UHC gets an edge in competition to be school board insurer

CENTERVILLE — And you thought dealing with your health insurance was complicated.
The St. Mary Parish School Board voted Thursday to make United Health Care the insurer for the employees, retirees and dependents enrolled in its group plan next year — possibly.
The board’s acceptance of UHC’s proposal depends on whether it will match the 2 percent reduction in premiums offered by the current insurer, Blue Cross/Blue Shield of Louisiana. If UHC doesn’t match the 2 percent cut by Monday, Blue Cross gets the business.
The school board was already trying to cope with an increase in health care costs for its employees. Part of the increase has resulted from a glut of big claims. Prescription drug costs have also been a growing part of the problem.
Board insurance consultant James Perez said after the meeting that 15 years ago, prescription drugs made up about 25 percent of claims. Last year, Perez said, drugs accounted for about 42 percent.
The original Blue Cross renewal proposal for 2019 called for a premium increase of more than 9 percent. That sent the board scrambling for lower-cost options.
The key appears to be moving Medicare-eligible retirees and their dependents to Medicare Advantage Plans.
In standard Medicare coverage, medical services for people 65 and over are paid for directly by the federal Medicare system. In a Medicare Advantage Plan, the system pays an insurer to cover eligible people.
One of the keys to cutting costs is that the insurer has a financial stake in keeping Medicare Advantage Plan enrollees healthy. So enrollees may find they’re eligible for help with health club memberships, for example, or that they have an easier time getting podiatry services important to preventive care for diabetes.
Both the UHC and Blue Cross proposals now under consideration by the board would move school board Medicare-eligible enrollees into Medicare Advantage Plans.
UHC’s proposal included a premium increase, but it had another feature that caught the eye of board members. It did away with a $250 prescription drug deductible for active employees.
Board members Wayne Deslatte and Kenny Alfred raised questions about the back-and-forth between the central office staff and the insurance companies between the Oct. 11 regular board meeting and Thursday’s special meeting. They were concerned that the process didn’t treat the companies fairly by giving them time to respond to counteroffers.
But it was prescription drugs that played a big role in what could turn out to be the final decision. Board member Marilyn LaSalle said she likes UHC’s $75 cap on enrollee spending for specialty drugs.
LaSalle suffers from rheumatoid arthritis. She said after the meeting she has learned that some of the medications targeting that condition can run into thousands of dollars. The same is true of cancer drugs, she said.
LaSalle moved to accept UHC’s proposal if UHC can match the 2 percent premium reduction by Monday. Board member Ginger Griffin seconded the motion with an amendment saying the UHC proposal must also include a $200,000 cap on “pooling charges,” the out-of-pocket expense for enrollees facing catastrophic hospital expenses.
The motion passed the 11-member board 7-3 with an abstention by Mary L. Lockley.
Alfred, Deslatte, LaSalle, Griffin, Anthony Streva, Michael Taylor and Roland Verret voted yes. Pearl Rack, Joseph Foulcard and Bill McCarty voted no.
Under the current Blue Cross plan, covering a single employee costs either $610 or $522 per month, depending on coverage options. The employee’s share is either $220 or $96.
Employees with two dependents cost either $1,361 or $1,163. The employee share is either $640 or $442.
A retiree with one dependent costs either $1,099 or $939. The retiree pays $501 or $341.
In all, the school board group plan enrolled 1,509 people in 2018.