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County Administrator Charlie Young said the volatile health insurance market and changes to the plan changed the bottom line.
“If we just duplicated our plans from this year to next year the increase would be 8.4 percent,” Young said. “But there were some complaints about our plan this year that have caused there to be an interest in changing the plans a little bit and those make the plans higher in actuarial value which translates into a slightly better plan but also slightly more expensive.”
Young said until the employees select from the various plans — pricing is different for family, individual and other types of plans — and they calculate how many employees have earned wellness credits — they are estimating the county will pick up about $300,000 in credits for employees — they won’t know exactly how much of an increase they might face next year.
There was a lively discussion during the commissioners meeting last week with the commissioners, especially Cindy Carpenter calling their consultant and plan administrator on the carpet for all the problems employees have experienced getting their claims paid.
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She said employees are coming to her and the other commissioners with the problems and that is not appropriate.
“I think the whole structure of how we report the countless complaints is not appropriate,” Carpenter said. “I think for Horan to put up something called an engagement team, our consultant to have an engagement team because our provider does not provide enough customer service, I think that’s outrageous. The whole thing is outrageous to me.”
Young said when Meritain Health — a subsidiary of Aetna — took over as the third party administrator of the health insurance this year they were denying claims that had always been covered in the past, communication was very difficult and there were other problems.
“It’s really been a whole year’s worth of complaints and unhappiness and our consultant Horan brought something they call their Engagement Team to bear,” Young said. “In retrospect we should have had them involved from the very beginning. It’s just that we didn’t expect to have this much difficulty with Meritain.”
Meritain could not be reached for comment about the problems.
The county’s consultant from Horan, Angela Wolfe, agreed it has been a difficult year for employees.
“I do understand the impact this has had on employees,” Wolfe said. “It’s very difficult, even though employees may feel like it’s okay now, what they’ve had to go through this year has been very difficult for them and I do empathize with that.”
Commissioner Don Dixon said it has been “painful” to watch what their employees have gone through but they are locked into a contract with Meritain so they can’t switch to another company.
“If it was up to me I would have changed (from Meritain) but the fact of the matter is we have a three year contract and a three year run out,” he said. “We can’t change, financially we’re locked in. We’ve made a lot of improvements we need to do more. I don’t think there’s any way we can step out of the situation we’re in right now and look for another mode or another method or another company.”
High claims have torpedoed the county’s health insurance costs in recent years — a single claim for $5 million came in a couple years ago — but Dixon said their claims look to be coming in right where they expected for this year. He said self insurance was still the right way to go.
“It gives us more control,” he said. “In all this uncertainty that’s going on in the insurance world, as long as we can manage our costs and manage our claims, we’ve got reinsurance for that, our numbers are pretty much what we thought year over year… At 10 percent I’m really not thrilled but it’s manageable.”
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