Florida Lee County School Board HMO To Replace 927 PPO Plan
The Lee County School Board announced that it would vote on changes involving the district’s employee health care coverage at the Nov. 3 board meeting, but with little information available about the cost of the new HMO, the school board could be voting blindly.
Negotiations were originally halted in May to allow the district to find out how much money it would lose due to the state’s economy and student enrollment.
Representatives from the Teacher and Support Personnel Associations of Lee County met with district officials, led by Dr. Gregory Adkins, in hashing out the deal and studied closely the recommendations made by the district’s Insurance Task Force.
Their conclusion was that three of the health coverage plans would remain the same, while one that has experienced higher monthly premiums will be discontinued.
On April 1, the 927 Plan — a Blue Cross/Blue Shield PPO plan — will be phased out and for the first time the district will use an HMO in its place. The HMO, named Blue Care 10, reportedly costs less making it easier for employees to acquire health insurance.
On the other hand, until now the district has not released figures or estimates on the anticipated costs shouldered by district staff.
“We haven’t determined them yet, we are waiting for at least one more month’s worth of claim data before we know that. It will probably be a month or so,” said Susan Strong, representative of the Insurance Task Force.
In the meantime, the school board will hold a meeting Nov. 3 to discuss the specifics of the new HMO plan, only to turn around hours later and give it an up or down vote without spreading the word to staff.
“They will roll out that on the next briefing (Nov. 3),” said Superintendent James Browder. “We will show what each plan will do and what the HMO will provide.”
At the end of the action meeting Tuesday night, Browder explained that there is “an understanding that in April we will make decisions about insurance for individuals,” adding that “they (employees) will have options to make decisions on.”
Adkins, who hosted the negotiations Oct. 14, said the district used an interest-based bargaining arrangement and decided that the district’s benefit bank — or money given to employees for health plans — totals $6,372, the same as the year before.
Adkins explained that the 927 Plan will be discontinued because it is growing increasingly expensive. He said the district is doing everything it can to creatively help employees and their families.
“(Plan) 927 is expensive and not as benefit rich as the 903 plan, and we continue to have a high degree of migration out of that plan,” said Adkins.
Since Plan 927 is a PPO, employees had a choice of 100 percent of available doctors. The new HMO offers 60 percent to 70 percent of doctors.
Those employees receiving mental health services may also see a disruption in their coverage, even though Strong said on Oct. 14 that only three employees had crossed the district’s threshold for mental health visits.
It is also unclear at this time what affect the new plan would have on employees with children or dependents. The only assurance given by the district is that the other three plans exist unscathed.
“There will be no changes in those three plans (903, 706 and 118), but we will offer a lower cost HMO which does have a lot of benefits if, of course, you follow the guidelines of an HMO,” said Adkins.
HMOs have generally been criticized for not covering cutting edge or experimental procedures. They are lower in cost, but generally focus on preventative care to avoid being responsible for advanced procedures down the line. Patients in these plans also have to receive a referral from their primary doctor before seeing a specialist.
Doctors who are part of an HMO are rewarded for cutting costs and not providing certain expensive procedures or care.
Board Member Jane Kuckel said it is sad to reduce health care benefits to the school district’s employees.
“These are tough times and it is sad we couldn’t offer the original agreement to teachers,” she said. “It is sad to reduce health care benefits to employees.”
According to Board Member Robert Chilmonik, health benefit utilization increased from 90 percent to 100 percent, and he said the district funds its own health insurance.
But, as health costs and insurance premiums increase, the district is forced to consider other options, especially after hearing that it will lose millions of dollars from the state. With Lee Memorial Health System the only major health provider in the region, the district and its employees also are subject to the health system’s cost increases.
Over the last four years Lee Memorial Health System has reported higher rates of uncompensated care, resulting in a “hidden tax” that has driven health costs through the roof.
School district bargaining units have spent the week presenting the new plan to their teams and school employees, who will ratify the agreement Tuesday and Wednesday and forward it to the board for approval.
Browder explained that it is now up to the unit membership inside the district to vote on the proposal.
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