County health premiums set to rise

Mesa County employees may see an increase in their medical plan premiums next year as a result of extra costs this year.

After two straight years of relatively low medical claim costs for the county’s self-insured program in 2011 and 2012, the county has been hit with an unexpectedly high number of expensive claims so far in 2013 due to serious illnesses, according to Mesa County Assistant Director of Human Resources Sheryl Coffey. Coffey told Mesa County commissioners in a medical plan update meeting Tuesday that claims of $25,000 or more have increased from $607,472.89 in the first five months of 2012 to $833,978.17 in the first five months of 2013.

The cost of claims, stop loss premiums and administration for the medical program, plus an anticipated spending of $765,000 for the county’s two-and-a-half-year-old health clinic for employees will exceed the county’s anticipated revenue from premiums by nearly $250,000 if county predictions for total 2013 medical plan costs and income prove true. Coffey said the worst case scenario for a deficit in the medical plan could be $725,000 if the county continues to implement health care reform provisions as originally planned. It was announced Tuesday some federally-mandated health care reporting requirements for large employers can begin Jan. 1, 2015, instead of Jan. 1, 2014.

There is $978,791.83 in reserves to cover the deficit at the end of 2013, but increased premiums would be needed in the future to restore reserves and/or keep the plan going in other years.

Commissioners showed initial support in the meeting for increasing employee premiums Jan. 1, 2014, by implementing a four-tier medical plan system instead of the three-tier system currently in use. The three tiers now are plans for one employee, an employee and another person and family coverage. The four-tier system would replace the employee plus one category with an employee plus child category and an employee plus spouse category. Premium prices have not been decided for the plans but those prices and the decision whether to increase premiums should be set by the end of August or early September, Coffey said.

This is the first year since the county clinic opened that the county has faced a medical plan deficit, Coffey said. County Administrator Tom Fisher said the shock claims of 2013 may be an anomaly. “It seems like a very explainable year-to-year problem,” he said.

Commissioner Steve Acquafresca said he understands this has been a tougher year for claims in the county, but he questions whether the county is seeing appropriate returns on the county clinic to justify its presence. Acquafresca said Tuesday he does not suggest closing the clinic and he hopes to see a cost savings due to the clinic in five or more years, but he’s skeptical those results are coming, especially since many county employees use both the clinic and a primary care physician.

“It’s possible that the clinic could be used by many folks just as some additional supplementary care that they wouldn’t seek if they didn’t have this free option,” he said.

Coffey responded that the potential cost-savings of the clinic will require the county to take a long-term view of at least five years.

“We would rather them (employees) take care of their diabetes than pay for an amputation. We would rather them take their high blood pressure medication than pay for a heart attack,” she said. “A lot of it is giving employees quality, low-cost health care so they can begin to take care of themselves so we don’t have these shock claims and large claims down the road.”

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