Health, Dental and Vision Benefits

The battle to preserve quality affordable health care for both active and retired employees was at the core of the fight for a fair contract that AFSCME members waged over the past 15 months. Never be­fore had Management pushed for such excessive and unaffordable increases. The Employer’s proposal would have increased the average employee health care costs by more than $10,000 over the three-year contract. Costs would have increased by as much as $8,000 a year for many retirees.

The Bargaining Committee succeeded in staving off this massive health care cost-shifting. The Tentative Agreement ensures that state employees and retirees continue to have access to quality, affordable health care.

–      NO requirement that employees and retirees pay a percentage of total costs

Management demanded that the employee and retiree share of the health premiums be determined as a percentage of the overall cost of the health plan, automatically going up each year, rather than the cur­rent practice where the union contract locks in the specific amount to be deducted.

The Bargaining Committee refused to agree to shifting to employee/retiree premiums based on a per­centage of the overall premium cost which would have resulted in employee/retiree premiums uncon­trollably going up—with much sharper increases in each succeeding year.

  • NO retroactive employee and retiree health care cost increases

Management demanded that all increases in employee and retiree premiums, co-pays and deductibles be effective July 1, 2012—which would have meant that employees and retirees would have incurred huge retroactive health care contribution costs.

The Bargaining Committee resisted this demand and prevailed: No health care changes will go into effect until July 1, 2013.

–      NO massive increases in premiums. co-pays and deductibles

Management demanded massive increases in employee costs for premiums, co-pays and deductibles. Under Management’s proposals, premiums would have skyrocketed in the first year of the contract, as would most co-pays and deductibles.

The Bargaining Committee fought for more than a year against these excessive increases—and beat them back! Under the Tentative Agreement, the increase in premiums for active employees will be 1% of pay. That 1% of pay will be added to the actual dollar amount currently deducted, and will of course be more than offset by the general pay increase. Dependent premiums will increase but will continue to be a flat dollar amount.

The Committee also succeeded in preventing steep hikes in co-pays and deductibles that would have severely penalized employees or their family members who had the misfortune to suffer serious or chronic illness. The co-pay and deductible rates that the Union achieved take into account the rising costs of health care without placing such an excessive burden on employees or retirees.

Retiree Health

The Bargaining Committee fought to minimize the impact of the newly-enacted Public Act 97-695 (originally SB 1313) by limiting the premium costs that could be imposed on retirees. Under the original CMS implementation plan, many retirees would have paid more than 20% of their pension income for health care premiums. Now retirees will pay only a small fraction of that.

Premiums–Medicare Eligible Retirees

Effective 7-1-13, Medicare Eligible retirees will have 1% of their pension annuity deducted to pay for their share of the health care premium. Effective 7-1-14, an additional 1% will be deducted.

Effective 1-1-14, all Medicare Eligible Retirees will be enrolled in a Medicare Advantage plan that provides a comparable level of services and a comparable range of providers as the current health plans. According to the U.S. Medicare website: A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans.

Medicare Eligible dependents enrolled in a MCHP plan will pay no more than $89.91/month and de­pendents in a QCHP plan will pay no more than $142/month through 6-30-15–the same rates they are currently paying.

Premiums–Pre-65 Non-Medicare Eligible Retirees

Effective 7/1/13, pre-65 Non-Medicare Eligible retirees will be offered a $500/month subsidy if they opt out of the state’s group health insurance plan to be covered in another health insurance plan. Effective 7-1-13, Pre-65 Non-Medicare Eligible retirees will have 2% of their pension annuity deduct­ed to pay for their share of the health care premium. Effective 7-1-14, an additional 2% will be deduct­ed.

QCHP

Effective 7-1-13, premium monthly rates for dependents in the Retiree +1 Dependent plan option will increase $53, from $196 to $249.

Effective 7-1-13, premium monthly rates for dependents in the Retiree +2 or More Dependent plan option will increase $61, from $226 to $287.

MCHP

Effective 7-1-13, premium monthly rates for dependents in the Retiree +1 Dependent plan option will increase $19. The current monthly rate of $94 will increase to $113.

Effective 7-1-13, premium monthly rates for dependents in the Retiree +2 or More Dependent plan option will increase $26.50. The current monthly rate of $132.50 will increase to $159.

Managed Care Healt Plans (MCHP)

MCHP Medical

*Effective 7-1-13, Doctor Office Visits will increase from the current $15 to $18, and effective

7-1-14, the visit will increase to $20.

*Effective 7-1-13, Office Visits to specialists and Home Health Visits will increase from the current

$20 to $25, and effective 7-1-14, the visit will increase to $30.

*Effective 7-1-13, the Emergency Room co-pay will increase from the current $200 to $225, and

effective 7-1-14, the co-pay will increase to $250.

*Effective 7-1-13, the Hospital Inpatient co-pay will increase from $275 to $325, and effective

7-1-14, the co-pay will increase to $350.

*Effective 7-1-13, the Hospital Outpatient co-pay will increase from the current $175 to $225,

and effective 7-1-14, the co-pay will increase to $250.

MCHP Prescription Drugs

*Effective 7-1-13, the prescription deductible will increase from $50 to $75, and effective 7-1-14 the deductible will increase to $100.

*Effective 7/1/13:

  • Generic drug co-pays will decrease from $10 to $8.
  • Formulary co-pays will increase from $24 to $26.
  • Non-formulary co-pays will increase from $48 to $50.

*Effective 7/1/13, the Mail Multiplier for prescription drugs will increase from 2x to 2.5x, resulting in a reduction in the cost savings to employees but still costing less than a purchase at the pharmacy.

Oualitv Care Health Plan (OCHP)

QCHP Medical

*The plan year employee deductible will increase, based on salary, to $350-$500 in FY 14 and to

$375-$525 in FY 15.

*Plan year retiree deductible and dependent deductible each increase from $300 to $350 in FY 14

and to $375 in FY 15.

*In-network, in-patient hospitalization deductible for member and dependent will each increase

from $50 to $100 effective 7/1/14

*Out-of-network, in-patient hospitalization deductible for member and dependent will each

increase from $300 to $500, effective 7/1/14

*Emergency room deductibles increase from $400 to $425 in FY 14 and to $450 in FY 15.

*Co-Insurance In-Network will decrease to 85% effective 7/1/14

*Co-Insurance Out-of-Network will decrease to 60% effective 7/1/13.

*Individual Out-of-Pocket Maximum (In-Network) will increase from $1,200 to $1,500

Effective 7/1/13.

*Family Out-of-Pocket Maximum (In-Network) remains at 2.5x the individual rate.

*Individual Out-of-Pocket Maximum (Out-of-Network) will increase from $4,400 to $6,000

Effective 7/1/13.

*Family Out-of-Pocket Maximum (Out-of-Network) remains 2x the individual Out-of-Network rate.

*Lab/X-Ray In-Network co-insurance will decrease to 85% effective 7-1-14.

*Lab/X-Ray Out-of-Network co-insurance will decrease to 60% effective 7/1/13.

QCHP Prescription Drugs

Effective 7-1-13, the prescription deductible will increase from $75 to $100, and effective 7-1-14 the deductible will increase to $125.

Effective 7/1/13 prescription co-pays will change as follows:

  • Generic drugs co-pays will decrease from $11 to $10;
  • Formulary co-pays will increase from $26 to $30;
  • Non-formulary co-pays will increase from $52 to $60.

The Mail Multiplier for a 90-day supply of prescription drugs will increase from 2x the 30-day rate to 2.5x the 30-day rate, resulting in a reduction in the cost savings but still costing less than the pharmacy rate.

Vision

Effective 7/1/14, new lenses will be covered on an annual basis.

Effective 7-1-13, the co-pay for Vision Eye Exams, Vision Lenses, and Vision Standard Frames will increase from $10 to $20. Effective 7-1-14, the co-pays will increase from $20 to $25.

Dental (OCDP)

Effective 7-1-13, the QDCP Annual Deductible will increase from $125 to $150. Effective 7-1-14, the deductible will increase to $175.

Effective 7/1/13, the QDCP Annual Maximum for Out-of-Network will decrease from $2,500 to $2,000.

Effective 7/1/13, the QDCP Orthodontia Maximum for Out-of-Network will decrease from the current $2,000 to $1,500.

Life Insurance

Life Insurance coverage remains unchanged for employees and retirees.

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