The Public Employees Benefit Board held the line on some cost increases pushed by Kaiser Permanente, renewing dental coverage with Kaiser with just a 4 percent increase -- down from Kaiser’s original 9.5 percent request.
The board also voted Tuesday to cut retirees and other non-employees who buy PEBB insurance some slack by removing requirements that they enroll in the state’s wellness program or be moved into a flimsier health plan.
Kaiser had started with a 9.5 increase rate hike request in March, but agreed to drop the rate hike to the cost trend rate of 5.5 percent that it had witnessed in 2013 through November. It also offered PEBB a 4 percent increase if a $5 copayment for office visits was added.
But in May, PEBB negotiators were able to get Kaiser to drop the copayment idea while keeping dental rates for 2015 at 4 percent higher than 2014.
In April, PEBB approved a 3.2 percent rate hike in 2015 for its ODS dental plan, as well as maintained rates without an increase for the dental plan from PEBB members’ third choice, Willamette Dental Group.
When the new rates kick in, a single, full-time employee will have to pay $85 for Kaiser’s dental plan; $79 to $86 for ODS, depending on the network, and $75 for Willamette.
Health Engagement Changes
Retirees, COBRA beneficiaries and self-pay PEBB members will no longer be required to conform to PEBB’s controversial health engagement module. These members saw only health benefits from greater wellness -- they couldn’t get the roughly $100 premium rebate that state employees receive for complying with the electronic wellness plan and, if needed, they had to undergo a fitness regimen or smoking cessation program.
But if they didn’t complete the electronic health survey process, they would get kicked into a higher deductible health plan.
“They got the stick but not the carrot,” said PEBB deputy administrator Kathy Loretz. She said the health module was also difficult because many retirees don’t use e-mail or have enough familiarity with computers.
Loretz said even if retirees and others are not required to sign up with the health engagement module, they will still have access to state-sponsored programs such as Weight Watchers and the diabetes prevention program.
From March 2010 to the implementation of Cover Oregon in March 2014, PEBB has seen its membership numbers for COBRA and retirees plummet by 40 percent -- a trend that will likely continue now that they have more options on the federally subsidized insurance exchange.
Optical Health
Finally, the PEBB board approved a 4.1 percent rate hike for the optical health plan from VSP. Employees will see their premiums go up about 50 cents.
After some discussion, the board decided against expanding coverage to include bifocals, trifocals and polycarbonate lenses, the latter which are often used for those with a strong prescription for myopia or astigmatism. PEBB members will have to pay for these lenses out-of-pocket, though many had been receiving discounts from their VSP providers so that they paid only $27 on average out-of-pocket for polycarbonate and $102 for bifocals or trifocals.
“I’m not hearing anyone say we want to add these benefits,” said Paul McKenna, PEBB’s vice-chair who represents the Service Employees International Union.
The board also voted to allow PEBB members to waive their dental or vision benefits -- but they won’t qualify for a cash rebate by doing so. That decision was made so PEBB could comply with the Affordable Care Act without creating a huge administrative headache.
A flaw in the Affordable Care Act prohibits health plans from setting caps on the benefit of optical and dental care for children, but only if the benefit is combined with the medical plan. The prohibition does not apply if these benefits are offered in separate dental or optical plans.
“If we allow opting out, we won’t have to make changes to our benefits,” Loretz said.
By segregating these benefits, PEBB will be able to keep caps on children’s benefits while also avoiding limits on out-of-pocket expenses, which would have to be measured across multiple insurance carriers. That would have thrown a wrench into PEBB’s decision to have five different medical plans next year as well as three different dental plans and the vision plan.
Chris can be reached at [email protected]. The image for this story is by M.O. Stevens (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0-2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons.
