Board approves adding deductibles to employee health plans

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MADISON, Wis. (AP) — Wisconsin's insurance board voted Tuesday to add deductibles and increase out-of-pocket payments in state employees' health care plans in a move designed to save an estimated $85 million over the next two years.

The state Department of Employee Trust Fund's Group Insurance Board approved the measure on a 9-2 vote. The health care system covers about 240,000 state employees, families and dependents.

Gov. Scott Walker's proposed budget calls for saving $81 million on health care coverage, but he didn't lay out how to get those savings. He asked the insurance board to work with New York-based Segal Consulting, and those consultants presented their recommendations to the board Tuesday.

Besides adding deductibles — $250 for individuals and $500 for families — to the uniform benefits plan that covers most state workers, the board voted to double maximum annual out-of-pocket payments to $1,000 for individuals and $2,000 for families.

The head of the state's largest employees union reacted angrily.

"What the group insurance board did today is unconscionable," Marty Beil, executive director of the Wisconsin AFSCME, said. "I'd also call it evil that they're treating state employees at that level. It's incredible."

Two other health insurance plans cover a small portion of state workers. Those covered under the two plans already pay deductibles. Those deductibles will increase, as will maximum out-of-pocket payments.

Chairman Jon Litscher had proposed dropping the new deductibles, saying the board could meet the governor's goals without them. His amendment was approved, but Litscher withdrew it before a vote because he said it was causing too much confusion.

The plan would also increase out-of-pocket limits for prescription drugs. Employees would pay between 20 percent and 40 percent of name-brand drugs. Generics would remain at $5 each.

The plan would also replace coinsurance with copays for office visits. Employees currently pay 10 percent of the price of their appointment or service for primary care visits; that would change to a fixed $15 copay.

The plan would reduce costs enough to avoid the Affordable Care Act excise tax, Alternate Health Plans manager Tara Pray said at the meeting Tuesday. The 40 percent excise tax will affect health benefits companies that provide insurance coverage above a certain threshold. The tax, which will go into effect in 2018, would affect providers under the state's current health insurance structure.

Segal's recommendation also would have included bariatric surgery in health care plans, but the board dropped the weight loss surgery coverage from the package.

Also on Tuesday, the Legislature's Joint Finance Committee approved a measure that would require that any changes implemented by the board dealing with the state insurance program also be approved by the Legislature's Joint Committee on Employment Relations. Those changes would then be submitted to the governor. It wasn't immediately clear Tuesday if the board's decision would be subject to that additional review.


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