State health rates jump again

Kansas Health Care Commission rate increase will take effect in January

Rates for all health insurance plans will be available in October.

Faculty and staff already coping with this year’s meager pay increases will also see insurance rates rise for all state employees.

The increase announcement coincides with open enrollment in October and will affect paychecks beginning in January 2004. Full-time KU employees who insure their entire families will see rate changes between $18 and $67 semimonthly. Full-time employee member-only coverage changes will range from less than $1 to $28.

The increase in premiums follows a change in the way the Kansas Health Care Commission determines employer premiums. To encourage efficient plan selection, the commission based 2004 employer premium contributions on the most affordable HMO or PPO in the region.

Under the new formula, PPO plans (Kansas Choice, Kansas Prefer and Preferred Health Systems) are seeing larger increases than HMO plans (Coventry Health Care, Preferred Plus Kansas and Premier Blue).

Other changes include:

PPO changes to deductible/co-payment/co-insurance: Out-of-pocket expenses will change for all plans. For PPO plans the network deductible has been eliminated but the non-network deductible will increase to $500 single/$1,500 family. Kansas Choice and Kansas Prefer will have tiered co-insurance amounts: 50 percent until half the co-insurance maximum is reached and 30 percent until the full co-insurance maximum is reached. Preferred Health Systems’ co-insurance will be 50 percent until the maximum co-insurance is reached. The co-insurance maximums vary depending upon the plan, whether network or non-network services are used and single/family maximums.

HMO changes to deductible/co-payment/co-insurance: Changes to out-of-pocket expenses for the HMOs include office visits, which will increase from $10 to $20 for a primary care physician and $30 for a specialist. There will be a 10 percent co-insurance for designated services with an annual co-insurance maximum of $1,000 single/$2,000 family. The annual inpatient deductible of $200 single/$400 family will change to $200 per admission plus 10 percent co-insurance.

New lab card service: Kansas Choice and Kansas Prefer plan participants will have the option of using a lab card service, LabOne, for outpatient lab work covered by the medical plan. When LabOne is used for lab tests, the cost will be covered at 100 percent with no co-payment, no deductible and no co-insurance.

Preventive care allowance: Kansas Choice will have a $300 per person preventive care allowance for services provided in-network. This feature already was available in the other PPOs (Kansas Prefer and Preferred Health). The first $300 per person is covered in full before being subject to the plan’s co-insurance for services such as well-woman and well-man care, periodic adult physical exams, routine hearing and vision exams.

Dental plan changes: Delta Dental has been awarded a three-year contract. Changes for 2004 include an increase from $35 to $45 in the deductible for major services and an annual maximum benefit level increased from $1,500 to $1,600. Participants will be able to use the national network of Delta Dental plan providers for all services.

Prescription drug plan changes: AdvancePCS Prescription Drug Program changes include an increase in the co-insurance amount participants pay for preferred brand name drugs from 30 percent to 35 percent, for non-preferred brand name drugs from 50 percent to 60 percent, and for special case medication the $70 co-payment will increase to $75. The maximum co-insurance/co-payment will increase from $2,400 to $2,580 for generic, preferred brand and special case medications only.

Vision plan changes: The Superior Vision enhanced plan coverage for progressive lenses has been changed to a flat dollar amount up to $165, and coverage has been added for high index and polycarbonate lenses up to $116. The basic vision plan benefits will remain the same.

Health Risk Appraisal (HRA) continued: The HRA program will be offered again in 2004. Faculty and staff need to enroll online to participate and receive a $5 semimonthly health plan premium discount. Faculty and staff who elected to participate in the HRA program during 2003 but did not complete the program will not be eligible during 2004.

Open enrollment information for health insurance, flexible spending accounts and the Health Risk Appraisal program will be distributed to benefits-eligible faculty and staff in late September. Open enrollment is Oct. 1 through 31 and is available online.

Faculty and staff must log in during open enrollment to change, add or drop health plan election for 2004, change coverage elections or add or drop dependents from coverage; to register for the Health Risk Appraisal program and receive a $120 annual premium discount; or enroll as a new participant or to continue participating in the dependent care and/or health care flexible spending accounts. Participation for those currently enrolled will end Dec. 31, 2003.