By Heather Mullinix
Assistant editor
—
The Cumberland County Board of Education voted Thursday to encourage its employees to make healthier lifestyle decisions by voting to fund the ParTNers for Health insurance.
Those choosing standard PPO insurance will be required to pay the difference in the premium, about $300 a year, and will also have higher out-of-pocket costs.
Director of Schools Aarona VanWinkle said, "We've got to do this to keep a comprehensive, affordable and dependable plan for all members. If we don't take an active role in this health plan, our insurance is going to suffer, not just in Cumberland County, but across the state."
The state has changed the insurance plans offered to employees, eliminating the Health Management Organization option. The ParTNers for Health and standard Preferred Provider Organization are the only two options available to the school system.
ParTNers for Health requires employees to sign a Partnership Promise, which includes completing a health questionnaire, having a health screening, getting routine preventive care, reducing health risk factors and, if necessary, working with a health coach.
VanWinkle said, "They have to make a commitment to the partnership program. Members will pay a greater share of the cost if they choose the standard. Everyone is eligible for the partnership program if they are willing to make the partnership promise and make the effort."
There is a difference in premiums of $300 a year for single coverage between the ParTNers PPO and Standard PPO.
Employees will have two options for insurance carriers, Blue Cross/Blue Shield or Cigna, and choose single coverage or premium levels for employee and child, employee and spouse or employee, spouse and children.
The ParTNers PPO offers lower co-pays, deductibles and co-insurance than the standard PPO. Both plans offer preventive care and well baby and well child office visits with no co-pay. ParTNers PPO co-pays for primary care are $25 per office visit and $40 for specialty care when using an in-network provider. The standard PPO has a $30 primary care co-pay and $45 specialty care co-pay. Prescription drugs also cost more under the standard PPO plan. ParTNers PPO offers prescription drugs with a $5 co-pay for generic, $30 co-pay for preferred brand and $80 co-pay for non-preferred brands. The standard PPO offers prescription drugs with a $10 co-pay for generic drugs, $40 copay for preferred brands and a $90 co-pay for non-preferred brands.
The annual deductible is $300 for an employee on the ParTNers PPO plan, while the standard PPO has a $700 deductible for the employee. This is the amount that must be paid before co-insurance benefits begin each year.
ParTNers PPO also offers inpatient care, advanced X-ray, scans and imaging, and occupational, physical and speech therapy at a cost of 10 percent to the covered employee, after the deductible is met. That cost is 20 percent in the standard PPO plan.
The out-of-pocket maximums are also higher in the standard PPO. In the ParTNers PPO, an employee would pay a maximum of $1,350 in a year, while that employee would pay a maximum of $1,700 under the standard PPO plan.
Both plans have significantly higher costs if using out-of-network providers. VanWinkle said she will print copies of the list of doctors for the Cigna and Blue Cross/Blue Shield providers. Employees can also research providers online through the www.partnersforhealthtn.gov website or by calling ParTNers for Health Call Center at 1 (866) 741-6464.
Susan Serleth, representing the Cumberland County Education Association, felt the board should wait to vote until CCEA had a chance to review the two insurance plans and make a recommendation.
"We are still negotiating," Serleth said, noting the association and board are in the process of renegotiating the teachers' contract. "I really think we need a chance to sit down at the table and allow the association and board to review this."
VanWinkle said the contract with teachers only stated the school system would offer a comprehensive health insurance plan and pay 100 percent of the individual coverage and a portion of the family coverage.
"We're not making any changes in the contract," she said. "We've been at the table for two years. This is not something we were blindsided by, this is something we saw coming for many, many months."
The deadline to enroll for benefits also prompted VanWinkle to recommend the board take action. Open enrollment begins Sept. 15 and must be completed by Oct. 15.
"They have to know if you're going to fund the standard or partnership option," VanWinkle said. "They need to know before they sign up. The coverage is above what we have now. The coverage is higher, the deductibles are higher. The state took the HMO away. It is no longer an option. All we have left are the PPO plans."
Dan Schlafer, 9th District representative, moved to approve the school system funding the ParTNers PPO plan, with employees electing standard PPO coverage paying the difference in the premium. The motion was supported by Jim Blalock, 8th District representative. The motion was approved unanimously.
VanWinkle plans to meet with teachers during the first week of September, and all those currently receiving benefits should receive information in the mail on insurance changes this week.
