Teacher group says premiums would soar for some on state health plan

It turns out the era of good feeling teachers had about their new health insurance plan only lasted a few days.

Once a teacher group analyzed new insurance rates for 650,000 educators, state employees, retirees and their dependents on the State Health Benefit Plan, they found that prices will shoot up dramatically for many if they decide to switch coverage, something a lot of them have been itching to do.

“These new rates, combined with the excessively high deductibles and out-of-pocket maximums, make this insurance unaffordable for most state employees and teachers,” said John Palmer, a Cobb County middle school band director and member of Teachers Rally to Advocate for Georgia Insurance Choices, or TRAGIC, which compared the new rates over the weekend.

That’s a far cry from the praise the new plans received when they were approved by the Department of Community Health board last week.

DCH officials said many plan members would see their rates decrease or remain the same. They noted Monday that premiums will remain the same for SHBP members who keep the same coverage they now have with Blue Cross and Blue Shield of Georgia. But many teachers, retirees and state employees want to switch from the current plans because they will include high out-of-pocket costs in 2015.

“The department listened to the concerns presented by our SHBP members last year and is offering more options that provide members with a choice of vendor, plan design and associated costs for 2015,” said Lisa Marie Shekell, a spokeswoman for the DCH.

The plans continue to be a political headache for the DCH and Gov. Nathan Deal, who is running for re-election this year and has been the focus of anger from members of TRAGIC since the start of this year.

Deal and the DCH had hoped they’d at least temporarily addressed concerns of teachers, retirees and state employees by increasing the number of plan options and holding down premiums.

The plans has been a political thorn in Deal’s side since last summer, when the contract to manage the program for 2014 was awarded to Blue Cross. That prompted one of the companies that had been managing the plan, UnitedHealthcare, to sue the state, accusing the DCH of resorting to “state-sponsored bid-rigging” to steer the contract to Blue Cross.

To save money, the state limited the insurance offerings to three plans, with different deductibles and premiums, along with higher out-of-pocket costs.

Once those higher costs started kicking in, teachers, state employees and retirees revolted, forcing Deal and the DCH to add back co-payments for services, costing the state more than $100 million. The extra money, however, didn’t solve all the plan’s problems, and teachers and retirees called for more choices and better coverage. A class-action lawsuit was filed in May, claiming that thousands of plan members had been overcharged on their premiums.

When comparing the current plan with the new options approved last week, TRAGIC found that members will see premiums jump 20 percent to 180 percent if they move to some of the new plans being offered.

It also saw major price differences — based on which companies members choose — in the cost of HMO and supplemental Medicare coverage.

Ashley Cline, the wife of a Cherokee County teacher who founded TRAGIC in January, said the premiums for teachers, retirees and state employees are far higher than they are for University System of Georgia employees. University System workers are also state employees, but they are covered under a separate plan.

“The Department of Community Health needs to consider the financial constraints and hardships of the hardworking state employees, teachers and retirees of Georgia who rely on the State Health Benefits Plan to provide insurance for themselves and their families,” Cline said.

The story so far

2013 – The state Department of Community Health decides to award Blue Cross and Blue Shield of Georgia the administrative/management contract for the State Health Benefit Plan that serves 650,000 teachers, state employees, retirees and their family members. Opponents organize against the new plan, saying it strips beneficiaries of their choice in health care plans and means higher out-of-pocket costs to them.

Thursday – The state Department of Community Health’s board approves new plans and rates for 2015, increasing offerings that it said would mean minimal change in premiums for many. Kaiser Permanente and UnitedHealthcare will participate in the plan in addition to Blue Cross and Blue Shield.

Monday – A group that opposed the shift, Teachers Rally to Advocate for Georgia Insurances Choices, or TRAGIC, says its analysis of the new plan shows insurance premiums for many will skyrocket next year. Premiums could jump up to 180 percent for some if they move to new plans offered under the coverage, the group says.

To see more of The Atlanta Journal-Constitution’s coverage on the State Health Benefit Plan, go to MyAJC.com.

By James Salzer
The Atlanta Journal-Constitution


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