Changes in Insurance Plans Confusing for Employees

Oregon Educators Benefit board makes the decision to give employees more options

January 25, 2012 -- It can be very exasperating when an employer changes health plan options and people no longer have quite the same benefits.

Irma Gentile faced that dilemma. An early retiree, she joined the Oregon Educators Benefit Board in 2008, choosing Providence Health Plan after reviewing the other three choices available to her.

But last fall she learned that her employer had dropped Providence as one of the four OEBB options it offered and she was no longer able to get the same prescriptions from her new provider, ODS, without trying three cheaper drugs -- a process she’d already been through with Providence.

Having spent years trying to fine-tune her medications, Gentile opted to pay out of pocket for some of her medications rather than going through the hoops.

“The frustration was having to get med-approval once again because I’m on a new plan,” she said.

Gentile’s experience is not unique because most insurance companies have a different formulary, benefit levels and networks, which aren’t always easily understood.

Because of situations like Gentile’s OEBB’s Board has decided to open all medical, dental and vision plans to all employees and/or early retirees who are in that service area. Currently, OEBB offers 11 medical plans including 2 Providence plans, 2 Kaiser plans, and 7 ODS plans. Until the Board’s recent decision, each OEBB participating employer had to choose 4 of those 11 to offer to its employees. Upon final Board approval in April, employers will be able to offer all of them.

“This will increase the choices available to many employees and early retirees,” said Denise Hall, OEBB’s deputy administrator, adding that the agency realized this may create confusion.

During open enrollment in the fall, OEBB sends materials to employees and early retirees letting them know the plan options available and includes a toll-free number for people to ask questions. OEBB’s team is also available throughout the year to help people who experience claim’s problems.

OEBB has also created an online cost calculation tool for members to compare the various medical, dental and/or vision plans, and review benefit details and premiums side-by-side. They can also plug in the amount their employer contributes to determine their monthly cost.

And, OEBB’s reaches out to early retirees, those who retire before age 65, to make sure they understand their choices.

“Over the first few years of OEBB, it became apparent that many prospective (and current) early retirees didn’t know everything they needed to know about early retiree benefits, especially how Medicare eligibility affected those benefits,” Hall explained. “OEBB staff prepared an informational piece to try to help with some of those questions.” 

Meanwhile, no matter how many choices she has, Gentile realizes that, “All in all, I am fortunate enough to have insurance.”

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The fact that the author does not bring out is why the early retiree's employer had to drop the Providence Health plan in the first place--was it because her employer was no longer in Providence service area (medical home), or because the OEBB rates were too high for everyone in the group that the employer had to drop the plan? Is this description of her problems really the "Health Care Transformation" that is supposed to take place? Sounds like inefficiency and waste all the way around. Is the answer to offer everyone all the OEBB plans? If you ask OEBB employers, the answer would be a strong "no"--is it more efficient for them to administer anywhere from 5 to 9 plans at one time? I don't think so. If the early retiree had been in our group--(non-OEBB district) she would have had assistance and guidance before the plan was changed and would have been assisted early on by the new carrier so that there wasn't this double medication trial that has resulted in her paying more out of pocket instead of getting the services she is paying for through her OEBB premium. Debbie Johnson, RN