On Monday May 10, 2010 Brigid Woods and Jim Lynett attended the annual SISC (Self Insured Schools of California) health benefits update meeting in San Luis Obispo.  SISC is a joint powers authority that administers health benefits plans for hundreds of school districts in California.  They primarily contract with Anthem Blue Cross for the service provided to their members.  All of the school districts in San Luis Obispo County are members of SISC and they were also represented at the meeting.

     Last year (2009-2010) SISC “used their reserves” because of the economic conditions to keep rates the same as the previous year (2008-2009).  This year they were unable to do so because of “rising costs” although they contend that they also used “some reserves” to mitigate the premium increases that they contend would have been 5% higher without their action.  The bad news is that almost every rate has dramatically increased.  Delta Dental Incentive is the only provider that has kept rates unchanged from last year.  Our vision provider VSP has increased rates by 8.5%.  Major medical is where the majority of the premium dollars go and it is the area with the largest increases. Your Anthem/SISC III Card will state your group number listed below. 

 

 Group 40311G

2009-2010                                                                   2010-2011

Plan #1  Prudent Buyer Classic (PBC) 100% - C            PBC  100% - C

Deductible Individual/Family $200/$400                          Deductible Ind/Fam $200/$400

Maximum Co-Insurance  $0                                          Max Co-Insurance $0

Office Visit $30                                                            Office Visit $30

RX G 2-Tier $3/$15                                                       RX $3/$15

                          10.4% Increase or $110.40 per month more

Delta Dental Premier Incentive $1000                            No increase

Delta Dental DPO (PPO)/Ortho $2000/$2000                 10% Increase or $9.60 per month

Vision Services Plan B $15/$25                                    8.5% Increase or $1.44 per month

 

2009-2010 Payroll Deduction with Delta Incentive              $239.35 per month

2010-2011 Payroll Deduction with Delta Incentive              $351.19 per month

 

2009-2010 Payroll Deduction with Delta DPO                   $246.67 per month

2010-2011 Payroll Deduction with Delta DPO                   $368.11 per month

 

 

Group 40311H   

2009-2010                                                                   2010-2011

Plan #2 PBC 90% - E                                                   PBC  90% - E

Deductible Indiv/Fam $300/$600                                    Deductible Ind/Fam $300/$600

Max Co-Insurance $600/$1800                                      Max Co-Insurance $600/$1800

Office Visit $30                                                            Office Visit $20

RX $10/$35 ($200 deductible/brand name)                      RX $10/$35 ($200 Deduct)

                                    12.9% Increase or $109.20 per month more

Delta Dental Premier Incentive $1000                             No Increase

Delta Dental DPO (PPO)/Ortho $2000/$2000                  10% Increase or $9.60 per month

Vision Services Plan B $15/$25                                    8.5% Increase or $1.44 per month

 

2009-2010 Payroll Deduction with Delta Incentive              $30.55 per month

2010-2011 Payroll Deduction with Delta Incentive              $141.19 per month

 

2009-2010 Payroll Deduction with Delta DPO                   $37.87 per month

2010-2011 Payroll Deduction with Delta Incentive              $158.11 per month

 

 

Group 40312F

2009-2010                                                                   2010-2011

Plan #3 PBC 80% -G                                                   PBC  80% - G 

Deductible Indiv/Fam $500/$1000                                  Deductible Indiv/Fam $500/$1000

Max Co-Insurance $1000/$3000                                    Max Co-Insurance $1000/$3000

Office Visit $30                                                            Office Visit $30

RX Consumer Share $5/$15/$35                                    RX Consumer Share  $5/$15/$35

                                   13.3% Increase or $110.40 per month more

Delta Dental Premier Incentive $1000                             No Increase

Delta Dental DPO (PPO)/Ortho $2000/$2000                  10% Increase or $9.60 per month

Vision Services Plan B $15/$25                                     8.5% Increase or $1.44 per month

 

2009-2010 Payroll Deduction with Delta Incentive              $10.15 per month

2010-2011 Payroll Deduction with Delta Incentive              $121.99 per month

 

2009-2010 Payroll Deduction with Delta DPO                   $17.47 per month

2010-2011 Payroll Deduction with Delta DPO                   $138.91

 

 

NOTE:  Plan #4 is only for dual-insured members, meaning the spouse or domestic partner of a fully insured member if they are both employed by Paso Robles Public Schools.

 Group 40312C

2009-2010                                                                   2010-2011

Plan #4 Prudent Buyer Base Plan 80%                          Plan #4 PB Base Plan 80%

Deductible Indiv/Fam $2000/$4000                                 Deductible Indiv/Fam $2000/$4000

Co-Insurance $3000/$6000                                            Co-Insurance $3000/$6000

Office Visit $30                                                            Office Visit $30

RX $10/$35 ($200 deductible/brand name)                      RX $10/$35 ($200 deductible/brand)

                                       12.3% Increase or $82.80 per month more

Delta Dental Premier Incentive $1000                            No Increase

Delta Dental DPO (PPO)/Ortho $2000/$2000                 10% Increase or $9.60 per month

Vision Services Plan B $15/$25                                    8.5% Increase or $1.44 per month

 

2009-2010       Cost $8103.50             Contract CAP $9392.00

Medical Reserve Account Contribution: $1,288.50 annually with Delta Incentive

2010-2011       Cost $8945.94             Contract CAP $9392.00

Medical Reserve Account Contribution: $446.06 annually with Delta Incentive

 

2009-2010       Cost $8176.20             Contract CAP $9392.00

Medical Reserve Account Contribution: $1215.80 annually with Delta DPO

2010-2011       Cost $9114.60             Contract CAP $9392.00

Medical Reserve Account Contribution: $277.40 annually with Delta DPO

 

 

There are other changes for 2010-2011 that are important to note.

1. Health Care Reform has eliminated the lifetime CAP on services that was $5,000,000. This means there is no CAP on the amount of services paid.
2. Health Care Reform has also made children eligible for coverage under their parent(s) plan(s) until age 26. This benefit takes effect on 10/1/10. As of now, when a child turns 25, they are not covered. After 10/1/10 this will change and a child will no longer be covered when they turn 27. This also applies to married children and they will no longer need to be dependents or students.
3. All plans will have a $100 emergency room co-pay unless you are admitted to the hospital.
4. Because of a change in Federal law all mental health benefits must be equal to medical benefits so there is no longer a separate Behavioral Health Plan because the benefits are identical to the medical benefits listed above.
5. Bariatric surgery such as lap band, gastric, weight loss related must be performed at a credentialed medical facility.
6. COBRA benefits subsidy expires on 5/31/10 as of now. It has been extended before, but nothing new as of now. What this means is that last year members who were laid off had to pay 35% of their group premium to continue benefits coverage and the federal government paid the other 65% in the form of a tax credit to the school district. If this is not extended beyond 5/31/10 then laid off members will have to pay 100% of the premium (that includes the district’s share and the member’s out of pocket cost) to extend health benefits coverage.  CTA/NEA and CFT/AFT are lobbying very hard for an extension past 5/31/10.
7. We have researched other health benefits administrators in order to determine if we could receive the same or better service elsewhere, but for a variety of reasons we have been unable to find another administrator that we could contract with that could both provide us with better rates and the same quality of service. In other words, SISC has a virtual monopoly and they know it.
8. Remember that the premiums you pay out-of-pocket can be tax sheltered (they are paid with pre-tax dollars) if you enroll through American Fidelity in the currently offered IRC 125 plan.
9. All of the above plans include Income Protection for disability payments.   

 

     In addition, please be aware that your union has been as pro-active as possible both locally and through our affiliates at CTA and CFT to contain healthcare rate increases. Two years ago we wrote a letter to Russ Bigler, the CEO of SISC, asking him to explain why SISC was not a member of the California Health Care Coalition (CHCC). The CHCC has been one of the leaders in the state working to contain healthcare cost increases. It is a coalition of labor, business and governmental groups working together to find ways to measure the quality of care correlated to outcomes and costs. After 3 months we received a letter from Mr. Bigler that said that SISC had joined the CHCC. The CHCC has been a leader in developing tools to access data on the comparison of hospitals and doctors who perform the same procedures. There is a wide variation in outcomes and costs associated with the same procedures depending on the hospital or doctor a patient chooses. This variation can affect the quality of care and the CHCC is using this data to attempt to identify the best hospitals and doctors. This may even lead to the elimination of some hospitals and doctors from the available care network. It also speaks to the fact that healthcare consumers need to be educated and aware of what they are buying. Many people spend more time researching a car or appliance purchase than they do major surgery. We will continue to pressure SISC to participate in cost containment strategies like those pioneered by the CHCC.

 

     Finally, we want to make it completely clear that the above increases are proposed as part of the negotiations process. The district has proposed that their contribution to health benefits remain the same for the 2010-2011 and the 2011-2012 school years. This contribution is referred to as the “Contract CAP” and it is currently in the amount of $9392.00 per year. This means that the district proposal is to pass on 100% of the proposed increase in premiums from SISC to us (the certificated bargaining unit). In the past, we have split the increases 50/50 and we think this has been a fair arrangement. However, now the district says it has no money and wants us to absorb all of the increases for next year and 2011-2012. This is in addition to furlough days and the suspension of all stipends. As we have said before, we will not rest until we have complete knowledge of all the district financial information and we are fully convinced that the district has exhausted all avenues related to cost-savings and moreover has oriented its priorities to put the core academic program inside the instructional day at the forefront. Please contact us with your ideas and concerns.

     The district will be sending out its Health Benefit Selection Form over the summer that will mirror the rates listed above.  There might be some minor changes to the out-of-pocket amounts listed above.

 

 

Your PRPE Negotiations Team:

Lisa Tate (Chair), KK

Brigid Woods, WP

Robert Skinner, PRHS

Kathleen Saxby, BS

Jenny Martinez, LMS

Jim Lynett, IHS