Employees of Seymour Community School Corp. can expect changes to their health insurance in 2018, including a slight increase in cost.
Business manager Steve Nauman presented staff insurance options which include three different plans through Anthem during this month’s regular school board meeting Sept. 12.
Open enrollment for school employees to sign up for or change their health insurance benefits begins in October.
“Basically, our renewal is 1.6 percent,” Nauman said of the increase.
The corporation’s insurance fund is now back in the positive, but barely, he added.
“Our overall claims are down, so people are really doing some of the things we ask to help the plan, especially utilization of our health clinic and shopping around for prescriptions,” Nauman said.
The biggest increase is for those employees on the Preferred Provider Organization (PPO) insurance plan.
An individual on that plan will pay a total of $318 per month ($159 per pay period), which is $25 more monthly ($12.50 per pay period) than what they currently are paying for coverage.
A family on the same plan will have to pay a total of $807 per month ($403.50 per pay period) or $50 more per month ($25 per pay period).
Seymour Community Schools’ contribution for the PPO plan will be $503 per month for those on the single plan and $1,196 for families.
Plan 2, a health savings account (HSA)/high deductible plan, will see a $15 per month ($7.50 per pay period) increase for individuals and a $25 per month ($12.50 per pay period) increase for families.
Single employees will pay a total of $184 per month ($92 per pay period) and employees on the family plan will pay $496 per month ($248 per pay period).
The third option, Plan 3, also an HSA/high deductible plan, will see a $5 per month ($2.50 per pay period) increase for individual employees or $10 per month ($5 per pay period) for the family plan.
The cost for a single employee on this plan will be $111 per month ($55.50 per pay period) or $327 per month ($163.50 per pay period) for employees on the family plan.
The school corporation’s contributions for those on Plan 2 and 3 will be $450 per month for individuals and $1,050 for families.
“Those increases bring in about $80,000 more,” Nauman said. “We are, right now, around $100,000 to the plus in our insurance fund, but we should be around half a million dollars.”
Last year at this time, the corporation was “in the hole,” when it came to insurance, he added.
The past two years the corporation has kept the increase the same for individuals and for families, regardless of which plan they were on.
“We did that to try to keep people from jumping from one plan to the other in big amounts, because that skews your renewal,” Nauman said. “Anthem makes the assumption that nobody is going to change plans, so if you lose a lot of PPOs or if you have a lot of people going from the lower high-deductible to the higher high-deductible, those premiums don’t come in and therefore you have to reverse.”
After reviewing renewal information and claims, Nauman said the school corporation is collecting more money on Plan 3 than it takes to pay claims and the other two plans are not funding themselves.
“I would never suggest that that be the deciding factor,” he said. “You have to weigh everything out and people come and go off of plans.”
For dental insurance, single employees will pay $32 per month or $16 per pay period and those on the family plan will pay $73 per month or $36.50 per pay period. The corporation pays $20 per month for individual employees and $41 per month for those on the family plan.
Vision insurance will cost $2 per month or $1 per pay period for single employees or $4 per month, $2 per pay period, for the family plan. The corporation plays $10 per month for individual employees and $23 per month for families.
All employees must also purchase life insurance provided through One America Insurance Co. for $1 per year. Voluntary life insurance is offered to employees working at least 20 hours per week.
Another major change for employees on the school’s health insurance plan is that beginning Jan. 1 Anthem will not pay for emergency room visits that are not deemed an emergency.
“Supposedly there are some exemptions for that, for instance if you are under the age of 14, it doesn’t apply. If the visit is on a Sunday or certain times, it doesn’t apply,” he said. “The emergency room is supposed to tell you upfront if you come in whether Anthem will cover you or not.”
The change is not just for Seymour Community School Corp. but impacts people covered by Anthem nationwide, Nauman said.
“My best advice would be if you go to the emergency room, ask first,” he said.
Nauman said the change is likely the result of too many people using emergency rooms for primary family health care instead of just emergencies.
“From my understanding, that’s what is driving it,” he said.