Travis County Commissioners Court
June 24, 2008
Item 11
Number 11 is to consider and take appropriate action regarding group benefits health plan fy '09 rates and issues. A, maintaining fy '08 rates and subsidy amounts for the fy '09 plan year for all plans. B, continuing life, ad and d and disability coverages at the current rates for fy '09. And c-1, increasing the emergency room co-pay from $50 to $100 on all three plans. C-2, covering colonoscopies at 100% on all three plans. And c-3, covering diabetic supplies at 100% on all three plans.
>> yes, sir. Good morning. Alicia perez, executive manager for administrative operations. And dan mansour, risk manager is here. And norman mccree, who does our financial analysis for the health care fund. We have for fy '09 very good news. We will not have -- do not anticipate an increase in any of the premiums that are paid by county employees or their families for health care. We have three plans. An epo, which is 100% coverage. A ppo, which is 90-10, and a co-insured epo, which is an 80-20 plan. So we have very affordable health care for our employees. Very little change in any of the plans. We did increase last year our life insurance or life and dismemberment from 25,000 to 50,000 per employee. This year we are improving our benefits by asking the court to approve increasing er -- approve coverage of colonoscopies at 100% as you said, judge, and approving diabetic supplies at 100%. We will experience a slight increase in er co-pay from 50 to $100. We have received very good comments for them, our employees, we offer an employee clinic that is at no cost to the employees that visit and their dependents. So we are ready to have the court act on this. We have open enrollment starting July 21st and run through August 22nd, through August the 22nd. We encourage all employees -- all employees, elected officials, appointed officials must enroll for their health care benefits on an annual basis. If someone does not enroll, then they will go to the default plan, which is the co-insured epo. And the insurance will only be for them. So it's very, very, very important that if you have dependents or you want different coverage that you go ahead and enroll. We have wonderful benefits. We have the flexible spending account also where you can set money aside before taxes and then get reimbursed for your medical expenses. And we would -- dan, do you have anything else to offer?
>> just that at open enrollment there are 10 steps that have to be completed, so we encourage all employees to take their time, complete the screen, complete all 10 central texans so they finish their enrollment requirement.
>> what responses, if any, did we get to the recommendation in a? To basically maintain the rates and subsidy amounts?
>> we didn't receive any great number of negative comments. As a matter of fact as a matter of fact, I'm not aware of any negative comments. I think that everyone understands that emergency room costs have gone way up. And in addition to that --
>> a.
>> oh, I think we got favorable results.
>> move approval of a.
>> second.
>> discussion? All in favor? That passes by unanimous vote. B is continuing life and accidental death and disability coverages at the current rate. Move approval.
>> second.
>> discussion? All in favor? That passes by unanimous vote. The new thing about c I guess would be the emergency room co-pay going from $50 to 100.
>> yes. What do we think other major employers in this area assess on that or impose?
>> cindy had surveyed the other employers in the area and we had the lowest er co-pay in the area. And that was one of the reasons --
>> so do they do 55?
>> I don't know the exact amount. Cindy had that information.
>> I think the $100 co-pay is probably the lower limit. Most of them are a little bit higher than that for emergency room, some as high as $400. And with the addition of a lot of urgent care centers that are open now in the Austin area, the emergency room is less attractive, yet more costly.
>> what your commitment is to help us educate our employees and retirees on the availability of emergency care facilities throughout Travis County.
>> yes, sir.
>> because I don't know that we've done a whole lot of that in the past, but -- so coupled with the increase is our intention to do a better job of getting out the word.
>> education. And nurse line 2 that we have available, educate employees on that so they can call the nurse line and make sure it really, truly is an emergency. And they would urge employees if it is an emergency to go, but education would be important.
>> what about the -- judge, the --
>> judge.
>> I guess the way I'm looking at this also, going from $50 to $100 and the emergency room co-pay, emergency service co-pay, I guess, is that -- is there any opportunity for employees maybe not going to the emergency room, but having access to our wellness center that we've established? I ask that because sometimes -- I don't know. What are the hours of the -- let me ask this question. What are the hours of our wellness center here, right across the street, the one at airport? What are the hours there?
>> 7:30 to 4:30.
>> 7:30 to 4:30. And so if a person thinks an emergency is called for,, we don't have any access to that, so some folks maybe end up going to the emergency room. And as far as the type of care that -- you mentioned that earlier. I guess I'm trying to figure out how we're maybe looking at ways to expand services to our wellness clinic as far as hours are concerned. I mean, those type of hours that we're talking about, everybody is here at work. And the dependents of the person that's insure the may have access if they're not at work if they're not doing other things. I'm trying to look at other ways to maybe provide a service that's very well needed, and that's through our wellness clinic. And I understand now that the wellness clinic is booming in business. I mean, it's hard to even hardly get in as far as appointments are concerned. So could you maybe talk to me about that just a little bit?
>> well, first of all, I want to encourage everyone, if there is an emergency, dial 911. If it's a true emergency. Don't expect that -- to arrive at the clinic, because if you do and it's truly an emergency, that's what's going to happen. So dial 911. The clinic is there to treat acute care, sinus, colds, disease management, which it does very well. But it shouldn't be look at for emergency purposes because it's vital that you get attention, medical attention immediately. What we're doing to try to address the overflow issue of the appointments and so forth is to -- we've requested additional staff. We've requested additional space at del valle, which has grown dramatically over the last few months, so that we can schedule our appointments on same day or next day. We can continue to focus on disease management, which is where our greatest degree of effect on a health plan occurs. And we want to again step up our wellness program, which is part of the education that you were talking about, judge. And what is an emergency where you can access care on an urgent basis, but maybe is an emergency situation that you have to go to a hospital.
>> but the point is that I think there are instances where persons that need to see a doctor -- it may not come up under the, quote, emergency, per se, but in order to see their physician they end up going to the emergency room or emergency in a hospital or whatever. And it may not be an emergency as we would see it, but they need the services of a physician, and the other primary care providers may be closed. I think they close at 6:00 also.
>> there are some after hour clinics.
>> pardon me?
>> there are some after hour clinics available as well as the urgent care centers. What we need to do is to get a directory of participating urgent care centers and after hour centers and educate our employees on what's available after regular hours.
>> okay. That would be really good to know if that's made available because right now I wouldn't know, and there may be others, that after hours services of urgent care is available. So that's part of what my concern is.
>> we do have a list of urgent care centers that are in the network and we'll be sharing that with employees.
>> that would be good to be shared, dan, just because of what I stated.
>> do we have any -- the ability to show any stats about how many of these things our group uses or utilizes? Utilizes, I mean, with regard to emergency needs? I mean, can somebody tell -- is that 200 times a year?
>> the backup --
>> I was looking for that.
>> there was 1420 visits this year versus 1337 the previous year. So it's going up, which was 30% more than our peer groups used emergency room visits. Now, if you're admitted to the hospital, then that -- that deductible or co-pay is waived, so if it truly is an emergency, you won't be penalized by this increase. What we're trying to do is reduce the number of people just that are going to the emergency room for a regular doctor visit kind of thing. It should be an emergency to go there. With education and nurse line, I think that that would help.
>> I mean, we do need to understand that we as Travis County citizens, we pay for it one way or the other.
>> yes.
>> and it's not like I'm trying to find a way to take our family, our people that are on our program, and to unduly get in their pocket, so to speak. But there is no question that every one of us, all of the entities, it us, city of Austin, state or whatever, you really would like to try to get over to people that if there is another place to get the service that you need, the first thing that comes to mind is not brack. Because I will guarantee thaw the health care district, somebody is coming to us and needing our help.
>> from personal --
>> that's something that I think we need to be aware of. Obviously charity starts at home and I'm sure people will say, hey, you're really going to stick me for 50 bucks. But if it's something that gives somebody the incentive to use something else other than the emergency room -- I get it. It jumps out of the page that you're going from 50 to 100, no question. And if you could get in front of everybody individually and say, okay, here's what we're really looking for here. We need for you to be as conscientious as you possibly can be. Then it probably would help us overall. I see barbara's hand go up, so I just hush whenever I see that.
>> you can keep going. I just think that there's an interesting aspect of this that hasn't been brought up. And that is if we reduce the number of people who go to the emergency room and they go to urgent care centers instead, number one, when you really need the emergency room you're going to get faster service there because it won't be clogged up with people who have minor issues. Number two, when have you a minor issue and you go to an urgent care thing, you won't be put to the end of the line. Because the way they triage in emergency you might wait five or six hours. So you really are -- we're really trying to encourage people to go where they can get help faster and make sure that the service that they really need at the emergency room is more readily available to them. So there's all these side benefits too.
>> and you're absolutely right. I think that that is another perspective and one that will needs to be taken into account that if you go to the emergency room with a minor issue, you may not be seen for five or six hours. And what I can tell you from personal experience.
>> that's why I move approval of c-1.
>> second, judge.
>> discussion of the motion?
>> yes, judge. With the caveat, how can we make that information available for urgent care, the network, how do we make that available to the employees? I really haven't noticed an after hour urgent care network, so how can we acquire that and make it available to the employees of Travis County?
>> we have several urgent care centers under contract as part of the plan. We will send that out as part of our information in open enrollment, and we'll also do that during the year. And we have -- part of the recommendations from frost insurance, the group that studied our health care benefits, emphasized that education was very, very important. So in this next year we plan to make that part of our work plan with an emphasis on getting education to employees, retirees and all dependents, through e-mail, letters and mailers.
>> we'll have a link on our website.
>> all in favor? That passes by unanimous vote. Move approval of c-2 and c-3.
>> second.
>> discussion? All in favor? That passes by unanimous vote. Thank y'all.
>> thank y'all.
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Last Modified:
Tuesday, June 24, 2008 1:51 PM