Wednesday July 17, 2002 Volume 67, Issue 156


 
 









 

Time to ask about new HMOs

By Dionne Victor
The Daily Cougar

Monday marked the beginning of open enrollment, a time when employees can update or make changes to their current health care
plans. But for faculty and staff in Rm. 102 of the University Science Center, it was also the first opportunity they had to ask questions
about those plans.

Employees will notice changes in the offerings with the withdrawal of AmCare Health Systems, one of the state's current health
maintenance organization. Current users of AmCare have been automatically switched to HealthSelect, the preferred health care
program. While HealthSelect Plus the other HMO provided by Texas has stopped accepting new members but will keep their current
members.

"ERS has been pretty firm in over the last four years that they want to keep benefits as they are," said Lance Renfro, benefits manager
for Human Resources. With the change in health plans the biggest difference is an increase in premium rates.

The 12.4 percent increase is used to offset cost of increasing health care cost and will affect employees who claim dependents and
is small in comparison to some rate increases that are 40 percent. Currently the state pays 100 percent of the member premium of
those who are dependent and 50 percent for those who claim dependents.

Another program that aides employees with children is the State Kids Insurance Program, a program started in 1999 to provide
assistance for dependents up to age 18. If employees meet the salary requirements, which are done by family size, yearly gross
income and monthly gross income.

Other requirements include families that don't qualify for Medicaid and according to Victoria Sanchez, benefits assistant for the
Department of Human Resources, SKIP is not an actual insurance program but instead it is an assistance program that offsets the
cost of healthcare.

Although AmCare's premium rates were significantly lower than HealthSelect, there was little security when it came to keeping a
doctor. For employees who are currently HealthSelect Plus members, there is also less security when it comes to having a long-term
physician.

"HealthSelect affords the participants greater selection of physicians and treatment facilities," said Robert Herrington, assistant
vice-president for human resources. In comparison the HMOs do not allow their users this freedom which is why they can operate at
a lower cost, Herrington said.

"Due to the fact that they provide health benefits and services out-of-area and out-of-network ... the need for physician referrals before
services and treatment can be rendered," Herrington said.

HealthSelect Plus users only receive benefits when they use a primary care physician and it does not require an annual deductible.
The plan offers a minimum co-payment and also covers services such as well-child care, immunizations and routines physicals. It is
a self-insured plan that does not require evidence of insurability.

HealthSelect Plus, which is the only HMO plan available, is closed to new members and there are currently 1,126 employees covered
under the program. Some employees are not satisfied with it. "I originally signed up for HealthSelect Plus, I was wondering where's
the plus," said Larry Flowers, a carpenter at UH.

"The only issue that some employees might consider as a disadvantage to HealthSelect is that there is a deductible, annual out-of
pocket expense and a percentage payment for services including diagnostic, lab and x-ray treatments that most HMO participants do
not currently pay," Herrington said.

Additional question and answer sessions will be held at 10 a.m. every Tuesday for a month in the University Science Center.
 
 
 

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