2016 benefits changes to state employee health insurance program

The Department of Employee Trust Funds Group Insurance Board met on May 19, 2015 and approved changes to the state employee health insurance program.  The Department of Employee Trust Funds (ETF) will be summarizing the changes made to employee benefits for 2016 in an upcoming communication. This article is intended to assist employees with understanding the benefit changes prior to the official summary from ETF.  The changes affect participants’ deductibles, out-of-pocket limits, copays and drug costs. The changes include:

  • Implementing an annual deductible of $250 for single coverage and $500 for families. Employees insured in uniform benefits plans (i.e., health maintenance organizations – HMOs) do not currently have a deductible.
  • Increasing the annual out-of-pocket limit for uniform benefit plans (i.e., HMOs) from $500 to $1,000 (single coverage) and from $1,000 to $2,000 (families).
  • Replacing the 10% current coinsurance patient payment for non-preventative services with a $15 copay for each primary care physician/therapy visit, and a $25 copay for each specialist visit.
  • Increasing the Standard Plan annual deductible from $200 to $250 (single coverage) and from $400 to $500 (families).
  • Increasing the Standard Plan annual out-of-pocket limit for single plans from $800 to $1000, and from $1,600 to $2,000 for families.
  • Increasing out-of-pocket expenses for non-generic prescriptions. Instead of the current $15, $35 or $50 copays, employees will pay a percentage of the cost of the prescription, up to a specified dollar maximum ($50-$200, depending on the drug).
  • The GIB recommended that the Office of State Employee Relations (OSER) increases the state’s contribution to health savings accounts for employees who participate in a high-deductible health plan (HDHP) from $170 to $750 (single coverage) and $340 to $1,500 (families). The 2016 HDHP out-of-pocket limit has not yet been determined.
  • Making advanced-care planning and/or palliative care (end-of-life care consultations) available to the seriously ill with a likely survival of less than six months.
  • Adding coverage for therapies associated with habilitative care (i.e., to gain or maintain skills or functions for daily living).

All of the health plan changes will be effective on January 1, 2016.

 The 2016 fall open enrollment period, where employees can make changes to their benefits, will take place from October 5-30, 2015.