Christine Jordan Sexton
A 23-page bill released by the House Health Care Services Committee proposes to redesign the state group insurance plan and begin offering state employees access to a variety of plans, including discount medical plans and direct primary care plans beginning 2016.
The proposed committee bill, PCB HHSC 15-02, will be discussed by the House Health Care Services Committee at its meeting today.
The proposed changes to the plan are phased in. The first phase, effective 2016, would direct DMS to establish employee contribution rates in 2016 that reflect the actuarial benefit difference between HMOs and PPOs. Also effective 2016, the bill would require the state to offer employees access to a variety of health options, from prepaid health plans to direct primary care to discount medical plans.
Also in 2016, the state moves ahead with a shared savings approach by requiring the Division of Management Services to contract with at least one entity that provides comprehensive pricing and inclusive services for surgery and other medical procedures.
Any costs savings resulting from the contract would be split between the state and the employee. Savings would be directed to the employee’s Health Savings Account (HSA), Health Retirement Account (HRA) or paid back to the employee through health plan reimbursements.
Also effective 2016 DMS would be required to offer in at least one area of the state — no more than a three-year price transparency pilot project where the prices of elective and diagnostic procedures are published.
Under the pilot project the state would publish a benchmark price for procedures based on information submitted to the state by health plans. If the employee uses a provider who charges less than the benchmark price, 50% of the savings will be directed toward the employee’s HRA, or HSA. Alternatively the money could be spent on health plan reimbursements so long as it doesn’t exceed the employee’s out-of-pocket expenses. The other savings would be directed toward the state.
DMS is required under the bill to report the cost savings under the pilot project to the Senate president, speaker of the house, and the governor.
Effective 2017 the Legislature will establish premiums that reflect the differences in benefit design and value between HMOs and PPOs as well as for family and individual coverage. DMS is required to contract with an independent benefits consultant to prepare recommendations for modifications to the state group plan and assist the department in ensuring compliance with any federal or state regulations. The recommendations are due to the Legislature and governor no later than Dec. 1 so the Legislature can consider the recommendations and include changes in the 2016 budget to take effect for the 2017 plan year.
Effective 2018 the state will begin offering employees access to health plans at benefit levels that, like the federal health law, are named after metals: platinum level, with a 90% actuarial value; gold, with an 80% actuarial value; silver, with a 70% actuarial value; and bronze, with a 60% actuarial value. If the state’s contribution to the plan exceeds the premium cost of the plan selected by the employee, the employee may have the balance deposited into an FSA or HSA It also could be used to purchase additional benefits that the state will offer or can be used to increase their salary, if allowed by the feds.
Committee Chairman Jason Brodeur, a Republican of Sanford, told Florida Politics this month that the state group plan does not reflect other employer-sponsored health plans. The House analysis of the proposed committee bill underscores Brodeur’s assessment. According to the staff analysis, in 2013-14 the state contributed about 90% toward the total annual premium for active employees for a total of $1.55 billion out of total premium of $2 billion .
State employees and retirees contributed $393 million, and the remaining $89 million was from other sources such as interest, refunds, and rebates.
