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Health insurance plans add options, wellness programs

Insurance plans add options, wellness programs

Nov. 6, 2013 - 06:00AM   |  
By AL KARR   |   Comments
Open Enrollment Kicks Off For Affordable Care Act
A woman gets a prescription with her son at a Denver health clinic. Federal employees have more choices for 2014 when selecting a health insurance plan. (Chris Schneider / Getty Images)




It’s time for federal workers to select their health insurance plan for 2014, and they’re once again starting to immerse themselves in mulling over tradeoffs between the costs and benefits of the plans being offered.

The open season enrollment process for the Federal Employees Health Benefits Program (FEHBP) — which covers 8.2 million federal employees, retirees and their families — runs from Nov. 11 to Dec. 9.

John Patrick, director of federal programs for Kaiser Permanente, urges FEHBP members to weigh the “quality, service and price” features of each candidate plan against “what’s important to them.” But only a fraction actually do that each year. A study commissioned by Kaiser found that only 7 percent actually switch plans, Patrick said.

Federal employees and retirees are a loyal lot and tend to stick with their existing plans in large proportions. More than 95 percent of those enrolled in Government Employees Health Association (GEHA) coverage, for example, stayed last year, officials said.

And when an enrollee does switch plans, it is usually to move to a high-option plan — in which the enrollee pays a higher premium, but lower co-pays and deductibles — or to a low-option plan that features smaller premiums and higher co-pays and deductibles, Patrick said.

Walton Francis, principal author of the Washington Consumers’ Checkbook “Guide to Health Plans for Federal Employees,” said it is a mistake to not carefully evaluate the options each year.

“No one wants to look at health-insurance plans,” he said. But to make an intelligent choice, research is necessary, he said. And, indeed, “we find great differences between plans.”

For most feds who do the research, their number one priority is holding down costs, Francis said, followed by:

■ Ensuring access to their favorite doctors;

■ Having top-quality coverage for common health concerns like diabetes, maternity issues and chiropractors; and

■ Having coverage for specialized health needs.

Aware of employees’ changing needs, some insurers are making adjustments in their plan offerings. Both Aetna and the National Association of Letter Carriers (NALC) are adding two new lower-premium health plans to their options — Consumer Driven and Value plans — bowing to to customer cost concerns and zeal for flexibility in premium payments and benefits. The Blue Cross and Blue Shield Association will offer a new dental plan.

“We have seen a shift from our High Option plan to our Standard and high-deductible plans,” said Julie Browne, vice president of managed care and marketing at GEHA. “That trend will continue as federal workers manage through the pay freeze and other financial pressures.”

Overall, average health insurance premiums for FEHBP plans will rise 3.7 percent in 2014, slightly more than the 3.4 percent increase this year.

GEHA will make “a small increase,” said Browne. “Premiums are one of the biggest things [employees and retirees] look at,” said Bernard Perlmutter, administrator of the NALC health benefit plan.

Blue Cross and Blue Shield lifted its rates by 3 percent or less. The NALC moved its rates up for the employee on its High Option plan only 56 cents and, for a family, just $1.23, Perlmutter said. Kaiser Permanente increased its premiums by 10 percent on the High Option plan and 2 percent on the Standard Option plan, with all other price changes being benefit enhancements, including some specific elimination of premiums.

GEHA members who have Medicare get special cost savings — GEHA pays 100 percent of covered hospital expenses after Medicare, those in High and Standard Option plans pay no deductibles or co-pays for surgical and medical benefits, Browne said.

More health insurers are launching “wellness” programs, which emphasize healthy living and illness prevention. Often free, the programs promote healthier diet, exercise and other positive lifestyle changes.

Blue Cross and Blue Shield now pay enrollees $40 to do a self-assessment of their health profile, along with checking their vital signs, said Bill Breskin, vice president of government programs, and Josh Smith, director of benefits development. The assessment asks enrollees whether they meet certain healthy goals, like eating seven vegetables a week, exercise twice a week, if they smoke, or if they have been diagnosed with diabetes, for example.

The company follows some Accessible Care Act requirements, like having customers take vitamin D to reduce the risk of broken bones in falls or aspirin to lessen the risk of a heart attack, the officials said. Another innovation: an online “home” for patients, their doctors and specialists to discuss the patient’s health. ■

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