Beginning July 1, 2014, EVSC began offering an insurance marketplace to its employees. Employees were able to choose from one of six insurance plan designs. A summary of benefits for each of the offered plans is available below. All individuals covered by an EVSC health insurance plan will continue to have access to the services offered at the EVSC Health and Wellness Centers at no charge.
On October 20, 2014, the School Board approved a move to a partially self-funded health insurance plan. In short, this move minimizes the cost increase to employees at the Jan. 1, 2015 renewal date and improves the potential that premium costs will be more contained in the future. By moving to a partially self-funded model, $12.53 in monthly fees that were previously incorporated into the fully-funded plan will be added to every employee’s insurance premium, effective Jan. 1. In addition, due to changes in the Affordable Care Act, prescription drug co-pays on Plans A, C, E, and F will count toward the maximum out-of-pocket, effective Jan. 1. There are no other changes to the plans that are offered, coverages, or EVSC contributions toward health insurance premiums or HSA accounts.
In contrast, remaining on a fully-funded plan would have meant that monthly premiums would have increased between $34 and $129 per month depending on the plan that was selected. The differences between a fully-funded plan and partially self-funded plan are largely at the corporate level, and the individual employee should notice no difference to the way their insurance is administered as a result of this change.
HOW DO I CHOOSE A PLAN THAT IS BEST FOR ME?
Selecting an appropriate health insurance plan is an individual decision which involves a number of complicated factors. Some of the factors ETA recommends its members consider are:
Claims History: Log into anthem.com and review your claims history. Have you met your deductible and/or your out-of-pocket maximum in recent years? Do you have ongoing or planned medical treatments in the next 6 months?
Prescription Drug Costs: This information is also available by logging in to anthem.com. If you are considering Plan G or H, research the full cost of your prescription. The following websites may assist you with prescription drug costs:
Medtipster, where you can find prescription drugs available on discount generic programs across the country.
GoodRx, where you can compare prices for all FDA-approved prescription drugs at virtually every pharmacy in America and find pharmacy coupons, manufacturer discounts, generics, comparable drug choices and savings tips all in one place.
Maximum Financial Exposure: Determine the maximum potential financial exposure for the plan(s) you are considering. The monthly premium is your guaranteed cost. The out-of-pocket maximum is your potential cost. The sum of those two factors is your exposure. Choosing an insurance plan involves a certain level of financial risk, and every individual has to determine their own risk tolerance.
Remember: Open enrollment will occur annually with a January 1 effective date absent changes to federal law.
