Sun Guild Unit - Oct. 12, 2004 Bulletin

Oct. 12, 2004

Health Enrollment Time, Again
Ways to Soften the Blow as Tribune Hikes Out-of-Pocket Charges

You should have received a notice at home that it's benefits enrollment time again. What's new is that enrollment this year is being done on line. (You'll need your Triblink user name and password. If you have problems or questions, call the Trib service center, 1-800-872-2222.) Enrollment started this week, and continues through October 29.

What's not new is that Tribune is again passing more of the costs of health care on to you -- both through increased deductibles and co-payments and through increasing the percentage of the premium you pay for family coverage.

Given the increased out-of-pocket costs, there are two options you might want to think about, even if you've rejected them in the past. Neither solves the problem entirely, and both have drawbacks, but either or both can reduce your out-of-pocket costs. They are:

Use a tax-sheltered "flex spending account" for your deductibles and co-payments.
The paperwork can be somewhat of a hassle, but you can save some money. Perhaps because of the paperwork, only about ten percent of us are signed up for this option currently, but the more Trib jacks up our out-of-pocket charges, the more taxes you can save.

You set up the account during enrollment, designating an amount to be deposited in the account from each paycheck. This money is deducted before state and federal income and social security taxes, so if you spend $1,000 a year, you can save (depending on your tax bracket) $400 in taxes.

You then need to save receipts from your health spending, and send them in with a form you can print from the loop. You'll get a check from your account reimbursing you for what you've spent (with your own money, but untaxed money).

A plus is that you can use this not only for deductibles and co-payments, but for some health-related spending not covered by insurance, such as over-the-counter medicines and laser eye surgery.

A minus, beyond the paperwork, is that each year's account is use-it-or-lose-it. So if you put, say $1,000 into the account, but only spend $900, the extra $100 is gone. On the other hand, if you've saved $400 in taxes, you're still ahead of the game. Also, if it looks like you're not spending fast enough, you can always stock up on over-the-counter meds or other covered items, in December.

Switch from Blue Cross to an HMO.
The Blue Cross plan gives you more flexibility, but it costs more out of each paycheck, and it can cost you more when you visit the doctor or fill a prescription.

About half of us are in Blue Cross, having decided that that advantanges outweigh the extra costs. Now that the extra costs have increased, you might want to look at the cost-benefit equation again.

There's no plan that's best for everybody. Whether a given plan is worth the cost to you depends on your finances, your health and your family.

While we can't tell you which plan to choose, we can tell you some advantages and disadvantages of each. Also, on the back of this sheet is more information about the HMOs and Blue Cross. (over)

Kaiser Permanente was singled out by state regulators for top performance on the annual HMO report card, showing how our plans performed on clinical measures (such as childhood immunization rate) and on a survey of consumer satisfaction. For example, 40 percent of members surveyed said they would definitely recommend Kaiser to a friend or relative, compared to 33 percent for Aetna and 25 percent for CIGNA. The full report card is available at www.mhcc.state.md.us.

(There is no report card data for Blue Cross Blue Shield PPO because the state only rates HMO plans, but the Blue Cross PPO in Maryland ranked fourth of 43 plans ranked in consumer satisfaction in a survey by Consumer Reports.)

Whatever the report card shows, the most important factor for you may be which plan your doctor or doctors are in. If you're new to the area, you might want to pick a doctor first, then find out which plans the doctor participates in. If you've already got a doctor, you might want to check with your doctors to find out which plans they'll be in.

For technical legal reasons, Kaiser and Aetna are subject to Maryland's state mandates, which require certain benefits and establish an appeal procedure with the state insurance administration if there's a dispute over whether you need care. Blue Cross PPO and CIGNA are exempt from these requirements. If there's a particular service you want - such as in vitro fertilization - you should check to see if Blue Cross PPO and CIGNA cover it. Blue Cross PPO is the only plan that pays part of the costs (but you pay part as well) if you use doctors or hospitals out of the network. HMOs only pay for in-network care, but if your doctors participate in that HMO, that may be enough for you.

Blue Cross Blue Shield PPO:
This is most flexible of the plans offered, but also the most expensive. This is a preferred provider organization. Like HMOs, PPOs have a network of participating doctors and hospitals. But as long as a doctor is in the network - and in Maryland, most are in the Blue Cross PPO network -- you can go without a referral or other action from a primary care physician or "gatekeeper."

Kaiser Permanente:
This is a so-called group model HMO, meaning most of the care is provided by doctors who work full-time in Kaiser centers. This can result in care that's better coordinated and simpler, since all of your doctors are in one place. On the other hand, it offers the least choice of providers; if you want to go to a non-Kaiser specialist, for example, it won't be covered. And if you don't live near a Kaiser center, this might not work for you. In the Baltimore area, Kaiser has centers in downtown, Towson, White Marsh, Woodlawn, Severna Park, Columbia and Annapolis. In addition, Kaiser has a network of "community physicians" similar to the other HMOs, but not all hospitals are in the network. You have the same co-pays if you use the community physicians. For prescriptions, you can get them filled at Rite Aid, Giant, Target, Safeway and some independent pharmacies, but the co-payment is higher than if you fill them at a Kaiser pharmacy.

Aetna and CIGNA:
Aetna and CIGNA contract with doctors who work in their own offices, and nearly all hospitals are in their network. Otherwise, like Kaiser, they pay only for care given by network doctors, and require approvals for certain types of care. Remember that Aetna must meet state requirements for benefits and appeals; CIGNA doesn't have to.

-- Bill Salganik