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Changes Slated For State Worker Health Insurance

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As many as 2,000 obese state employees who suffer from conditions such as diabetes or hypertension can enroll online for a program that provides coverage for treatment and management of obesity and related conditions.

The offering is one of a number of changes legislators authorized to the state group health-insurance plan during the 2017 session. Available to employees who were enrolled in Aetna, AvMed, Florida Blue or UnitedHealthcare plans in 2017, the benefit is available for 2018.

Tami Fillyaw, director of the Division of State Group Insurance in the , appeared Tuesday before the House Health & Human Services Committee and the Senate Governmental Oversight and Accountability Committee to update lawmakers on steps the department has taken to retool the health-insurance program, which, as of June 30, provided benefits to more than 367,000 state employees, spouses and dependents. 

Fillyaw told lawmakers that the state inked a contract last week with the independent benefits consultant Foster & Foster to meet requirements of the bill approved during the 2017 session. Among other things the consultants will analyze the state group plan, compare its benefits to that of other large employers and submit a report to the Legislature by Dec. 1.

Foster & Foster also will assist the state as it moves forward with two new health-care offerings that will be made available in the 2019 plan year: an online tool to shop and compare the quality of available in-network providers; and a service that offers employees access to comprehensive pricing for surgery and other medical procedures.

Both of those benefits also will include a “shared savings program,” where employees can receive a portion of any savings attributable to their health-care choices.

Fillyaw said employees' shared savings will be deposited into flexible savings accounts, health savings accounts or health reimbursement accounts (which would be a new benefit offering) or could be used for out-of-pocket medical expenses.

Fillyaw said the state has met with potential vendors interested in both initiatives and issued requests for information about the potential services. She said the state will issue invitations to negotiate in January and hopes to have signed agreements with vendors by April. “Ideally,” she said, the offerings can be in place for the 2019 benefit year.

As part of an overall budget agreement that included pay raises for state employees and changes to the Florida Retirement System, the Legislature during the 2017 session agreed to pass SB 7022, which directed the Department of Management Services to begin offering state employees a variety of health plans.

Currently, employees have access to HMO coverage, PPO coverage and a high-deductible health plan. 

One of the biggest changes will take place in 2020 when the Department of Management Services offers access to four different levels of insurance: platinum, gold, silver and bronze. The plans will have different actuarial values --- ranging from a high of 90 percent, meaning the policy will cover 90 percent of health-care costs --- to a low of 60 percent.

The higher the actuarial value of the plan, the more it will cost. If an employee chooses a health plan that costs less than what the state contributes in premium, the employee can request that the difference be directed toward other benefits or to salary.

While the legislation was not touted as a cost-saving measure, expenses in the state group health insurance are a growing concern for lawmakers. State economists say the trust fund that pays the costs of the program will have a $357.3 million deficit by June 30, 2019.

Helping drive the costs increase, Fillyaw told lawmakers Tuesday, are prescription drugs.

Fillyaw said that regardless of the plan, all employees are enrolled in the state's self-insured prescription drug program. Pharmacy costs for state employees are projected to be $693.1 million this year, a jump of more than $81 million from the previous year's spending.

To help curb the costs, the Department of Management Services will ask the Legislature to consider changes to the pharmacy program.

“Prescription drug spend is the most unpredictable cost driver in our program,” Fillyaw told lawmakers, adding that there are formulary-management programs in 18 state-employee health insurance programs across the country.

Copyright 2017 Health News Florida