Smokers will pay more for health care
By Steve Herring
Published in News on July 20, 2010 1:46 PM
Wayne County employees who choose to smoke will soon find themselves paying higher insurance premiums. Also looking at higher health costs - although not for a few more years - are those who are overweight.
County employees who are smokers, and eventually those who are overweight, can look forward to paying more out-of-pocket health care expenses than their co-workers.
Starting in fiscal year 2011-12, employees who smoke will be required to accept a health care plan that carries a higher deductible. That change will be followed within a year or two when overweight employees are added to the higher cost tier.
"We are looking into doing the same thing the state is doing," said Sue Guy, county human resources director. "The state has two tiers also. If you are obese or a smoker in the state plan over a certain timetable, you will be required to go to the higher deductible plan.
"Smoking is the first thing that we want to focus on so if you are a smoker it is our intent next year to require you to move to the higher deductible plan so that you will take a greater ownership of your lifestyle choices."
Since the county is self-insured, technically there are no premiums, so the deductible is what increases, she said.
"A young smoker may not be having those adverse (health) impacts," she said. "As the smoking continues and they start having trouble with asthma and some of the other related issues, then they will have to front more money up front than those who are not smoking. We hope we are encouraging our employees to make health-style choices to stop smoking so they can move between the two plans. We think what will happen is that if they don't take some corrective action to stop smoking, then they will have to pay more out of pocket for their health care."
The county offers free plans to help employees stop smoking.
Ms. Guy said county employees are aware of the pending changes, even though the plan for overweight employees is still several years out.
Both plans are aimed at improving quality of life as well as for savings, she said.
Blue Cross Blue Shield is the third-party claims processor for the county's self-insured plan. Premiums are a budget item, and each year the county calculates how much it thinks will be needed for each person each month.
The total runs about $550 per person a month, she said.
This year's budgeted total is the same as last year's, an indication that the county's wellness program that started in 2005 is working, she said.
"In the wellness program, we have, I would say, a major victory this year," Ms. Guy said. "A gentleman who has not had physicals every year and kind of pushed back on that idea finally caved this year and said I am going to go have my physical and discovered he had two arteries blocked -- one 100 percent and the other 90 percent. They sent him immediately to Wake Med and he had bypass surgery.
"Had he not had that (surgery), doctors said he could have had a fatal heart attack or at the very least a stroke at anytime. That is the kind of thing that makes us feel really good that we kind of require you to have a physical."
Under the plan, employees must have a physical every two years, although they can be done annually.
Employees are required to take part in two wellness events, and the county tries to schedule events after looking at the number and types of certain claims, she said.
For example, she said, is it heart disease or diabetes?
"We try to plan wellness events that center around that and encourage people to attend those," Ms. Guy said. "A lot of people have major lifestyle (changes) because of things they learn in those programs."
This year the claims increase was very nominal, she said.
A new option offered this year is a high-deductible plan that is not tied to smoking or weight, but rather is for people who are basically very healthy, Ms. Guy said.
"They can opt out of our traditional plan, and we will put $500 in reserve in an account for them and a debit card so they can use it for those little (health) things that occur," she said. "Their deductible will be like $3,500, where my out-of-pocket max might be $2,000."
The $500 bridges some of that cost, while at the same time taking some of the liability off of the county, she said.
The advantage to employees is if it is not used, then at the end of the year the $500 will roll over into the next year. It is a pre-tax dollars savings account and the employee may contribute more to the account if they want to, she said.
Unlike some flexible expense spending accounts where the money has to be used or it is lost, this plan allows the money to accrue.
"They don't have co-pays on drugs and stuff like that that they do in a traditional plan," she said. "You have a major medical plan in case something horrific happens. You can still file on that, but you do not have the plan that covers every doctor's visit or prescription with just a co-pay."
To provide people with an incentive to move to that plan, the county provides the $500 and continues to pay for the physicals.
"At the end of the year, if you have not used it, that is fine, it rolls over," she said. "When you retire, you could have a tidy little sum kind of invested over there.
"It is not like we are leaving them out there with no insurance. It is more like a major medical plan. It is not like we are saving great amounts of money, but it encourages different thinking about health care."
Ms. Guy said not many employees have switched to the new plan and that they seem to be taking a wait-and-see approach.
"We had some who did move to it, but not as many as we thought we would have," she said. "We think it is because, it is not an odd thing anymore, it is getting to be more common, but it is just a way people think.
"I think after a year of using it and people see their peers with $500 that they don't have that we will see more interest in the plan."