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Falls School Board details insurance plans with $750,000 in potential savings

Two plans feature reimbursement for higher deductibles

Oct. 23, 2012

Menomonee Falls - The Menomonee Falls School Board yesterday discussed offering three options to employees for health insurance, with a final vote slated for Monday.

Open enrollment for the new benefit plans that offer differing deductibles and out-of-pocket expenses will begin Jan. 1 as the district moves to self-funded insurance through Humana. This change will save the district roughly $750,000. The savings is a ballpark estimate as the numbers will not be finalized until open enrollment is complete, Human Resources Director Christiane Standlee said.

Preventive care would be covered 100% in all three plans.

Plan one is a traditional preferred provider organization plan and most similar to the employees' current insurance plan, with the exception of adding in-network coinsurance.

"That operates after you meet the deductible, it's a percentage of money you pay on each claim," Standlee said. "If you have a $100 deductible and a 20% claim, you pay $20."

This plan has the highest premium and a $250 deductible for singles. The deductibles in each plan double for families.

Plans two and three are consumer-driven plans with higher deductibles. The employee would pay less for premiums from their pay checks through contributions; however, the deductibles are higher. The third option has the highest deductible, but lowest premium. The second and third options also include a Health Reimbursement Arrangement, or HRA.

District pays half of deductible

An HRA is a health benefit plan that reimburses employees for half of their deductible expenses.

Plan two has a medium employee contribution and a $1,000 deductible. The district would pay half of the deductible, or $500.

Plan three has a deductible of $2,000, but the lowest employee contribution rate. With plan three, the district would pay half of the deductible, or $1,000.

Standlee said employees would be responsible for paying the deductible, then submit a reimbursement to Eflex, a third party administrator, to receive payment.

"Eflex is very timely," Standlee said, adding it should only take a few days to receive the reimbursement once it's submitted. "Staff and employees really seem to like this plan because it's cheaper. If you don't incur a claim it will cost less."

Reimbursements are district funds and are not deducted from the employees' paycheck.

Co-pays the same

Co-pays in all three plans are the same for office, emergency room and urgent care visits. The co-pay is $10 for an office visit; $100 for an emergency room visit; and $35 for an urgent care visit.

"The district is paying the same (for) all three plans so it's known as defined contribution," Standlee said.

Currently the district is paying $637.90 per employee. Next year, it will pay $607.40 per employee.

There was one concern expressed during the meeting about whether the district is taking into account changes taking place due to the Patient Protection and Affordable Care Act, known as ObamaCare, to see how that could affect future insurance coverage for employees.

"We are currently under what would be a Cadillac plan for ObamaCare," School Board Member Lori Blodorn said.

Employees can also set up a Health Savings Account, which employees can use to pay for medical expenses.

Standlee said the district has been educating employees on all three plans, as well as the difference between an HRA and HSA account.

"The premise behind (offering three plans) is it's good to give the employees choice and allow them to elect what is best for them and their families' needs," Standlee said. "It's no longer a one-stop shop."

AT A GLANCE

Here are the three health insurance options the Menomonee Falls School District is offering its employees:

Plan 1: Traditional PPO, maintains current deductible level and introduces in-network coinsurance. This plan has the highest employee premium.

Plan 2: Consumer-driven plan with medium deductible and health reimbursement arrangement or HRA. This plan has medium employee premium.

Plan 3: Consumer-drive plan with higher deductible and larger health reimbursement arrangement than Plan 2. This plan has the lowest employee premium.

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