Logan County sifting through fine details of choosing a health insurance provider

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[March 15, 2017]  LINCOLN - On Tuesday, March 14, 2017, the Logan County Board's Finance Committee held its monthly meeting. The focus of their discussion was proposals for health and dental services to county employees.

Nathan Whiteman, the county's new insurance consultant, thanked the board for the chance to serve the employees of the county. He said, "I am committed to providing the absolute best service in the industry, solid reliable consultation with employee benefits management design, and [will always have an] open door for the employees of the county." Whiteman said, "I want to make sure the employees have access to what they need when they need it."

Whiteman said that with a "time crunch," he has worked diligently with the Logan County employees on the 2107-2018 health renewal due soon.

Whiteman shared what he has been researching and gave county board members a packet outlining some of the bids he has gotten from insurance agencies.

He said his office is in the process of granting Vicki Dugan and Penny Thomas "access to some of our human resources and employee benefits management database tools. These tools are sure to save them many hours of work in their database management of the benefit plans and employees."

Whiteman said with the assistance of Dugan and Thomas and our current Blue Cross/Blue Shield account representative, "we have collected the needed information to successfully take the group medical and dental insurance to market for competitive pricing." He said the proposal is not final, but shows what he has done and where bids are at right now.
He asked for quotes from Health Alliance, Aetna, Humana, United Health Care, and Blue Cross for medical. He said, "I am working on dental comparisons from Aetna, MetLife, GuardianLife, Standard, Delta Dental, Principal, Ameritas, and United Healthcare."

Whiteman said several county employees have contacted him and some wanted to "voice their wishes for the direction of future benefit offerings." He has talked to around 20 county employees during the two weeks of data preparation and collection, adding, "My office has logged over 25 hours" meeting with Dugan and Thomas, multitudes of emails, phone calls with multiple insurance companies, and organizing important renewal data.

He said, "our goal is to get approval on the benefit selection for 2017-2018 by March 21 and be finished with the employee enrollment by no later than April 1 so that Vicki and Penny can get their payroll set up for the upcoming month."

Whiteman said the Blue Cross plan is set to take a decrease of 1.7 percent. He said, "you were set to take a little over a six percent increase and that is just general costs and inflation." Whiteman said a decrease in demographics, the average age of the group, and credits for better risks account for the 1.7 percent decrease on the table from Blue Cross.

Whiteman said employee rates, employee spouse rates, and employee family rates are "all adjusted across the board a little differently. On average, they went down 1.2 percent, but a few went up a few bucks, and couple down five dollars." Employees need to understand the differences.

Whiteman said taking a decrease or flat renewal is the time you want to "go shop" and "take your case to other insurance carriers" saying "we're a healthy group, you should want us this year, give us your best price. That is what we are doing."

Whiteman said the carrier his office has the most business with is Health Alliance and they quickly sent the county a quote. He said their quote is "significantly higher than the Blue Cross/Blue Shield" when comparing their Preferred Provider Organization networks.

Whiteman said the only way to make Health Alliance competitive in that situation is to "start raising deductibles" but "that is something we want to avoid if we can do it." He said, "In working very diligently with Sara, our Health Alliance representative," I had her look at a point of service network which is "a blend of an HMO network where you can only see your primary care physician as in-network and a PPO, so it is kind of a hybrid model."

Whiteman said the point of service network is a "tremendous value" and can save premium costs. Whiteman said, "The challenge we have run into with Health Alliance, and where we stand today, is that Health Alliance was able to mimic almost line for line your current Blue Cross plan design and put it on the point of service network and the costs are almost the same." He said I am trying to "educate you" on the plans, but not necessarily make a recommendation.

Whiteman said when comparing them side-by-side and from the employee shoes, "I think there is less risk being on the Blue Cross platform for the employee than on the Health Alliance assuming that they are the same cost." Whiteman said, "In a lot of situations, that point of service plan from Health Alliance can be significantly less expensive."

Whiteman said the comparison is "apples to apples in price, but they are oranges to apples in terms of the network."

Whiteman said the Humana representative did not provide a quote because she told them there is not a good network in Lincoln. Whiteman said, "United Health Care and Aetna both told me they would have quotes Monday or Tuesday, and I do not yet have quotes from them." He plans to ask them for quotes by tomorrow, but said they may decline or price themselves out. Whiteman said, "We have done business with both of them" and "both are good."

Committee Chairman David Hepler said he was "uncomfortable" about Whiteman calling Health Alliance a "strong network" and in the next paragraph essentially "suggesting we reject because it is an inferior network." Hepler said, "my concern is we should be making the judgment without the consultant biasing the data."

Hepler said Whiteman explained it better tonight and what Whiteman sees as an inferior network might "very well be what we need where we have some steerage and we have some directed care."

Board Chairman Chuck Ruben said he felt when Whiteman called it an "inferior network, it was the fact that their point of service would be an inferior network in the sense that we would not be able to use all the same people we were used to using." Ruben said some find it worth more to keep the same doctors and that can be a "strong point."

Whiteman said, "In the context of what I intended, that is what I meant." He said, "It is very expensive to have a wide open door of doctors you can see anytime for any reason. Health Alliance has made huge strides in constructing this hybrid point of service model."

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Whiteman said, if the point of service network is going to cost the same as the Blue Cross PPO network, "that is not the direction I would go. That being said, long term it is absolutely a direction we should investigate every year." He wants to provide transparency and ideas by looking at every carrier and plan design. Whiteman said he does business with all of them and does not benefit more from one or the other.

Board member Adam Schmidt, who chairs the board's Insurance and Legislative Committee asked if the "apples to apples" comparison between Blue Cross and Health Alliance includes the consultant fee.

Whiteman said he did not add the consulting fee in for Health Alliance. Since it is already included in the Blue Cross pricing, "They are not apples to apples when you add the consulting fee." Health Alliance would be $30,000 more with that fee added.
Lisa Bobb asked about the referrals and costs and whether the primary care doctor will charge an office fee.

Whiteman said primary care doctors will usually write referrals for specialists in the network, and thought someone could get a referral without an office visit. He said it could be "very situational." He said a point of service has the flexibility of a PPO but can be less expensive.

Hepler said some problems can be managed by a primary care physician more cost effectively than referring someone to a specialist.

Whiteman said the Health Alliance representative has offered to come Thursday and answer questions about the point of service concept. He said the numbers have to make sense.

Board Office Administrative Assistant Brenda Clark asked whether United Health Care and Aetna offered point of service.

Whiteman said United Health Care does, but he is unsure about Aetna. He said United Health Care has a "skinnier network" south of Peoria.

Ruben said previous large claims may keep some providers from giving their best bid and the others may be able to do better pricing in a year or two. He asked whether other board members would even consider Health Alliance with a bid that would be $30,000 higher after consultant fee.

Hepler said he would because "in the long run, it could reverse a trend. It could make others interested in bidding."

Schmidt asked about employee feedback on the current plan we are in.

Whiteman said people want a "stronger plan for less money," so "a lot of the feedback was, how do I get a lower deductible and can you also lower the premium for my spouse. The general feedback regarding Blue Cross alone was that they are happy with it." Some may be looking for alternatives.

Whiteman said a broker needs to provide people the "full gamut of options looked at, given consideration, presented in its entirety every year for the board to digest information, discuss opportunities, risk, [and] costs. That is what we will do."

Dugan asked about Blue Cross costs and whether they could have "a PPO, an HMO, and a high deductible" to help with "lower premiums."

Whiteman said for one place he is quoting three plans. He said the high cost one is a PPO plan, the middle one a HMO plan, and the third one is a Health Savings Account plan with "a $5000 deductible on the point of service plan driving down the premium a lot. There is savings in that strategy."

Whiteman said he could look at plans more affordable for dependents, which many employees have asked about.

Dugan said some people would like to switch to a cheaper plan where they could add their spouse without "breaking the bank."

Cheryl Hedrick said the employees in the county's Emergency Management Agency want to keep what they have now, but want something cheaper.

Whiteman said the dental insurance is currently provide by Blue Cross, which last year provided a rate relief. He said the rate relief was a one time benefit.

Whiteman said he had heard from Delta Dental, MetLife, And Principal and "we have lots and lots of great options on the dental coverage and lowering the cost."

Hepler asked Whiteman whether by Thursday he would have the network of dental providers in Logan County.

Whiteman said, "Yes, I can put that together. We will take the best quotes we have and maybe put a snippet of what that looks like." He said out of network is not as big a problem with dental insurance.

Ruben said they need to check on eligibility for board members for dental insurance. They were not eligible with Blue Cross.

Whiteman said he wants to improve what is being offered. He will be at Thursday's board workshop to provide updates and answer more questions.

Finance Committee members present were Committee Chairman David Hepler, Vice Chairman Janet Dahmm, Dave Blankenship, Bob Farmer, Gene Rohlfs and Board Chairman Chuck Ruben. Other board members present were Emily Davenport, Bob Sanders and Scott Schaffenacker.

Guests were several county employees including county treasurer Vicky Dugan, Cheryl Hedrick from Logan County EMA, Amy Kuhlman and Brenda Clark from the county board office, and victim's assistant Lisa Bobb.

[Angela Reiners]

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