Employee Benefits Seminar (Health Insurance)

One of the key considerations in any benefit package is the Health Insurance package. The City needs to consider the cost, and the benefit to personnel. I think the City has a stake in providing insurance so the employees remain healthy, and, as has recently been emphasized, the City and personnel need to be concerned about employee actions that affect their health.

The seminar I attended had some interesting highlights about health insurance and especially employee retiree health insurance. I doubt that the City of Lakeland can even provide for retiree health insurance (although currently we have no retirees, with the except of one medically retired retiree who qualifies for medicare as a result of disability.)

The first session concerned the reason (or reasons) for the high cost of medical care. There are a number of considerations:

-The structure of health care providers (especially the “middleman” between the manufacturers of medicine and the pharmacy)

-“Lifestyle” decisions by consumers that lead to higher medical costs. (Obesity, GERD, stress, failure to exercise, smoking etc.)

-Baby boomers aging

-Consumer confusion resulting in the options available and the lack of transparency of the health care delivery system-the consumer is unable to make an educated decision.

It was explained that under the traditional system, the health insurer (more of an Administrator) re-insures much of the risk.

Studies by health insurance companies indicate in general that over 57% of group members have claims of less than $500 and 70% have claims of less than $1,000! This generally means that most groups are “over insured” and have too low of deducibles.

RETIREMENT HEALTH

“Retirement Health” refers to both pre-medicare (55-64) and medicare (65 plus) retirees. Each group must be considered differently.

There are several plans for the pre-medicare retiree. The City currently offers a Retirement Health Savings program, and that is probably the limit that the City can consider for pre-medicare retiree’s. There are other programs available that the City would have to partner with other cities or on a regional basis.

Medicare retirees (and personnel over 65 still working) also have options and this is perhaps more interest to the City at this time, since several personnel (or dependent) are becoming medicate eligible. I have found the information on medicare to be horrible so I feel the City had to be able to at least provide information for the medicare eligible employee/retiree to make a decision.

Medicare includes the following:

Part A-(Hospital)
-Available to all

Part B: (Medical)

-Optional coverage
-Choice of Doctors

Part C: Medicare Advantage Plans
(private companies htat actually handle the coverage)

Part D: Prescription Drug Coverage
(optional)

Medicap: coverage: retiree chooses this fills in “gaps” of A, B and D coverage.

(NOTE: With Part C., the insurer provides “one card” and files claims with Medicare etc.)

The purpose of this session was not to discuss personnel over 65 who continue to work. However, this did provide a framework for me to get additional information and provide alternatives to personnel who are 65 or have family coverage for someone over 65.