February 25, 2010
Representative Hugh Holliman, Co-Chair
Senator Dan Blue-Co-Chair
State Health Plan as Compared to other State-Operated Governmental Health Benefit Plan in Georgia, Tennessee and Virginia Carol Durrell, Director of Product Development, State Health Plan for Teachers and State Employees presented the AON state health benefit study required as part of Senate Bill 287. NC was compared to VA, GA, and TN. NC has the most comprehensive health care plan, because it covers state employees, public school employees and university and community college employees, unlike the other states. NC has significantly higher number of individual employees (74%) in the state health plan than the other states (average 45%) while the other states serve more families and dependents. NC also has the highest number of non-medicare retirees compared to the other states. NC has the highest percentage of females in their plan, while VA has the highest number of males. NC has the lowest ratio of members per contracts (1.385) of any of the states primarily because NC does not provide any funding to support the cost of dependent coverage. Eighty percent of all members in NC are in the Standard Plan. While NC has two plans a basic and standard PPO the other states have multiple plans. Some of the key findings from this report include some of the items above and the following: NC is the only state that covers universities and community colleges, NC is the only state that provides employee-only and retiree-only coverage without a cost, VA and GA charge a premium for employee only and retiree only coverage and in turn subsidize dependent coverage, NC has the highest active member/contract ratios for both employee and children and family ties (meaning that employees are less inclined to purchase dependent coverage if they only have one child). Members expressed concerns about the high cost of dependent coverage. They want the administrative costs of the plan reviewed. They want to know if health care costs are rising faster in NC than surrounding states. They asked about provider reimbursement rates. They asked about the impact of requiring an employee contribution for employee-only members. Jack Walker reminded the commission members the average age of health plan members in NC is 9 years higher than the other states and the worst group and costliest to the State are the employee/spouse plan members. An explanation of how the dependent coverage costs were determined was explained and Jack told them the cost is in line with the benefits being distributed/used. The group that NC needs to attract into its plan to help it become more sustainable and those that are the least expensive are the children dependents in the family plan. They continue to be concerned about the almost 9 percent projected increases in the plan premiums every year for the next five years. The commission members plan to make recommendations on how to make changes to the State Health Plan to keep it solvent and yet affordable for employees and their families. A copy of this report is available upon request from my office.
Select Follow-up Items Requested by Task Force Members Cost-sharing and other policy issues related to plan member access to nutritional visits and weight-loss drugs under the Comprehensive Wellness Initiative, were presented by Ann Rogers, Director of Integrated Health Management, State Health Plan for Teachers and State Employees. She provided information to members about the expansion of the nutritional benefit to employees on the State Health Plan. Previously this was limited to diabetes and other high risk employees. They are also supporting Eat Smart Move More and Weigh Less programs. In August 2009 they had 250 participants in the 15 week nutritional education program and 70 percent lost more than 5 lbs. Two videos were shared of participants who talked about some of the ways they were able to change their lifestyles and lose weight.
Dr. Derek Prentice, Consulting Medical Director State Health Plan for Teachers and State Employees reviewed the Health Plan’s coverage of obesity by assisting with the cost of medication. Physicians must prescribe these drugs and there was concern from members about the associated health issues (heart problems) related to taking some of these drugs used to manage or reduce weight.
NEXT MEETING: March 25 9:00 AM