Cape school district insurance likely to be chosen by November

Health insurance options recently were discussed during a Cape Girardeau School Board work session and probably will be brought back for action before winter break, assistant superintendent for administrative services Neil Glass said.

The district has a Jan. 1 renewal date on its current coverage.

"We want to get everybody enrolled before they leave for Christmas break, so we need to bring something to the board at least by November," Glass said.

The school district has 731 members in its health-care plan, including employees and retirees, and pays 100 percent of insurance costs for employees, Glass said.

Options include keeping the district's fully insured plan; going to self-insurance; renting a Preferred Provider Organization; and partial self-insurance.

Fully insured plans would mean contracting with a large carrier such as Anthem, United or Coventry. That company would pay all the district's claims for it and the district would know exactly what it would be out for the year, Glass said.

"We budget that amount. We know what our risk is at that point," he added.

With self-insurance, the district would take that money and administer payments and claims with the help of a third-party administrator "and basically control the plan at that point."

Renting a PPO would involve approaching Healthlink, for example, and saying the district wants to be part of its PPO network. Healthlink would charge a certain amount per employee to be part of the network. The firm has made deals with hospitals, doctors and chiropractors and the district could be part of those contracts, Glass said.

A partially self-insured plan would mean the district could limit its risk per individual and employee, but also limit its risk per aggregate of Cape Girardeau School District employees.

The district would pay a certain amount and then reinsurance would kick in. Reinsurance is like buying a policy with a large carrier that says a person will pay up to a particular amount and the company will cover the rest.

Last year, the board approved a "narrow network" plan offered by Anthem Blue Cross/Blue Shield to cut costs. The decision saved the district $317,000 for 2014.

The plan excluded Saint Francis Medical Center from the district's insurance network unless employees were willing to pay $40 more per month.

Current Anthem plans remained the same, except without the option of going to Saint Francis Medical Center, Barnes Hospital in St. Louis or facilities owned and operated by those hospitals, according to information from the district. It includes Southeast Hospital and other hospitals in St. Louis.

However, if an employee wished to include Saint Francis and Barnes hospitals or facilities, he or she could pay an additional $41.30 a month. Otherwise, Saint Francis and Barnes would be out of the network.

If an employee used Saint Francis or Barnes, they would receive only out-of-network benefits, according to district information.

But Saint Francis stepped in to reimburse school district employees who selected the Saint Francis option. It also reimburses for their covered dependents for copays and out-of-pocket expenses incurred at the hospital and accumulated in calendar year 2014, up to $500 per family. The reimbursement checks for these expenses are issued to the responsible party when the $500 threshold is reached, or on Dec. 31, 2014, whichever comes first, account services coordinator Emily Sikes Blattel said in an email.

"Federal regulations do not allow us to offer this reimbursement to those covered in whole or in part by government programs like Medicare, Medicaid or the VA. If the responsible party or his or her covered dependent has a federal supplement, they are not eligible for this reimbursement," Blattel wrote.

Saint Francis assumes responsibility for collecting the data and reimbursing patients. Once the patients' copay and out-of-pocket payments total $500, the hospital issues them a check. If they have not reached the $500 threshold by Dec. 31, they will be reimbursed for whatever amount they have spent, she said.

rcampbell@semissourian.com

388-3639

Pertinent address:

301 N. Clark Ave., Cape Girardeau, Mo.