthMiles, etc. are continuing for both plans.