Oneonta poised to join health insurance consortium [The Daily Star, Oneonta, N.Y.]

Sep. 14—City of Oneonta officials have proposed joining the Cayuga County health insurance consortium, a move that would change city employees' health plans from a zero deductible but would eliminate co-pays after the deductible is reached.

The Common Council's finance committee decided Thursday to move forward with the proposal.

City Administrator Greg Mattice said that the city's health care task force and the city's health insurance broker, USI, have been looking into other options, including having preliminary conversations with the Cayuga County consortium.

"They are open to having the city of Oneonta join their consortium," Mattice said. "We're recommending joining that, and switching to what is actually a high deductible health plan, which would be fully funded in the sense that the deductible for in-network costs would be funded by the city. There is no out-of-pocket costs going toward the in-network deductible coming from an employee."

A deductible is the amount an insurance holder pays out-of-pocket for covered health care services before insurance starts to pay. After the deductible has been reached, the insurance holders usually pay only a co-payment or co-insurance with the insurance company picking up the rest.

There are low and high deductible plans. Low-deductible plans have a lower threshold to reach before the insurance kicks in. Insurance holders pay less money upfront for medical costs, but pay more for monthly premiums.

High-deductible plans have higher out-of-pocket maximums, but the benefit of a lower monthly premium.

Healthy people may go with a high-deductible plan to save money month to month, but a low-deductible plan means you generally won't be stuck with high medical bills after a health emergency event.

According to a benefit outline by USI presented to the committee, the deductible would be $7,500 for an individual and $15,000 for a family.

"If that sounds high, it is," City Human Resources Director Joseph Temming said, "and the reason why is that it helps draw down the premium costs."

The city would also do a health reimbursement arrangement.

"What we're doing is essentially ensuring the HRA deductible piece of it," Temming said, "so that there will be no cost to the employees. They will not need to pay deductibles."

The city is proposing staying with Excellus BlueCross BlueShield. The underlying PPO plan would be the current plan that the city offers to most employees, so the benefits there would remain the same.

The consortium plan would eliminate in-network co-pays for wellness and preventative care, primary care office visits, specialist office visits, walk-in and urgent care visits, emergency room, outpatient lab and x-rays, complex imaging like MRI and CAT scans, outpatient surgeries and inpatient hospital stays, and instead cover them 100 percent after the deductible.

Retail, mail order and specialty prescription drugs also would be covered 100 percent after the deductible.

Temming added that the city would see about a 10 percent reduction in costs overall.

City Finance Director Virginia Lee said that if the city sticks with the status quo and doesn't make the change, health insurance rates are poised to go up by 12.5 percent.

"By making this change," she said, "our health insurance premiums city-wide will go down about $388,000."

Temming said that joining the consortium would bring savings in the first year.

"In the future, it's likely the rates will still go up," he said, "but I think it's important to note that by being in this consortium, with a large group, there's kind of a better buying power. Also the risk is spread out over a larger population group ... We do believe based on the history for this consortium, and even factoring in our membership, that those percentage increases would be significantly lower than what we're getting in the market right now."

___

(c)2023 The Daily Star (Oneonta, N.Y.)

Visit The Daily Star (Oneonta, N.Y.) at www.thedailystar.com

Distributed by Tribune Content Agency, LLC.