Teachers and other state employees across North Carolina will see premiums and out-of-pocket costs rise next year if state lawmakers approve a proposal before the State Health Plan’s board of trustees.
That plan would raise premiums by about $40 a month in 2016, while also boosting out-of-pocket costs on two of the state’s three plans.
During the 12-plus years I covered education, I heard plenty of teacher complaints about health insurance, especially after the recession spurred cost-cutting. I avoided delving into the details. But now that I’m writing about high-deductible insurance, I can see why teachers were fuming.
The traditional plan currently has deductibles of $933 for an individual and $2,799 for family coverage, not huge compared to many private-sector plans but still a pinch on a teacher’s salary. After that the plan pays 70 percent of costs – and the employee keeps paying 30 percent until hitting a cap of $4,726 individual or $14,178 family. That’s a higher limit than most companies set on high-deductible plans.
State employees can also pay a higher premium to cut their share to 20 percent and limit out-of-pocket exposure, though at $11,730 for family coverage it’s still a big hit.
This year the state added a “consumer-directed” plan that requires a higher deductible up front ($1,500 individual/$4,500 family) but limits the total out-of-pocket risk and includes a contribution to a health reimbursement account. Charlotte-Mecklenburg Schools, which has more than 15,000 covered employees, saw just over 4 percent choose that option, and that’s higher than statewide participation of 3 percent.
State employees can expect a push this year to persuade them that the new option is, in the words of spokesman Schorr Johnson, “the best valued plan the State Health Plan offers and provides the richest benefit.”
Last year “the Plan did not push or market the (Consumer Driven Health Plan), and given that many of our members were not familiar with how it works and often find it easiest to stay with what they currently have and know, the initial enrollment results are not surprising,” Johnson said.
Under the 2016 proposal, the state’s contributions to employee reimbursement accounts would increase. The plan also includes bigger incentives to take part in healthy lifestyle activities and use preferred providers.
Meanwhile, increases to out-of-pocket costs on the traditional 70-30 plan might nudge employees to try something different. Under the proposal, those who choose the traditional family coverage could end up paying $16,000 out of pocket.