State health plan could see changes amidst backlash
by Mark Andrews
Jan 26, 2014 | 6480 views | 0 0 comments | 57 57 recommendations | email to a friend | print
It’s no secret that many state employees, including current and former educators, are upset with the new Georgia State Health Benefit Plan. On Monday, the Georgia Department of Community Health is expected to discuss proposed changes to the plan amidst the backlash.

The Daily Tribune News spoke with two former state employees, who worked as school system faculty and central office personnel, who said they feel the reason the state initially made the change from United Health Care to Blue Cross Blue Shield is because Gov. Nathan Deal wants state employees to not be able to afford the plan, thus forcing them to pursue other options.

Per request, DTN only is using last names — Heath and Hayes — to identify the former employees. Heath is a former educator and Hayes is a former school system benefits manager.

Hayes spoke on the health reimbursement account option of the plan.

“The state contributes money to the [health reimbursement account] to pay for your service. After credits are exhausted, you pay the full amount of service to meet the deductible before the plan begins to pay ...,” Hayes explained.

The three tiers of the HRA provide credits ranging from $100 to $800 depending on the number of family members claimed. The out-of-pocket maximum costs range from $4,000 up to $24,000 with deductibles ranging from $1,500 to $10,000 once the credits have been used.

“Most of the people who are complaining about this are families. ... It doesn’t take long to use up $800 and when you take [family members] to the doctor a time or two — that comes out [of the HRA credits] too,” Hayes said.

Hayes, who requires the assistance of an oxygen tank, said under the new HRA plan her prescriptions will cost about $300 more a month than under last year’s plan.

“[Gov. Nathan Deal] is saying it has to do with ObamaCare. It does not,” Hayes said.

She said the governor also is placing the blame on Blue Cross Blue Shield.

“I’ve been involved in creating plans over the years and it takes somebody to sign off on these things,” Hayes said. “They don’t do this by themselves, this is employer approved.”

Hayes said another aspect of the state health benefits plan that needs to be addressed is, according to the Fiscal Year 2014 budget from the Georgia Department of Community Health, available for view online,, 54 percent of the state funds budgeted for the plan go toward “Aged, Blind and Disabled.” More than 35 percent of the budget goes toward “Low Income Medicaid.”

Heath, who is on the HRA Gold Plan, said her premiums have gone up $100 a month in 2014.

“We’re ill about it, we’re not happy with Gov. Deal; he has put us in a mess,” Heath said. “... I’m living on a retirement check right now, my husband is self employed and I have three children — two in college and a 10-year-old at home.”

She said her family had some prescriptions filled in December and she does not know what to expect later this month when getting prescriptions filled and fears her family will not be able to afford certain necessary treatments under the plan.

“They want all of us to sign up for ObamaCare, that’s what they want us to do,” Heath said.

Another aspect of the change in providers that Hayes and Heath said is of concern is the way the state went about contacting retirees to inform them of the change.

“I didn’t get anything as a retiree, I received nothing but a United Health Care booklet that was mailed to my house and ... we did have the option to go to some meetings, but the meetings were in so many different places you either had to call somebody to find out where the meetings were going to be,” Heath said. “But as a retiree, we’re not kept in the know of everything.”

Hayes added, “They didn’t give out the information on the plan until a couple of weeks before open enrollment.”

The Atlanta Journal-Constitution initially reported on Friday evening the DCH will discuss proposed changes to the plan during its Monday meeting. The information was posted on State Rep. Don Parson’s website,, but has since been removed.

However, the proposed changes went viral in a matter of hours, being shared across a number of websites, including the Teachers Rally Against Insurance Changes Facebook page.

According to the .pdf, which lists the proposed changes, “The plan design changes being considered by the DCH Board will add some features of HMO managed care to the current Health Reimbursement Arrangement (HRA) plan. These changes will apply to all metallic plans (bronze, silver and gold). Member premiums, deductibles, HRA contributions and out-of-pocket limits in the current plans will not be impacted. There will be no additional open enrollment for the 2014 plan year.

“... The plan design changes being considered by the DCH board will replace pharmacy coinsurance with copays. The plan design changes being considered by the DCH board will replace out-of-pocket and co-insurance for office/rehab/ER visits with co-pays. The proposed co-pays are identical to those contained in the 2013 HMO wellness option. Preventive care office visits will continue to be covered by the plan at 100%.

“... For Plan Year 2014, members will have access to HMO cost-sharing features at HRA prices. Unlike traditional HMO plans, members will also have access to a reimbursement account which may be used to satisfy co-pays and other out-of-pocket expenses.

“...The costs of these changes are being absorbed by the plan. Total estimated cost to the plan for both changes is approximately $114M for 12 months. Projected plan reserves will be lowered to account for the increased costs.”

For updates on the state health benefits plan, read The Daily Tribune News.