Employees facing health care limits

CELINA - An above average number of health insurance claims this year by spouses of county workers prompted officials to make cost-cutting changes in 2013.

At a meeting Tuesday with elected and appointed officials, Mercer County Commissioners announced that spouses offered insurance by their employers will only receive secondary coverage from the county starting in January. Currently, they can receive primary coverage from the county.

"They can still be covered, but they have to be covered by their own employer first," commissioner John Bruns told the crowd in the courthouse auditorium.  

The change was prompted by statistics that show 37 percent of claims turned in this year were for spouses of county employees. The industry average is 29 percent. Employee claims totaled 43 percent, below the industry average of 56 percent.

Four of the top five highest claims during the last eight months were for spouses, Bruns pointed out. Those claims ranged from $71,649 to $139,001.

Another change discussed was the implementation of a "generic step therapy" program. If generic drugs aren't tried first, employees may have to pay the full cost for brand-name medications, Bruns explained.

"If you try a generic drug and it does not work for you, then you may receive coverage for a non-preferred brand drug," he noted in a PowerPoint presentation.

The cost of a generic drug prescription for eligible county employees is a flat $6 fee.

Commissioner Jerry Laffin explained the county needs to lower its claim loss ratio - the difference between the amount of claims paid and the dollars collected for insurance.

The county's claim loss since January stands at 116 percent, and its five-year combined claim loss is 91.2 percent. The five-county insurance pool, in which the county belongs, requires a 90.5 percent loss ratio. To achieve it, employees next year will pay 1.1 percent more for health benefits, commissioners said.

Bruns said he's talked to area businesses who require employees to pay 25 to 50 percent.

"I feel we're doing a pretty good job," he added.
  The increase means workers in 2013 will pay 10 percent of the county's health care cost or $22 per 26 pay periods for single coverage and $78 for family coverage. The county's cost will be $479 for single and $1,359 for family - an increase of 6.9 percent from 2012.

Commissioners warned the audience that additional health benefit changes are coming in 2014 through the Affordable Care Act, also known as Obamacare. Many of the changes, such as the elimination of annual maximum benefits and pre-existing waiting periods, could significantly increase the county's costs, Bruns said.

Officials also learned overall revenues are up $145,005 and expenses are down $138,810 for the year.

"Congrats to all of you for making that happen," county auditor Randy Grapner said, praising officials for being frugal.

He said sales tax revenue is up 5.6 percent over last year and property tax collections are $76,000 higher than expected. Casino revenue in July put $35,647 in the county's coffers and will add $71,150 when the quarterly dividend is released today, Grapner added.

Unfortunately, the overall increase in revenue doesn't cover the 50 percent cut ($450,000) in local government funding this year and in 2013, he said. He reminded officials to stay on budget.

"You need to look wherever you can" to cover expenses, he said.

Commissioners said they will begin meeting with department heads in coming weeks to figure appropriations for 2013. Bruns asked officials to exclude employee raises from their budget for next year until the county's budget is finalized.