Changes in the 2010 Kentucky Employees’ Health Plan

State employee health insurance open enrollment will be held from Oct. 12-25 this year, so today seemed like a good time to go over any changes that active employees can expect from the Kentucky Employees’ Health Plan for 2010.

First, let us look at what will not change for the 2010 KEHP plan year. None of the current health plans has been discontinued, meaning Commonwealth Maximum Choice, Optimum PPO, Capitol Choice and the Standard PPO plans currently offered to employees can be selected for 2010.  Also, like last year, all active employees must enroll for the upcoming plan year either online or by paper application to receive health benefits next year, preferably by enrolling online (you should have received or will receive your enrollment ID and password in the mail in separate envelopes) while all retirees except KCTCS retirees should get their insurance applications and rates from the state retirement systems. Also, active employees in the state health insurance group can still expect to pay premiums well below the national benchmark, since premiums have only increased around 7 percent annually since January 2006.

The lowest cost non-smoker plan will still be the Standard PPO, which requires no premium contribution from single employees and has the lowest monthly premiums for the Parent Plus, Couple, Family and Family cross reference options. The next least expensive non-smoker plan is Maximum Choice, followed by Capitol Choice. The most expensive non-smoker plan is Optimum PPO, with monthly premiums of $27.50 for singles, $176.52 Parent Plus, $469.52 Couple, $561.16 Family and $28.34 for Family cross referencing plans.

Another benefit that will still be offered are Flexible Spending Accounts–tax-free accounts that are used to pay for certain health or dependent care expenses through payroll deduction. State employees and school board employees as well as certain local health department or quasi-governmental agency employees are eligible to participate in an FSA, which allows employees to pay less income and Social Security taxes. Eligible, active employees choosing to waive health insurance with the state will still receive $175 per month (up to $2,100 a year) from their employer in a Health Reimbursement Account (HRA) for reimbursement of qualified medical expenses. Funds remaining in the HRA account at year’s end will roll over to the next year for employees who continue to waive health insurance coverage or continue to select the health plan for which an HRA is offered.

Now, let us look at what will change. While basic coverage won’t change, some costs have been reduced while other costs will rise. First, employee premiums for Parent Plus, Couple and Family coverage under the Standard PPO plan have been reduced, with significant reductions from $64.72 a month to $8.28 a month for Parent Plus and $376.72 to $288.44 for Family coverage. This is excellent news for our families, especially in this economy.

Second, the copay for Optimum PPO emergency room visits in cases where the patient is not admitted will increase $25 to $75. This will only apply to cases where the patient is not admitted to the hospital. Also, in-network Optimum PPO deductibles will increase from $250/$300 for single/family plans to $300/$600 respectively. Please review your enrollment materials carefully to determine how this affects your overall costs.

Third, there will be a $5 increase in copays for visits to specialists under the Optimum and Capitol Choice plans. Copays for visits to primary care doctors will remain the same under those two plans.

A few other changes I would like to share with you are known as benefit “enhancements” under KEHP.

First, employees selecting the Capitol Choice plan who make a copayment to his or her provider will not have the remaining cost of their office visit deducted from the $500 up-front benefit allowance, as has happened in the past. The remaining cost will be paid by KEHP.

Second, those with the Standard PPO single plan will have their in-network deductible decreased to $500 and pay nothing in premiums. Premiums for other levels of coverage have also been reduced with no loss of benefits.

Third, KEHP–not you, the employee–will pay the cost of removing polyps during a routine colonoscopy and the doctor’s visit charge will include a regular office visit copay.

Another thing to keep in mind for 2010 are the Virgin HealthMiles program and a new group plan Wellness Hotline. First, Virgin HealthMiles: This program provides KEHP members discounts on packages that reward you for healthy living. KEHP members have until Oct. 31 to sign up for the discounts.

I encourage you to study the 2010 KEHP handbook carefully and attend local KEHP benefit fairs so that you can make the best choices concerning the health needs of you and your family. I will share more with you next week.